LMR GEORGETTE PMHNP BOARD EXAM 2026/2027 PRACTICE
QUESTIONS AND A NEW UPDATED STUDY GUIDE COMPLETE
ACCURATE QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) LATEST UPDATED VERSION
2026 EDITION/ GUARANTEED PASS A+ (BRAND NEW!) FULL
REVISED LMR GEORGETTE PMHNP BOARD ACTUAL EXAM
1. A 32-year-old patient with major depressive disorder has failed two SSRIs.
Which medication mechanism is most appropriate as next-line monotherapy?
A) Serotonin reuptake inhibition
B) Norepinephrine reuptake inhibition only
C) Serotonin and norepinephrine reuptake inhibition
D) Dopamine antagonism
CORRECT ANSWER: C – Serotonin and norepinephrine reuptake inhibition (e.g.,
venlafaxine, duloxetine) is guideline-supported after two SSRI failures.
Rationale: SNRIs offer dual mechanism without switching classes abruptly;
MAOIs or TCAs are later options.
2. A patient with bipolar I disorder presents with euphoria, grandiosity, and
aggression. Which first-line acute manic treatment is most appropriate?
A) Fluoxetine and olanzapine
,B) Lithium monotherapy
C) Quetiapine monotherapy
D) Aripiprazole monotherapy
CORRECT ANSWER: B – Lithium monotherapy is first-line for acute mania.
Rationale: Lithium has robust efficacy; combination with antipsychotics if severe,
but monotherapy is preferred initially unless psychosis or agitation is prominent.
3. Which laboratory value requires immediate monitoring in a patient starting
clozapine?
A) Serum creatinine
B) Thyroid-stimulating hormone
C) Absolute neutrophil count
D) Hepatic transaminases
CORRECT ANSWER: C – Absolute neutrophil count (ANC).
Rationale: Clozapine causes agranulocytosis; ANC must be monitored weekly for
first 6 months, then biweekly.
4. A 45-year-old female with panic disorder reports daily benzodiazepine use for 8
months. Which is the safest taper strategy?
,A) Abrupt discontinuation with hydroxyzine
B) 25% dose reduction every week
C) 10% dose reduction every 2–4 weeks
D) Switch to clonazepam and stop after 1 week
CORRECT ANSWER: C – 10% dose reduction every 2–4 weeks.
Rationale: Slow taper minimizes withdrawal seizures and rebound anxiety; longer-
acting benzodiazepines may be substituted, but gradual reduction is key.
5. A 19-year-old with first-episode psychosis has akathisia from risperidone.
Which intervention is most appropriate?
A) Increase risperidone dose
B) Add propranolol
C) Add benztropine
D) Switch to clozapine
CORRECT ANSWER: B – Add propranolol.
, Rationale: Propranolol is first-line for antipsychotic-induced akathisia; benztropine
treats dystonia/parkinsonism, not akathisia.
6. Which finding is most specific for neuroleptic malignant syndrome (NMS) vs.
malignant catatonia?
A) Fever
B) Elevated creative kinase
C) Rigidity
D) Recent antipsychotic use
CORRECT ANSWER: D – Recent antipsychotic use.
Rationale: NMS is drug-induced; malignant catatonia occurs without neuroleptics
but presentation overlaps. Antipsychotic history is key differentiator.
7. A patient on valproate for bipolar disorder has a level of 120 mcg/mL
(therapeutic range 50–125). She is drowsy and tremulous. Next step?
A) Add lamotrigine
B) Reduce valproate dose
C) Obtain ammonia level
QUESTIONS AND A NEW UPDATED STUDY GUIDE COMPLETE
ACCURATE QUESTIONS AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) LATEST UPDATED VERSION
2026 EDITION/ GUARANTEED PASS A+ (BRAND NEW!) FULL
REVISED LMR GEORGETTE PMHNP BOARD ACTUAL EXAM
1. A 32-year-old patient with major depressive disorder has failed two SSRIs.
Which medication mechanism is most appropriate as next-line monotherapy?
A) Serotonin reuptake inhibition
B) Norepinephrine reuptake inhibition only
C) Serotonin and norepinephrine reuptake inhibition
D) Dopamine antagonism
CORRECT ANSWER: C – Serotonin and norepinephrine reuptake inhibition (e.g.,
venlafaxine, duloxetine) is guideline-supported after two SSRI failures.
Rationale: SNRIs offer dual mechanism without switching classes abruptly;
MAOIs or TCAs are later options.
2. A patient with bipolar I disorder presents with euphoria, grandiosity, and
aggression. Which first-line acute manic treatment is most appropriate?
A) Fluoxetine and olanzapine
,B) Lithium monotherapy
C) Quetiapine monotherapy
D) Aripiprazole monotherapy
CORRECT ANSWER: B – Lithium monotherapy is first-line for acute mania.
Rationale: Lithium has robust efficacy; combination with antipsychotics if severe,
but monotherapy is preferred initially unless psychosis or agitation is prominent.
3. Which laboratory value requires immediate monitoring in a patient starting
clozapine?
A) Serum creatinine
B) Thyroid-stimulating hormone
C) Absolute neutrophil count
D) Hepatic transaminases
CORRECT ANSWER: C – Absolute neutrophil count (ANC).
Rationale: Clozapine causes agranulocytosis; ANC must be monitored weekly for
first 6 months, then biweekly.
4. A 45-year-old female with panic disorder reports daily benzodiazepine use for 8
months. Which is the safest taper strategy?
,A) Abrupt discontinuation with hydroxyzine
B) 25% dose reduction every week
C) 10% dose reduction every 2–4 weeks
D) Switch to clonazepam and stop after 1 week
CORRECT ANSWER: C – 10% dose reduction every 2–4 weeks.
Rationale: Slow taper minimizes withdrawal seizures and rebound anxiety; longer-
acting benzodiazepines may be substituted, but gradual reduction is key.
5. A 19-year-old with first-episode psychosis has akathisia from risperidone.
Which intervention is most appropriate?
A) Increase risperidone dose
B) Add propranolol
C) Add benztropine
D) Switch to clozapine
CORRECT ANSWER: B – Add propranolol.
, Rationale: Propranolol is first-line for antipsychotic-induced akathisia; benztropine
treats dystonia/parkinsonism, not akathisia.
6. Which finding is most specific for neuroleptic malignant syndrome (NMS) vs.
malignant catatonia?
A) Fever
B) Elevated creative kinase
C) Rigidity
D) Recent antipsychotic use
CORRECT ANSWER: D – Recent antipsychotic use.
Rationale: NMS is drug-induced; malignant catatonia occurs without neuroleptics
but presentation overlaps. Antipsychotic history is key differentiator.
7. A patient on valproate for bipolar disorder has a level of 120 mcg/mL
(therapeutic range 50–125). She is drowsy and tremulous. Next step?
A) Add lamotrigine
B) Reduce valproate dose
C) Obtain ammonia level
