APEA PMHNP Practice Exam Questions with correct answers and rationales
2026/2027 version
1. A patient with major depressive disorder reports depressed mood,
anhedonia, fatigue, and poor concentration for 3 weeks. Which
neurotransmitter is most closely associated with mood regulation and is
commonly targeted by antidepressants?
A. Acetylcholine
B. Serotonin
C. Glutamate only
D. Histamine
Correct Answer: B
Rationale: Serotonin plays an important role in mood regulation and is a major
target of SSRIs.
2. Which symptom is most characteristic of mania?
A. Hypersomnia and psychomotor slowing
B. Decreased need for sleep with increased energy
C. Social withdrawal and anhedonia
D. Persistent fear of specific objects
Correct Answer: B
Rationale: Mania commonly includes elevated or irritable mood, increased
energy, decreased need for sleep, pressured speech, and increased goal-directed
activity.
3. A patient taking an SSRI develops agitation, diaphoresis, hyperreflexia,
clonus, and fever. Which condition should the PMHNP suspect?
,A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Lithium toxicity
Correct Answer: B
Rationale: Serotonin syndrome is associated with excessive serotonergic activity
and commonly presents with autonomic instability and neuromuscular
hyperactivity.
4. Which medication is considered a first-line pharmacologic treatment for
generalized anxiety disorder?
A. SSRI
B. Haloperidol
C. Carbamazepine
D. Benztropine
Correct Answer: A
Rationale: SSRIs and SNRIs are commonly used as first-line treatments for
generalized anxiety disorder.
5. A patient taking lithium reports severe diarrhea, coarse tremor, confusion,
and unsteady gait. What is the priority action?
A. Administer the next lithium dose.
B. Hold lithium and obtain an urgent evaluation.
C. Encourage strenuous exercise.
D. Increase the patient's caffeine intake.
Correct Answer: B
Rationale: These findings suggest possible lithium toxicity, which requires
immediate evaluation.
,6. Which laboratory test is especially important for a patient receiving lithium
therapy?
A. Serum lithium level and renal function
B. Troponin only
C. Amylase only
D. Hemoglobin A1C only
Correct Answer: A
Rationale: Lithium is renally cleared, so serum levels and renal function must be
monitored.
7. A patient taking clozapine develops fever and a sore throat. What should
the PMHNP do?
A. Reassure the patient that this is expected.
B. Obtain an urgent CBC with ANC.
C. Increase the clozapine dose.
D. Recommend increased exercise.
Correct Answer: B
Rationale: Clozapine can cause severe neutropenia; infection symptoms require
urgent assessment of the absolute neutrophil count.
8. Which medication is commonly used to treat acute dystonia caused by
antipsychotic medication?
A. Benztropine
B. Fluoxetine
C. Lithium
D. Lamotrigine
Correct Answer: A
, Rationale: Anticholinergic medications such as benztropine are commonly used
for acute dystonic reactions.
9. A patient taking an antipsychotic develops fever, severe muscle rigidity,
altered mental status, and autonomic instability. Which condition is most
likely?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Akathisia
Correct Answer: B
Rationale: NMS is a potentially fatal reaction associated with dopamine blockade
and is characterized by severe rigidity, fever, altered mental status, and autonomic
instability.
10. Which medication is commonly used for treatment-resistant schizophrenia
and is associated with agranulocytosis risk?
A. Clozapine
B. Buspirone
C. Sertraline
D. Hydroxyzine
Correct Answer: A
Rationale: Clozapine is effective for treatment-resistant schizophrenia but requires
ANC monitoring.
11. A patient reports hearing voices that others cannot hear. This is classified
as:
2026/2027 version
1. A patient with major depressive disorder reports depressed mood,
anhedonia, fatigue, and poor concentration for 3 weeks. Which
neurotransmitter is most closely associated with mood regulation and is
commonly targeted by antidepressants?
A. Acetylcholine
B. Serotonin
C. Glutamate only
D. Histamine
Correct Answer: B
Rationale: Serotonin plays an important role in mood regulation and is a major
target of SSRIs.
2. Which symptom is most characteristic of mania?
A. Hypersomnia and psychomotor slowing
B. Decreased need for sleep with increased energy
C. Social withdrawal and anhedonia
D. Persistent fear of specific objects
Correct Answer: B
Rationale: Mania commonly includes elevated or irritable mood, increased
energy, decreased need for sleep, pressured speech, and increased goal-directed
activity.
3. A patient taking an SSRI develops agitation, diaphoresis, hyperreflexia,
clonus, and fever. Which condition should the PMHNP suspect?
,A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Lithium toxicity
Correct Answer: B
Rationale: Serotonin syndrome is associated with excessive serotonergic activity
and commonly presents with autonomic instability and neuromuscular
hyperactivity.
4. Which medication is considered a first-line pharmacologic treatment for
generalized anxiety disorder?
A. SSRI
B. Haloperidol
C. Carbamazepine
D. Benztropine
Correct Answer: A
Rationale: SSRIs and SNRIs are commonly used as first-line treatments for
generalized anxiety disorder.
5. A patient taking lithium reports severe diarrhea, coarse tremor, confusion,
and unsteady gait. What is the priority action?
A. Administer the next lithium dose.
B. Hold lithium and obtain an urgent evaluation.
C. Encourage strenuous exercise.
D. Increase the patient's caffeine intake.
Correct Answer: B
Rationale: These findings suggest possible lithium toxicity, which requires
immediate evaluation.
,6. Which laboratory test is especially important for a patient receiving lithium
therapy?
A. Serum lithium level and renal function
B. Troponin only
C. Amylase only
D. Hemoglobin A1C only
Correct Answer: A
Rationale: Lithium is renally cleared, so serum levels and renal function must be
monitored.
7. A patient taking clozapine develops fever and a sore throat. What should
the PMHNP do?
A. Reassure the patient that this is expected.
B. Obtain an urgent CBC with ANC.
C. Increase the clozapine dose.
D. Recommend increased exercise.
Correct Answer: B
Rationale: Clozapine can cause severe neutropenia; infection symptoms require
urgent assessment of the absolute neutrophil count.
8. Which medication is commonly used to treat acute dystonia caused by
antipsychotic medication?
A. Benztropine
B. Fluoxetine
C. Lithium
D. Lamotrigine
Correct Answer: A
, Rationale: Anticholinergic medications such as benztropine are commonly used
for acute dystonic reactions.
9. A patient taking an antipsychotic develops fever, severe muscle rigidity,
altered mental status, and autonomic instability. Which condition is most
likely?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Akathisia
Correct Answer: B
Rationale: NMS is a potentially fatal reaction associated with dopamine blockade
and is characterized by severe rigidity, fever, altered mental status, and autonomic
instability.
10. Which medication is commonly used for treatment-resistant schizophrenia
and is associated with agranulocytosis risk?
A. Clozapine
B. Buspirone
C. Sertraline
D. Hydroxyzine
Correct Answer: A
Rationale: Clozapine is effective for treatment-resistant schizophrenia but requires
ANC monitoring.
11. A patient reports hearing voices that others cannot hear. This is classified
as:
