Psychiatric Mental Health Nurse
Practitioner (PMHNP) Certification
Practice Examination Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
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1. A 28-year-old patient with a history of bipolar I disorder presents with acute
mania characterized by grandiosity, decreased need for sleep, pressured
speech, and psychomotor agitation. The patient has been nonadherent to
lithium for three weeks. Current lithium level is 0.2 mEq/L, serum creatinine
is 1.1 mg/dL, and thyroid-stimulating hormone (TSH) is 2.1 mIU/L. Which
intervention is the priority?
A. Restart lithium at the previous maintenance dose and titrate rapidly
B. Administer an intramuscular first-generation antipsychotic and obtain an
electrocardiogram
C. Initiate valproate with a loading dose while restarting lithium
D. Prescribe a high-potency benzodiazepine alone to reduce agitation
Answer: B. Administer an intramuscular first-generation antipsychotic and
obtain an electrocardiogram
Rationale: In acute manic episodes with severe agitation, rapid
tranquillization is essential for safety. Intramuscular haloperidol or another
high-potency first-generation antipsychotic provides immediate behavioral
control. An ECG is warranted because antipsychotics can prolong the QTc
interval, and acute mania may mask underlying cardiac risk. While lithium
and valproate are foundational mood stabilizers, they do not act quickly
enough for acute behavioral emergencies. Restarting lithium without
, addressing imminent danger to self or others is unsafe. Monotherapy with a
benzodiazepine risks disinhibition and does not treat the core manic
symptoms. Therefore, the priority is immediate stabilization with an
antipsychotic and baseline cardiac assessment.*
2. A 45-year-old patient with recurrent major depressive disorder and
comorbid generalized anxiety disorder has achieved remission on
escitalopram 20 mg daily but reports new-onset sexual dysfunction,
including delayed ejaculation and reduced libido. Which medication
adjustment is most supported by evidence?
A. Add mirtazapine 15 mg at bedtime
B. Switch to bupropion extended-release after a cross-taper
C. Add buspirone 10 mg twice daily
D. Decrease escitalopram to 10 mg and monitor
Answer: B. Switch to bupropion extended-release after a cross-taper
Rationale: Selective serotonin reuptake inhibitor (SSRI)-induced sexual
dysfunction is common. Bupropion, a norepinephrine-dopamine reuptake
inhibitor, has minimal sexual side effects and is an evidence-based
alternative for depression with good efficacy. Adding mirtazapine may help
sexual function but is less robustly studied as a switch strategy for
depression remission. Buspirone augmentation may partially alleviate
sexual dysfunction but is not a first-line switch agent when depression has
remitted; switching to a non-serotonergic agent addresses both depression
and side effects. Simply reducing escitalopram risks relapse. Cross-tapering
to bupropion maintains antidepressant coverage while resolving sexual
adverse effects.*
3. A 72-year-old patient with neurocognitive disorder due to Alzheimer’s
disease exhibits agitation, aggression, and psychotic features. The caregiver
reports that the patient has punched a wall and accused family members of
stealing. Which medication class is most appropriate for initial
pharmacologic management of agitation and psychosis in this population,
given black box warnings?
A. Atypical antipsychotics, after thorough risk-benefit discussion and using
, the lowest effective dose
B. Long-acting benzodiazepines to provide consistent sedation
C. First-generation antipsychotics as first-line due to lower metabolic risk
D. Valproic acid monotherapy
Answer: A. Atypical antipsychotics, after thorough risk-benefit discussion
and using the lowest effective dose
Rationale: Atypical antipsychotics (e.g., risperidone, olanzapine,
aripiprazole) are FDA-approved or supported for severe agitation/psychosis
in dementia when nonpharmacological interventions fail. They carry a black
box warning for increased mortality in elderly patients with dementia-
related psychosis, so their use requires informed consent, documentation of
risk-benefit discussion, and the lowest effective dose for the shortest
duration. Benzodiazepines increase fall and delirium risk and are not first-
line. First-generation antipsychotics have similar mortality risks and more
extrapyramidal side effects. Valproic acid has insufficient evidence and can
cause sedation and thrombocytopenia. The PMHNP must prioritize safety
while addressing severe symptoms.*
4. A mother brings her 8-year-old child for evaluation, reporting that the child
often interrupts, blurts out answers in class, fidgets excessively, and forgets
to turn in homework. These behaviors occur both at home and school for
over eight months. The child’s academic performance is declining. Which
diagnosis should be considered first?
A. Oppositional defiant disorder
B. Adjustment disorder with disturbance of conduct
C. Attention-deficit/hyperactivity disorder, combined presentation
D. Specific learning disorder
Answer: C. Attention-deficit/hyperactivity disorder, combined
presentation
Rationale: Symptoms of inattention (forgetting homework, disorganization)
and hyperactivity-impulsivity (fidgeting, blurting out, interrupting) persisting
for at least six months across multiple settings and impairing academic
functioning meet DSM-5-TR criteria for ADHD, combined presentation.
, Oppositional defiant disorder involves a pattern of angry/irritable mood,
argumentative/defiant behavior, or vindictiveness, not simply hyperactivity
or inattention. Adjustment disorder is time-limited following an identifiable
stressor. A specific learning disorder would present with academic skill
deficits not solely due to inattention. Comprehensive evaluation for ADHD
must rule out other causes, but the presentation is classic.*
5. A 34-year-old patient with schizophrenia has been stable on risperidone 4
mg daily for six months. During a routine follow-up, the PMHNP observes
involuntary, worm-like movements of the tongue and slight lip smacking.
The patient is unaware of these movements. Which assessment scale is
most appropriate for monitoring this finding?
A. Barnes Akathisia Rating Scale
B. Simpson-Angus Scale
C. Abnormal Involuntary Movement Scale (AIMS)
D. Columbia-Suicide Severity Rating Scale
Answer: C. Abnormal Involuntary Movement Scale (AIMS)
Rationale: The described movements are characteristic of tardive
dyskinesia (TD), a potentially irreversible movement disorder associated
with long-term antipsychotic use. The AIMS is the standard screening and
monitoring tool for TD, assessing orofacial, extremity, and trunk
movements. The Barnes Akathisia Rating Scale measures akathisia
(subjective restlessness). The Simpson-Angus Scale evaluates drug-induced
parkinsonism. The Columbia-Suicide Severity Rating Scale assesses suicidal
ideation and behavior. Early detection of TD with AIMS allows for
intervention, such as dose reduction, switching to a lower-risk
antipsychotic, or using VMAT2 inhibitors.*
6. A patient with posttraumatic stress disorder (PTSD) reports recurrent,
intrusive memories of a motor vehicle crash, hypervigilance while driving,
and nightmares. The patient avoids highways and has become socially
withdrawn. Which psychotherapy has the strongest evidence for reducing
PTSD symptoms in this presentation?
A. Psychodynamic psychotherapy
Practitioner (PMHNP) Certification
Practice Examination Questions And
Correct Answers (Verified Answers) Plus
Rationales 2026 Q&A Instant Download
1. A 28-year-old patient with a history of bipolar I disorder presents with acute
mania characterized by grandiosity, decreased need for sleep, pressured
speech, and psychomotor agitation. The patient has been nonadherent to
lithium for three weeks. Current lithium level is 0.2 mEq/L, serum creatinine
is 1.1 mg/dL, and thyroid-stimulating hormone (TSH) is 2.1 mIU/L. Which
intervention is the priority?
A. Restart lithium at the previous maintenance dose and titrate rapidly
B. Administer an intramuscular first-generation antipsychotic and obtain an
electrocardiogram
C. Initiate valproate with a loading dose while restarting lithium
D. Prescribe a high-potency benzodiazepine alone to reduce agitation
Answer: B. Administer an intramuscular first-generation antipsychotic and
obtain an electrocardiogram
Rationale: In acute manic episodes with severe agitation, rapid
tranquillization is essential for safety. Intramuscular haloperidol or another
high-potency first-generation antipsychotic provides immediate behavioral
control. An ECG is warranted because antipsychotics can prolong the QTc
interval, and acute mania may mask underlying cardiac risk. While lithium
and valproate are foundational mood stabilizers, they do not act quickly
enough for acute behavioral emergencies. Restarting lithium without
, addressing imminent danger to self or others is unsafe. Monotherapy with a
benzodiazepine risks disinhibition and does not treat the core manic
symptoms. Therefore, the priority is immediate stabilization with an
antipsychotic and baseline cardiac assessment.*
2. A 45-year-old patient with recurrent major depressive disorder and
comorbid generalized anxiety disorder has achieved remission on
escitalopram 20 mg daily but reports new-onset sexual dysfunction,
including delayed ejaculation and reduced libido. Which medication
adjustment is most supported by evidence?
A. Add mirtazapine 15 mg at bedtime
B. Switch to bupropion extended-release after a cross-taper
C. Add buspirone 10 mg twice daily
D. Decrease escitalopram to 10 mg and monitor
Answer: B. Switch to bupropion extended-release after a cross-taper
Rationale: Selective serotonin reuptake inhibitor (SSRI)-induced sexual
dysfunction is common. Bupropion, a norepinephrine-dopamine reuptake
inhibitor, has minimal sexual side effects and is an evidence-based
alternative for depression with good efficacy. Adding mirtazapine may help
sexual function but is less robustly studied as a switch strategy for
depression remission. Buspirone augmentation may partially alleviate
sexual dysfunction but is not a first-line switch agent when depression has
remitted; switching to a non-serotonergic agent addresses both depression
and side effects. Simply reducing escitalopram risks relapse. Cross-tapering
to bupropion maintains antidepressant coverage while resolving sexual
adverse effects.*
3. A 72-year-old patient with neurocognitive disorder due to Alzheimer’s
disease exhibits agitation, aggression, and psychotic features. The caregiver
reports that the patient has punched a wall and accused family members of
stealing. Which medication class is most appropriate for initial
pharmacologic management of agitation and psychosis in this population,
given black box warnings?
A. Atypical antipsychotics, after thorough risk-benefit discussion and using
, the lowest effective dose
B. Long-acting benzodiazepines to provide consistent sedation
C. First-generation antipsychotics as first-line due to lower metabolic risk
D. Valproic acid monotherapy
Answer: A. Atypical antipsychotics, after thorough risk-benefit discussion
and using the lowest effective dose
Rationale: Atypical antipsychotics (e.g., risperidone, olanzapine,
aripiprazole) are FDA-approved or supported for severe agitation/psychosis
in dementia when nonpharmacological interventions fail. They carry a black
box warning for increased mortality in elderly patients with dementia-
related psychosis, so their use requires informed consent, documentation of
risk-benefit discussion, and the lowest effective dose for the shortest
duration. Benzodiazepines increase fall and delirium risk and are not first-
line. First-generation antipsychotics have similar mortality risks and more
extrapyramidal side effects. Valproic acid has insufficient evidence and can
cause sedation and thrombocytopenia. The PMHNP must prioritize safety
while addressing severe symptoms.*
4. A mother brings her 8-year-old child for evaluation, reporting that the child
often interrupts, blurts out answers in class, fidgets excessively, and forgets
to turn in homework. These behaviors occur both at home and school for
over eight months. The child’s academic performance is declining. Which
diagnosis should be considered first?
A. Oppositional defiant disorder
B. Adjustment disorder with disturbance of conduct
C. Attention-deficit/hyperactivity disorder, combined presentation
D. Specific learning disorder
Answer: C. Attention-deficit/hyperactivity disorder, combined
presentation
Rationale: Symptoms of inattention (forgetting homework, disorganization)
and hyperactivity-impulsivity (fidgeting, blurting out, interrupting) persisting
for at least six months across multiple settings and impairing academic
functioning meet DSM-5-TR criteria for ADHD, combined presentation.
, Oppositional defiant disorder involves a pattern of angry/irritable mood,
argumentative/defiant behavior, or vindictiveness, not simply hyperactivity
or inattention. Adjustment disorder is time-limited following an identifiable
stressor. A specific learning disorder would present with academic skill
deficits not solely due to inattention. Comprehensive evaluation for ADHD
must rule out other causes, but the presentation is classic.*
5. A 34-year-old patient with schizophrenia has been stable on risperidone 4
mg daily for six months. During a routine follow-up, the PMHNP observes
involuntary, worm-like movements of the tongue and slight lip smacking.
The patient is unaware of these movements. Which assessment scale is
most appropriate for monitoring this finding?
A. Barnes Akathisia Rating Scale
B. Simpson-Angus Scale
C. Abnormal Involuntary Movement Scale (AIMS)
D. Columbia-Suicide Severity Rating Scale
Answer: C. Abnormal Involuntary Movement Scale (AIMS)
Rationale: The described movements are characteristic of tardive
dyskinesia (TD), a potentially irreversible movement disorder associated
with long-term antipsychotic use. The AIMS is the standard screening and
monitoring tool for TD, assessing orofacial, extremity, and trunk
movements. The Barnes Akathisia Rating Scale measures akathisia
(subjective restlessness). The Simpson-Angus Scale evaluates drug-induced
parkinsonism. The Columbia-Suicide Severity Rating Scale assesses suicidal
ideation and behavior. Early detection of TD with AIMS allows for
intervention, such as dose reduction, switching to a lower-risk
antipsychotic, or using VMAT2 inhibitors.*
6. A patient with posttraumatic stress disorder (PTSD) reports recurrent,
intrusive memories of a motor vehicle crash, hypervigilance while driving,
and nightmares. The patient avoids highways and has become socially
withdrawn. Which psychotherapy has the strongest evidence for reducing
PTSD symptoms in this presentation?
A. Psychodynamic psychotherapy
