LMR Georgette PMHNP Board Exam Review (2026/2027) | Board
Review Material with Complete Solutions.
1.
A 34-year-old patient with bipolar I disorder presents with acute mania,
including pressured speech, decreased need for sleep, and aggressive
behavior. The patient has a history of non-adherence to lithium. Which
medication strategy is most appropriate for immediate stabilization?
A. Start sertraline monotherapy
B. Initiate valproate and risperidone combination
C. Restart lithium at full outpatient dose only
D. Begin buspirone and psychotherapy
Correct Answer: B
Explanation:
Acute mania often requires mood stabilizer + antipsychotic combination
for rapid symptom control. Valproate and risperidone are effective for acute
stabilization. Antidepressants worsen mania. Lithium alone may be too slow.
2.
A patient on clozapine presents with fever, chest pain, and elevated troponin.
What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Clozapine-induced myocarditis
C. Serotonin syndrome
D. Panic disorder
Correct Answer: B
1|Page
,Explanation:
Clozapine is strongly associated with myocarditis, especially early in
treatment. Fever + chest pain + troponin elevation is highly suggestive.
3.
Which neurotransmitter is primarily implicated in the positive symptoms of
schizophrenia?
A. Serotonin
B. Dopamine
C. GABA
D. Acetylcholine
Correct Answer: B
Explanation:
Positive symptoms (hallucinations, delusions) are associated with dopamine
excess in the mesolimbic pathway.
4.
A patient on phenelzine develops agitation, hyperreflexia, and diaphoresis
after taking dextromethorphan. What is the mechanism?
A. Dopamine depletion
B. Serotonin excess
C. GABA inhibition
D. Cholinergic blockade
Correct Answer: B
Explanation:
MAOIs + serotonergic agents → serotonin syndrome due to excessive
serotonin activity.
2|Page
,5.
Which finding is most consistent with delirium rather than dementia?
A. Gradual cognitive decline
B. Stable attention span
C. Fluctuating consciousness
D. Preserved orientation in early stages
Correct Answer: C
Explanation:
Delirium is characterized by acute onset and fluctuating consciousness and
attention deficits.
6.
Which medication is first-line for generalized anxiety disorder (GAD)?
A. Alprazolam
B. Fluoxetine
C. Haloperidol
D. Lithium
Correct Answer: B
Explanation:
SSRIs such as fluoxetine are first-line long-term treatment for GAD.
7.
A patient with schizophrenia develops rigidity, hyperthermia, and autonomic
instability after starting haloperidol. What is the first action?
A. Give fluoxetine
B. Discontinue antipsychotic immediately
3|Page
, C. Increase haloperidol dose
D. Start lithium
Correct Answer: B
Explanation:
This is neuroleptic malignant syndrome (NMS) → stop antipsychotic
immediately.
8.
Which symptom is most characteristic of major depressive disorder?
A. Elevated mood with decreased sleep
B. Hallucinations without mood changes
C. Anhedonia and persistent low mood
D. Grandiosity and impulsivity
Correct Answer: C
Explanation:
Core MDD features include depressed mood and anhedonia.
9.
A patient is started on lithium. Which lab must be monitored regularly?
A. Liver function tests only
B. Serum creatinine and TSH
C. Troponin levels
D. Amylase levels
Correct Answer: B
Explanation:
Lithium affects renal and thyroid function, requiring monitoring.
4|Page
Review Material with Complete Solutions.
1.
A 34-year-old patient with bipolar I disorder presents with acute mania,
including pressured speech, decreased need for sleep, and aggressive
behavior. The patient has a history of non-adherence to lithium. Which
medication strategy is most appropriate for immediate stabilization?
A. Start sertraline monotherapy
B. Initiate valproate and risperidone combination
C. Restart lithium at full outpatient dose only
D. Begin buspirone and psychotherapy
Correct Answer: B
Explanation:
Acute mania often requires mood stabilizer + antipsychotic combination
for rapid symptom control. Valproate and risperidone are effective for acute
stabilization. Antidepressants worsen mania. Lithium alone may be too slow.
2.
A patient on clozapine presents with fever, chest pain, and elevated troponin.
What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Clozapine-induced myocarditis
C. Serotonin syndrome
D. Panic disorder
Correct Answer: B
1|Page
,Explanation:
Clozapine is strongly associated with myocarditis, especially early in
treatment. Fever + chest pain + troponin elevation is highly suggestive.
3.
Which neurotransmitter is primarily implicated in the positive symptoms of
schizophrenia?
A. Serotonin
B. Dopamine
C. GABA
D. Acetylcholine
Correct Answer: B
Explanation:
Positive symptoms (hallucinations, delusions) are associated with dopamine
excess in the mesolimbic pathway.
4.
A patient on phenelzine develops agitation, hyperreflexia, and diaphoresis
after taking dextromethorphan. What is the mechanism?
A. Dopamine depletion
B. Serotonin excess
C. GABA inhibition
D. Cholinergic blockade
Correct Answer: B
Explanation:
MAOIs + serotonergic agents → serotonin syndrome due to excessive
serotonin activity.
2|Page
,5.
Which finding is most consistent with delirium rather than dementia?
A. Gradual cognitive decline
B. Stable attention span
C. Fluctuating consciousness
D. Preserved orientation in early stages
Correct Answer: C
Explanation:
Delirium is characterized by acute onset and fluctuating consciousness and
attention deficits.
6.
Which medication is first-line for generalized anxiety disorder (GAD)?
A. Alprazolam
B. Fluoxetine
C. Haloperidol
D. Lithium
Correct Answer: B
Explanation:
SSRIs such as fluoxetine are first-line long-term treatment for GAD.
7.
A patient with schizophrenia develops rigidity, hyperthermia, and autonomic
instability after starting haloperidol. What is the first action?
A. Give fluoxetine
B. Discontinue antipsychotic immediately
3|Page
, C. Increase haloperidol dose
D. Start lithium
Correct Answer: B
Explanation:
This is neuroleptic malignant syndrome (NMS) → stop antipsychotic
immediately.
8.
Which symptom is most characteristic of major depressive disorder?
A. Elevated mood with decreased sleep
B. Hallucinations without mood changes
C. Anhedonia and persistent low mood
D. Grandiosity and impulsivity
Correct Answer: C
Explanation:
Core MDD features include depressed mood and anhedonia.
9.
A patient is started on lithium. Which lab must be monitored regularly?
A. Liver function tests only
B. Serum creatinine and TSH
C. Troponin levels
D. Amylase levels
Correct Answer: B
Explanation:
Lithium affects renal and thyroid function, requiring monitoring.
4|Page
