NR 547 PMHNP MIDTERM ACTUAL EXAM REVIEW 2025”2026 150
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES COVERING
THE RECENT MOST TESTED QUESTIONS GUARANTEE OVER 80%
PASSMARK
1. A patient presents with restlessness, excessive worry, and muscle tension for 6 months.
Which is the most likely diagnosis?
☑ A. Generalized Anxiety Disorder
☐ B. Panic Disorder
☐ C. PTSD
☐ D. OCD
Rationale: GAD is characterized by persistent worry, physical tension, and difficulty controlling
anxiety for ≥6 months.
2. Which neurotransmitter is primarily involved in the pathophysiology of schizophrenia?
☑ A. Dopamine
☐ B. GABA
☐ C. Acetylcholine
☐ D. Serotonin
Rationale: Dopamine hyperactivity in the mesolimbic system contributes to positive psychotic
symptoms.
3. Which of the following antidepressants is most likely to cause sedation and weight gain?
☑ A. Mirtazapine
☐ B. Fluoxetine
☐ C. Bupropion
☐ D. Sertraline
Rationale: Mirtazapine blocks histamine receptors, causing sedation and increased appetite.
4. What is the black box warning for all antidepressants?
☑ A. Increased suicidal ideation in young adults
,☐ B. Liver toxicity
☐ C. Agranulocytosis
☐ D. Stevens-Johnson syndrome
Rationale: All antidepressants warn of an increased risk of suicidal thoughts in individuals under
25.
5. Which medication is most effective for treating manic episodes in bipolar I disorder?
☑ A. Lithium
☐ B. Sertraline
☐ C. Aripiprazole
☐ D. Lamotrigine
Rationale: Lithium is the gold-standard mood stabilizer for acute mania and maintenance.
6. What laboratory test is essential before starting clozapine?
☑ A. CBC with differential
☐ B. Liver function test
☐ C. Thyroid panel
☐ D. Lipid panel
Rationale: Clozapine may cause agranulocytosis; ANC monitoring is mandatory.
7. Which of the following therapies is most appropriate for borderline personality disorder?
☑ A. Dialectical Behavior Therapy (DBT)
☐ B. Cognitive-behavioral therapy (CBT)
☐ C. Psychoanalysis
☐ D. EMDR
Rationale: DBT focuses on mindfulness, distress tolerance, and emotional regulation—effective
for BPD.
8. Which medication is contraindicated in bulimia nervosa due to seizure risk?
☑ A. Bupropion
☐ B. Fluoxetine
☐ C. Paroxetine
☐ D. Sertraline
,Rationale: Bupropion lowers seizure threshold; contraindicated in eating disorders.
9. Which of the following symptoms differentiates bipolar disorder from major depressive
disorder?
☑ A. Presence of manic or hypomanic episodes
☐ B. Anhedonia
☐ C. Sleep disturbance
☐ D. Fatigue
Rationale: Mania/hypomania episodes are the hallmark of bipolar disorder.
10. A 45-year-old patient on sertraline develops confusion, hyperreflexia, and diaphoresis
after adding St. John’s Wort. What is the likely diagnosis?
☑ A. Serotonin Syndrome
☐ B. Neuroleptic Malignant Syndrome
☐ C. EPS
☐ D. Akathisia
Rationale: Combining serotonergic agents increases risk for serotonin syndrome.
11. Which of the following is the first-line treatment for PTSD?
☑ A. SSRIs (Sertraline or Paroxetine)
☐ B. Benzodiazepines
☐ C. Antipsychotics
☐ D. Beta-blockers
Rationale: SSRIs are first-line for PTSD core symptoms.
12. Which lab must be monitored in a patient on valproic acid?
☑ A. Liver function test
☐ B. TSH
☐ C. CBC only
☐ D. Renal function
Rationale: Valproic acid may cause hepatotoxicity; LFT monitoring is required.
, 13. Which of the following describes akathisia?
☑ A. Inner restlessness and inability to sit still
☐ B. Muscle rigidity
☐ C. Tardive dyskinesia
☐ D. Sedation
Rationale: Akathisia is a movement disorder often caused by antipsychotics.
14. Which antipsychotic has the lowest risk of metabolic syndrome?
☑ A. Ziprasidone
☐ B. Clozapine
☐ C. Olanzapine
☐ D. Quetiapine
Rationale: Ziprasidone is weight-neutral with minimal metabolic effects.
15. Which therapy focuses on cognitive restructuring to change negative thought patterns?
☑ A. Cognitive-Behavioral Therapy (CBT)
☐ B. DBT
☐ C. EMDR
☐ D. Exposure Therapy
Rationale: CBT helps identify and replace distorted thinking with adaptive beliefs.
16. Which symptom is most associated with panic disorder?
☑ A. Sudden, intense fear with physical symptoms
☐ B. Persistent low mood
☐ C. Flashbacks
☐ D. Social withdrawal
Rationale: Panic disorder involves unexpected panic attacks and physical symptoms like
palpitations.
17. What lab should be monitored for lithium therapy?
☑ A. Renal function and thyroid panel
☐ B. LFT only
QUESTIONS AND CORRECT ANSWERS WITH RATIONALES COVERING
THE RECENT MOST TESTED QUESTIONS GUARANTEE OVER 80%
PASSMARK
1. A patient presents with restlessness, excessive worry, and muscle tension for 6 months.
Which is the most likely diagnosis?
☑ A. Generalized Anxiety Disorder
☐ B. Panic Disorder
☐ C. PTSD
☐ D. OCD
Rationale: GAD is characterized by persistent worry, physical tension, and difficulty controlling
anxiety for ≥6 months.
2. Which neurotransmitter is primarily involved in the pathophysiology of schizophrenia?
☑ A. Dopamine
☐ B. GABA
☐ C. Acetylcholine
☐ D. Serotonin
Rationale: Dopamine hyperactivity in the mesolimbic system contributes to positive psychotic
symptoms.
3. Which of the following antidepressants is most likely to cause sedation and weight gain?
☑ A. Mirtazapine
☐ B. Fluoxetine
☐ C. Bupropion
☐ D. Sertraline
Rationale: Mirtazapine blocks histamine receptors, causing sedation and increased appetite.
4. What is the black box warning for all antidepressants?
☑ A. Increased suicidal ideation in young adults
,☐ B. Liver toxicity
☐ C. Agranulocytosis
☐ D. Stevens-Johnson syndrome
Rationale: All antidepressants warn of an increased risk of suicidal thoughts in individuals under
25.
5. Which medication is most effective for treating manic episodes in bipolar I disorder?
☑ A. Lithium
☐ B. Sertraline
☐ C. Aripiprazole
☐ D. Lamotrigine
Rationale: Lithium is the gold-standard mood stabilizer for acute mania and maintenance.
6. What laboratory test is essential before starting clozapine?
☑ A. CBC with differential
☐ B. Liver function test
☐ C. Thyroid panel
☐ D. Lipid panel
Rationale: Clozapine may cause agranulocytosis; ANC monitoring is mandatory.
7. Which of the following therapies is most appropriate for borderline personality disorder?
☑ A. Dialectical Behavior Therapy (DBT)
☐ B. Cognitive-behavioral therapy (CBT)
☐ C. Psychoanalysis
☐ D. EMDR
Rationale: DBT focuses on mindfulness, distress tolerance, and emotional regulation—effective
for BPD.
8. Which medication is contraindicated in bulimia nervosa due to seizure risk?
☑ A. Bupropion
☐ B. Fluoxetine
☐ C. Paroxetine
☐ D. Sertraline
,Rationale: Bupropion lowers seizure threshold; contraindicated in eating disorders.
9. Which of the following symptoms differentiates bipolar disorder from major depressive
disorder?
☑ A. Presence of manic or hypomanic episodes
☐ B. Anhedonia
☐ C. Sleep disturbance
☐ D. Fatigue
Rationale: Mania/hypomania episodes are the hallmark of bipolar disorder.
10. A 45-year-old patient on sertraline develops confusion, hyperreflexia, and diaphoresis
after adding St. John’s Wort. What is the likely diagnosis?
☑ A. Serotonin Syndrome
☐ B. Neuroleptic Malignant Syndrome
☐ C. EPS
☐ D. Akathisia
Rationale: Combining serotonergic agents increases risk for serotonin syndrome.
11. Which of the following is the first-line treatment for PTSD?
☑ A. SSRIs (Sertraline or Paroxetine)
☐ B. Benzodiazepines
☐ C. Antipsychotics
☐ D. Beta-blockers
Rationale: SSRIs are first-line for PTSD core symptoms.
12. Which lab must be monitored in a patient on valproic acid?
☑ A. Liver function test
☐ B. TSH
☐ C. CBC only
☐ D. Renal function
Rationale: Valproic acid may cause hepatotoxicity; LFT monitoring is required.
, 13. Which of the following describes akathisia?
☑ A. Inner restlessness and inability to sit still
☐ B. Muscle rigidity
☐ C. Tardive dyskinesia
☐ D. Sedation
Rationale: Akathisia is a movement disorder often caused by antipsychotics.
14. Which antipsychotic has the lowest risk of metabolic syndrome?
☑ A. Ziprasidone
☐ B. Clozapine
☐ C. Olanzapine
☐ D. Quetiapine
Rationale: Ziprasidone is weight-neutral with minimal metabolic effects.
15. Which therapy focuses on cognitive restructuring to change negative thought patterns?
☑ A. Cognitive-Behavioral Therapy (CBT)
☐ B. DBT
☐ C. EMDR
☐ D. Exposure Therapy
Rationale: CBT helps identify and replace distorted thinking with adaptive beliefs.
16. Which symptom is most associated with panic disorder?
☑ A. Sudden, intense fear with physical symptoms
☐ B. Persistent low mood
☐ C. Flashbacks
☐ D. Social withdrawal
Rationale: Panic disorder involves unexpected panic attacks and physical symptoms like
palpitations.
17. What lab should be monitored for lithium therapy?
☑ A. Renal function and thyroid panel
☐ B. LFT only
