NRNP 6665 PMHNP PRACTICE EXAMINATION 2026–
2027 — STUDY GUIDE | LATEST UPDATE 2026/2027 |
PRACTICE QUESTIONS AND ANSWERS | EXAM
REVIEW | 100% CORRECT ANSWERS | VERIFIED
SOLUTIONS | ALREADY GRADED A+
1. A 32-year-old female presents with a 2-week history of depressed mood,
anhedonia, fatigue, and feelings of worthlessness. She reports sleeping 12
hours per day and gaining 8 pounds. Which specifier should the PMHNP
consider?
A) Melancholic features
B) Atypical features
C) Catatonic features
D) Postpartum onset
Correct Answer: B
Atypical depression includes mood reactivity, hypersomnia, hyperphagia, leaden
paralysis, and rejection sensitivity. Melancholic features would show insomnia and
weight loss. Catatonia involves motor abnormalities. Postpartum onset is a
specifier if symptoms begin within 4 weeks postpartum.
2. A 45-year-old male with bipolar I disorder is stable on lithium. He reports
increased thirst and urination. Which laboratory test is most important?
A) Serum lithium level
B) Fasting blood glucose
C) Urine osmolality and specific gravity
D) Liver function tests
Correct Answer: C
Polyuria and polydipsia may indicate lithium-induced nephrogenic diabetes
insipidus. Urine osmolality and specific gravity help assess concentrating ability.
,Serum lithium level monitors toxicity but not the renal concentration defect. Blood
glucose rules out diabetes mellitus. Liver function is unrelated.
3. A 25-year-old patient with schizophrenia is started on clozapine. Which
monitoring is essential before each dispensing?
A) Serum lithium level
B) Absolute neutrophil count (ANC)
C) Thyroid-stimulating hormone
D) Prolactin level
Correct Answer: B
Clozapine can cause agranulocytosis; absolute neutrophil count must be
monitored per REMS schedule before each dispensing. Lithium, TSH, and prolactin
monitoring are not specific to clozapine safety.
4. A patient with major depressive disorder has not responded to two SSRIs.
Which augmentation strategy is best supported by evidence?
A) Adding a benzodiazepine
B) Adding bupropion or an atypical antipsychotic
C) Switching to a stimulant
D) Adding a beta-blocker
Correct Answer: B
For treatment-resistant depression, augmentation with bupropion, mirtazapine, or
atypical antipsychotics (e.g., aripiprazole, quetiapine) is evidence-based.
Benzodiazepines do not treat core depression. Stimulants are not first-line
augmentation. Beta-blockers are not indicated.
5. A patient presents with recurrent, unexpected panic attacks and persistent
worry about future attacks. What is the first-line medication?
A) Propranolol
B) Sertraline
C) Alprazolam
D) Quetiapine
,Correct Answer: B
SSRIs such as sertraline are first-line for panic disorder. Propranolol is for
performance anxiety. Alprazolam is effective but second-line due to dependence
risk. Quetiapine is not first-line.
6. A 16-year-old presents with a 6-month history of excessive worry about
school and social situations, restlessness, and difficulty concentrating. The
most likely diagnosis is:
A) Panic disorder
B) Generalized anxiety disorder
C) Social anxiety disorder
D) Separation anxiety disorder
Correct Answer: B
Generalized anxiety disorder involves excessive, difficult-to-control worry across
multiple domains with associated symptoms. Panic disorder has discrete attacks.
Social anxiety is specific to social situations. Separation anxiety focuses on
separation from attachment figures.
7. A patient with bipolar II disorder is started on lamotrigine. Which adverse
effect requires immediate reporting?
A) Nausea
B) Headache
C) Rash
D) Dizziness
Correct Answer: C
Lamotrigine can cause serious rash, including Stevens-Johnson syndrome,
especially with rapid titration. Any new rash requires immediate evaluation and
likely discontinuation. Nausea, headache, and dizziness are less concerning.
8. A 55-year-old male with major depressive disorder is started on venlafaxine.
He has hypertension and coronary artery disease. What is the most
important nursing consideration?
A) Monitor blood pressure and heart rate
, B) Check liver enzymes weekly
C) Avoid all foods with tyramine
D) Administer only at bedtime
Correct Answer: A
Venlafaxine is an SNRI that can increase blood pressure and heart rate, especially
in patients with cardiovascular disease. Monitoring BP and HR is essential. Liver
enzymes are not routinely weekly. Tyramine is MAOI restriction. Bedtime dosing
does not eliminate cardiovascular effects.
9. A 22-year-old patient with schizophrenia is stable on risperidone. He
develops restlessness and an urge to move his legs constantly. This is most
likely:
A) Tardive dyskinesia
B) Akathisia
C) Dystonia
D) Parkinsonism
Correct Answer: B
Akathisia is a subjective feeling of restlessness and urge to move, common with
antipsychotics. Tardive dyskinesia involves involuntary movements of face/tongue.
Dystonia involves muscle spasms. Parkinsonism involves tremor, rigidity,
bradykinesia.
10.A patient with opioid use disorder is started on buprenorphine-naloxone.
What is the primary purpose of naloxone in the formulation?
A) To increase euphoria
B) To deter intravenous misuse
C) To reduce constipation
D) To prevent withdrawal
Correct Answer: B
Naloxone is added to buprenorphine to deter intravenous misuse; if injected,
naloxone precipitates withdrawal. It does not increase euphoria, reduce
constipation, or prevent withdrawal when taken sublingually.
2027 — STUDY GUIDE | LATEST UPDATE 2026/2027 |
PRACTICE QUESTIONS AND ANSWERS | EXAM
REVIEW | 100% CORRECT ANSWERS | VERIFIED
SOLUTIONS | ALREADY GRADED A+
1. A 32-year-old female presents with a 2-week history of depressed mood,
anhedonia, fatigue, and feelings of worthlessness. She reports sleeping 12
hours per day and gaining 8 pounds. Which specifier should the PMHNP
consider?
A) Melancholic features
B) Atypical features
C) Catatonic features
D) Postpartum onset
Correct Answer: B
Atypical depression includes mood reactivity, hypersomnia, hyperphagia, leaden
paralysis, and rejection sensitivity. Melancholic features would show insomnia and
weight loss. Catatonia involves motor abnormalities. Postpartum onset is a
specifier if symptoms begin within 4 weeks postpartum.
2. A 45-year-old male with bipolar I disorder is stable on lithium. He reports
increased thirst and urination. Which laboratory test is most important?
A) Serum lithium level
B) Fasting blood glucose
C) Urine osmolality and specific gravity
D) Liver function tests
Correct Answer: C
Polyuria and polydipsia may indicate lithium-induced nephrogenic diabetes
insipidus. Urine osmolality and specific gravity help assess concentrating ability.
,Serum lithium level monitors toxicity but not the renal concentration defect. Blood
glucose rules out diabetes mellitus. Liver function is unrelated.
3. A 25-year-old patient with schizophrenia is started on clozapine. Which
monitoring is essential before each dispensing?
A) Serum lithium level
B) Absolute neutrophil count (ANC)
C) Thyroid-stimulating hormone
D) Prolactin level
Correct Answer: B
Clozapine can cause agranulocytosis; absolute neutrophil count must be
monitored per REMS schedule before each dispensing. Lithium, TSH, and prolactin
monitoring are not specific to clozapine safety.
4. A patient with major depressive disorder has not responded to two SSRIs.
Which augmentation strategy is best supported by evidence?
A) Adding a benzodiazepine
B) Adding bupropion or an atypical antipsychotic
C) Switching to a stimulant
D) Adding a beta-blocker
Correct Answer: B
For treatment-resistant depression, augmentation with bupropion, mirtazapine, or
atypical antipsychotics (e.g., aripiprazole, quetiapine) is evidence-based.
Benzodiazepines do not treat core depression. Stimulants are not first-line
augmentation. Beta-blockers are not indicated.
5. A patient presents with recurrent, unexpected panic attacks and persistent
worry about future attacks. What is the first-line medication?
A) Propranolol
B) Sertraline
C) Alprazolam
D) Quetiapine
,Correct Answer: B
SSRIs such as sertraline are first-line for panic disorder. Propranolol is for
performance anxiety. Alprazolam is effective but second-line due to dependence
risk. Quetiapine is not first-line.
6. A 16-year-old presents with a 6-month history of excessive worry about
school and social situations, restlessness, and difficulty concentrating. The
most likely diagnosis is:
A) Panic disorder
B) Generalized anxiety disorder
C) Social anxiety disorder
D) Separation anxiety disorder
Correct Answer: B
Generalized anxiety disorder involves excessive, difficult-to-control worry across
multiple domains with associated symptoms. Panic disorder has discrete attacks.
Social anxiety is specific to social situations. Separation anxiety focuses on
separation from attachment figures.
7. A patient with bipolar II disorder is started on lamotrigine. Which adverse
effect requires immediate reporting?
A) Nausea
B) Headache
C) Rash
D) Dizziness
Correct Answer: C
Lamotrigine can cause serious rash, including Stevens-Johnson syndrome,
especially with rapid titration. Any new rash requires immediate evaluation and
likely discontinuation. Nausea, headache, and dizziness are less concerning.
8. A 55-year-old male with major depressive disorder is started on venlafaxine.
He has hypertension and coronary artery disease. What is the most
important nursing consideration?
A) Monitor blood pressure and heart rate
, B) Check liver enzymes weekly
C) Avoid all foods with tyramine
D) Administer only at bedtime
Correct Answer: A
Venlafaxine is an SNRI that can increase blood pressure and heart rate, especially
in patients with cardiovascular disease. Monitoring BP and HR is essential. Liver
enzymes are not routinely weekly. Tyramine is MAOI restriction. Bedtime dosing
does not eliminate cardiovascular effects.
9. A 22-year-old patient with schizophrenia is stable on risperidone. He
develops restlessness and an urge to move his legs constantly. This is most
likely:
A) Tardive dyskinesia
B) Akathisia
C) Dystonia
D) Parkinsonism
Correct Answer: B
Akathisia is a subjective feeling of restlessness and urge to move, common with
antipsychotics. Tardive dyskinesia involves involuntary movements of face/tongue.
Dystonia involves muscle spasms. Parkinsonism involves tremor, rigidity,
bradykinesia.
10.A patient with opioid use disorder is started on buprenorphine-naloxone.
What is the primary purpose of naloxone in the formulation?
A) To increase euphoria
B) To deter intravenous misuse
C) To reduce constipation
D) To prevent withdrawal
Correct Answer: B
Naloxone is added to buprenorphine to deter intravenous misuse; if injected,
naloxone precipitates withdrawal. It does not increase euphoria, reduce
constipation, or prevent withdrawal when taken sublingually.
