PMHNP CERTIFICATION EXAM/ ACTUAL
EXAM VERIFIED QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 28-year-old presents with decreased sleep, pressured speech, grandiosity,
and risky spending. Which medication is most appropriate for acute
stabilization?
A. Fluoxetine
B. Bupropion
C. Lithium carbonate
D. Buspirone
✅ Answer: C. Lithium carbonate
Rationale: Classic symptoms of mania require a mood stabilizer. Lithium is first-
line for acute mania and long-term prophylaxis. SSRIs or bupropion could worsen
mania.
2. During assessment, a client reports hearing voices that tell him to harm
himself. The nurse practitioner’s first priority is to:
A. Document the hallucinations
B. Assess the plan, intent, and means for self-harm
C. Increase antipsychotic dose
D. Explore medication adherence
✅ Answer: B. Assess the plan, intent, and means for self-harm
Rationale: Safety assessment always precedes other actions. Determining lethality
guides immediate intervention.
,3. A 70-year-old on sertraline reports new confusion and tremor after taking
sumatriptan for migraine. The NP suspects:
A. Serotonin syndrome
B. Parkinson’s disease
C. Dementia progression
D. Hypertensive crisis
✅ Answer: A. Serotonin syndrome
Rationale: Combining SSRIs and triptans increases serotonin activity → agitation,
tremor, confusion, hyperreflexia.
4. Which finding most strongly supports a diagnosis of generalized anxiety
disorder (GAD)?
A. Panic attacks lasting 10–20 min
B. Excessive worry occurring more days than not for ≥6 months
C. Fear of social scrutiny
D. Obsessions and compulsions
✅ Answer: B. Excessive worry occurring more days than not for ≥6 months
Rationale: Duration and pervasive worry define GAD.
5. A patient with schizophrenia taking clozapine develops fever and sore
throat. The most critical lab test is:
A. ALT and AST
B. CBC with differential
C. Serum prolactin
D. Renal panel
✅ Answer: B. CBC with differential
Rationale: Clozapine may cause agranulocytosis; absolute neutrophil count must
be checked immediately.
,6. A 15-year-old exhibits irritability, poor concentration, and failing grades
for 8 months. The NP should first rule out:
A. Bipolar disorder
B. Major depressive disorder
C. ADHD
D. Substance use disorder
✅ Answer: D. Substance use disorder
Rationale: In adolescents, new behavioral and academic changes often stem from
substance use; rule out before diagnosing a primary mood/attention disorder.
7. Which antidepressant has the highest risk of seizure at high doses?
A. Paroxetine
B. Venlafaxine
C. Bupropion
D. Sertraline
✅ Answer: C. Bupropion
Rationale: Dose-related seizure risk, especially >450 mg/day or in patients with
eating disorders or head trauma.
8. A client newly diagnosed with PTSD reports recurrent nightmares. Which
medication has best evidence for reducing trauma-related nightmares?
A. Prazosin
B. Diazepam
C. Olanzapine
D. Mirtazapine
✅ Answer: A. Prazosin
Rationale: Alpha-1 antagonist prazosin blocks norepinephrine effects during
sleep, reducing nightmare frequency.
, 9. A 32-year-old woman with panic disorder is starting an SSRI. The NP
should educate that:
A. Symptoms improve immediately
B. Short-term benzodiazepine may be used during initial activation
C. Avoid caffeine because it decreases drug efficacy
D. Medication must be taken PRN
✅ Answer: B. Short-term benzodiazepine may be used during initial activation
Rationale: SSRIs can transiently worsen anxiety; short-term benzo use may bridge
until response develops (4–6 weeks).
10. When discontinuing paroxetine, the NP advises:
A. Stop abruptly
B. Taper over several weeks
C. Double dose every other day
D. Substitute fluoxetine for 1 week
✅ Answer: B. Taper over several weeks
Rationale: Paroxetine has a short half-life and high risk of discontinuation
syndrome; gradual taper minimizes symptoms.
11. A patient on lithium presents with diarrhea, ataxia, and coarse tremor.
The next best action is:
A. Reassure and continue current dose
B. Check serum lithium level immediately
C. Add propranolol
D. Encourage hydration only
✅ Answer: B. Check serum lithium level immediately
Rationale: Signs indicate possible toxicity (>1.5 mEq/L). Serum level
confirmation guides urgent management.
EXAM VERIFIED QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
GRADED A+ LATEST
1. A 28-year-old presents with decreased sleep, pressured speech, grandiosity,
and risky spending. Which medication is most appropriate for acute
stabilization?
A. Fluoxetine
B. Bupropion
C. Lithium carbonate
D. Buspirone
✅ Answer: C. Lithium carbonate
Rationale: Classic symptoms of mania require a mood stabilizer. Lithium is first-
line for acute mania and long-term prophylaxis. SSRIs or bupropion could worsen
mania.
2. During assessment, a client reports hearing voices that tell him to harm
himself. The nurse practitioner’s first priority is to:
A. Document the hallucinations
B. Assess the plan, intent, and means for self-harm
C. Increase antipsychotic dose
D. Explore medication adherence
✅ Answer: B. Assess the plan, intent, and means for self-harm
Rationale: Safety assessment always precedes other actions. Determining lethality
guides immediate intervention.
,3. A 70-year-old on sertraline reports new confusion and tremor after taking
sumatriptan for migraine. The NP suspects:
A. Serotonin syndrome
B. Parkinson’s disease
C. Dementia progression
D. Hypertensive crisis
✅ Answer: A. Serotonin syndrome
Rationale: Combining SSRIs and triptans increases serotonin activity → agitation,
tremor, confusion, hyperreflexia.
4. Which finding most strongly supports a diagnosis of generalized anxiety
disorder (GAD)?
A. Panic attacks lasting 10–20 min
B. Excessive worry occurring more days than not for ≥6 months
C. Fear of social scrutiny
D. Obsessions and compulsions
✅ Answer: B. Excessive worry occurring more days than not for ≥6 months
Rationale: Duration and pervasive worry define GAD.
5. A patient with schizophrenia taking clozapine develops fever and sore
throat. The most critical lab test is:
A. ALT and AST
B. CBC with differential
C. Serum prolactin
D. Renal panel
✅ Answer: B. CBC with differential
Rationale: Clozapine may cause agranulocytosis; absolute neutrophil count must
be checked immediately.
,6. A 15-year-old exhibits irritability, poor concentration, and failing grades
for 8 months. The NP should first rule out:
A. Bipolar disorder
B. Major depressive disorder
C. ADHD
D. Substance use disorder
✅ Answer: D. Substance use disorder
Rationale: In adolescents, new behavioral and academic changes often stem from
substance use; rule out before diagnosing a primary mood/attention disorder.
7. Which antidepressant has the highest risk of seizure at high doses?
A. Paroxetine
B. Venlafaxine
C. Bupropion
D. Sertraline
✅ Answer: C. Bupropion
Rationale: Dose-related seizure risk, especially >450 mg/day or in patients with
eating disorders or head trauma.
8. A client newly diagnosed with PTSD reports recurrent nightmares. Which
medication has best evidence for reducing trauma-related nightmares?
A. Prazosin
B. Diazepam
C. Olanzapine
D. Mirtazapine
✅ Answer: A. Prazosin
Rationale: Alpha-1 antagonist prazosin blocks norepinephrine effects during
sleep, reducing nightmare frequency.
, 9. A 32-year-old woman with panic disorder is starting an SSRI. The NP
should educate that:
A. Symptoms improve immediately
B. Short-term benzodiazepine may be used during initial activation
C. Avoid caffeine because it decreases drug efficacy
D. Medication must be taken PRN
✅ Answer: B. Short-term benzodiazepine may be used during initial activation
Rationale: SSRIs can transiently worsen anxiety; short-term benzo use may bridge
until response develops (4–6 weeks).
10. When discontinuing paroxetine, the NP advises:
A. Stop abruptly
B. Taper over several weeks
C. Double dose every other day
D. Substitute fluoxetine for 1 week
✅ Answer: B. Taper over several weeks
Rationale: Paroxetine has a short half-life and high risk of discontinuation
syndrome; gradual taper minimizes symptoms.
11. A patient on lithium presents with diarrhea, ataxia, and coarse tremor.
The next best action is:
A. Reassure and continue current dose
B. Check serum lithium level immediately
C. Add propranolol
D. Encourage hydration only
✅ Answer: B. Check serum lithium level immediately
Rationale: Signs indicate possible toxicity (>1.5 mEq/L). Serum level
confirmation guides urgent management.
