PMHNP BOARD CERTIFICATION
PRACTICE EXAM QUESTIONS AND
VERIFIED ANSWERS |GRADE A+| JUST
RELEASED
1. Which dopamine pathway is hypothesized to be responsible for the negative symptoms
and cognitive deficits associated with schizophrenia due to a state of hypodopaminergia?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: The mesocortical pathway is thought to be underactive
(hypodopaminergic) in schizophrenia, leading to negative symptoms such as alogia,
avolition, and cognitive impairment. In contrast, the mesolimbic pathway is overactive,
leading to positive symptoms.
2. A 24-year-old patient of Asian descent is being considered for Carbamazepine therapy for
bipolar disorder. Which genetic screening is mandatory before initiation due to the risk of
Stevens-Johnson Syndrome?
A. CYP2D6
,B. HLA-A*3101
C. MTHFR C677T
D. HLA-B*1502
Answer: D
Conceptual Explanation: The FDA recommends screening for the HLA-B*1502 allele in
patients of Asian descent before starting Carbamazepine, as it is highly associated with the
development of life-threatening Stevens-Johnson Syndrome and Toxic Epidermal
Necrolysis.
3. A patient taking Clozapine presents with a fever, sore throat, and an Absolute Neutrophil
Count (ANC) of 800/mm³. What is the most appropriate immediate action?
A. Continue the medication and recheck ANC in one week.
B. Discontinue Clozapine immediately and monitor daily ANCs.
C. Reduce the dose by 50%.
D. Switch to a second-generation antipsychotic like Olanzapine.
Answer: B
Conceptual Explanation: An ANC below 1000/mm³ constitutes severe neutropenia
(agranulocytosis risk). Clozapine must be discontinued immediately, and the patient must
be monitored closely for infection and daily blood counts.
, 4. Which neuroanatomical structure is primarily responsible for the ‘fear response’ and is
often overactive in patients with Panic Disorder?
A. Hippocampus
B. Basal Ganglia
C. Amygdala
D. Prefrontal Cortex
Answer: C
Conceptual Explanation: The amygdala is the core of the brain’s fear circuitry, processing
emotions and triggering the ‘fight or flight’ response. Hyperactivity here is linked to anxiety
and panic disorders.
5. A patient with a history of heart failure is prescribed Lithium. Which of the following
electrolyte imbalances would most likely increase the risk of Lithium toxicity?
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hyponatremia
Answer: D
PRACTICE EXAM QUESTIONS AND
VERIFIED ANSWERS |GRADE A+| JUST
RELEASED
1. Which dopamine pathway is hypothesized to be responsible for the negative symptoms
and cognitive deficits associated with schizophrenia due to a state of hypodopaminergia?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: The mesocortical pathway is thought to be underactive
(hypodopaminergic) in schizophrenia, leading to negative symptoms such as alogia,
avolition, and cognitive impairment. In contrast, the mesolimbic pathway is overactive,
leading to positive symptoms.
2. A 24-year-old patient of Asian descent is being considered for Carbamazepine therapy for
bipolar disorder. Which genetic screening is mandatory before initiation due to the risk of
Stevens-Johnson Syndrome?
A. CYP2D6
,B. HLA-A*3101
C. MTHFR C677T
D. HLA-B*1502
Answer: D
Conceptual Explanation: The FDA recommends screening for the HLA-B*1502 allele in
patients of Asian descent before starting Carbamazepine, as it is highly associated with the
development of life-threatening Stevens-Johnson Syndrome and Toxic Epidermal
Necrolysis.
3. A patient taking Clozapine presents with a fever, sore throat, and an Absolute Neutrophil
Count (ANC) of 800/mm³. What is the most appropriate immediate action?
A. Continue the medication and recheck ANC in one week.
B. Discontinue Clozapine immediately and monitor daily ANCs.
C. Reduce the dose by 50%.
D. Switch to a second-generation antipsychotic like Olanzapine.
Answer: B
Conceptual Explanation: An ANC below 1000/mm³ constitutes severe neutropenia
(agranulocytosis risk). Clozapine must be discontinued immediately, and the patient must
be monitored closely for infection and daily blood counts.
, 4. Which neuroanatomical structure is primarily responsible for the ‘fear response’ and is
often overactive in patients with Panic Disorder?
A. Hippocampus
B. Basal Ganglia
C. Amygdala
D. Prefrontal Cortex
Answer: C
Conceptual Explanation: The amygdala is the core of the brain’s fear circuitry, processing
emotions and triggering the ‘fight or flight’ response. Hyperactivity here is linked to anxiety
and panic disorders.
5. A patient with a history of heart failure is prescribed Lithium. Which of the following
electrolyte imbalances would most likely increase the risk of Lithium toxicity?
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hyponatremia
Answer: D
