2026/2027
LMR Georgette PMHNP Board
Exam 2026/2027 Advanced Practice
Test Bank, Study Notes, and
Certification Exam Prep Manual
Batch 1: Questions 1–50
Question 1
A nursing instructor asks a student to explain the purpose f the nursing process using
the acronym ADPIE. Which sequence correctly represents the nursing process?
A. Assessment, Diagnosis, Planning, Intervention, Evaluation
B. Assessment, Diagnosis, Planning, Implementation, Evaluation
C. Analysis, Documentation, Planning, Intervention, Execution
D. Assessment, Determination, Prioritization, Intervention, Examination
Correct Answer: B. Assessment, Diagnosis, Planning, Implementation,
Evaluation
Rationale:
ADPIE is the standard framework used in nursing practice to guide patient-centered
care. It stands for Assessment, Diagnosis, Planning, Implementation, and Evaluation.
Assessment involves gathering patient data; Diagnosis identifies actual or potential
health problems; Planning establishes measurable goals and interventions;
Implementation is the execution of nursing actions; and Evaluation determines
whether outcomes were achieved. Option A is incorrect because “Intervention” is not
the official term used in the acronym. Options C and D contain inaccurate
terminology that does not reflect the recognized nursing process model.
Question 2
A mother reports that her 6-year-old child suddenly awoke screaming during the night
and appeared frightened. What is the nurse’s most appropriate initial response?
A. Recommend immediate sleep medication
B. Advise the mother to wake the child fully during episodes
C. Ask whether similar episodes have occurred previously
D. Refer the child immediately for neurological testing
Correct Answer: C. Ask whether similar episodes have occurred previously
,2026/2027
Rationale:
The nurse should first assess for patterns and frequency of the episodes before
initiating interventions. Recurrent nighttime screaming may indicate night terrors,
sleep disturbances, anxiety, or other pediatric sleep disorders. Determining whether
the behavior is isolated or recurrent helps guide further assessment and management.
Option A is inappropriate because medication should not be the first intervention.
Option B may worsen agitation during night terrors. Option D may eventually be
necessary if neurological symptoms are suspected, but initial assessment should focus
on history and pattern recognition.
Question 3
A patient presents with thickened, discolored toenails suspicious for a fungal infection.
Which nursing action is most appropriate?
A. Begin oral antifungal therapy immediately
B. Recommend daily soaking of the feet only
C. Scrape the nail for laboratory testing
D. Remove the affected toenail surgically
Correct Answer: C. Scrape the nail for laboratory testing
Rationale:
Definitive diagnosis of onychomycosis requires fungal testing, often through nail
scraping and microscopic or culture examination. This ensures accurate treatment and
helps distinguish fungal infection from psoriasis, trauma, or other nail disorders.
Option A is inappropriate without confirmation because antifungal medications may
have significant adverse effects. Option B may provide comfort but does not establish
diagnosis or treat the infection. Option D is invasive and not the first-line intervention.
Question 4
A patient taking lithium carbonate reports dark brown urine and increasing fatigue.
Which nursing action is the priority?
A. Assess for suicidal ideation
B. Check renal function studies
C. Encourage increased calcium intake
D. Administer the next lithium dose as prescribed
Correct Answer: B. Check renal function studies
Rationale:
Lithium is nephrotoxic and may impair renal function. Dark urine may indicate
dehydration, renal impairment, or rhabdomyolysis. Monitoring renal function through
serum creatinine and BUN levels is essential because lithium is excreted through the
kidneys. Option A may be appropriate in psychiatric assessment but is not the priority
,2026/2027
here. Option C is unrelated to the immediate concern. Option D is unsafe because
signs of toxicity or renal dysfunction warrant withholding lithium until evaluated.
Question 5
A client receiving Clozapine develops fever and sore throat. Which laboratory value
should the nurse assess immediately?
A. Serum potassium
B. ANC level
C. Blood glucose
D. Thyroid-stimulating hormone
Correct Answer: B. ANC level
Rationale:
Clozapine can cause agranulocytosis, a potentially life-threatening reduction in
neutrophils. Fever and sore throat are classic warning signs of infection secondary to
neutropenia. The absolute neutrophil count (ANC) must be assessed immediately.
Option A is unrelated to the risk profile of clozapine. Option C may be monitored
because atypical antipsychotics can increase glucose levels, but it is not the priority.
Option D does not address the urgent concern of agranulocytosis.
Question 6
Which combination of substances places a patient at highest risk for developing
serotonin syndrome?
A. Acetaminophen and ibuprofen
B. Lithium and calcium supplements
C. Antidepressants combined with St. John’s Wort
D. Antacids combined with antihistamines
Correct Answer: C. Antidepressants combined with St. John’s Wort
Rationale:
Serotonin syndrome occurs when serotonergic activity becomes excessive, commonly
due to combining serotonergic medications or supplements. Antidepressants
combined with substances such as St. John’s Wort, tryptophan, SAM-e, or certain
herbal supplements significantly increase serotonin levels. Symptoms may include
hyperreflexia, fever, agitation, and autonomic instability. The other combinations do
not significantly increase serotonin activity.
Question 7
, 2026/2027
A patient suspected of having neuroleptic malignant syndrome (NMS) is likely to
demonstrate which laboratory findings?
A. Elevated WBC count and elevated CPK
B. Decreased platelet count and low sodium
C. Elevated calcium and low potassium
D. Increased hemoglobin and elevated glucose
Correct Answer: A. Elevated WBC count and elevated CPK
Rationale:
NMS is a severe reaction to antipsychotic medications characterized by muscle
rigidity, hyperthermia, and autonomic instability. Muscle breakdown causes elevated
creatine phosphokinase (CPK), while systemic stress may elevate the white blood cell
count. The remaining options are not hallmark findings of NMS.
Question 8
Which assessment finding is most consistent with neuroleptic malignant syndrome?
A. Hyperreflexia and diarrhea
B. Muscle rigidity with hyperthermia
C. Pinpoint pupils and sedation
D. Euphoria with increased appetite
Correct Answer: B. Muscle rigidity with hyperthermia
Rationale:
Classic signs of NMS include severe muscle rigidity, hyperthermia, tachycardia,
diaphoresis, labile blood pressure, altered mental status, and elevated CPK. Option A
is more suggestive of serotonin syndrome. Option C is associated with opioid
intoxication. Option D is unrelated to NMS.
Question 9
A psychiatric patient develops cherry-colored urine while taking antipsychotic
medication. Which complication should the nurse suspect?
A. Hepatic encephalopathy
B. Rhabdomyolysis
C. Hyperglycemia
D. Agranulocytosis
Correct Answer: B. Rhabdomyolysis
Rationale:
Cherry-colored or dark urine may indicate myoglobinuria resulting from
LMR Georgette PMHNP Board
Exam 2026/2027 Advanced Practice
Test Bank, Study Notes, and
Certification Exam Prep Manual
Batch 1: Questions 1–50
Question 1
A nursing instructor asks a student to explain the purpose f the nursing process using
the acronym ADPIE. Which sequence correctly represents the nursing process?
A. Assessment, Diagnosis, Planning, Intervention, Evaluation
B. Assessment, Diagnosis, Planning, Implementation, Evaluation
C. Analysis, Documentation, Planning, Intervention, Execution
D. Assessment, Determination, Prioritization, Intervention, Examination
Correct Answer: B. Assessment, Diagnosis, Planning, Implementation,
Evaluation
Rationale:
ADPIE is the standard framework used in nursing practice to guide patient-centered
care. It stands for Assessment, Diagnosis, Planning, Implementation, and Evaluation.
Assessment involves gathering patient data; Diagnosis identifies actual or potential
health problems; Planning establishes measurable goals and interventions;
Implementation is the execution of nursing actions; and Evaluation determines
whether outcomes were achieved. Option A is incorrect because “Intervention” is not
the official term used in the acronym. Options C and D contain inaccurate
terminology that does not reflect the recognized nursing process model.
Question 2
A mother reports that her 6-year-old child suddenly awoke screaming during the night
and appeared frightened. What is the nurse’s most appropriate initial response?
A. Recommend immediate sleep medication
B. Advise the mother to wake the child fully during episodes
C. Ask whether similar episodes have occurred previously
D. Refer the child immediately for neurological testing
Correct Answer: C. Ask whether similar episodes have occurred previously
,2026/2027
Rationale:
The nurse should first assess for patterns and frequency of the episodes before
initiating interventions. Recurrent nighttime screaming may indicate night terrors,
sleep disturbances, anxiety, or other pediatric sleep disorders. Determining whether
the behavior is isolated or recurrent helps guide further assessment and management.
Option A is inappropriate because medication should not be the first intervention.
Option B may worsen agitation during night terrors. Option D may eventually be
necessary if neurological symptoms are suspected, but initial assessment should focus
on history and pattern recognition.
Question 3
A patient presents with thickened, discolored toenails suspicious for a fungal infection.
Which nursing action is most appropriate?
A. Begin oral antifungal therapy immediately
B. Recommend daily soaking of the feet only
C. Scrape the nail for laboratory testing
D. Remove the affected toenail surgically
Correct Answer: C. Scrape the nail for laboratory testing
Rationale:
Definitive diagnosis of onychomycosis requires fungal testing, often through nail
scraping and microscopic or culture examination. This ensures accurate treatment and
helps distinguish fungal infection from psoriasis, trauma, or other nail disorders.
Option A is inappropriate without confirmation because antifungal medications may
have significant adverse effects. Option B may provide comfort but does not establish
diagnosis or treat the infection. Option D is invasive and not the first-line intervention.
Question 4
A patient taking lithium carbonate reports dark brown urine and increasing fatigue.
Which nursing action is the priority?
A. Assess for suicidal ideation
B. Check renal function studies
C. Encourage increased calcium intake
D. Administer the next lithium dose as prescribed
Correct Answer: B. Check renal function studies
Rationale:
Lithium is nephrotoxic and may impair renal function. Dark urine may indicate
dehydration, renal impairment, or rhabdomyolysis. Monitoring renal function through
serum creatinine and BUN levels is essential because lithium is excreted through the
kidneys. Option A may be appropriate in psychiatric assessment but is not the priority
,2026/2027
here. Option C is unrelated to the immediate concern. Option D is unsafe because
signs of toxicity or renal dysfunction warrant withholding lithium until evaluated.
Question 5
A client receiving Clozapine develops fever and sore throat. Which laboratory value
should the nurse assess immediately?
A. Serum potassium
B. ANC level
C. Blood glucose
D. Thyroid-stimulating hormone
Correct Answer: B. ANC level
Rationale:
Clozapine can cause agranulocytosis, a potentially life-threatening reduction in
neutrophils. Fever and sore throat are classic warning signs of infection secondary to
neutropenia. The absolute neutrophil count (ANC) must be assessed immediately.
Option A is unrelated to the risk profile of clozapine. Option C may be monitored
because atypical antipsychotics can increase glucose levels, but it is not the priority.
Option D does not address the urgent concern of agranulocytosis.
Question 6
Which combination of substances places a patient at highest risk for developing
serotonin syndrome?
A. Acetaminophen and ibuprofen
B. Lithium and calcium supplements
C. Antidepressants combined with St. John’s Wort
D. Antacids combined with antihistamines
Correct Answer: C. Antidepressants combined with St. John’s Wort
Rationale:
Serotonin syndrome occurs when serotonergic activity becomes excessive, commonly
due to combining serotonergic medications or supplements. Antidepressants
combined with substances such as St. John’s Wort, tryptophan, SAM-e, or certain
herbal supplements significantly increase serotonin levels. Symptoms may include
hyperreflexia, fever, agitation, and autonomic instability. The other combinations do
not significantly increase serotonin activity.
Question 7
, 2026/2027
A patient suspected of having neuroleptic malignant syndrome (NMS) is likely to
demonstrate which laboratory findings?
A. Elevated WBC count and elevated CPK
B. Decreased platelet count and low sodium
C. Elevated calcium and low potassium
D. Increased hemoglobin and elevated glucose
Correct Answer: A. Elevated WBC count and elevated CPK
Rationale:
NMS is a severe reaction to antipsychotic medications characterized by muscle
rigidity, hyperthermia, and autonomic instability. Muscle breakdown causes elevated
creatine phosphokinase (CPK), while systemic stress may elevate the white blood cell
count. The remaining options are not hallmark findings of NMS.
Question 8
Which assessment finding is most consistent with neuroleptic malignant syndrome?
A. Hyperreflexia and diarrhea
B. Muscle rigidity with hyperthermia
C. Pinpoint pupils and sedation
D. Euphoria with increased appetite
Correct Answer: B. Muscle rigidity with hyperthermia
Rationale:
Classic signs of NMS include severe muscle rigidity, hyperthermia, tachycardia,
diaphoresis, labile blood pressure, altered mental status, and elevated CPK. Option A
is more suggestive of serotonin syndrome. Option C is associated with opioid
intoxication. Option D is unrelated to NMS.
Question 9
A psychiatric patient develops cherry-colored urine while taking antipsychotic
medication. Which complication should the nurse suspect?
A. Hepatic encephalopathy
B. Rhabdomyolysis
C. Hyperglycemia
D. Agranulocytosis
Correct Answer: B. Rhabdomyolysis
Rationale:
Cherry-colored or dark urine may indicate myoglobinuria resulting from
