GEORGETTE'S LMR PMHNP CERTIFICATION EXAM
NEWEST 2026/ 2027 PACKAGE DEAL| 2 VERSIONS
(EXAM 1 & 2)WITH COMPLETE 1,350 ACTUAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) GRADED A | GEORGETTE'S LMR
PMHNP CERTIFICATION EXAM PREP (BRAND NE
1. A 32-year-old patient with major depressive disorder has
been taking fluoxetine 20 mg daily for 6 weeks with minimal
improvement. The patient reports no side effects. What is the
most appropriate next step?
A. Increase fluoxetine to 40 mg daily
B. Add aripiprazole 2 mg daily
C. Switch to venlafaxine XR 75 mg daily
D. Continue current dose and reassess in 4 weeks
1
,Answer: A
Rationale: Fluoxetine can be increased to 40 mg after 4–6
weeks if response is inadequate. Augmentation (aripiprazole) is
considered after adequate trials of first-line agents.
2. A patient with bipolar I disorder is maintained on lithium
900 mg daily. The patient presents with coarse tremor, ataxia,
and nausea. The lithium level is 1.8 mEq/L. What is the
priority intervention?
A. Increase lithium to 1200 mg daily
B. Hold lithium and assess for signs of toxicity
C. Add propranolol for tremor
D. Administer activated charcoal
Answer: B
Rationale: Lithium toxicity occurs at levels >1.5 mEq/L with
2
,symptoms (ataxia, coarse tremor, nausea). Lithium should be held,
and medical evaluation is needed.
3. A 28-year-old patient presents with recurrent episodes of
palpitations, diaphoresis, trembling, and a fear of dying.
Episodes peak within 10 minutes and occur unexpectedly.
What is the most likely diagnosis?
A. Generalized anxiety disorder
B. Panic disorder
C. Social anxiety disorder
D. Posttraumatic stress disorder
Answer: B
Rationale: Panic disorder is characterized by recurrent,
unexpected panic attacks followed by at least one month of
concern about additional attacks or maladaptive behavior
changes.
3
, 4. A patient with schizophrenia has been taking clozapine for
6 months. Which laboratory finding requires immediate
discontinuation of clozapine?
A. WBC 2,500/mm³ (absolute neutrophil count <500/mm³)
B. Hemoglobin 12 g/dL
C. Platelet count 150,000/mm³
D. Glucose 110 mg/dL
Answer: A
Rationale: Clozapine can cause agranulocytosis. Absolute
neutrophil count (ANC) <500/mm³ or WBC <3,000/mm³
requires immediate discontinuation per REMS protocol.
5. A 45-year-old patient with alcohol use disorder reports
craving, insomnia, and anxiety 24 hours after the last drink.
What is the most appropriate pharmacologic intervention to
4
NEWEST 2026/ 2027 PACKAGE DEAL| 2 VERSIONS
(EXAM 1 & 2)WITH COMPLETE 1,350 ACTUAL EXAM
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) GRADED A | GEORGETTE'S LMR
PMHNP CERTIFICATION EXAM PREP (BRAND NE
1. A 32-year-old patient with major depressive disorder has
been taking fluoxetine 20 mg daily for 6 weeks with minimal
improvement. The patient reports no side effects. What is the
most appropriate next step?
A. Increase fluoxetine to 40 mg daily
B. Add aripiprazole 2 mg daily
C. Switch to venlafaxine XR 75 mg daily
D. Continue current dose and reassess in 4 weeks
1
,Answer: A
Rationale: Fluoxetine can be increased to 40 mg after 4–6
weeks if response is inadequate. Augmentation (aripiprazole) is
considered after adequate trials of first-line agents.
2. A patient with bipolar I disorder is maintained on lithium
900 mg daily. The patient presents with coarse tremor, ataxia,
and nausea. The lithium level is 1.8 mEq/L. What is the
priority intervention?
A. Increase lithium to 1200 mg daily
B. Hold lithium and assess for signs of toxicity
C. Add propranolol for tremor
D. Administer activated charcoal
Answer: B
Rationale: Lithium toxicity occurs at levels >1.5 mEq/L with
2
,symptoms (ataxia, coarse tremor, nausea). Lithium should be held,
and medical evaluation is needed.
3. A 28-year-old patient presents with recurrent episodes of
palpitations, diaphoresis, trembling, and a fear of dying.
Episodes peak within 10 minutes and occur unexpectedly.
What is the most likely diagnosis?
A. Generalized anxiety disorder
B. Panic disorder
C. Social anxiety disorder
D. Posttraumatic stress disorder
Answer: B
Rationale: Panic disorder is characterized by recurrent,
unexpected panic attacks followed by at least one month of
concern about additional attacks or maladaptive behavior
changes.
3
, 4. A patient with schizophrenia has been taking clozapine for
6 months. Which laboratory finding requires immediate
discontinuation of clozapine?
A. WBC 2,500/mm³ (absolute neutrophil count <500/mm³)
B. Hemoglobin 12 g/dL
C. Platelet count 150,000/mm³
D. Glucose 110 mg/dL
Answer: A
Rationale: Clozapine can cause agranulocytosis. Absolute
neutrophil count (ANC) <500/mm³ or WBC <3,000/mm³
requires immediate discontinuation per REMS protocol.
5. A 45-year-old patient with alcohol use disorder reports
craving, insomnia, and anxiety 24 hours after the last drink.
What is the most appropriate pharmacologic intervention to
4
