LMR Georgette PMHNP Board Exam Review (2026/2027) PDF |
High-Yield Board Prep - 182 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Psychiatric Mental Health Nurse Practitioner
Description This exam assesses advanced knowledge in psychopharmacology, psychotherapy,
neurobiology, and clinical management across the lifespan for PMHNP board
preparation. Questions integrate current practice guidelines, ethical
considerations, and evidence-based interventions.
Expected Grade A+
Total Questions 182
Duration 3 hours
Learning Outcomes 1. Differentiate first-line pharmacotherapy for major psychiatric disorders per
latest guidelines.
2. Apply principles of psychotherapy integration to complex clinical scenarios.
3. Analyze neurobiological underpinnings of psychiatric conditions to inform
treatment.
4. Evaluate metabolic and other adverse effects of psychotropic medications.
5. Navigate legal and ethical issues in psychiatric practice.
Accreditation This exam aligns with the content outline for the ANCC Psychiatric-Mental
Health Nurse Practitioner (PMHNP-BC) certification exam.
Page 1
,1. A patient with major depressive disorder has failed two adequate trials of
SSRIs. Pharmacogenomic testing reveals a CYP2C19 poor metabolizer
phenotype. Which antidepressant selection is most appropriate based on this
result?
A. Escitalopram 10 mg daily, monitoring for increased side effects
B. Citalopram 40 mg daily, with dose reduction due to prolonged half-life
C. Sertraline 100 mg daily, as it is primarily metabolized by CYP3A4
D. Venlafaxine XR 75 mg daily, avoiding CYP2C19 metabolism
Answer: C. Sertraline 100 mg daily, as it is primarily metabolized by
CYP3A4
Sertraline is not significantly metabolized by CYP2C19; it uses CYP2B6 and
3A4. Escitalopram and citalopram are both metabolized by CYP2C19; in poor
metabolizers, they accumulate, increasing QTc risk (citalopram) or side effects.
Venlafaxine is metabolized by CYP2D6, not relevant. Therefore, sertraline is a
safe choice.
2. In a patient with chronic, treatment-resistant PTSD, which psychotherapy
integration strategy is supported by recent evidence for augmenting
trauma-focused therapy?
A. Adding dialectical behavior therapy (DBT) skills training to prolonged exposure
(PE)
B. Replacing PE with eye movement desensitization and reprocessing (EMDR)
C. Substituting trauma-focused cognitive behavioral therapy (TF-CBT) with
supportive counseling
D. Integrating cognitive processing therapy (CPT) with acceptance and commitment
therapy (ACT)
Answer: A. Adding dialectical behavior therapy (DBT) skills training to
prolonged exposure (PE)
DBT skills (emotion regulation, distress tolerance) help patients manage intense
emotions during PE, reducing dropout and improving outcomes. While CPT and
ACT have some evidence, directly adding DBT skills to PE is supported by recent
trials. Replacing or substituting trauma-focused therapy is not recommended.
Page 2
,3. Neurobiological studies indicate that dysfunction in the default mode
network (DMN) is implicated in which of the following clinical presentations?
A. Heightened amygdala reactivity in panic disorder
B. Rumination and self-referential processing in major depressive disorder
C. Impaired extinction recall in posttraumatic stress disorder
D. Prefrontal hypoactivity in attention-deficit/hyperactivity disorder
Answer: B. Rumination and self-referential processing in major depressive
disorder
The DMN is active during self-referential thought and rumination, which are
core to depression. The amygdala is part of the salience network, not DMN.
PTSD extinction recall involves ventromedial prefrontal cortex and
hippocampus. ADHD involves frontoparietal and default mode network
interactions, but the key dysfunction is in task-positive networks.
4. A patient with schizophrenia on olanzapine 20 mg/day develops a weight
gain of 12 kg over 6 months and new-onset type 2 diabetes. According to
ADA/APA consensus guidelines, which metabolic monitoring schedule is most
appropriate?
A. BMI, waist circumference, fasting glucose, and lipids at baseline and every 12
weeks
B. Fasting glucose and lipids at baseline, then annually if normal
C. Hemoglobin A1c monthly for 3 months, then every 6 months
D. Oral glucose tolerance test at baseline and every 6 months
Answer: A. BMI, waist circumference, fasting glucose, and lipids at baseline
and every 12 weeks
ADA/APA guidelines recommend monitoring weight/BMI, waist circumference,
fasting glucose, and lipids at baseline and every 12 weeks for patients on
olanzapine due to high metabolic risk. Annual monitoring is insufficient for this
high-risk drug. Hemoglobin A1c is not as sensitive; OGTT is not routine.
Page 3
, 5. A psychiatric nurse practitioner is subpoenaed to provide records of a
patient with whom they have a dual relationship (the patient is also a
neighbor). The state law requires mandatory reporting of child abuse. The
patient discloses during a session that they spanked their child hard enough to
leave bruises. Which action is legally and ethically most appropriate?
A. Maintain confidentiality because the patient is a neighbor and reporting could harm
the relationship
B. Report to child protective services as mandated by law, despite the dual
relationship
C. Discuss with the patient the limits of confidentiality and offer to make the report
together
D. Consult with a colleague and decide based on the severity of the bruises
Answer: C. Discuss with the patient the limits of confidentiality and offer to
make the report together
Mandatory reporting laws require reporting suspected child abuse. It is ethical to
first discuss with the patient the limits of confidentiality and offer to make the
report collaboratively. While the dual relationship is problematic, it does not
excuse reporting. Option D undermines legal duty. Option A violates the law.
6. In the treatment of a child with moderate-to-severe separation anxiety
disorder who has not responded to 8 sessions of child-centered play therapy,
which intervention is most supported by evidence?
A. Cognitive behavioral therapy (CBT) with exposure and parent training
B. Selective serotonin reuptake inhibitor (SSRI) monotherapy
C. Intensive group therapy with social skills training
D. Psychodynamic psychotherapy focusing on attachment issues
Answer: A. Cognitive behavioral therapy (CBT) with exposure and parent
training
CBT with exposure is first-line for childhood anxiety disorders. Play therapy
lacks strong evidence for separation anxiety. SSRI monotherapy is second-line
and usually combined with CBT. Group therapy and psychodynamic approaches
have less support for this disorder in children.
Page 4
High-Yield Board Prep - 182 Questions and Answers Already
Graded A+ Premium Exam Tested And Verified
Subject Area Psychiatric Mental Health Nurse Practitioner
Description This exam assesses advanced knowledge in psychopharmacology, psychotherapy,
neurobiology, and clinical management across the lifespan for PMHNP board
preparation. Questions integrate current practice guidelines, ethical
considerations, and evidence-based interventions.
Expected Grade A+
Total Questions 182
Duration 3 hours
Learning Outcomes 1. Differentiate first-line pharmacotherapy for major psychiatric disorders per
latest guidelines.
2. Apply principles of psychotherapy integration to complex clinical scenarios.
3. Analyze neurobiological underpinnings of psychiatric conditions to inform
treatment.
4. Evaluate metabolic and other adverse effects of psychotropic medications.
5. Navigate legal and ethical issues in psychiatric practice.
Accreditation This exam aligns with the content outline for the ANCC Psychiatric-Mental
Health Nurse Practitioner (PMHNP-BC) certification exam.
Page 1
,1. A patient with major depressive disorder has failed two adequate trials of
SSRIs. Pharmacogenomic testing reveals a CYP2C19 poor metabolizer
phenotype. Which antidepressant selection is most appropriate based on this
result?
A. Escitalopram 10 mg daily, monitoring for increased side effects
B. Citalopram 40 mg daily, with dose reduction due to prolonged half-life
C. Sertraline 100 mg daily, as it is primarily metabolized by CYP3A4
D. Venlafaxine XR 75 mg daily, avoiding CYP2C19 metabolism
Answer: C. Sertraline 100 mg daily, as it is primarily metabolized by
CYP3A4
Sertraline is not significantly metabolized by CYP2C19; it uses CYP2B6 and
3A4. Escitalopram and citalopram are both metabolized by CYP2C19; in poor
metabolizers, they accumulate, increasing QTc risk (citalopram) or side effects.
Venlafaxine is metabolized by CYP2D6, not relevant. Therefore, sertraline is a
safe choice.
2. In a patient with chronic, treatment-resistant PTSD, which psychotherapy
integration strategy is supported by recent evidence for augmenting
trauma-focused therapy?
A. Adding dialectical behavior therapy (DBT) skills training to prolonged exposure
(PE)
B. Replacing PE with eye movement desensitization and reprocessing (EMDR)
C. Substituting trauma-focused cognitive behavioral therapy (TF-CBT) with
supportive counseling
D. Integrating cognitive processing therapy (CPT) with acceptance and commitment
therapy (ACT)
Answer: A. Adding dialectical behavior therapy (DBT) skills training to
prolonged exposure (PE)
DBT skills (emotion regulation, distress tolerance) help patients manage intense
emotions during PE, reducing dropout and improving outcomes. While CPT and
ACT have some evidence, directly adding DBT skills to PE is supported by recent
trials. Replacing or substituting trauma-focused therapy is not recommended.
Page 2
,3. Neurobiological studies indicate that dysfunction in the default mode
network (DMN) is implicated in which of the following clinical presentations?
A. Heightened amygdala reactivity in panic disorder
B. Rumination and self-referential processing in major depressive disorder
C. Impaired extinction recall in posttraumatic stress disorder
D. Prefrontal hypoactivity in attention-deficit/hyperactivity disorder
Answer: B. Rumination and self-referential processing in major depressive
disorder
The DMN is active during self-referential thought and rumination, which are
core to depression. The amygdala is part of the salience network, not DMN.
PTSD extinction recall involves ventromedial prefrontal cortex and
hippocampus. ADHD involves frontoparietal and default mode network
interactions, but the key dysfunction is in task-positive networks.
4. A patient with schizophrenia on olanzapine 20 mg/day develops a weight
gain of 12 kg over 6 months and new-onset type 2 diabetes. According to
ADA/APA consensus guidelines, which metabolic monitoring schedule is most
appropriate?
A. BMI, waist circumference, fasting glucose, and lipids at baseline and every 12
weeks
B. Fasting glucose and lipids at baseline, then annually if normal
C. Hemoglobin A1c monthly for 3 months, then every 6 months
D. Oral glucose tolerance test at baseline and every 6 months
Answer: A. BMI, waist circumference, fasting glucose, and lipids at baseline
and every 12 weeks
ADA/APA guidelines recommend monitoring weight/BMI, waist circumference,
fasting glucose, and lipids at baseline and every 12 weeks for patients on
olanzapine due to high metabolic risk. Annual monitoring is insufficient for this
high-risk drug. Hemoglobin A1c is not as sensitive; OGTT is not routine.
Page 3
, 5. A psychiatric nurse practitioner is subpoenaed to provide records of a
patient with whom they have a dual relationship (the patient is also a
neighbor). The state law requires mandatory reporting of child abuse. The
patient discloses during a session that they spanked their child hard enough to
leave bruises. Which action is legally and ethically most appropriate?
A. Maintain confidentiality because the patient is a neighbor and reporting could harm
the relationship
B. Report to child protective services as mandated by law, despite the dual
relationship
C. Discuss with the patient the limits of confidentiality and offer to make the report
together
D. Consult with a colleague and decide based on the severity of the bruises
Answer: C. Discuss with the patient the limits of confidentiality and offer to
make the report together
Mandatory reporting laws require reporting suspected child abuse. It is ethical to
first discuss with the patient the limits of confidentiality and offer to make the
report collaboratively. While the dual relationship is problematic, it does not
excuse reporting. Option D undermines legal duty. Option A violates the law.
6. In the treatment of a child with moderate-to-severe separation anxiety
disorder who has not responded to 8 sessions of child-centered play therapy,
which intervention is most supported by evidence?
A. Cognitive behavioral therapy (CBT) with exposure and parent training
B. Selective serotonin reuptake inhibitor (SSRI) monotherapy
C. Intensive group therapy with social skills training
D. Psychodynamic psychotherapy focusing on attachment issues
Answer: A. Cognitive behavioral therapy (CBT) with exposure and parent
training
CBT with exposure is first-line for childhood anxiety disorders. Play therapy
lacks strong evidence for separation anxiety. SSRI monotherapy is second-line
and usually combined with CBT. Group therapy and psychodynamic approaches
have less support for this disorder in children.
Page 4
