PMHNP-BC Certification
Examination. 150 Advanced
Practice Questions Across the Five
ANCC Domains — A
Comprehensive Board Review for
Psychiatric-Mental Health Nurse
Practitioners.
Question % of
Section Domain
Range Exam
Q1–Q33 22%
Q34–Q74 27%
Q75–Q108 22%
, Question % of
Section Domain
Range Exam
Q109–Q125 11%
Q126–Q150 17%
Neuroanatomy, neurophysiology, pathophysiology, psychopharmacology,
pharmacokinetics, pharmacodynamics, genetics, epidemiology, research methodology, and
evidence-based practice.
A PMHNP is reviewing the mechanism of action of a newly prescribed atypical
antipsychotic. Which receptor profile is most strongly associated with the drug's efficacy in
treating positive symptoms of schizophrenia?
A) Selective serotonin reuptake inhibition
B) Dopamine D2 receptor antagonism in mesolimbic pathways
C) GABA-A receptor potentiation
D) Norepinephrine reuptake inhibition
Positive symptoms of schizophrenia are primarily mediated by
hyperdopaminergic activity in the mesolimbic pathway. D2 receptor antagonism in this region is
the cornerstone of antipsychotic efficacy for positive symptoms. SSRIs, GABA-A potentiators,
and NRIs do not directly target the mesolimbic dopamine system.
, A patient on clozapine presents with fever, tachycardia, and a creatine kinase level of
1,800 U/L. What is the most likely diagnosis?
A) Serotonin syndrome
B) Neuroleptic-induced catatonia
C) Neuroleptic malignant syndrome (NMS)
D) Acute dystonic reaction
The triad of fever, autonomic instability (tachycardia), and elevated CK strongly
suggests NMS. Clozapine carries a boxed warning for NMS. Serotonin syndrome typically
presents with clonus and hyperreflexia; dystonia involves muscle spasms without systemic
features.
Which cytochrome P450 enzyme is primarily responsible for the metabolism of
fluoxetine?
A) CYP2D6
B) CYP3A4
C) CYP1A2
D) CYP2C19
Fluoxetine is a potent inhibitor and substrate of CYP2D6. This is clinically
significant because many psychiatric medications (e.g., risperidone, atomoxetine, metoprolol)
are also CYP2D6 substrates, leading to potential drug–drug interactions.
A patient with bipolar I disorder is being initiated on lamotrigine. Which titration
strategy minimizes the risk of Stevens-Johnson syndrome?
A) Start at 100 mg/day and increase by 100 mg every 3 days
B) Start at 25 mg/day and increase by 25 mg every 2 weeks
C) Start at 50 mg/day and increase by 50 mg weekly
D) Start at 200 mg/day and decrease if rash appears
, The risk of serious rash is dose-dependent and titration-dependent. The
recommended starting dose is 25 mg/day (or 12.5 mg/day if on valproate), with slow titration
over 4–6 weeks. Rapid titration significantly increases the risk of Stevens-Johnson
syndrome/toxic epidermal necrolysis.
A 28-year-old female of childbearing age is prescribed valproate for bipolar disorder.
Which is the most critical counseling point?
A) Valproate is safe during pregnancy
B) Valproate may reduce the efficacy of oral contraceptives
C) Valproate requires monitoring of thyroid function
D) Valproate is associated with neural tube defects and should be avoided in pregnancy
Valproate is a known teratogen associated with neural tube defects (spina bifida),
craniofacial anomalies, and reduced IQ in offspring. It is contraindicated in pregnancy unless
there is no alternative. Effective contraception is essential.
Which brain region is most implicated in the pathophysiology of obsessive-compulsive
disorder (OCD)?
A) Amygdala
B) Hippocampus
C) Orbitofrontal cortex–caudate–thalamic circuit
D) Dorsolateral prefrontal cortex
OCD is associated with hyperactivity in the cortico-striato-thalamo-cortical (CSTC)
circuit, specifically involving the orbitofrontal cortex, caudate nucleus, and thalamus. This circuit
mediates error detection, impulse control, and habit formation.
A patient taking lithium reports increased thirst and urination. Which laboratory value
should the PMHNP monitor most closely?
Examination. 150 Advanced
Practice Questions Across the Five
ANCC Domains — A
Comprehensive Board Review for
Psychiatric-Mental Health Nurse
Practitioners.
Question % of
Section Domain
Range Exam
Q1–Q33 22%
Q34–Q74 27%
Q75–Q108 22%
, Question % of
Section Domain
Range Exam
Q109–Q125 11%
Q126–Q150 17%
Neuroanatomy, neurophysiology, pathophysiology, psychopharmacology,
pharmacokinetics, pharmacodynamics, genetics, epidemiology, research methodology, and
evidence-based practice.
A PMHNP is reviewing the mechanism of action of a newly prescribed atypical
antipsychotic. Which receptor profile is most strongly associated with the drug's efficacy in
treating positive symptoms of schizophrenia?
A) Selective serotonin reuptake inhibition
B) Dopamine D2 receptor antagonism in mesolimbic pathways
C) GABA-A receptor potentiation
D) Norepinephrine reuptake inhibition
Positive symptoms of schizophrenia are primarily mediated by
hyperdopaminergic activity in the mesolimbic pathway. D2 receptor antagonism in this region is
the cornerstone of antipsychotic efficacy for positive symptoms. SSRIs, GABA-A potentiators,
and NRIs do not directly target the mesolimbic dopamine system.
, A patient on clozapine presents with fever, tachycardia, and a creatine kinase level of
1,800 U/L. What is the most likely diagnosis?
A) Serotonin syndrome
B) Neuroleptic-induced catatonia
C) Neuroleptic malignant syndrome (NMS)
D) Acute dystonic reaction
The triad of fever, autonomic instability (tachycardia), and elevated CK strongly
suggests NMS. Clozapine carries a boxed warning for NMS. Serotonin syndrome typically
presents with clonus and hyperreflexia; dystonia involves muscle spasms without systemic
features.
Which cytochrome P450 enzyme is primarily responsible for the metabolism of
fluoxetine?
A) CYP2D6
B) CYP3A4
C) CYP1A2
D) CYP2C19
Fluoxetine is a potent inhibitor and substrate of CYP2D6. This is clinically
significant because many psychiatric medications (e.g., risperidone, atomoxetine, metoprolol)
are also CYP2D6 substrates, leading to potential drug–drug interactions.
A patient with bipolar I disorder is being initiated on lamotrigine. Which titration
strategy minimizes the risk of Stevens-Johnson syndrome?
A) Start at 100 mg/day and increase by 100 mg every 3 days
B) Start at 25 mg/day and increase by 25 mg every 2 weeks
C) Start at 50 mg/day and increase by 50 mg weekly
D) Start at 200 mg/day and decrease if rash appears
, The risk of serious rash is dose-dependent and titration-dependent. The
recommended starting dose is 25 mg/day (or 12.5 mg/day if on valproate), with slow titration
over 4–6 weeks. Rapid titration significantly increases the risk of Stevens-Johnson
syndrome/toxic epidermal necrolysis.
A 28-year-old female of childbearing age is prescribed valproate for bipolar disorder.
Which is the most critical counseling point?
A) Valproate is safe during pregnancy
B) Valproate may reduce the efficacy of oral contraceptives
C) Valproate requires monitoring of thyroid function
D) Valproate is associated with neural tube defects and should be avoided in pregnancy
Valproate is a known teratogen associated with neural tube defects (spina bifida),
craniofacial anomalies, and reduced IQ in offspring. It is contraindicated in pregnancy unless
there is no alternative. Effective contraception is essential.
Which brain region is most implicated in the pathophysiology of obsessive-compulsive
disorder (OCD)?
A) Amygdala
B) Hippocampus
C) Orbitofrontal cortex–caudate–thalamic circuit
D) Dorsolateral prefrontal cortex
OCD is associated with hyperactivity in the cortico-striato-thalamo-cortical (CSTC)
circuit, specifically involving the orbitofrontal cortex, caudate nucleus, and thalamus. This circuit
mediates error detection, impulse control, and habit formation.
A patient taking lithium reports increased thirst and urination. Which laboratory value
should the PMHNP monitor most closely?
