Psychiatric-Mental Health Nurse
Practitioner (PMHNP-BC) Exam 2026–
2027 | 100-Question Advanced Practice
Exam | Questions & Answers with
Detailed Rationales | Complete Study
Guide
1. A 32-year-old patient with bipolar I disorder presents with decreased need for
sleep, pressured speech, grandiosity, and increasingly risky financial behavior. The
patient has been taking lithium inconsistently. Serum lithium is 0.3 mEq/L. Which
intervention is most appropriate?
A. Discontinue lithium and initiate an SSRI
B. Increase lithium toward a therapeutic concentration while assessing safety and
adherence
,C. Add a stimulant for impaired concentration
D. Initiate psychotherapy alone
Answer: B. Increase lithium toward a therapeutic concentration while assessing
safety and adherence
Rationale: The presentation is consistent with an acute manic episode, and the
subtherapeutic lithium concentration suggests inadequate exposure. Treatment
should include optimization of an evidence-based mood stabilizer while
assessing adherence, renal and thyroid function, hydration, drug interactions,
and immediate safety risks.
2. A patient taking clozapine develops fever, sore throat, and profound fatigue.
What is the priority action?
A. Reassure the patient that these are expected adverse effects
B. Increase the clozapine dose
C. Obtain an urgent CBC with absolute neutrophil count and evaluate for infection
D. Add benztropine
Answer: C. Obtain an urgent CBC with absolute neutrophil count and evaluate
for infection
Rationale: Clozapine can cause severe neutropenia. Fever and sore throat may
indicate a serious infection associated with neutropenia. Urgent assessment of
the absolute neutrophil count and medical evaluation are warranted.
3. A patient taking sertraline and linezolid develops agitation, diaphoresis,
hyperreflexia, inducible clonus, and temperature of 39.2°C. Which diagnosis is
most likely?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
,C. Anticholinergic toxicity
D. Malignant catatonia
Answer: B. Serotonin syndrome
Rationale: Serotonin syndrome typically presents with autonomic instability,
gastrointestinal symptoms, agitation, hyperreflexia, clonus, and hyperthermia.
The combination of an SSRI and linezolid substantially increases serotonergic
toxicity risk.
4. A patient with schizophrenia receiving haloperidol develops severe muscular
rigidity, altered consciousness, diaphoresis, and a temperature of 40°C. Creatine
kinase is markedly elevated. What is the most likely diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Acute dystonia
D. Tardive dyskinesia
Answer: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is characterized by severe rigidity,
hyperthermia, autonomic instability, altered mental status, and often markedly
elevated creatine kinase. Immediate discontinuation of the offending
antipsychotic and urgent medical management are required.
5. A 68-year-old patient develops visual hallucinations, fluctuating cognition, REM
sleep behavior disorder, and marked sensitivity to antipsychotics. Which disorder
should be strongly considered?
A. Alzheimer disease
B. Dementia with Lewy bodies
C. Frontotemporal dementia
D. Vascular dementia
, Answer: B. Dementia with Lewy bodies
Rationale: Fluctuating cognition, recurrent visual hallucinations, REM sleep
behavior disorder, and parkinsonian features are characteristic of dementia
with Lewy bodies. Antipsychotic sensitivity is particularly important when
considering treatment.
6. A patient with major depressive disorder reports insomnia, decreased appetite,
weight loss, and low energy. Which antidepressant may be particularly useful
when increased appetite and weight gain would be therapeutically desirable?
A. Bupropion
B. Mirtazapine
C. Fluoxetine
D. Venlafaxine
Answer: B. Mirtazapine
Rationale: Mirtazapine commonly increases appetite and may promote weight
gain while also having sedating effects, particularly at lower doses. These
characteristics can be useful in selected patients with depression accompanied
by insomnia and reduced appetite.
7. A patient with schizophrenia has persistent auditory hallucinations despite
adequate trials of two different antipsychotics at therapeutic doses and
durations. What treatment should be considered?
A. Switch to an SSRI
B. Initiate clozapine
C. Discontinue antipsychotic treatment
D. Add a benzodiazepine as the sole treatment
Answer: B. Initiate clozapine
Practitioner (PMHNP-BC) Exam 2026–
2027 | 100-Question Advanced Practice
Exam | Questions & Answers with
Detailed Rationales | Complete Study
Guide
1. A 32-year-old patient with bipolar I disorder presents with decreased need for
sleep, pressured speech, grandiosity, and increasingly risky financial behavior. The
patient has been taking lithium inconsistently. Serum lithium is 0.3 mEq/L. Which
intervention is most appropriate?
A. Discontinue lithium and initiate an SSRI
B. Increase lithium toward a therapeutic concentration while assessing safety and
adherence
,C. Add a stimulant for impaired concentration
D. Initiate psychotherapy alone
Answer: B. Increase lithium toward a therapeutic concentration while assessing
safety and adherence
Rationale: The presentation is consistent with an acute manic episode, and the
subtherapeutic lithium concentration suggests inadequate exposure. Treatment
should include optimization of an evidence-based mood stabilizer while
assessing adherence, renal and thyroid function, hydration, drug interactions,
and immediate safety risks.
2. A patient taking clozapine develops fever, sore throat, and profound fatigue.
What is the priority action?
A. Reassure the patient that these are expected adverse effects
B. Increase the clozapine dose
C. Obtain an urgent CBC with absolute neutrophil count and evaluate for infection
D. Add benztropine
Answer: C. Obtain an urgent CBC with absolute neutrophil count and evaluate
for infection
Rationale: Clozapine can cause severe neutropenia. Fever and sore throat may
indicate a serious infection associated with neutropenia. Urgent assessment of
the absolute neutrophil count and medical evaluation are warranted.
3. A patient taking sertraline and linezolid develops agitation, diaphoresis,
hyperreflexia, inducible clonus, and temperature of 39.2°C. Which diagnosis is
most likely?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
,C. Anticholinergic toxicity
D. Malignant catatonia
Answer: B. Serotonin syndrome
Rationale: Serotonin syndrome typically presents with autonomic instability,
gastrointestinal symptoms, agitation, hyperreflexia, clonus, and hyperthermia.
The combination of an SSRI and linezolid substantially increases serotonergic
toxicity risk.
4. A patient with schizophrenia receiving haloperidol develops severe muscular
rigidity, altered consciousness, diaphoresis, and a temperature of 40°C. Creatine
kinase is markedly elevated. What is the most likely diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Acute dystonia
D. Tardive dyskinesia
Answer: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is characterized by severe rigidity,
hyperthermia, autonomic instability, altered mental status, and often markedly
elevated creatine kinase. Immediate discontinuation of the offending
antipsychotic and urgent medical management are required.
5. A 68-year-old patient develops visual hallucinations, fluctuating cognition, REM
sleep behavior disorder, and marked sensitivity to antipsychotics. Which disorder
should be strongly considered?
A. Alzheimer disease
B. Dementia with Lewy bodies
C. Frontotemporal dementia
D. Vascular dementia
, Answer: B. Dementia with Lewy bodies
Rationale: Fluctuating cognition, recurrent visual hallucinations, REM sleep
behavior disorder, and parkinsonian features are characteristic of dementia
with Lewy bodies. Antipsychotic sensitivity is particularly important when
considering treatment.
6. A patient with major depressive disorder reports insomnia, decreased appetite,
weight loss, and low energy. Which antidepressant may be particularly useful
when increased appetite and weight gain would be therapeutically desirable?
A. Bupropion
B. Mirtazapine
C. Fluoxetine
D. Venlafaxine
Answer: B. Mirtazapine
Rationale: Mirtazapine commonly increases appetite and may promote weight
gain while also having sedating effects, particularly at lower doses. These
characteristics can be useful in selected patients with depression accompanied
by insomnia and reduced appetite.
7. A patient with schizophrenia has persistent auditory hallucinations despite
adequate trials of two different antipsychotics at therapeutic doses and
durations. What treatment should be considered?
A. Switch to an SSRI
B. Initiate clozapine
C. Discontinue antipsychotic treatment
D. Add a benzodiazepine as the sole treatment
Answer: B. Initiate clozapine
