PMHNP Certification Exam Questions And Verified
Answers Detailed Answers
Question 1: Psychopharmacology – Antidepressants
A 35-year-old female with major depressive disorder (MDD) reports no
improvement after 6 weeks on sertraline 100 mg daily. She has no side
effects but mentions mild sexual dysfunction. What is the most
appropriate next step?
A. Increase sertraline to 200 mg daily
B. Switch to bupropion 150 mg daily
C. Add buspirone 10 mg BID
D. Discontinue sertraline and start venlafaxine 75 mg daily
<<Answer>> B. Switch to bupropion 150 mg daily
<<Rationale>> Sertraline (an SSRI) is first-line for MDD, but if there's
partial response with sexual side effects, switching to bupropion (an
NDRI) is ideal as it has minimal sexual side effects and can even improve
libido/energy. Increasing sertraline (A) might worsen sexual dysfunction
without addressing it. Buspirone (C) is for anxiety augmentation, not
,depression. Venlafaxine (D) is an SNRI and could cause more sexual side
effects.
Mnemonic: "Bupropion = Better for Boredom and Bedroom" (helps with
low energy and sexual issues).
Clinical Pearl: Always assess sexual side effects in women—it's a top
reason for non-adherence. Monitor for seizure risk with bupropion
(contraindicated in eating disorders).
---
Question 2: Diagnostics – Mood Disorders
A 22-year-old male presents with elevated mood, grandiosity,
decreased sleep (3 hours/night for 1 week), and risky behaviors like
spending sprees. He denies psychosis. What is the most likely diagnosis?
A. Bipolar I disorder, manic episode
B. Bipolar II disorder, hypomanic episode
C. Cyclothymic disorder
D. Major depressive disorder with mixed features
<<Answer>> A. Bipolar I disorder, manic episode
,<<Rationale>> Mania requires symptoms for ≥7 days, causing marked
impairment (e.g., risky behaviors). Bipolar I involves full mania.
Hypomania (B) is milder (≥4 days, no marked impairment). Cyclothymia
(C) is chronic mild mood swings without full episodes. Mixed features
(D) involve depression + manic symptoms simultaneously.
Mnemonic: "Mania = Major Impairment Now" (7+ days, severe impact).
Clinical Pearl: Screen for bipolar before starting antidepressants—SSRIs
alone can trigger mania. Use mood stabilizers like lithium first.
---
Question 3: Ethics and Legal
A 16-year-old patient discloses suicidal ideation during a session but
refuses hospitalization. The PMHNP knows the patient's parents are
unaware. What is the most ethical action?
A. Respect confidentiality and continue outpatient therapy
B. Break confidentiality and notify parents
C. Involve child protective services immediately
D. Document and refer to a psychiatrist
, <<Answer>> B. Break confidentiality and notify parents
<<Rationale>> Under the Tarasoff duty-to-warn (and state laws for
minors), confidentiality can be broken if there's imminent harm to
self/others. Suicidal ideation in a minor warrants parental notification
for safety. A is incorrect as safety trumps confidentiality. C is overkill
without abuse/neglect. D delays action.
Mnemonic: "Tarasoff = Tell Others to Protect" (duty to protect).
Clinical Pearl: Document rationale for breaking confidentiality
thoroughly. For minors, consent laws vary—check your state's
emancipated minor rules.
---
Question 4: Psychopharmacology – Antipsychotics
A patient on haloperidol develops muscle rigidity, fever, and altered
mental status. What is the most likely diagnosis, and what's the first-line
treatment?
A. Tardive dyskinesia; benztropine
Answers Detailed Answers
Question 1: Psychopharmacology – Antidepressants
A 35-year-old female with major depressive disorder (MDD) reports no
improvement after 6 weeks on sertraline 100 mg daily. She has no side
effects but mentions mild sexual dysfunction. What is the most
appropriate next step?
A. Increase sertraline to 200 mg daily
B. Switch to bupropion 150 mg daily
C. Add buspirone 10 mg BID
D. Discontinue sertraline and start venlafaxine 75 mg daily
<<Answer>> B. Switch to bupropion 150 mg daily
<<Rationale>> Sertraline (an SSRI) is first-line for MDD, but if there's
partial response with sexual side effects, switching to bupropion (an
NDRI) is ideal as it has minimal sexual side effects and can even improve
libido/energy. Increasing sertraline (A) might worsen sexual dysfunction
without addressing it. Buspirone (C) is for anxiety augmentation, not
,depression. Venlafaxine (D) is an SNRI and could cause more sexual side
effects.
Mnemonic: "Bupropion = Better for Boredom and Bedroom" (helps with
low energy and sexual issues).
Clinical Pearl: Always assess sexual side effects in women—it's a top
reason for non-adherence. Monitor for seizure risk with bupropion
(contraindicated in eating disorders).
---
Question 2: Diagnostics – Mood Disorders
A 22-year-old male presents with elevated mood, grandiosity,
decreased sleep (3 hours/night for 1 week), and risky behaviors like
spending sprees. He denies psychosis. What is the most likely diagnosis?
A. Bipolar I disorder, manic episode
B. Bipolar II disorder, hypomanic episode
C. Cyclothymic disorder
D. Major depressive disorder with mixed features
<<Answer>> A. Bipolar I disorder, manic episode
,<<Rationale>> Mania requires symptoms for ≥7 days, causing marked
impairment (e.g., risky behaviors). Bipolar I involves full mania.
Hypomania (B) is milder (≥4 days, no marked impairment). Cyclothymia
(C) is chronic mild mood swings without full episodes. Mixed features
(D) involve depression + manic symptoms simultaneously.
Mnemonic: "Mania = Major Impairment Now" (7+ days, severe impact).
Clinical Pearl: Screen for bipolar before starting antidepressants—SSRIs
alone can trigger mania. Use mood stabilizers like lithium first.
---
Question 3: Ethics and Legal
A 16-year-old patient discloses suicidal ideation during a session but
refuses hospitalization. The PMHNP knows the patient's parents are
unaware. What is the most ethical action?
A. Respect confidentiality and continue outpatient therapy
B. Break confidentiality and notify parents
C. Involve child protective services immediately
D. Document and refer to a psychiatrist
, <<Answer>> B. Break confidentiality and notify parents
<<Rationale>> Under the Tarasoff duty-to-warn (and state laws for
minors), confidentiality can be broken if there's imminent harm to
self/others. Suicidal ideation in a minor warrants parental notification
for safety. A is incorrect as safety trumps confidentiality. C is overkill
without abuse/neglect. D delays action.
Mnemonic: "Tarasoff = Tell Others to Protect" (duty to protect).
Clinical Pearl: Document rationale for breaking confidentiality
thoroughly. For minors, consent laws vary—check your state's
emancipated minor rules.
---
Question 4: Psychopharmacology – Antipsychotics
A patient on haloperidol develops muscle rigidity, fever, and altered
mental status. What is the most likely diagnosis, and what's the first-line
treatment?
A. Tardive dyskinesia; benztropine
