PMHNP Mock Board Review (Fitzgerald) Exam STUDY GUIDE
2026 COMPLETE QUESTIONS WITH CORRECT DETAILED
ANSWERS || 100% GUARANTEED PASS <RECENT VERSION>
Sample: PMHNP Board Review - Core Concepts (10 Questions)
Topic: Assessment & Diagnosis
1. A 28-year-old female presents with a 3-week history of depressed mood, anhedonia, a 10-
pound weight loss, insomnia with early morning awakening, and poor concentration. She
denies suicidal ideation. Her medical workup is normal. What is the most
appropriate initial diagnosis?
• A. Adjustment Disorder with Depressed Mood
• B. Persistent Depressive Disorder (Dysthymia)
• C. Major Depressive Disorder, single episode
• D. Unspecified Depressive Disorder
Detailed Answer: The correct answer is C. This presentation meets DSM-5-TR criteria for
a Major Depressive Episode (MDE): ≥5 symptoms for ≥2 weeks, including either depressed
mood or anhedonia. She has depressed mood, anhedonia, significant weight loss, insomnia
(often with terminal insomnia in MDD), and psychomotor agitation. This constitutes her first
MDE. Adjustment Disorder (A) requires a identifiable stressor and symptoms that don't meet
full MDE criteria. Persistent Depressive Disorder (B) requires a depressed mood for most of the
day, for more days than not, for at least 2 years. While MDD can be superimposed on PDD, the
acute 3-week history points to a new MDE.
2. A 65-year-old male with hypertension presents with a sudden onset of fluctuating
confusion, visual hallucinations, and agitation over the past 48 hours. His wife reports he was
fine last week. What is the most urgent diagnostic consideration?
• A. Late-onset Schizophrenia
• B. Alzheimer's Disease
• C. Delirium
• D. Bipolar I Disorder, Manic Episode
,Detailed Answer: The correct answer is C. Delirium is a medical emergency
characterized by an acute onset (hours to days) of fluctuating disturbance in attention,
awareness, and cognition. The key clues are the sudden change and fluctuating course in an
older adult with a medical comorbidity (hypertension, which could be related to an underlying
cause like infection, metabolic issue, or stroke). Visual hallucinations are also more common in
delirium than in primary psychosis. Alzheimer's (B) has an insidious onset and progressive
course. Late-onset psychosis (A) is rare and would not present with this acute, fluctuating
confusion.
Topic: Psychopharmacology
3. Which of the following antidepressants carries the highest risk for pharmacokinetically
significant drug-drug interactions via cytochrome P450 inhibition?
• A. Sertraline
• B. Bupropion
• C. Fluoxetine
• D. Vilazodone
Detailed Answer: The correct answer is C. Fluoxetine and its active metabolite
norfluoxetine are potent inhibitors of multiple CYP450 enzymes, notably CYP2D6 and
CYP2C9/19. This can significantly increase levels of co-administered medications metabolized by
these pathways (e.g., TCAs, some antipsychotics, beta-blockers, warfarin). Sertraline (A) is a mild
inhibitor. Bupropion (B) is a moderate inhibitor of CYP2D6. Vilazodone (D) has minimal CYP450
inhibition. Understanding these interactions is critical for patient safety.
4. A patient stabilized on Lithium 600mg BID for Bipolar I Disorder presents with new-onset
coarse hand tremor, nausea, and lethargy. Their lithium level last month was 0.9 mEq/L. What
is the most appropriate immediate action?
• A. Order a STAT lithium level and assess for signs of toxicity.
• B. Reduce the lithium dose by 300 mg/day.
• C. Prescribe propranolol for the tremor.
• D. Reassure the patient that these are benign side effects.
Detailed Answer: The correct answer is A. The symptoms described (coarse tremor, GI
upset, lethargy) are classic for lithium toxicity, even if a previous level was therapeutic. Toxicity
can be caused by dehydration, new medications (e.g., NSAIDs, ACE inhibitors), or renal changes.
,The immediate action is to obtain a STAT serum lithium level and perform a full clinical
assessment (including hydration status, electrolytes, and renal function). Adjusting the dose (B)
or treating a side effect (C) without confirming the level is dangerous, as toxicity can progress to
seizures, coma, and death.
Topic: Psychotherapy & Modalities
5. A patient with Borderline Personality Disorder (BPD) who frequently engages in self-harm
during interpersonal conflicts would benefit MOST from which evidence-based
psychotherapy?
• A. Cognitive Behavioral Therapy (CBT)
• B. Dialectical Behavior Therapy (DBT)
• C. Supportive Psychotherapy
• D. Psychodynamic Psychotherapy
Detailed Answer: The correct answer is B. Dialectical Behavior Therapy (DBT) is
the gold-standard, evidence-based treatment for BPD, specifically designed to address
emotional dysregulation, impulsivity, and self-harming behaviors. Its core modules
(mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) directly target
the patient's presenting problems. While CBT (A) and other modalities can be helpful, DBT has
the most robust empirical support for reducing self-harm and suicide attempts in this
population.
Topic: Special Populations
6. What is the first-line pharmacotherapy for ADHD in a healthy 8-year-old child, according to
most current guidelines?
• A. Atomoxetine
• B. Guanfacine XR
• C. Mixed Amphetamine Salts
• D. Methylphenidate-based stimulants
Detailed Answer: The correct answer is D. Stimulant medications, specifically
methylphenidate-based formulations, are consistently supported as first-line
pharmacotherapy for ADHD in school-aged children due to their superior efficacy and well-
established safety profile. The choice between methylphenidate and amphetamine-based (C)
products is often based on individual response and tolerability, but methylphenidate is
, frequently tried first. Alpha-2 agonists (B) and atomoxetine (A) are considered second-line or
adjunctive agents.
Topic: Legal & Ethical Issues
7. A patient with schizophrenia tells you he has a plan to harm his neighbor, whom he
believes is poisoning him. He provides the neighbor's name and address. What is the
PMHNP's primary ethical and legal duty?
• A. Increase his antipsychotic dose and schedule a follow-up.
• B. Hospitalize the patient involuntarily for safety.
• C. Maintain confidentiality, as the threat may be delusional.
• D. Take steps to warn the identified victim.
Detailed Answer: The correct answer is D. This scenario invokes the Tarasoff duty to
protect (or "duty to warn"). When a patient presents a specific, serious threat of violence
toward a clearly identifiable victim, the clinician has a legal and ethical obligation to take
reasonable steps to protect the intended victim. This typically includes warning the victim and
possibly notifying law enforcement. Involuntary hospitalization (B) may also be necessary, but
the specific duty to warn the identified individual is paramount and distinct.
Topic: Somatic Therapies
8. For which of the following patients would Electroconvulsive Therapy (ECT) be considered a
FIRST-line treatment option?
• A. A 30-year-old with mild, treatment-naïve depression.
• B. A 45-year-old with Bipolar Depression who failed two medication trials.
• C. A 70-year-old with severe MDD with psychotic features and catatonia, who is refusing
food/fluids.
• D. A 55-year-old with OCD.
Detailed Answer: The correct answer is C. ECT is a first-line treatment in life-
threatening or urgent situations where a rapid response is needed. This includes severe
depression with psychotic features, catatonia, or severe malnutrition/dehydration due to
refusal. It is also first-line for malignant catatonia or neuroleptic malignant syndrome. For other
cases (A, B, D), ECT is a highly effective but typically later-line intervention after several
pharmacological failures.
2026 COMPLETE QUESTIONS WITH CORRECT DETAILED
ANSWERS || 100% GUARANTEED PASS <RECENT VERSION>
Sample: PMHNP Board Review - Core Concepts (10 Questions)
Topic: Assessment & Diagnosis
1. A 28-year-old female presents with a 3-week history of depressed mood, anhedonia, a 10-
pound weight loss, insomnia with early morning awakening, and poor concentration. She
denies suicidal ideation. Her medical workup is normal. What is the most
appropriate initial diagnosis?
• A. Adjustment Disorder with Depressed Mood
• B. Persistent Depressive Disorder (Dysthymia)
• C. Major Depressive Disorder, single episode
• D. Unspecified Depressive Disorder
Detailed Answer: The correct answer is C. This presentation meets DSM-5-TR criteria for
a Major Depressive Episode (MDE): ≥5 symptoms for ≥2 weeks, including either depressed
mood or anhedonia. She has depressed mood, anhedonia, significant weight loss, insomnia
(often with terminal insomnia in MDD), and psychomotor agitation. This constitutes her first
MDE. Adjustment Disorder (A) requires a identifiable stressor and symptoms that don't meet
full MDE criteria. Persistent Depressive Disorder (B) requires a depressed mood for most of the
day, for more days than not, for at least 2 years. While MDD can be superimposed on PDD, the
acute 3-week history points to a new MDE.
2. A 65-year-old male with hypertension presents with a sudden onset of fluctuating
confusion, visual hallucinations, and agitation over the past 48 hours. His wife reports he was
fine last week. What is the most urgent diagnostic consideration?
• A. Late-onset Schizophrenia
• B. Alzheimer's Disease
• C. Delirium
• D. Bipolar I Disorder, Manic Episode
,Detailed Answer: The correct answer is C. Delirium is a medical emergency
characterized by an acute onset (hours to days) of fluctuating disturbance in attention,
awareness, and cognition. The key clues are the sudden change and fluctuating course in an
older adult with a medical comorbidity (hypertension, which could be related to an underlying
cause like infection, metabolic issue, or stroke). Visual hallucinations are also more common in
delirium than in primary psychosis. Alzheimer's (B) has an insidious onset and progressive
course. Late-onset psychosis (A) is rare and would not present with this acute, fluctuating
confusion.
Topic: Psychopharmacology
3. Which of the following antidepressants carries the highest risk for pharmacokinetically
significant drug-drug interactions via cytochrome P450 inhibition?
• A. Sertraline
• B. Bupropion
• C. Fluoxetine
• D. Vilazodone
Detailed Answer: The correct answer is C. Fluoxetine and its active metabolite
norfluoxetine are potent inhibitors of multiple CYP450 enzymes, notably CYP2D6 and
CYP2C9/19. This can significantly increase levels of co-administered medications metabolized by
these pathways (e.g., TCAs, some antipsychotics, beta-blockers, warfarin). Sertraline (A) is a mild
inhibitor. Bupropion (B) is a moderate inhibitor of CYP2D6. Vilazodone (D) has minimal CYP450
inhibition. Understanding these interactions is critical for patient safety.
4. A patient stabilized on Lithium 600mg BID for Bipolar I Disorder presents with new-onset
coarse hand tremor, nausea, and lethargy. Their lithium level last month was 0.9 mEq/L. What
is the most appropriate immediate action?
• A. Order a STAT lithium level and assess for signs of toxicity.
• B. Reduce the lithium dose by 300 mg/day.
• C. Prescribe propranolol for the tremor.
• D. Reassure the patient that these are benign side effects.
Detailed Answer: The correct answer is A. The symptoms described (coarse tremor, GI
upset, lethargy) are classic for lithium toxicity, even if a previous level was therapeutic. Toxicity
can be caused by dehydration, new medications (e.g., NSAIDs, ACE inhibitors), or renal changes.
,The immediate action is to obtain a STAT serum lithium level and perform a full clinical
assessment (including hydration status, electrolytes, and renal function). Adjusting the dose (B)
or treating a side effect (C) without confirming the level is dangerous, as toxicity can progress to
seizures, coma, and death.
Topic: Psychotherapy & Modalities
5. A patient with Borderline Personality Disorder (BPD) who frequently engages in self-harm
during interpersonal conflicts would benefit MOST from which evidence-based
psychotherapy?
• A. Cognitive Behavioral Therapy (CBT)
• B. Dialectical Behavior Therapy (DBT)
• C. Supportive Psychotherapy
• D. Psychodynamic Psychotherapy
Detailed Answer: The correct answer is B. Dialectical Behavior Therapy (DBT) is
the gold-standard, evidence-based treatment for BPD, specifically designed to address
emotional dysregulation, impulsivity, and self-harming behaviors. Its core modules
(mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) directly target
the patient's presenting problems. While CBT (A) and other modalities can be helpful, DBT has
the most robust empirical support for reducing self-harm and suicide attempts in this
population.
Topic: Special Populations
6. What is the first-line pharmacotherapy for ADHD in a healthy 8-year-old child, according to
most current guidelines?
• A. Atomoxetine
• B. Guanfacine XR
• C. Mixed Amphetamine Salts
• D. Methylphenidate-based stimulants
Detailed Answer: The correct answer is D. Stimulant medications, specifically
methylphenidate-based formulations, are consistently supported as first-line
pharmacotherapy for ADHD in school-aged children due to their superior efficacy and well-
established safety profile. The choice between methylphenidate and amphetamine-based (C)
products is often based on individual response and tolerability, but methylphenidate is
, frequently tried first. Alpha-2 agonists (B) and atomoxetine (A) are considered second-line or
adjunctive agents.
Topic: Legal & Ethical Issues
7. A patient with schizophrenia tells you he has a plan to harm his neighbor, whom he
believes is poisoning him. He provides the neighbor's name and address. What is the
PMHNP's primary ethical and legal duty?
• A. Increase his antipsychotic dose and schedule a follow-up.
• B. Hospitalize the patient involuntarily for safety.
• C. Maintain confidentiality, as the threat may be delusional.
• D. Take steps to warn the identified victim.
Detailed Answer: The correct answer is D. This scenario invokes the Tarasoff duty to
protect (or "duty to warn"). When a patient presents a specific, serious threat of violence
toward a clearly identifiable victim, the clinician has a legal and ethical obligation to take
reasonable steps to protect the intended victim. This typically includes warning the victim and
possibly notifying law enforcement. Involuntary hospitalization (B) may also be necessary, but
the specific duty to warn the identified individual is paramount and distinct.
Topic: Somatic Therapies
8. For which of the following patients would Electroconvulsive Therapy (ECT) be considered a
FIRST-line treatment option?
• A. A 30-year-old with mild, treatment-naïve depression.
• B. A 45-year-old with Bipolar Depression who failed two medication trials.
• C. A 70-year-old with severe MDD with psychotic features and catatonia, who is refusing
food/fluids.
• D. A 55-year-old with OCD.
Detailed Answer: The correct answer is C. ECT is a first-line treatment in life-
threatening or urgent situations where a rapid response is needed. This includes severe
depression with psychotic features, catatonia, or severe malnutrition/dehydration due to
refusal. It is also first-line for malignant catatonia or neuroleptic malignant syndrome. For other
cases (A, B, D), ECT is a highly effective but typically later-line intervention after several
pharmacological failures.
