LMR Georgette PMHNP Board Exam
Review (2026/2027) PDF | Full Study
Guide & Practice Questions with Detailed
Rationales | Latest ANCC Blueprint
Compliant
Question 1
A 28-year-old patient reports two weeks of depressed mood, anhedonia, fatigue,
insomnia, impaired concentration, and feelings of worthlessness. The patient
denies mania, psychosis, and substance use. Which diagnosis is most appropriate?
A. Persistent depressive disorder
B. Major depressive disorder
C. Cyclothymic disorder
D. Adjustment disorder
Answer: B. Major depressive disorder
Rationale: A major depressive episode requires at least five depressive symptoms
occurring during the same two-week period, including depressed mood or
anhedonia, with clinically significant impairment.
Question 2
Which neurotransmitter system is most directly associated with the therapeutic
mechanism of selective serotonin reuptake inhibitors (SSRIs)?
A. Dopamine
B. Gamma-aminobutyric acid
C. Serotonin
D. Acetylcholine
,Answer: C. Serotonin
Rationale: SSRIs inhibit serotonin reuptake at the presynaptic neuron, increasing
serotonin availability in the synaptic cleft.
Question 3
A patient taking sertraline develops agitation, diaphoresis, diarrhea, tremor,
hyperreflexia, and clonus. Which condition should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Tardive dyskinesia
Answer: B. Serotonin syndrome
Rationale: Serotonin syndrome is characterized by autonomic instability,
gastrointestinal symptoms, altered mental status, hyperreflexia, clonus, and
neuromuscular excitation.
Question 4
Which finding is most characteristic of bipolar I disorder?
A. Recurrent hypomanic episodes only
B. At least one manic episode
C. Depressive symptoms lasting one year
D. Mood changes caused exclusively by substances
Answer: B. At least one manic episode
Rationale: Bipolar I disorder requires at least one manic episode. Major
depressive episodes commonly occur but are not required for the diagnosis.
Question 5
A patient with bipolar disorder develops four days of elevated mood, increased
energy, decreased need for sleep, and increased productivity without marked
impairment or hospitalization. Which condition is most consistent with these
findings?
,A. Mania
B. Hypomania
C. Cyclothymia
D. Major depression
Answer: B. Hypomania
Rationale: Hypomania is a distinct period of elevated, expansive, or irritable mood
lasting at least four days without the marked functional impairment characteristic
of mania.
Question 6
Which medication is commonly considered a first-line treatment for acute mania?
A. Lithium
B. Buspirone
C. Escitalopram monotherapy
D. Trazodone
Answer: A. Lithium
Rationale: Lithium is an established mood stabilizer used in the treatment of acute
mania and maintenance treatment of bipolar disorder.
Question 7
A patient taking lithium develops coarse tremor, severe diarrhea, vomiting,
confusion, and ataxia. What is the priority action?
A. Give the next lithium dose with food
B. Increase the lithium dose
C. Hold lithium and obtain urgent medical evaluation
D. Add an SSRI
Answer: C. Hold lithium and obtain urgent medical evaluation
Rationale: Severe gastrointestinal symptoms, neurologic changes, tremor, and
ataxia can indicate lithium toxicity, which requires prompt evaluation and serum
lithium measurement.
, Question 8
Which factor can increase lithium levels and contribute to toxicity?
A. Increased sodium intake
B. Dehydration
C. Increased fluid intake
D. High dietary fiber
Answer: B. Dehydration
Rationale: Dehydration can reduce renal clearance and increase lithium
concentrations. Patients should maintain consistent fluid and sodium intake.
Question 9
Which laboratory test is particularly important before and during lithium therapy?
A. Serum creatinine and thyroid function
B. Troponin only
C. Amylase only
D. Hemoglobin A1c only
Answer: A. Serum creatinine and thyroid function
Rationale: Lithium is renally eliminated and can affect thyroid function, so renal
and thyroid monitoring is important.
Question 10
A patient taking valproate reports severe abdominal pain, nausea, and vomiting.
Which serious adverse effect should be considered?
A. Pancreatitis
B. Agranulocytosis
C. Pulmonary fibrosis
D. Cataracts
Answer: A. Pancreatitis
Rationale: Valproate can rarely cause pancreatitis. Severe abdominal pain and
persistent vomiting warrant prompt evaluation.
Review (2026/2027) PDF | Full Study
Guide & Practice Questions with Detailed
Rationales | Latest ANCC Blueprint
Compliant
Question 1
A 28-year-old patient reports two weeks of depressed mood, anhedonia, fatigue,
insomnia, impaired concentration, and feelings of worthlessness. The patient
denies mania, psychosis, and substance use. Which diagnosis is most appropriate?
A. Persistent depressive disorder
B. Major depressive disorder
C. Cyclothymic disorder
D. Adjustment disorder
Answer: B. Major depressive disorder
Rationale: A major depressive episode requires at least five depressive symptoms
occurring during the same two-week period, including depressed mood or
anhedonia, with clinically significant impairment.
Question 2
Which neurotransmitter system is most directly associated with the therapeutic
mechanism of selective serotonin reuptake inhibitors (SSRIs)?
A. Dopamine
B. Gamma-aminobutyric acid
C. Serotonin
D. Acetylcholine
,Answer: C. Serotonin
Rationale: SSRIs inhibit serotonin reuptake at the presynaptic neuron, increasing
serotonin availability in the synaptic cleft.
Question 3
A patient taking sertraline develops agitation, diaphoresis, diarrhea, tremor,
hyperreflexia, and clonus. Which condition should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Tardive dyskinesia
Answer: B. Serotonin syndrome
Rationale: Serotonin syndrome is characterized by autonomic instability,
gastrointestinal symptoms, altered mental status, hyperreflexia, clonus, and
neuromuscular excitation.
Question 4
Which finding is most characteristic of bipolar I disorder?
A. Recurrent hypomanic episodes only
B. At least one manic episode
C. Depressive symptoms lasting one year
D. Mood changes caused exclusively by substances
Answer: B. At least one manic episode
Rationale: Bipolar I disorder requires at least one manic episode. Major
depressive episodes commonly occur but are not required for the diagnosis.
Question 5
A patient with bipolar disorder develops four days of elevated mood, increased
energy, decreased need for sleep, and increased productivity without marked
impairment or hospitalization. Which condition is most consistent with these
findings?
,A. Mania
B. Hypomania
C. Cyclothymia
D. Major depression
Answer: B. Hypomania
Rationale: Hypomania is a distinct period of elevated, expansive, or irritable mood
lasting at least four days without the marked functional impairment characteristic
of mania.
Question 6
Which medication is commonly considered a first-line treatment for acute mania?
A. Lithium
B. Buspirone
C. Escitalopram monotherapy
D. Trazodone
Answer: A. Lithium
Rationale: Lithium is an established mood stabilizer used in the treatment of acute
mania and maintenance treatment of bipolar disorder.
Question 7
A patient taking lithium develops coarse tremor, severe diarrhea, vomiting,
confusion, and ataxia. What is the priority action?
A. Give the next lithium dose with food
B. Increase the lithium dose
C. Hold lithium and obtain urgent medical evaluation
D. Add an SSRI
Answer: C. Hold lithium and obtain urgent medical evaluation
Rationale: Severe gastrointestinal symptoms, neurologic changes, tremor, and
ataxia can indicate lithium toxicity, which requires prompt evaluation and serum
lithium measurement.
, Question 8
Which factor can increase lithium levels and contribute to toxicity?
A. Increased sodium intake
B. Dehydration
C. Increased fluid intake
D. High dietary fiber
Answer: B. Dehydration
Rationale: Dehydration can reduce renal clearance and increase lithium
concentrations. Patients should maintain consistent fluid and sodium intake.
Question 9
Which laboratory test is particularly important before and during lithium therapy?
A. Serum creatinine and thyroid function
B. Troponin only
C. Amylase only
D. Hemoglobin A1c only
Answer: A. Serum creatinine and thyroid function
Rationale: Lithium is renally eliminated and can affect thyroid function, so renal
and thyroid monitoring is important.
Question 10
A patient taking valproate reports severe abdominal pain, nausea, and vomiting.
Which serious adverse effect should be considered?
A. Pancreatitis
B. Agranulocytosis
C. Pulmonary fibrosis
D. Cataracts
Answer: A. Pancreatitis
Rationale: Valproate can rarely cause pancreatitis. Severe abdominal pain and
persistent vomiting warrant prompt evaluation.
