1
ANCC PMHNP Exam (NEW 2025/ 2026
Update) Questions and Answers
1. A patient with schizophrenia is prescribed clozapine. Which lab monitoring
protocol is mandated by the REMS program?
• A) Monthly CBC and platelet count
• B) Weekly WBC and ANC for first 6 months, then biweekly
• C) Monthly LFTs and renal function
• D) Weekly serum glucose and lipid panel
Correct Answer: B
Rationale: Clozapine requires strict monitoring via the REMS program due to risk
of agranulocytosis. Weekly WBC and ANC are required for the first 6 months; if
stable, monitoring may be reduced to biweekly.
2. A patient on sertraline reports sexual dysfunction. The PMHNP considers
adding which medication to address this side effect?
• A) Bupropion
• B) Trazodone
• C) Hydroxyzine
• D) Propranolol
Correct Answer: A
Rationale: Bupropion has been shown to improve or reverse SSRI-induced sexual
dysfunction due to its dopaminergic and noradrenergic effects.
3. A patient with bipolar I disorder on lithium presents with coarse tremor,
ataxia, and confusion. Lithium level is 2.4 mEq/L. What is the priority
intervention?
,2
• A) Decrease lithium dose by 50%
• B) Add a beta-blocker for tremor
• C) Discontinue lithium and refer to ED for possible hemodialysis
• D) Increase fluid intake to 3L/day
Correct Answer: C
Rationale: Level >2.0 mEq/L indicates severe toxicity with neurological symptoms.
Lithium must be discontinued and emergent medical evaluation (possible
hemodialysis) is indicated.
4. Which CYP enzyme is induced by tobacco smoking, leading to reduced levels
of clozapine and olanzapine?
• A) CYP1A2
• B) CYP2D6
• C) CYP3A4
• D) CYP2C19
Correct Answer: A
Rationale: Tobacco smoke induces CYP1A2, which increases metabolism of
clozapine and olanzapine, potentially reducing efficacy.
5. A patient on valproic acid for bipolar disorder requires baseline and periodic
monitoring of which labs?
• A) CBC, LFTs, and serum ammonia
• B) BUN, creatinine, and TSH
• C) Fasting glucose and HbA1c
• D) Serum calcium and magnesium
Correct Answer: A
Rationale: Valproate carries black box warnings for hepatotoxicity and
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pancreatitis. CBC (for thrombocytopenia) and LFTs are essential; ammonia may be
checked if encephalopathy suspected.
6. The PMHNP explains to a patient that SSRIs work by which primary
mechanism?
• A) Blocking dopamine D2 receptors
• B) Inhibiting monoamine oxidase
• C) Blocking reuptake of serotonin at the synaptic cleft
• D) Enhancing GABA activity at the chloride channel
Correct Answer: C
Rationale: SSRIs selectively block the serotonin transporter (SERT), increasing
serotonin availability in the synapse.
7. A patient with Alzheimer's disease is started on donepezil. The PMHNP
understands this medication works by:
• A) Increasing dopamine release in the prefrontal cortex
• B) Reversibly inhibiting acetylcholinesterase
• C) Blocking NMDA receptors
• D) Increasing GABA synthesis
Correct Answer: B
Rationale: Donepezil is a cholinesterase inhibitor that increases acetylcholine
levels in the brain, which is depleted in Alzheimer's disease.
8. Which of the following medications is most likely to cause QTc prolongation
and requires baseline ECG monitoring?
• A) Fluoxetine
• B) Citalopram
, 4
• C) Sertraline
• D) Escitalopram
Correct Answer: B
Rationale: Citalopram has a dose-dependent risk of QTc prolongation, especially
at doses >40 mg/day (20 mg/day in elderly). ECG is recommended prior to
initiation.
9. A patient with depression and chronic pain is started on duloxetine. This
medication's mechanism includes:
• A) SSRI effect only
• B) SNRI effect (serotonin and norepinephrine reuptake inhibition)
• C) Dopamine reuptake inhibition
• D) Alpha-2 antagonism
Correct Answer: B
Rationale: Duloxetine is an SNRI that inhibits reuptake of both serotonin and
norepinephrine, making it effective for depression and neuropathic pain.
10. A patient prescribed MAOI (phenelzine) must avoid which food to prevent
hypertensive crisis?
• A) Grapefruit juice
• B) Aged cheese
• C) Bananas
• D) Chocolate
Correct Answer: B
Rationale: Aged cheeses contain tyramine, which can cause a hypertensive crisis
when combined with MAOIs due to reduced tyramine metabolism.
ANCC PMHNP Exam (NEW 2025/ 2026
Update) Questions and Answers
1. A patient with schizophrenia is prescribed clozapine. Which lab monitoring
protocol is mandated by the REMS program?
• A) Monthly CBC and platelet count
• B) Weekly WBC and ANC for first 6 months, then biweekly
• C) Monthly LFTs and renal function
• D) Weekly serum glucose and lipid panel
Correct Answer: B
Rationale: Clozapine requires strict monitoring via the REMS program due to risk
of agranulocytosis. Weekly WBC and ANC are required for the first 6 months; if
stable, monitoring may be reduced to biweekly.
2. A patient on sertraline reports sexual dysfunction. The PMHNP considers
adding which medication to address this side effect?
• A) Bupropion
• B) Trazodone
• C) Hydroxyzine
• D) Propranolol
Correct Answer: A
Rationale: Bupropion has been shown to improve or reverse SSRI-induced sexual
dysfunction due to its dopaminergic and noradrenergic effects.
3. A patient with bipolar I disorder on lithium presents with coarse tremor,
ataxia, and confusion. Lithium level is 2.4 mEq/L. What is the priority
intervention?
,2
• A) Decrease lithium dose by 50%
• B) Add a beta-blocker for tremor
• C) Discontinue lithium and refer to ED for possible hemodialysis
• D) Increase fluid intake to 3L/day
Correct Answer: C
Rationale: Level >2.0 mEq/L indicates severe toxicity with neurological symptoms.
Lithium must be discontinued and emergent medical evaluation (possible
hemodialysis) is indicated.
4. Which CYP enzyme is induced by tobacco smoking, leading to reduced levels
of clozapine and olanzapine?
• A) CYP1A2
• B) CYP2D6
• C) CYP3A4
• D) CYP2C19
Correct Answer: A
Rationale: Tobacco smoke induces CYP1A2, which increases metabolism of
clozapine and olanzapine, potentially reducing efficacy.
5. A patient on valproic acid for bipolar disorder requires baseline and periodic
monitoring of which labs?
• A) CBC, LFTs, and serum ammonia
• B) BUN, creatinine, and TSH
• C) Fasting glucose and HbA1c
• D) Serum calcium and magnesium
Correct Answer: A
Rationale: Valproate carries black box warnings for hepatotoxicity and
,3
pancreatitis. CBC (for thrombocytopenia) and LFTs are essential; ammonia may be
checked if encephalopathy suspected.
6. The PMHNP explains to a patient that SSRIs work by which primary
mechanism?
• A) Blocking dopamine D2 receptors
• B) Inhibiting monoamine oxidase
• C) Blocking reuptake of serotonin at the synaptic cleft
• D) Enhancing GABA activity at the chloride channel
Correct Answer: C
Rationale: SSRIs selectively block the serotonin transporter (SERT), increasing
serotonin availability in the synapse.
7. A patient with Alzheimer's disease is started on donepezil. The PMHNP
understands this medication works by:
• A) Increasing dopamine release in the prefrontal cortex
• B) Reversibly inhibiting acetylcholinesterase
• C) Blocking NMDA receptors
• D) Increasing GABA synthesis
Correct Answer: B
Rationale: Donepezil is a cholinesterase inhibitor that increases acetylcholine
levels in the brain, which is depleted in Alzheimer's disease.
8. Which of the following medications is most likely to cause QTc prolongation
and requires baseline ECG monitoring?
• A) Fluoxetine
• B) Citalopram
, 4
• C) Sertraline
• D) Escitalopram
Correct Answer: B
Rationale: Citalopram has a dose-dependent risk of QTc prolongation, especially
at doses >40 mg/day (20 mg/day in elderly). ECG is recommended prior to
initiation.
9. A patient with depression and chronic pain is started on duloxetine. This
medication's mechanism includes:
• A) SSRI effect only
• B) SNRI effect (serotonin and norepinephrine reuptake inhibition)
• C) Dopamine reuptake inhibition
• D) Alpha-2 antagonism
Correct Answer: B
Rationale: Duloxetine is an SNRI that inhibits reuptake of both serotonin and
norepinephrine, making it effective for depression and neuropathic pain.
10. A patient prescribed MAOI (phenelzine) must avoid which food to prevent
hypertensive crisis?
• A) Grapefruit juice
• B) Aged cheese
• C) Bananas
• D) Chocolate
Correct Answer: B
Rationale: Aged cheeses contain tyramine, which can cause a hypertensive crisis
when combined with MAOIs due to reduced tyramine metabolism.
