PMHNP CERTIFICATION EXAM
REVIEW 2026/2027 QUESTIONS AND
ANSWERS
1. A 45-year-old patient on Lithium for Bipolar I Disorder presents with polyuria and
polydipsia. Lab tests reveal a low urine specific gravity. Which of the following conditions is
most likely occurring?
A. Nephrogenic Diabetes Insipidus
B. Diabetes Mellitus Type II
C. Chronic Kidney Disease Stage 3
D. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Answer: A
Conceptual Explanation: Lithium can inhibit the action of ADH on the distal renal tubules,
leading to Nephrogenic Diabetes Insipidus, characterized by the inability to concentrate
urine.
,2. Which cytochrome P450 enzyme is significantly induced by cigarette smoking, potentially
lowering the serum levels of Clozapine and Olanzapine?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Answer: A
Conceptual Explanation: Smoking tobacco induces the CYP1A2 enzyme. When a patient
stops smoking, the levels of medications metabolized by this enzyme (like Clozapine) can
rise to toxic levels.
3. According to the DSM-5-TR, what is the minimum duration of symptoms required to
diagnose Cyclothymic Disorder in an adult?
A. 6 months
B. 2 years
C. 1 year
D. 3 years
Answer: B
, Conceptual Explanation: For adults, Cyclothymic Disorder requires at least 2 years of
numerous periods with hypomanic and depressive symptoms that do not meet full criteria
for a major episode.
4. A PMHNP is treating a patient with Clozapine. The Absolute Neutrophil Count (ANC)
returns at 950/µL. What is the most appropriate action based on the Clozapine REMS
program?
A. Continue treatment but repeat ANC in 24 hours
B. Interrupt treatment and consult hematology
C. Reduce dose by 50% and monitor daily
D. Administer Filgrastim and continue Clozapine
Answer: B
Conceptual Explanation: For the general population, treatment must be interrupted if the
ANC falls below 1000/µL due to the risk of severe neutropenia.
5. Which brain region is primarily associated with the ‘negative symptoms’ of Schizophrenia
and executive dysfunction?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
REVIEW 2026/2027 QUESTIONS AND
ANSWERS
1. A 45-year-old patient on Lithium for Bipolar I Disorder presents with polyuria and
polydipsia. Lab tests reveal a low urine specific gravity. Which of the following conditions is
most likely occurring?
A. Nephrogenic Diabetes Insipidus
B. Diabetes Mellitus Type II
C. Chronic Kidney Disease Stage 3
D. Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Answer: A
Conceptual Explanation: Lithium can inhibit the action of ADH on the distal renal tubules,
leading to Nephrogenic Diabetes Insipidus, characterized by the inability to concentrate
urine.
,2. Which cytochrome P450 enzyme is significantly induced by cigarette smoking, potentially
lowering the serum levels of Clozapine and Olanzapine?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Answer: A
Conceptual Explanation: Smoking tobacco induces the CYP1A2 enzyme. When a patient
stops smoking, the levels of medications metabolized by this enzyme (like Clozapine) can
rise to toxic levels.
3. According to the DSM-5-TR, what is the minimum duration of symptoms required to
diagnose Cyclothymic Disorder in an adult?
A. 6 months
B. 2 years
C. 1 year
D. 3 years
Answer: B
, Conceptual Explanation: For adults, Cyclothymic Disorder requires at least 2 years of
numerous periods with hypomanic and depressive symptoms that do not meet full criteria
for a major episode.
4. A PMHNP is treating a patient with Clozapine. The Absolute Neutrophil Count (ANC)
returns at 950/µL. What is the most appropriate action based on the Clozapine REMS
program?
A. Continue treatment but repeat ANC in 24 hours
B. Interrupt treatment and consult hematology
C. Reduce dose by 50% and monitor daily
D. Administer Filgrastim and continue Clozapine
Answer: B
Conceptual Explanation: For the general population, treatment must be interrupted if the
ANC falls below 1000/µL due to the risk of severe neutropenia.
5. Which brain region is primarily associated with the ‘negative symptoms’ of Schizophrenia
and executive dysfunction?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
