Page 1 of 115
APEA Psychiatric-Mental Health Nurse Practitioner PMHNP
Real Exam 2026/2027 Practice | 100% Verified Questions
with NGN Integration for Certification | Pass Guaranteed -
A+ Graded
Q1: A 45-year-old client with a history of treatment-resistant depression has been on fluoxetine 60 mg
daily for 8 weeks with minimal improvement. The PMHNP is considering augmentation. Which
medication is most appropriate for augmentation of an SSRI in treatment-resistant depression?
A) Bupropion
B) Trazodone
C) Hydroxyzine
D) Propranolol
Correct Answer: A
Bupropion is a first-line augmentation agent for SSRI partial responders, with a different mechanism
(dopamine/norepinephrine reuptake inhibition) that complements SSRI action. Trazodone is used for
insomnia, hydroxyzine for anxiety, and propranolol for performance anxiety or akathisia.
Q2: A 32-year-old client is brought to the emergency department by police after being found wandering
in traffic, responding to internal stimuli. The client appears disheveled, is unable to provide a coherent
history, and exhibits echolalia. Based on these findings, which diagnosis should the PMHNP suspect?
A) Major depressive disorder with psychotic features
B) Schizophrenia
C) Delirium
D) Bipolar I disorder, manic episode
Correct Answer: B
1
, Page 2 of 115
Echolalia (repeating others' words), disorganized behavior, and responding to internal stimuli
(hallucinations) are hallmark features of schizophrenia, especially with the chronic presentation implied
by the disheveled appearance. The presence of positive symptoms without prominent mood symptoms
points toward a primary psychotic disorder.
Q3: A 28-year-old client with bipolar I disorder is stabilized on lithium 900 mg/day. The client is
currently experiencing a depressive episode. Which medication can be safely added to lithium for acute
bipolar depression without significant risk of inducing mania?
A) Bupropion
B) Fluoxetine
C) Lamotrigine
D) Venlafaxine
Correct Answer: C
Lamotrigine is FDA-approved for maintenance treatment of bipolar I disorder and has demonstrated
efficacy in bipolar depression with a low risk of inducing mania or rapid cycling. Antidepressants like
fluoxetine, bupropion, and venlafaxine carry a risk of mood destabilization in bipolar disorder.
Q4: A 16-year-old client is brought to the clinic by their parents due to declining grades, social
withdrawal, and spending excessive time in their room. The client reports hearing a voice that comments
on their actions and tells them they are "worthless." What is the most appropriate initial intervention?
A) Initiate an SSRI for depression
B) Refer for a comprehensive psychiatric evaluation
C) Recommend family therapy
D) Prescribe an atypical antipsychotic
Correct Answer: B
Auditory hallucinations with commentary and negative content, combined with social withdrawal and
functional decline, warrant a comprehensive psychiatric evaluation to rule out a primary psychotic
2
, Page 3 of 115
disorder. The PMHNP should avoid initiating medication before establishing a diagnosis and ruling out
substance-induced or medical causes.
Q5: A 55-year-old client with generalized anxiety disorder (GAD) has been on buspirone 15 mg twice
daily for 6 weeks. The client reports minimal improvement in anxiety symptoms. What is the most
appropriate next step?
A) Discontinue buspirone and start an SSRI
B) Increase buspirone to 30 mg twice daily
C) Add a benzodiazepine as needed
D) Continue buspirone and reassess in 4 weeks
Correct Answer: B
Buspirone has a delayed onset of action (2-4 weeks) and a therapeutic dose range of 15-60 mg/day in
divided doses. A dose increase to 30 mg twice daily (60 mg/day) is appropriate before considering the
medication a failure. Switching to an SSRI should be considered only after an adequate trial at therapeutic
doses.
Q6: A 62-year-old client with major depressive disorder and comorbid hypertension is started on
sertraline. One week later, the client reports increased anxiety, insomnia, and difficulty concentrating. The
PMHNP recognizes this as:
A) Serotonin syndrome
B) Activation syndrome
C) Akathisia
D) Hypertensive crisis
Correct Answer: B
Activation syndrome (also called jitteriness syndrome) is characterized by increased anxiety, agitation,
insomnia, and restlessness that can occur early in SSRI treatment. It is distinct from serotonin syndrome,
which includes autonomic instability and neuromuscular changes. Akathisia is a movement disorder, and
hypertensive crisis is associated with MAOI use.
3
, Page 4 of 115
Q7: A 38-year-old client with schizophrenia has been stable on risperidone 4 mg daily for 2 years. The
client now reports a 10-pound weight gain, development of galactorrhea, and amenorrhea. Based on these
findings, what is the most appropriate next step?
A) Add metformin
B) Switch to aripiprazole
C) Reduce risperidone to 2 mg daily
D) Add bromocriptine
Correct Answer: B
Galactorrhea and amenorrhea are signs of hyperprolactinemia, a common side effect of risperidone (and
other antipsychotics). Aripiprazole is a partial D2 agonist with a lower risk of hyperprolactinemia and
metabolic side effects. Switching to aripiprazole would address the client's symptoms while maintaining
antipsychotic efficacy.
Q8: A 24-year-old client with borderline personality disorder (BPD) presents with recurrent suicidal
ideation, self-harm behaviors, and intense fear of abandonment. Which evidence-based psychotherapy is
most appropriate?
A) Cognitive-behavioral therapy (CBT)
B) Dialectical behavior therapy (DBT)
C) Psychodynamic therapy
D) Interpersonal therapy (IPT)
Correct Answer: B
DBT is the gold-standard evidence-based psychotherapy for BPD, specifically targeting emotion
dysregulation, self-harm, and interpersonal difficulties. DBT incorporates mindfulness, distress tolerance,
emotion regulation, and interpersonal effectiveness skills.
Q9: A 70-year-old client with Alzheimer's disease is exhibiting increased agitation, wandering, and verbal
aggression in the evening hours. This pattern is most consistent with:
4
APEA Psychiatric-Mental Health Nurse Practitioner PMHNP
Real Exam 2026/2027 Practice | 100% Verified Questions
with NGN Integration for Certification | Pass Guaranteed -
A+ Graded
Q1: A 45-year-old client with a history of treatment-resistant depression has been on fluoxetine 60 mg
daily for 8 weeks with minimal improvement. The PMHNP is considering augmentation. Which
medication is most appropriate for augmentation of an SSRI in treatment-resistant depression?
A) Bupropion
B) Trazodone
C) Hydroxyzine
D) Propranolol
Correct Answer: A
Bupropion is a first-line augmentation agent for SSRI partial responders, with a different mechanism
(dopamine/norepinephrine reuptake inhibition) that complements SSRI action. Trazodone is used for
insomnia, hydroxyzine for anxiety, and propranolol for performance anxiety or akathisia.
Q2: A 32-year-old client is brought to the emergency department by police after being found wandering
in traffic, responding to internal stimuli. The client appears disheveled, is unable to provide a coherent
history, and exhibits echolalia. Based on these findings, which diagnosis should the PMHNP suspect?
A) Major depressive disorder with psychotic features
B) Schizophrenia
C) Delirium
D) Bipolar I disorder, manic episode
Correct Answer: B
1
, Page 2 of 115
Echolalia (repeating others' words), disorganized behavior, and responding to internal stimuli
(hallucinations) are hallmark features of schizophrenia, especially with the chronic presentation implied
by the disheveled appearance. The presence of positive symptoms without prominent mood symptoms
points toward a primary psychotic disorder.
Q3: A 28-year-old client with bipolar I disorder is stabilized on lithium 900 mg/day. The client is
currently experiencing a depressive episode. Which medication can be safely added to lithium for acute
bipolar depression without significant risk of inducing mania?
A) Bupropion
B) Fluoxetine
C) Lamotrigine
D) Venlafaxine
Correct Answer: C
Lamotrigine is FDA-approved for maintenance treatment of bipolar I disorder and has demonstrated
efficacy in bipolar depression with a low risk of inducing mania or rapid cycling. Antidepressants like
fluoxetine, bupropion, and venlafaxine carry a risk of mood destabilization in bipolar disorder.
Q4: A 16-year-old client is brought to the clinic by their parents due to declining grades, social
withdrawal, and spending excessive time in their room. The client reports hearing a voice that comments
on their actions and tells them they are "worthless." What is the most appropriate initial intervention?
A) Initiate an SSRI for depression
B) Refer for a comprehensive psychiatric evaluation
C) Recommend family therapy
D) Prescribe an atypical antipsychotic
Correct Answer: B
Auditory hallucinations with commentary and negative content, combined with social withdrawal and
functional decline, warrant a comprehensive psychiatric evaluation to rule out a primary psychotic
2
, Page 3 of 115
disorder. The PMHNP should avoid initiating medication before establishing a diagnosis and ruling out
substance-induced or medical causes.
Q5: A 55-year-old client with generalized anxiety disorder (GAD) has been on buspirone 15 mg twice
daily for 6 weeks. The client reports minimal improvement in anxiety symptoms. What is the most
appropriate next step?
A) Discontinue buspirone and start an SSRI
B) Increase buspirone to 30 mg twice daily
C) Add a benzodiazepine as needed
D) Continue buspirone and reassess in 4 weeks
Correct Answer: B
Buspirone has a delayed onset of action (2-4 weeks) and a therapeutic dose range of 15-60 mg/day in
divided doses. A dose increase to 30 mg twice daily (60 mg/day) is appropriate before considering the
medication a failure. Switching to an SSRI should be considered only after an adequate trial at therapeutic
doses.
Q6: A 62-year-old client with major depressive disorder and comorbid hypertension is started on
sertraline. One week later, the client reports increased anxiety, insomnia, and difficulty concentrating. The
PMHNP recognizes this as:
A) Serotonin syndrome
B) Activation syndrome
C) Akathisia
D) Hypertensive crisis
Correct Answer: B
Activation syndrome (also called jitteriness syndrome) is characterized by increased anxiety, agitation,
insomnia, and restlessness that can occur early in SSRI treatment. It is distinct from serotonin syndrome,
which includes autonomic instability and neuromuscular changes. Akathisia is a movement disorder, and
hypertensive crisis is associated with MAOI use.
3
, Page 4 of 115
Q7: A 38-year-old client with schizophrenia has been stable on risperidone 4 mg daily for 2 years. The
client now reports a 10-pound weight gain, development of galactorrhea, and amenorrhea. Based on these
findings, what is the most appropriate next step?
A) Add metformin
B) Switch to aripiprazole
C) Reduce risperidone to 2 mg daily
D) Add bromocriptine
Correct Answer: B
Galactorrhea and amenorrhea are signs of hyperprolactinemia, a common side effect of risperidone (and
other antipsychotics). Aripiprazole is a partial D2 agonist with a lower risk of hyperprolactinemia and
metabolic side effects. Switching to aripiprazole would address the client's symptoms while maintaining
antipsychotic efficacy.
Q8: A 24-year-old client with borderline personality disorder (BPD) presents with recurrent suicidal
ideation, self-harm behaviors, and intense fear of abandonment. Which evidence-based psychotherapy is
most appropriate?
A) Cognitive-behavioral therapy (CBT)
B) Dialectical behavior therapy (DBT)
C) Psychodynamic therapy
D) Interpersonal therapy (IPT)
Correct Answer: B
DBT is the gold-standard evidence-based psychotherapy for BPD, specifically targeting emotion
dysregulation, self-harm, and interpersonal difficulties. DBT incorporates mindfulness, distress tolerance,
emotion regulation, and interpersonal effectiveness skills.
Q9: A 70-year-old client with Alzheimer's disease is exhibiting increased agitation, wandering, and verbal
aggression in the evening hours. This pattern is most consistent with:
4
