NRNP 6665
PMHNP Comprehensive Practice Exam
75 Original Practice Questions with Answers and Rationales
Covers: Psychopharmacology • Diagnostic Criteria & Differential Diagnosis •
Treatment Planning & Therapeutic Modalities • Legal & Ethical Issues •
Population-Specific Considerations
This is an original study resource created for exam-preparation purposes. It is not affiliated with, endorsed by, or drawn from
any specific university's proprietary course exam.
,Table of Contents
Section 1: Psychopharmacology Across the Lifespan — Questions 1–15
Section 2: Diagnostic Criteria & Differential Diagnosis (DSM-5-TR) — Questions 16–30
Section 3: Treatment Planning & Therapeutic Modalities — Questions 31–45
Section 4: Legal, Ethical & Professional Practice Issues — Questions 46–60
Section 5: Population-Specific Considerations (Child/Adolescent, Geriatric, Perinatal) — Questions
61–75
, Section 1: Psychopharmacology Across the Lifespan
Questions 1–15
Question 1. Which antidepressant class carries the highest risk of hypertensive crisis when combined
with tyramine-rich foods?
A) Selective serotonin reuptake inhibitors (SSRIs)
B) Monoamine oxidase inhibitors (MAOIs)
C) Norepinephrine-dopamine reuptake inhibitors
D) Alpha-2 antagonists
Correct Answer: B) Monoamine oxidase inhibitors (MAOIs)
Rationale: MAOIs inhibit the enzyme that normally breaks down dietary tyramine. Excess tyramine
triggers massive norepinephrine release, precipitating a hypertensive crisis. SSRIs, NDRIs, and alpha-
2 antagonists do not carry this specific dietary interaction risk.
Question 2. A patient on lithium presents with coarse tremor, ataxia, and confusion. Serum lithium level
is 2.8 mEq/L. What is the priority action?
A) Increase fluid intake and recheck the level in one week
B) Hold lithium immediately and refer for emergency medical evaluation
C) Decrease the dose by half and continue outpatient monitoring
D) Add a thiazide diuretic to enhance clearance
Correct Answer: B) Hold lithium immediately and refer for emergency medical evaluation
Rationale: A level of 2.8 mEq/L with neurologic symptoms indicates lithium toxicity, a medical
emergency. The therapeutic range is 0.6–1.2 mEq/L. Immediate discontinuation and emergency
evaluation (with possible hemodialysis) are indicated; thiazides actually increase lithium levels and
would worsen toxicity.
Question 3. Which is the primary black box warning for atypical antipsychotics used in elderly patients
with dementia-related psychosis?
A) Increased risk of cerebrovascular events and death
B) Guaranteed weight loss
C) Tardive dyskinesia as the sole concern
D) Immediate hepatotoxicity
Correct Answer: A) Increased risk of cerebrovascular events and death
Rationale: The FDA black box warning specifically states that atypical antipsychotics increase
mortality (largely cardiovascular and infectious causes) in elderly patients with dementia-related
psychosis, which drives cautious, time-limited use in this population.
Question 4. Which SSRI has the strongest anticholinergic and antihistaminic (sedating) profile among the
class?
A) Fluoxetine
B) Paroxetine
C) Sertraline
D) Escitalopram
PMHNP Comprehensive Practice Exam
75 Original Practice Questions with Answers and Rationales
Covers: Psychopharmacology • Diagnostic Criteria & Differential Diagnosis •
Treatment Planning & Therapeutic Modalities • Legal & Ethical Issues •
Population-Specific Considerations
This is an original study resource created for exam-preparation purposes. It is not affiliated with, endorsed by, or drawn from
any specific university's proprietary course exam.
,Table of Contents
Section 1: Psychopharmacology Across the Lifespan — Questions 1–15
Section 2: Diagnostic Criteria & Differential Diagnosis (DSM-5-TR) — Questions 16–30
Section 3: Treatment Planning & Therapeutic Modalities — Questions 31–45
Section 4: Legal, Ethical & Professional Practice Issues — Questions 46–60
Section 5: Population-Specific Considerations (Child/Adolescent, Geriatric, Perinatal) — Questions
61–75
, Section 1: Psychopharmacology Across the Lifespan
Questions 1–15
Question 1. Which antidepressant class carries the highest risk of hypertensive crisis when combined
with tyramine-rich foods?
A) Selective serotonin reuptake inhibitors (SSRIs)
B) Monoamine oxidase inhibitors (MAOIs)
C) Norepinephrine-dopamine reuptake inhibitors
D) Alpha-2 antagonists
Correct Answer: B) Monoamine oxidase inhibitors (MAOIs)
Rationale: MAOIs inhibit the enzyme that normally breaks down dietary tyramine. Excess tyramine
triggers massive norepinephrine release, precipitating a hypertensive crisis. SSRIs, NDRIs, and alpha-
2 antagonists do not carry this specific dietary interaction risk.
Question 2. A patient on lithium presents with coarse tremor, ataxia, and confusion. Serum lithium level
is 2.8 mEq/L. What is the priority action?
A) Increase fluid intake and recheck the level in one week
B) Hold lithium immediately and refer for emergency medical evaluation
C) Decrease the dose by half and continue outpatient monitoring
D) Add a thiazide diuretic to enhance clearance
Correct Answer: B) Hold lithium immediately and refer for emergency medical evaluation
Rationale: A level of 2.8 mEq/L with neurologic symptoms indicates lithium toxicity, a medical
emergency. The therapeutic range is 0.6–1.2 mEq/L. Immediate discontinuation and emergency
evaluation (with possible hemodialysis) are indicated; thiazides actually increase lithium levels and
would worsen toxicity.
Question 3. Which is the primary black box warning for atypical antipsychotics used in elderly patients
with dementia-related psychosis?
A) Increased risk of cerebrovascular events and death
B) Guaranteed weight loss
C) Tardive dyskinesia as the sole concern
D) Immediate hepatotoxicity
Correct Answer: A) Increased risk of cerebrovascular events and death
Rationale: The FDA black box warning specifically states that atypical antipsychotics increase
mortality (largely cardiovascular and infectious causes) in elderly patients with dementia-related
psychosis, which drives cautious, time-limited use in this population.
Question 4. Which SSRI has the strongest anticholinergic and antihistaminic (sedating) profile among the
class?
A) Fluoxetine
B) Paroxetine
C) Sertraline
D) Escitalopram
