Fitzgerald PMHNP Psychiatric-Mental
Health Nurse Practitioner Final Exam
2026 Prep Questions and Answers
SECTION 1: LABORATORY & DIAGNOSTIC ASSESSMENT (1-20)
Question 1
A 76-year-old woman presents with worsening fatigue during the past 6 months.
She is currently being treated with an SSRI for MDD. Her lab results are: Hb=9.3
g/dL (13–17), MCV=71 fL (80–96 fL). This most likely represents:
A) Vitamin B12 deficiency
B) Iron-deficiency anemia
C) Anemia of chronic disease
D) Folate deficiency
Rationale: The combination of low hemoglobin (9.3) and low MCV (71) indicates
microcytic anemia . Iron-deficiency anemia is the most common cause. SSRIs can
contribute to GI bleeding, which may precipitate iron deficiency in vulnerable
patients.
Question 2
Is dry skin a clinical finding in hyperthyroidism, hypothyroidism, or both?
,A) Hyperthyroidism only
B) Hypothyroidism only
C) Both
D) Neither
Rationale: Dry skin can occur in both conditions . In hypothyroidism, decreased
metabolic activity leads to reduced sweating and dry, coarse skin. In
hyperthyroidism, increased metabolic rate can also lead to skin changes including
dryness and thinning.
Question 3
For a patient receiving valproate therapy, regular monitoring for all of the
following is recommended EXCEPT:
A) ALT and AST
B) Bilirubin
C) TSH
D) Platelet count
Rationale: Valproate (Depakote) requires monitoring of liver function tests (ALT,
AST), bilirubin, and platelet counts due to risks of hepatotoxicity and
thrombocytopenia . TSH monitoring is not specifically required for valproate
therapy.
Question 4
A potential laboratory indicator for alcohol abuse is:
,A) Elevated ALT
B) Diminished creatinine
C) Elevated alkaline phosphatase
D) Elevated creatine kinase
Rationale: Elevated ALT (alanine aminotransferase) is a common indicator of
alcohol-related liver damage . While other liver enzymes may also be elevated,
ALT is a sensitive marker for hepatocellular injury associated with alcohol abuse.
Question 5
The most accurate laboratory measurement for kidney function is:
A) BUN
B) Serum creatinine
C) GFR (calculated glomerular filtration rate)
D) Urinalysis
Rationale: GFR is considered the best overall index of kidney function . It is
calculated using serum creatinine, age, gender, and race. Normal GFR is >90
mL/min.
Question 6
Which of the following medications does NOT require initial laboratory testing
before implementing therapy?
A) Carbamazepine
B) Lamotrigine
, C) Valproate
D) Lithium
Rationale: Lamotrigine does not require baseline laboratory testing before
initiation . However, it does carry a risk of serious rash (including Stevens-Johnson
syndrome) requiring patient education. Carbamazepine requires HLA-B*1502
screening, valproate requires LFTs and CBC, and lithium requires renal function
tests.
Question 7
Ciprofloxacin is an inhibitor of which cytochrome P450 pathway?
A) CYP2D6
B) CYP3A4
C) CYP1A2
D) CYP2C19
Rationale: Ciprofloxacin is a known inhibitor of the CYP1A2 pathway . This is
clinically significant because it can increase levels of medications metabolized by
this enzyme, including some antipsychotics (clozapine, olanzapine) and
antidepressants (duloxetine).
Question 8
Which medication requires an alternative to oral contraceptive pills (OCPs) as a
method of contraception?
A) Duloxetine
B) Valproic Acid
Health Nurse Practitioner Final Exam
2026 Prep Questions and Answers
SECTION 1: LABORATORY & DIAGNOSTIC ASSESSMENT (1-20)
Question 1
A 76-year-old woman presents with worsening fatigue during the past 6 months.
She is currently being treated with an SSRI for MDD. Her lab results are: Hb=9.3
g/dL (13–17), MCV=71 fL (80–96 fL). This most likely represents:
A) Vitamin B12 deficiency
B) Iron-deficiency anemia
C) Anemia of chronic disease
D) Folate deficiency
Rationale: The combination of low hemoglobin (9.3) and low MCV (71) indicates
microcytic anemia . Iron-deficiency anemia is the most common cause. SSRIs can
contribute to GI bleeding, which may precipitate iron deficiency in vulnerable
patients.
Question 2
Is dry skin a clinical finding in hyperthyroidism, hypothyroidism, or both?
,A) Hyperthyroidism only
B) Hypothyroidism only
C) Both
D) Neither
Rationale: Dry skin can occur in both conditions . In hypothyroidism, decreased
metabolic activity leads to reduced sweating and dry, coarse skin. In
hyperthyroidism, increased metabolic rate can also lead to skin changes including
dryness and thinning.
Question 3
For a patient receiving valproate therapy, regular monitoring for all of the
following is recommended EXCEPT:
A) ALT and AST
B) Bilirubin
C) TSH
D) Platelet count
Rationale: Valproate (Depakote) requires monitoring of liver function tests (ALT,
AST), bilirubin, and platelet counts due to risks of hepatotoxicity and
thrombocytopenia . TSH monitoring is not specifically required for valproate
therapy.
Question 4
A potential laboratory indicator for alcohol abuse is:
,A) Elevated ALT
B) Diminished creatinine
C) Elevated alkaline phosphatase
D) Elevated creatine kinase
Rationale: Elevated ALT (alanine aminotransferase) is a common indicator of
alcohol-related liver damage . While other liver enzymes may also be elevated,
ALT is a sensitive marker for hepatocellular injury associated with alcohol abuse.
Question 5
The most accurate laboratory measurement for kidney function is:
A) BUN
B) Serum creatinine
C) GFR (calculated glomerular filtration rate)
D) Urinalysis
Rationale: GFR is considered the best overall index of kidney function . It is
calculated using serum creatinine, age, gender, and race. Normal GFR is >90
mL/min.
Question 6
Which of the following medications does NOT require initial laboratory testing
before implementing therapy?
A) Carbamazepine
B) Lamotrigine
, C) Valproate
D) Lithium
Rationale: Lamotrigine does not require baseline laboratory testing before
initiation . However, it does carry a risk of serious rash (including Stevens-Johnson
syndrome) requiring patient education. Carbamazepine requires HLA-B*1502
screening, valproate requires LFTs and CBC, and lithium requires renal function
tests.
Question 7
Ciprofloxacin is an inhibitor of which cytochrome P450 pathway?
A) CYP2D6
B) CYP3A4
C) CYP1A2
D) CYP2C19
Rationale: Ciprofloxacin is a known inhibitor of the CYP1A2 pathway . This is
clinically significant because it can increase levels of medications metabolized by
this enzyme, including some antipsychotics (clozapine, olanzapine) and
antidepressants (duloxetine).
Question 8
Which medication requires an alternative to oral contraceptive pills (OCPs) as a
method of contraception?
A) Duloxetine
B) Valproic Acid
