**Psychiatric-Mental Health Nurse
Practitioner (PMHNP) Certification Exam:
Advanced Psychopharmacology & Therapy**
1. Pt w/ bipolar I disorder, manic episode, not sleeping, aggressive, psychotic. First-line medication?
💫RATIONALE✔️✔️: Acute mania with psychosis: atypical antipsychotic (risperidone, olanzapine) plus
lithium or valproate.
💫ANSWER✔️✔️: C. Risperidone and lithium.
2. Pt w/ major depression, failed 3 antidepressants (SSRI, SNRI, bupropion). Next treatment?
💫RATIONALE✔️✔️: Treatment-resistant depression: augment with aripiprazole or switch to MAOI,
ketamine, or ECT.
💫ANSWER✔️✔️: D. Augment with aripiprazole.
3. Pt w/ generalized anxiety disorder, on escitalopram 20 mg x 12 weeks, GAD-7 12 (partial response).
Next?
💫RATIONALE✔️✔️: Augment with buspirone 15 mg BID or gabapentin, or switch to duloxetine.
💫ANSWER✔️✔️: B. Add buspirone.
4. Pt w/ PTSD, nightmares, hypervigilance, sleep disruption. Which medication reduces nightmares?
💫RATIONALE✔️✔️: Prazosin (alpha-1 blocker) 1-15 mg at bedtime significantly reduces trauma
nightmares.
💫ANSWER✔️✔️: A. Prazosin.
5. Pt w/ obsessive-compulsive disorder, Y-BOCS 28, on fluvoxamine 300 mg x 12 weeks, minimal
improvement. Next?
💫RATIONALE✔️✔️: Augment with risperidone or aripiprazole, or switch to clomipramine. ERP therapy
critical.
, 💫ANSWER✔️✔️: C. Add risperidone.
6. Pt w/ borderline personality disorder, self-harm, emotional dysregulation, impulsivity. First-line
psychotherapy?
💫RATIONALE✔️✔️: Dialectical behavior therapy (DBT) specifically for BPD (skills training, individual
therapy).
💫ANSWER✔️✔️: D. DBT.
7. Pt w/ schizophrenia, stable on paliperidone palmitate IM. Reports amenorrhea and galactorrhea.
Prolactin 120. Next?
💫RATIONALE✔️✔️: Hyperprolactinemia from D2 blockade. Switch to aripiprazole (partial agonist, lowers
prolactin).
💫ANSWER✔️✔️: A. Switch to aripiprazole.
8. Pt w/ panic disorder, agoraphobia, unable to leave home. First-line treatment?
💫RATIONALE✔️✔️: SSRI (sertraline) + CBT with exposure therapy. Benzodiazepines second-line only.
💫ANSWER✔️✔️: B. Sertraline and CBT.
9. Pt w/ alcohol use disorder, drinking 12 drinks/day, last drink 8 hr ago, CIWA-Ar 15. Which medication
for withdrawal?
💫RATIONALE✔️✔️: Symptom-triggered IV lorazepam or chlordiazepoxide. Also thiamine 100 mg IV/IM.
💫ANSWER✔️✔️: D. Lorazepam.
10. Pt w/ bipolar II depression, currently depressed, no hypomania. Which mood stabilizer first-line?
💫RATIONALE✔️✔️: Bipolar depression: quetiapine, lurasidone, or lamotrigine. Avoid antidepressants
(switch risk).
💫ANSWER✔️✔️: C. Quetiapine.
11. Pt w/ schizophrenia, clozapine 400 mg daily, ANC 1100. Action?
Practitioner (PMHNP) Certification Exam:
Advanced Psychopharmacology & Therapy**
1. Pt w/ bipolar I disorder, manic episode, not sleeping, aggressive, psychotic. First-line medication?
💫RATIONALE✔️✔️: Acute mania with psychosis: atypical antipsychotic (risperidone, olanzapine) plus
lithium or valproate.
💫ANSWER✔️✔️: C. Risperidone and lithium.
2. Pt w/ major depression, failed 3 antidepressants (SSRI, SNRI, bupropion). Next treatment?
💫RATIONALE✔️✔️: Treatment-resistant depression: augment with aripiprazole or switch to MAOI,
ketamine, or ECT.
💫ANSWER✔️✔️: D. Augment with aripiprazole.
3. Pt w/ generalized anxiety disorder, on escitalopram 20 mg x 12 weeks, GAD-7 12 (partial response).
Next?
💫RATIONALE✔️✔️: Augment with buspirone 15 mg BID or gabapentin, or switch to duloxetine.
💫ANSWER✔️✔️: B. Add buspirone.
4. Pt w/ PTSD, nightmares, hypervigilance, sleep disruption. Which medication reduces nightmares?
💫RATIONALE✔️✔️: Prazosin (alpha-1 blocker) 1-15 mg at bedtime significantly reduces trauma
nightmares.
💫ANSWER✔️✔️: A. Prazosin.
5. Pt w/ obsessive-compulsive disorder, Y-BOCS 28, on fluvoxamine 300 mg x 12 weeks, minimal
improvement. Next?
💫RATIONALE✔️✔️: Augment with risperidone or aripiprazole, or switch to clomipramine. ERP therapy
critical.
, 💫ANSWER✔️✔️: C. Add risperidone.
6. Pt w/ borderline personality disorder, self-harm, emotional dysregulation, impulsivity. First-line
psychotherapy?
💫RATIONALE✔️✔️: Dialectical behavior therapy (DBT) specifically for BPD (skills training, individual
therapy).
💫ANSWER✔️✔️: D. DBT.
7. Pt w/ schizophrenia, stable on paliperidone palmitate IM. Reports amenorrhea and galactorrhea.
Prolactin 120. Next?
💫RATIONALE✔️✔️: Hyperprolactinemia from D2 blockade. Switch to aripiprazole (partial agonist, lowers
prolactin).
💫ANSWER✔️✔️: A. Switch to aripiprazole.
8. Pt w/ panic disorder, agoraphobia, unable to leave home. First-line treatment?
💫RATIONALE✔️✔️: SSRI (sertraline) + CBT with exposure therapy. Benzodiazepines second-line only.
💫ANSWER✔️✔️: B. Sertraline and CBT.
9. Pt w/ alcohol use disorder, drinking 12 drinks/day, last drink 8 hr ago, CIWA-Ar 15. Which medication
for withdrawal?
💫RATIONALE✔️✔️: Symptom-triggered IV lorazepam or chlordiazepoxide. Also thiamine 100 mg IV/IM.
💫ANSWER✔️✔️: D. Lorazepam.
10. Pt w/ bipolar II depression, currently depressed, no hypomania. Which mood stabilizer first-line?
💫RATIONALE✔️✔️: Bipolar depression: quetiapine, lurasidone, or lamotrigine. Avoid antidepressants
(switch risk).
💫ANSWER✔️✔️: C. Quetiapine.
11. Pt w/ schizophrenia, clozapine 400 mg daily, ANC 1100. Action?
