GEORGETTE REVIEW PMHNP QUESTIONS AND
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026/2027 Q&A | INSTANT
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Core Domains
Neurobiology and Neurotransmitters
Psychopharmacology and Drug Interactions
Mood Stabilizers and Toxicity Monitoring
Antipsychotics and Metabolic Side Effects
Antidepressants and Mechanisms of Action
Anxiety Disorders and Treatment
Bipolar Disorder and Mood Stabilizers
Schizophrenia and Psychotic Disorders
Therapeutic Modalities and Psychotherapy
Ethics, Legal Principles, and Scope of Practice
Introduction
The Georgette Review PMHNP exam assesses the advanced clinical knowledge and decision-making skills
required for psychiatric-mental health nurse practitioner certification. This examination evaluates
neurobiology, psychopharmacology, mood stabilizers, antipsychotics, antidepressants, anxiety disorders,
bipolar disorder, schizophrenia, and therapeutic modalities. Questions are structured in multiple-choice
and scenario-based formats emphasizing real-world application, critical thinking, and evidence-based
management. Candidates must demonstrate competency in medication management, toxicity
monitoring, differential diagnosis, and ethical decision-making consistent with ANCC and AANPCB
certification blueprints.
SECTION ONE: QUESTIONS 1–100
Question 1
Where is norepinephrine primarily produced in the brain?
A. Raphe nuclei
B. Substantia nigra
C. Locus coeruleus
D. Basal nucleus of Meynert
C. Locus coeruleus
, RATIONALE: Norepinephrine is primarily synthesized in the locus coeruleus located in the pons. It
projects throughout the CNS and is associated with arousal, attention, and stress response. Serotonin is
produced in the raphe nuclei, dopamine in the substantia nigra and ventral tegmental area, and
acetylcholine in the basal forebrain .
Question 2
The amygdala is primarily responsible for:
A. Memory formation
B. Emotional processing and fear responses
C. Executive function and impulse control
D. Sensory relay
B. Emotional processing and fear responses
RATIONALE: The amygdala, a limbic structure, is central to processing emotions, particularly fear and
anxiety. It evaluates the emotional significance of stimuli and generates appropriate behavioral
responses. It is hyperactive in anxiety disorders and PTSD. The hippocampus is involved in memory; the
prefrontal cortex in executive function .
Question 3
Dopamine pathways involved in schizophrenia include all of the following EXCEPT:
A. Mesolimbic (positive symptoms)
B. Mesocortical (negative/cognitive symptoms)
C. Nigrostriatal (EPS)
D. Raphe-striatal
D. Raphe-striatal
RATIONALE: The raphe nuclei are the primary source of serotonin, not dopamine. The main
dopamine pathways are: mesolimbic (VTA to nucleus accumbens, reward, positive symptoms),
mesocortical (VTA to prefrontal cortex, cognition, negative symptoms), nigrostriatal (substantia nigra to
striatum, motor control, EPS), and tuberoinfundibular (hypothalamus to pituitary, prolactin regulation) .
Question 4
GABA is the primary __________ neurotransmitter in the brain.
A. Excitatory
B. Inhibitory
C. Modulatory
D. Synthetic
B. Inhibitory
RATIONALE: GABA (gamma-aminobutyric acid) is the most abundant inhibitory neurotransmitter in
the CNS. It reduces neuronal excitability and is the target of benzodiazepines and barbiturates, which
,enhance GABA's effects to produce sedation, anxiolysis, and anticonvulsant effects. Low GABA activity is
associated with anxiety disorders, insomnia, and seizures .
Question 5
Glutamate is the primary __________ neurotransmitter in the brain.
A. Inhibitory
B. Excitatory
C. Modulatory
D. Synthetic
B. Excitatory
RATIONALE: Glutamate is the most abundant excitatory neurotransmitter in the CNS. It is involved in
synaptic plasticity, learning, memory, and neural development. Excessive glutamate activity can cause
excitotoxicity, implicated in neurodegenerative disorders and stroke. NMDA receptor antagonists (e.g.,
ketamine) have rapid antidepressant effects by modulating glutamate .
Question 6
Which cytochrome P450 enzyme is induced by tobacco smoke and metabolizes clozapine and
olanzapine?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C19
C. CYP1A2
RATIONALE: CYP1A2 is induced by polycyclic aromatic hydrocarbons in cigarette smoke. It is the
primary enzyme for clozapine and olanzapine metabolism. Smokers require higher doses of these
medications. Fluvoxamine, ciprofloxacin, and caffeine inhibit CYP1A2. This is a classic high-yield board
question .
Question 7
The mnemonic "CRAP GPS" represents drugs that are:
A. CYP inhibitors
B. CYP inducers
C. Highly protein-bound
D. Narrow therapeutic index
B. CYP inducers
RATIONALE: "CRAP GPS" is a mnemonic for CYP inducers: Carbamazepine, Rifampin, Alcohol
(chronic), Phenytoin, Griseofulvin, Phenobarbital, St. John's Wort. Inducers increase metabolism,
decreasing serum levels of substrate drugs .
, Question 8
The mnemonic "SICKFACES" represents drugs that are:
A. CYP inducers
B. CYP inhibitors
C. Highly protein-bound
D. Narrow therapeutic index
B. CYP inhibitors
RATIONALE: "SICKFACES" represents CYP inhibitors: Sodium valproate, Isoniazid, Cimetidine,
Ketoconazole, Fluconazole, Alcohol (acute), Chloramphenicol, Erythromycin, Sulfonamide, Ciprofloxacin,
Omeprazole, Metronidazole. Inhibitors increase serum levels of substrate drugs .
Question 9
Intervention for Depakote toxicity includes:
A. Administer naloxone
B. Discontinue the medication
C. Administer flumazenil
D. Increase the dose
B. Discontinue the medication
RATIONALE: Depakote (divalproex sodium) toxicity presents with disorientation, lethargy,
respiratory depression, nausea/vomiting. The primary intervention is discontinuation of the medication.
Supportive care may be required .
Question 10
MAOI plus tyramine causes:
A. Serotonin syndrome
B. Hypertensive crisis
C. Neuroleptic malignant syndrome
D. Tardive dyskinesia
B. Hypertensive crisis
RATIONALE: MAOIs prevent the breakdown of tyramine, leading to excessive norepinephrine release
and hypertensive crisis. Symptoms include elevated BP, sudden explosive headache, facial flushing,
palpitations, pupillary dilation, diaphoresis, and fever .
Question 11
Treatment for hypertensive crisis includes:
A. Administer naloxone
B. Administer phentolamine
CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026/2027 Q&A | INSTANT
DOWNLOAD PDF
Core Domains
Neurobiology and Neurotransmitters
Psychopharmacology and Drug Interactions
Mood Stabilizers and Toxicity Monitoring
Antipsychotics and Metabolic Side Effects
Antidepressants and Mechanisms of Action
Anxiety Disorders and Treatment
Bipolar Disorder and Mood Stabilizers
Schizophrenia and Psychotic Disorders
Therapeutic Modalities and Psychotherapy
Ethics, Legal Principles, and Scope of Practice
Introduction
The Georgette Review PMHNP exam assesses the advanced clinical knowledge and decision-making skills
required for psychiatric-mental health nurse practitioner certification. This examination evaluates
neurobiology, psychopharmacology, mood stabilizers, antipsychotics, antidepressants, anxiety disorders,
bipolar disorder, schizophrenia, and therapeutic modalities. Questions are structured in multiple-choice
and scenario-based formats emphasizing real-world application, critical thinking, and evidence-based
management. Candidates must demonstrate competency in medication management, toxicity
monitoring, differential diagnosis, and ethical decision-making consistent with ANCC and AANPCB
certification blueprints.
SECTION ONE: QUESTIONS 1–100
Question 1
Where is norepinephrine primarily produced in the brain?
A. Raphe nuclei
B. Substantia nigra
C. Locus coeruleus
D. Basal nucleus of Meynert
C. Locus coeruleus
, RATIONALE: Norepinephrine is primarily synthesized in the locus coeruleus located in the pons. It
projects throughout the CNS and is associated with arousal, attention, and stress response. Serotonin is
produced in the raphe nuclei, dopamine in the substantia nigra and ventral tegmental area, and
acetylcholine in the basal forebrain .
Question 2
The amygdala is primarily responsible for:
A. Memory formation
B. Emotional processing and fear responses
C. Executive function and impulse control
D. Sensory relay
B. Emotional processing and fear responses
RATIONALE: The amygdala, a limbic structure, is central to processing emotions, particularly fear and
anxiety. It evaluates the emotional significance of stimuli and generates appropriate behavioral
responses. It is hyperactive in anxiety disorders and PTSD. The hippocampus is involved in memory; the
prefrontal cortex in executive function .
Question 3
Dopamine pathways involved in schizophrenia include all of the following EXCEPT:
A. Mesolimbic (positive symptoms)
B. Mesocortical (negative/cognitive symptoms)
C. Nigrostriatal (EPS)
D. Raphe-striatal
D. Raphe-striatal
RATIONALE: The raphe nuclei are the primary source of serotonin, not dopamine. The main
dopamine pathways are: mesolimbic (VTA to nucleus accumbens, reward, positive symptoms),
mesocortical (VTA to prefrontal cortex, cognition, negative symptoms), nigrostriatal (substantia nigra to
striatum, motor control, EPS), and tuberoinfundibular (hypothalamus to pituitary, prolactin regulation) .
Question 4
GABA is the primary __________ neurotransmitter in the brain.
A. Excitatory
B. Inhibitory
C. Modulatory
D. Synthetic
B. Inhibitory
RATIONALE: GABA (gamma-aminobutyric acid) is the most abundant inhibitory neurotransmitter in
the CNS. It reduces neuronal excitability and is the target of benzodiazepines and barbiturates, which
,enhance GABA's effects to produce sedation, anxiolysis, and anticonvulsant effects. Low GABA activity is
associated with anxiety disorders, insomnia, and seizures .
Question 5
Glutamate is the primary __________ neurotransmitter in the brain.
A. Inhibitory
B. Excitatory
C. Modulatory
D. Synthetic
B. Excitatory
RATIONALE: Glutamate is the most abundant excitatory neurotransmitter in the CNS. It is involved in
synaptic plasticity, learning, memory, and neural development. Excessive glutamate activity can cause
excitotoxicity, implicated in neurodegenerative disorders and stroke. NMDA receptor antagonists (e.g.,
ketamine) have rapid antidepressant effects by modulating glutamate .
Question 6
Which cytochrome P450 enzyme is induced by tobacco smoke and metabolizes clozapine and
olanzapine?
A. CYP2D6
B. CYP3A4
C. CYP1A2
D. CYP2C19
C. CYP1A2
RATIONALE: CYP1A2 is induced by polycyclic aromatic hydrocarbons in cigarette smoke. It is the
primary enzyme for clozapine and olanzapine metabolism. Smokers require higher doses of these
medications. Fluvoxamine, ciprofloxacin, and caffeine inhibit CYP1A2. This is a classic high-yield board
question .
Question 7
The mnemonic "CRAP GPS" represents drugs that are:
A. CYP inhibitors
B. CYP inducers
C. Highly protein-bound
D. Narrow therapeutic index
B. CYP inducers
RATIONALE: "CRAP GPS" is a mnemonic for CYP inducers: Carbamazepine, Rifampin, Alcohol
(chronic), Phenytoin, Griseofulvin, Phenobarbital, St. John's Wort. Inducers increase metabolism,
decreasing serum levels of substrate drugs .
, Question 8
The mnemonic "SICKFACES" represents drugs that are:
A. CYP inducers
B. CYP inhibitors
C. Highly protein-bound
D. Narrow therapeutic index
B. CYP inhibitors
RATIONALE: "SICKFACES" represents CYP inhibitors: Sodium valproate, Isoniazid, Cimetidine,
Ketoconazole, Fluconazole, Alcohol (acute), Chloramphenicol, Erythromycin, Sulfonamide, Ciprofloxacin,
Omeprazole, Metronidazole. Inhibitors increase serum levels of substrate drugs .
Question 9
Intervention for Depakote toxicity includes:
A. Administer naloxone
B. Discontinue the medication
C. Administer flumazenil
D. Increase the dose
B. Discontinue the medication
RATIONALE: Depakote (divalproex sodium) toxicity presents with disorientation, lethargy,
respiratory depression, nausea/vomiting. The primary intervention is discontinuation of the medication.
Supportive care may be required .
Question 10
MAOI plus tyramine causes:
A. Serotonin syndrome
B. Hypertensive crisis
C. Neuroleptic malignant syndrome
D. Tardive dyskinesia
B. Hypertensive crisis
RATIONALE: MAOIs prevent the breakdown of tyramine, leading to excessive norepinephrine release
and hypertensive crisis. Symptoms include elevated BP, sudden explosive headache, facial flushing,
palpitations, pupillary dilation, diaphoresis, and fever .
Question 11
Treatment for hypertensive crisis includes:
A. Administer naloxone
B. Administer phentolamine
