1|Page
AANP PMHNP Certification Board Exam Q&A 1-
300 | Latest 2026 Updated Practice Questions
with Answers & Rationales for Psychiatric
Mental Health Nurse Practitioner Test Prep
Question 1
A 34-year-old female with MDD on sertraline 50 mg for 4 weeks reports worsening
fatigue and 5-lb weight gain. What is the most appropriate initial action?
A) Increase sertraline
B) Add bupropion
C) Obtain TSH
D) Switch to venlafaxine
Answer: C) Obtain TSH
Rationale: Before altering psychotropics, rule out hypothyroidism, a common cause of
poor response and fatigue.
Question 2
Which SSRI has the shortest half-life and highest risk of discontinuation syndrome?
A) Fluoxetine
B) Sertraline
C) Paroxetine
D) Escitalopram
,2|Page
Answer: C) Paroxetine
Rationale: Paroxetine has a half-life of ~21 hours and potent anticholinergic effects,
making it notorious for withdrawal.
Question 3
A patient on fluoxetine develops serotonin syndrome. Which finding is classic?
A) Miosis
B) Bradycardia
C) Hyperreflexia
D) Hypothermia
Answer: C) Hyperreflexia
Rationale: Serotonin syndrome features neuromuscular hyperactivity including
hyperreflexia, clonus, and tremor.
Question 4
First-line treatment for acute mania in bipolar I disorder is:
A) Lithium
B) Valproate
C) Atypical antipsychotic
D) Lamotrigine
Answer: C) Atypical antipsychotic
Rationale: Current guidelines favor atypical antipsychotics (e.g., olanzapine,
risperidone) for acute mania due to rapid onset.
,3|Page
Question 5
Which medication is most associated with weight gain and metabolic syndrome?
A) Fluoxetine
B) Sertraline
C) Olanzapine
D) Aripiprazole
Answer: C) Olanzapine
Rationale: Olanzapine has the highest metabolic liability among atypicals, with
significant weight gain and dyslipidemia.
Question 6
A patient with schizophrenia has tardive dyskinesia. Which medication is FDA-
approved for this?
A) Benztropine
B) Diphenhydramine
C) Valbenazine
D) Amantadine
Answer: C) Valbenazine
Rationale: Valbenazine is a VMAT2 inhibitor FDA-approved for tardive dyskinesia.
Question 7
Which benzodiazepine is best for panic disorder due to rapid onset?
A) Diazepam
B) Lorazepam
C) Clonazepam
D) Chlordiazepoxide
, 4|Page
Answer: C) Clonazepam
Rationale: Clonazepam has rapid onset and long duration, ideal for panic.
Question 8
First-line pharmacotherapy for PTSD is:
A) Fluoxetine
B) Paroxetine
C) Sertraline
D) Venlafaxine
Answer: C) Sertraline
Rationale: Sertraline and paroxetine are FDA-approved; sertraline is often preferred due
to tolerability.
Question 9
A patient on MAOI eats aged cheese and develops hypertension. Which drug is
contraindicated?
A) Metoprolol
B) Nifedipine
C) Phentolamine
D) Nitroglycerin
Answer: C) Phentolamine
Rationale: Hypertensive crisis from tyramine requires phentolamine, an alpha-blocker.
Question 10
Which lab is required before starting clozapine?
AANP PMHNP Certification Board Exam Q&A 1-
300 | Latest 2026 Updated Practice Questions
with Answers & Rationales for Psychiatric
Mental Health Nurse Practitioner Test Prep
Question 1
A 34-year-old female with MDD on sertraline 50 mg for 4 weeks reports worsening
fatigue and 5-lb weight gain. What is the most appropriate initial action?
A) Increase sertraline
B) Add bupropion
C) Obtain TSH
D) Switch to venlafaxine
Answer: C) Obtain TSH
Rationale: Before altering psychotropics, rule out hypothyroidism, a common cause of
poor response and fatigue.
Question 2
Which SSRI has the shortest half-life and highest risk of discontinuation syndrome?
A) Fluoxetine
B) Sertraline
C) Paroxetine
D) Escitalopram
,2|Page
Answer: C) Paroxetine
Rationale: Paroxetine has a half-life of ~21 hours and potent anticholinergic effects,
making it notorious for withdrawal.
Question 3
A patient on fluoxetine develops serotonin syndrome. Which finding is classic?
A) Miosis
B) Bradycardia
C) Hyperreflexia
D) Hypothermia
Answer: C) Hyperreflexia
Rationale: Serotonin syndrome features neuromuscular hyperactivity including
hyperreflexia, clonus, and tremor.
Question 4
First-line treatment for acute mania in bipolar I disorder is:
A) Lithium
B) Valproate
C) Atypical antipsychotic
D) Lamotrigine
Answer: C) Atypical antipsychotic
Rationale: Current guidelines favor atypical antipsychotics (e.g., olanzapine,
risperidone) for acute mania due to rapid onset.
,3|Page
Question 5
Which medication is most associated with weight gain and metabolic syndrome?
A) Fluoxetine
B) Sertraline
C) Olanzapine
D) Aripiprazole
Answer: C) Olanzapine
Rationale: Olanzapine has the highest metabolic liability among atypicals, with
significant weight gain and dyslipidemia.
Question 6
A patient with schizophrenia has tardive dyskinesia. Which medication is FDA-
approved for this?
A) Benztropine
B) Diphenhydramine
C) Valbenazine
D) Amantadine
Answer: C) Valbenazine
Rationale: Valbenazine is a VMAT2 inhibitor FDA-approved for tardive dyskinesia.
Question 7
Which benzodiazepine is best for panic disorder due to rapid onset?
A) Diazepam
B) Lorazepam
C) Clonazepam
D) Chlordiazepoxide
, 4|Page
Answer: C) Clonazepam
Rationale: Clonazepam has rapid onset and long duration, ideal for panic.
Question 8
First-line pharmacotherapy for PTSD is:
A) Fluoxetine
B) Paroxetine
C) Sertraline
D) Venlafaxine
Answer: C) Sertraline
Rationale: Sertraline and paroxetine are FDA-approved; sertraline is often preferred due
to tolerability.
Question 9
A patient on MAOI eats aged cheese and develops hypertension. Which drug is
contraindicated?
A) Metoprolol
B) Nifedipine
C) Phentolamine
D) Nitroglycerin
Answer: C) Phentolamine
Rationale: Hypertensive crisis from tyramine requires phentolamine, an alpha-blocker.
Question 10
Which lab is required before starting clozapine?
