PMHNP LAST MINUTE REVIEW (LMR)
COMPREHENSIVE EXAM PREP
QUESTIONS AND ANSWERS
1. A 32-year-old patient on Lithium for Bipolar Disorder presents with coarse tremors, ataxia,
and confusion. Her serum Lithium level is 2.1 mEq/L. Which medication, if recently added,
likely contributed to this toxicity?
A. Furosemide
B. Hydrochlorothiazide
C. Aspirin
D. Acetaminophen
Answer: B
Conceptual Explanation: Thiazide diuretics like Hydrochlorothiazide increase Lithium
levels by decreasing renal clearance, whereas loop diuretics like Furosemide have a lesser
effect on Lithium levels.
,2. Which brain region is primarily responsible for the ‘positive’ symptoms of schizophrenia,
such as hallucinations and delusions, due to dopamine overactivity?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The mesolimbic pathway is associated with reward and
pleasure; excessive dopamine in this area leads to positive symptoms of schizophrenia.
3. A patient started on Clozapine requires absolute neutrophil count (ANC) monitoring.
According to the Clozapine REMS program, what is the minimum ANC required to initiate
treatment?
A. 500/mm3
B. 1000/mm3
C. 2000/mm3
D. 1500/mm3
Answer: D
Conceptual Explanation: For the general population, the ANC must be at least 1500/mm3
to initiate Clozapine treatment to monitor for agranulocytosis.
, 4. A PMHNP is evaluating a 10-year-old child. The child’s mother reports he is often irritable,
has severe temper outbursts at least three times a week, and is chronically angry between
outbursts. What is the most likely DSM-5 diagnosis?
A. Oppositional Defiant Disorder
B. Conduct Disorder
C. Pediatric Bipolar Disorder
D. Disruptive Mood Dysregulation Disorder
Answer: D
Conceptual Explanation: DMDD is characterized by severe temper outbursts and
persistent irritability between outbursts, specifically in children before age 10.
5. Which cytochrome P450 enzyme is primarily inhibited by Fluoxetine and Paroxetine,
potentially increasing levels of beta-blockers and tricyclic antidepressants?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which metabolizes many psychotropic medications.
COMPREHENSIVE EXAM PREP
QUESTIONS AND ANSWERS
1. A 32-year-old patient on Lithium for Bipolar Disorder presents with coarse tremors, ataxia,
and confusion. Her serum Lithium level is 2.1 mEq/L. Which medication, if recently added,
likely contributed to this toxicity?
A. Furosemide
B. Hydrochlorothiazide
C. Aspirin
D. Acetaminophen
Answer: B
Conceptual Explanation: Thiazide diuretics like Hydrochlorothiazide increase Lithium
levels by decreasing renal clearance, whereas loop diuretics like Furosemide have a lesser
effect on Lithium levels.
,2. Which brain region is primarily responsible for the ‘positive’ symptoms of schizophrenia,
such as hallucinations and delusions, due to dopamine overactivity?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The mesolimbic pathway is associated with reward and
pleasure; excessive dopamine in this area leads to positive symptoms of schizophrenia.
3. A patient started on Clozapine requires absolute neutrophil count (ANC) monitoring.
According to the Clozapine REMS program, what is the minimum ANC required to initiate
treatment?
A. 500/mm3
B. 1000/mm3
C. 2000/mm3
D. 1500/mm3
Answer: D
Conceptual Explanation: For the general population, the ANC must be at least 1500/mm3
to initiate Clozapine treatment to monitor for agranulocytosis.
, 4. A PMHNP is evaluating a 10-year-old child. The child’s mother reports he is often irritable,
has severe temper outbursts at least three times a week, and is chronically angry between
outbursts. What is the most likely DSM-5 diagnosis?
A. Oppositional Defiant Disorder
B. Conduct Disorder
C. Pediatric Bipolar Disorder
D. Disruptive Mood Dysregulation Disorder
Answer: D
Conceptual Explanation: DMDD is characterized by severe temper outbursts and
persistent irritability between outbursts, specifically in children before age 10.
5. Which cytochrome P450 enzyme is primarily inhibited by Fluoxetine and Paroxetine,
potentially increasing levels of beta-blockers and tricyclic antidepressants?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Answer: C
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which metabolizes many psychotropic medications.
