APEA PSYCHIATRIC-MENTAL HEALTH NURSE
PRACTITIONER PMHNP EXAM ACTUAL EXAM QUESTIONS
AND VERIFIED ANSWERS WITH NGN INTEGRATION FOR
CERTIFICATION PASS GUARANTEED A+
1. A 32-year-old female reports persistent sadness, anhedonia, fatigue, and difficulty concentrating for
the past 4 weeks. She denies suicidal ideation. What is the most appropriate initial treatment?
A) Fluoxetine 20 mg daily
*B) Psychotherapy alone
C) Escitalopram 10 mg daily and psychotherapy
D) Bupropion 150 mg daily
Rationale: Mild to moderate major depressive disorder can initially be treated with psychotherapy
alone, especially without suicidal ideation or severe functional impairment. Medication is added if no
response to therapy after 4–6 weeks. Fluoxetine and escitalopram are appropriate for
moderate-to-severe depression. Bupropion is often used for atypical depression or when fatigue is
prominent, but not first-line without therapy trial.
2. A patient with bipolar I disorder who is stable on lithium presents with nausea, vomiting, coarse
tremor, and confusion. Lithium level is 2.1 mEq/L. What is the priority intervention?
A) Administer activated charcoal
*B) Hold lithium and consider hemodialysis
C) Increase fluids and monitor levels
D) Add haloperidol for agitation
Rationale: Lithium toxicity with levels >2.0 mEq/L and neurological symptoms (confusion, coarse
tremor) is severe. Hemodialysis is indicated. Activated charcoal does not bind lithium. Increasing
fluids is insufficient. Haloperidol increases neurotoxicity risk.
,3. Which medication is FDA-approved for treatment-resistant depression (TRD) as adjunctive therapy?
A) Sertraline
*B) Aripiprazole
C) Venlafaxine
D) Trazodone
Rationale: Aripiprazole, brexpiprazole, and quetiapine are FDA-approved as adjuncts for TRD.
Sertraline and venlafaxine are first-line antidepressants, not adjuncts for TRD. Trazodone is used for
insomnia or as an adjunct, but not FDA-approved for TRD.
4. A 45-year-old man with alcohol use disorder reports craving, insomnia, and anxiety 8 hours after his
last drink. What is the most appropriate pharmacotherapy for withdrawal symptom prevention?
A) Naltrexone 50 mg daily
B) Disulfiram 250 mg daily
*C) Chlordiazepoxide tapered protocol
D) Acamprosate 666 mg three times daily
Rationale: Benzodiazepines (chlordiazepoxide, lorazepam) are first-line for alcohol withdrawal to
prevent seizures and delirium tremens. Naltrexone and acamprosate prevent relapse, not withdrawal.
Disulfiram causes aversive reaction.
5. Which antipsychotic is most likely to cause significant weight gain and metabolic syndrome?
A) Haloperidol
B) Lurasidone
C) Ziprasidone
*D) Olanzapine
Rationale: Olanzapine and clozapine have the highest metabolic risk (weight gain, dyslipidemia,
diabetes). Haloperidol has low risk. Lurasidone and ziprasidone have minimal metabolic effects.
6. A child with ADHD has been on methylphenidate extended-release 36 mg daily for 4 weeks with
mild improvement but persistent inattention and motor restlessness. The PMHNP should consider:
A) Switch to atomoxetine
,*B) Increase dose to 54 mg daily
C) Add guanfacine immediate release
D) Discontinue stimulant due to partial response
Rationale: Inadequate response to methylphenidate warrants dose optimization before switching or
adding non-stimulants. Max FDA-approved dose for methylphenidate ER is 72 mg. Atomoxetine is
second-line. Guanfacine can be added but not the first step after only 4 weeks.
7. A patient taking clozapine reports fever, malaise, and sore throat. CBC shows WBC 2,100/mm³
(normal 4,500–11,000) and ANC 800/mm³. What is the next step?
A) Continue clozapine and repeat labs in 1 week
B) Reduce clozapine dose by 50%
*C) Stop clozapine immediately and initiate infection workup
D) Add filgrastim
Rationale: Clozapine-induced agranulocytosis (ANC <500 is severe; ANC 500–1,000 is moderate).
Current ANC 800 requires immediate clozapine discontinuation and monitoring until recovery.
Filgrastim may be used in severe cases but not the first step without stopping the drug free.
8. Which medication is first-line for generalized anxiety disorder (GAD) in a patient with comorbid
hypertension?
A) Buspirone
*B) Sertraline
C) Propranolol
D) Alprazolam
Rationale: SSRIs (sertraline, escitalopram) are first-line for GAD. Buspirone is second-line.
Propranolol is for performance anxiety. Alprazolam is not first-line due to dependence risk.
9. A 28-year-old woman presents with intrusive thoughts about contamination and repetitive
handwashing for 3 hours daily. Which psychotherapy is most effective?
A) Supportive therapy
*B) Exposure and response prevention (ERP)
, C) Cognitive restructuring alone
D) Psychodynamic therapy
Rationale: ERP is the gold-standard psychotherapy for OCD. Cognitive restructuring is adjunctive.
Supportive and psychodynamic therapies lack strong evidence for OCD.
10. A patient with panic disorder has been on paroxetine 40 mg daily for 8 weeks with 50% reduction
in panic attacks but reports sexual dysfunction. The PMHNP should:
A) Switch to clomipramine
B) Add sildenafil
*C) Switch to escitalopram 20 mg daily
D) Reduce paroxetine to 20 mg daily
Rationale: Sexual dysfunction is common with high-dose paroxetine. Escitalopram has lower risk of
sexual side effects. Clomipramine is TCA with a worse side effect profile. Adding sildenafil treats
dysfunction but does not address drug cause. Dose reduction may cause relapse.
11. Which of the following is a core symptom of autism spectrum disorder (ASD)?
A) Hallucinations
*B) Deficits in social-emotional reciprocity
C) Rapid mood swings
D) Excessive guilt
Rationale: Impaired social interaction (e.g., poor reciprocity) is a core DSM-5 criterion for ASD.
Hallucinations suggest psychosis. Rapid mood swings may indicate bipolar. Excessive guilt is typical
of depression.
12. A 60-year-old with Parkinson’s disease develops visual hallucinations of small animals, paranoia,
and fluctuating cognition over 6 months. Which diagnosis is most likely?
A) Alzheimer’s disease
*B) Dementia with Lewy bodies (DLB)
C) Vascular dementia
D) Frontotemporal dementia
PRACTITIONER PMHNP EXAM ACTUAL EXAM QUESTIONS
AND VERIFIED ANSWERS WITH NGN INTEGRATION FOR
CERTIFICATION PASS GUARANTEED A+
1. A 32-year-old female reports persistent sadness, anhedonia, fatigue, and difficulty concentrating for
the past 4 weeks. She denies suicidal ideation. What is the most appropriate initial treatment?
A) Fluoxetine 20 mg daily
*B) Psychotherapy alone
C) Escitalopram 10 mg daily and psychotherapy
D) Bupropion 150 mg daily
Rationale: Mild to moderate major depressive disorder can initially be treated with psychotherapy
alone, especially without suicidal ideation or severe functional impairment. Medication is added if no
response to therapy after 4–6 weeks. Fluoxetine and escitalopram are appropriate for
moderate-to-severe depression. Bupropion is often used for atypical depression or when fatigue is
prominent, but not first-line without therapy trial.
2. A patient with bipolar I disorder who is stable on lithium presents with nausea, vomiting, coarse
tremor, and confusion. Lithium level is 2.1 mEq/L. What is the priority intervention?
A) Administer activated charcoal
*B) Hold lithium and consider hemodialysis
C) Increase fluids and monitor levels
D) Add haloperidol for agitation
Rationale: Lithium toxicity with levels >2.0 mEq/L and neurological symptoms (confusion, coarse
tremor) is severe. Hemodialysis is indicated. Activated charcoal does not bind lithium. Increasing
fluids is insufficient. Haloperidol increases neurotoxicity risk.
,3. Which medication is FDA-approved for treatment-resistant depression (TRD) as adjunctive therapy?
A) Sertraline
*B) Aripiprazole
C) Venlafaxine
D) Trazodone
Rationale: Aripiprazole, brexpiprazole, and quetiapine are FDA-approved as adjuncts for TRD.
Sertraline and venlafaxine are first-line antidepressants, not adjuncts for TRD. Trazodone is used for
insomnia or as an adjunct, but not FDA-approved for TRD.
4. A 45-year-old man with alcohol use disorder reports craving, insomnia, and anxiety 8 hours after his
last drink. What is the most appropriate pharmacotherapy for withdrawal symptom prevention?
A) Naltrexone 50 mg daily
B) Disulfiram 250 mg daily
*C) Chlordiazepoxide tapered protocol
D) Acamprosate 666 mg three times daily
Rationale: Benzodiazepines (chlordiazepoxide, lorazepam) are first-line for alcohol withdrawal to
prevent seizures and delirium tremens. Naltrexone and acamprosate prevent relapse, not withdrawal.
Disulfiram causes aversive reaction.
5. Which antipsychotic is most likely to cause significant weight gain and metabolic syndrome?
A) Haloperidol
B) Lurasidone
C) Ziprasidone
*D) Olanzapine
Rationale: Olanzapine and clozapine have the highest metabolic risk (weight gain, dyslipidemia,
diabetes). Haloperidol has low risk. Lurasidone and ziprasidone have minimal metabolic effects.
6. A child with ADHD has been on methylphenidate extended-release 36 mg daily for 4 weeks with
mild improvement but persistent inattention and motor restlessness. The PMHNP should consider:
A) Switch to atomoxetine
,*B) Increase dose to 54 mg daily
C) Add guanfacine immediate release
D) Discontinue stimulant due to partial response
Rationale: Inadequate response to methylphenidate warrants dose optimization before switching or
adding non-stimulants. Max FDA-approved dose for methylphenidate ER is 72 mg. Atomoxetine is
second-line. Guanfacine can be added but not the first step after only 4 weeks.
7. A patient taking clozapine reports fever, malaise, and sore throat. CBC shows WBC 2,100/mm³
(normal 4,500–11,000) and ANC 800/mm³. What is the next step?
A) Continue clozapine and repeat labs in 1 week
B) Reduce clozapine dose by 50%
*C) Stop clozapine immediately and initiate infection workup
D) Add filgrastim
Rationale: Clozapine-induced agranulocytosis (ANC <500 is severe; ANC 500–1,000 is moderate).
Current ANC 800 requires immediate clozapine discontinuation and monitoring until recovery.
Filgrastim may be used in severe cases but not the first step without stopping the drug free.
8. Which medication is first-line for generalized anxiety disorder (GAD) in a patient with comorbid
hypertension?
A) Buspirone
*B) Sertraline
C) Propranolol
D) Alprazolam
Rationale: SSRIs (sertraline, escitalopram) are first-line for GAD. Buspirone is second-line.
Propranolol is for performance anxiety. Alprazolam is not first-line due to dependence risk.
9. A 28-year-old woman presents with intrusive thoughts about contamination and repetitive
handwashing for 3 hours daily. Which psychotherapy is most effective?
A) Supportive therapy
*B) Exposure and response prevention (ERP)
, C) Cognitive restructuring alone
D) Psychodynamic therapy
Rationale: ERP is the gold-standard psychotherapy for OCD. Cognitive restructuring is adjunctive.
Supportive and psychodynamic therapies lack strong evidence for OCD.
10. A patient with panic disorder has been on paroxetine 40 mg daily for 8 weeks with 50% reduction
in panic attacks but reports sexual dysfunction. The PMHNP should:
A) Switch to clomipramine
B) Add sildenafil
*C) Switch to escitalopram 20 mg daily
D) Reduce paroxetine to 20 mg daily
Rationale: Sexual dysfunction is common with high-dose paroxetine. Escitalopram has lower risk of
sexual side effects. Clomipramine is TCA with a worse side effect profile. Adding sildenafil treats
dysfunction but does not address drug cause. Dose reduction may cause relapse.
11. Which of the following is a core symptom of autism spectrum disorder (ASD)?
A) Hallucinations
*B) Deficits in social-emotional reciprocity
C) Rapid mood swings
D) Excessive guilt
Rationale: Impaired social interaction (e.g., poor reciprocity) is a core DSM-5 criterion for ASD.
Hallucinations suggest psychosis. Rapid mood swings may indicate bipolar. Excessive guilt is typical
of depression.
12. A 60-year-old with Parkinson’s disease develops visual hallucinations of small animals, paranoia,
and fluctuating cognition over 6 months. Which diagnosis is most likely?
A) Alzheimer’s disease
*B) Dementia with Lewy bodies (DLB)
C) Vascular dementia
D) Frontotemporal dementia
