PMHNP CERTIFICATION EXAM
REVIEW (2026/2027) –PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A 32-year-old male patient with a history of schizophrenia is currently being treated with
Olanzapine. He reports that he has recently started smoking a pack of cigarettes a day. Which
of the following pharmacological outcomes should the PMHNP anticipate?
A. Olanzapine serum levels will increase due to CYP1A2 inhibition.
B. Olanzapine serum levels will decrease due to CYP1A2 induction.
C. Smoking has no clinical effect on the metabolism of second-generation antipsychotics.
D. Olanzapine levels will fluctuate due to competitive binding at the D2 receptor.
Answer: B
Conceptual Explanation: Cigarette smoke contains polycyclic aromatic hydrocarbons,
which induce the CYP1A2 enzyme. Since Olanzapine is a substrate of CYP1A2, induction of
the enzyme leads to faster metabolism and lower serum levels of the drug.
,2. When evaluating a research study, which level of evidence is considered the most reliable
for clinical decision-making?
A. Single randomized controlled trials (RCTs).
B. Systematic reviews or meta-analyses of randomized controlled trials (RCTs).
C. Case-control and cohort studies.
D. Opinions of respected authorities or expert committees.
Answer: B
Conceptual Explanation: Level I evidence, which consists of systematic reviews or meta-
analyses of all relevant RCTs, is the gold standard in the hierarchy of evidence.
3. A patient is prescribed Clozapine. According to the REMS program, at what Absolute
Neutrophil Count (ANC) level must the medication be permanently discontinued for a
member of the general population?
A. ANC < 2000/mm³
B. ANC < 1000/mm³
C. ANC < 1500/mm³
D. ANC < 500/mm³
Answer: B
Conceptual Explanation: For the general population, if the ANC falls below 1000/mm³, it
is classified as severe neutropenia, and Clozapine must be discontinued.
, 4. Which neurobiological pathway is primarily responsible for the negative symptoms of
schizophrenia, such as apathy and social withdrawal?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: The mesocortical pathway is associated with cognitive and
negative symptoms of schizophrenia. Positive symptoms are associated with the
mesolimbic pathway.
5. A patient taking Phenelzine (an MAOI) presents to the ER with a severe headache,
palpitations, and a blood pressure of 210/120 mmHg. Which dietary indiscretion most likely
caused this?
A. Fresh cottage cheese
B. Aged cheddar cheese
C. A glass of orange juice
D. Baked chicken breast
Answer: B
REVIEW (2026/2027) –PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A 32-year-old male patient with a history of schizophrenia is currently being treated with
Olanzapine. He reports that he has recently started smoking a pack of cigarettes a day. Which
of the following pharmacological outcomes should the PMHNP anticipate?
A. Olanzapine serum levels will increase due to CYP1A2 inhibition.
B. Olanzapine serum levels will decrease due to CYP1A2 induction.
C. Smoking has no clinical effect on the metabolism of second-generation antipsychotics.
D. Olanzapine levels will fluctuate due to competitive binding at the D2 receptor.
Answer: B
Conceptual Explanation: Cigarette smoke contains polycyclic aromatic hydrocarbons,
which induce the CYP1A2 enzyme. Since Olanzapine is a substrate of CYP1A2, induction of
the enzyme leads to faster metabolism and lower serum levels of the drug.
,2. When evaluating a research study, which level of evidence is considered the most reliable
for clinical decision-making?
A. Single randomized controlled trials (RCTs).
B. Systematic reviews or meta-analyses of randomized controlled trials (RCTs).
C. Case-control and cohort studies.
D. Opinions of respected authorities or expert committees.
Answer: B
Conceptual Explanation: Level I evidence, which consists of systematic reviews or meta-
analyses of all relevant RCTs, is the gold standard in the hierarchy of evidence.
3. A patient is prescribed Clozapine. According to the REMS program, at what Absolute
Neutrophil Count (ANC) level must the medication be permanently discontinued for a
member of the general population?
A. ANC < 2000/mm³
B. ANC < 1000/mm³
C. ANC < 1500/mm³
D. ANC < 500/mm³
Answer: B
Conceptual Explanation: For the general population, if the ANC falls below 1000/mm³, it
is classified as severe neutropenia, and Clozapine must be discontinued.
, 4. Which neurobiological pathway is primarily responsible for the negative symptoms of
schizophrenia, such as apathy and social withdrawal?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: The mesocortical pathway is associated with cognitive and
negative symptoms of schizophrenia. Positive symptoms are associated with the
mesolimbic pathway.
5. A patient taking Phenelzine (an MAOI) presents to the ER with a severe headache,
palpitations, and a blood pressure of 210/120 mmHg. Which dietary indiscretion most likely
caused this?
A. Fresh cottage cheese
B. Aged cheddar cheese
C. A glass of orange juice
D. Baked chicken breast
Answer: B
