Test Bank for PMHNP Boards
2026/2027 Questions and
Answers | 100% Corect.
Course
PMHNP
1. Major Depressive Disorder
A 35-year-old patient reports depressed mood, anhedonia, fatigue, insomnia, impaired
concentration, and feelings of worthlessness for 6 weeks. The symptoms significantly interfere
with occupational functioning. Which diagnosis is most appropriate?
A. Adjustment disorder
B. Major depressive disorder
C. Persistent depressive disorder
D. Bipolar II disorder
Answer: B. Major depressive disorder
Rationale:
The patient has multiple depressive symptoms lasting longer than 2 weeks with clinically
significant functional impairment. This presentation is consistent with a major depressive
episode and, in the absence of mania or hypomania, supports major depressive disorder.
2. Bipolar Disorder
A patient with bipolar I disorder presents with decreased need for sleep, pressured speech,
grandiosity, racing thoughts, and excessive spending for 10 days. Which feature most strongly
supports mania?
A. Symptoms lasting 2 days
B. Mild occupational impairment
C. Marked functional impairment requiring intervention
D. Depressed mood occurring most of the day
Answer: C. Marked functional impairment requiring intervention
Rationale:
A manic episode involves a distinct period of abnormally elevated, expansive, or irritable mood
,with increased energy/activity and associated symptoms. Significant impairment,
hospitalization, or psychotic features distinguishes mania from hypomania.
3. Antidepressant Safety
A patient taking an SSRI develops agitation, diaphoresis, diarrhea, tremor, hyperreflexia, and
clonus after starting another serotonergic medication. What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Tardive dyskinesia
Answer: B. Serotonin syndrome
Rationale:
Serotonin syndrome is characterized by mental-status changes, autonomic instability,
gastrointestinal symptoms, and neuromuscular hyperactivity such as clonus and hyperreflexia.
4. Neuroleptic Malignant Syndrome
A patient taking an antipsychotic develops high fever, severe muscle rigidity, altered mental
status, and autonomic instability. What is the priority concern?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Acute dystonia
D. Akathisia
Answer: B. Neuroleptic malignant syndrome
Rationale:
NMS is a potentially life-threatening reaction associated with dopamine blockade. Classic
findings include hyperthermia, severe rigidity, altered mental status, and autonomic
instability. The offending medication should be stopped and urgent medical management
initiated.
5. Acute Dystonia
,A patient develops painful neck spasms and upward deviation of the eyes several hours after
receiving an antipsychotic. Which treatment is most appropriate?
A. Propranolol
B. Benztropine
C. Fluoxetine
D. Lithium
Answer: B. Benztropine
Rationale:
Acute dystonia is an extrapyramidal adverse effect caused by dopamine blockade.
Anticholinergic medications such as benztropine or diphenhydramine are commonly used for
rapid treatment.
6. Akathisia
A patient recently started on an antipsychotic reports, “I feel like I cannot sit still,” and
repeatedly paces around the room. Which adverse effect is most likely?
A. Akathisia
B. Tardive dyskinesia
C. Acute dystonia
D. Parkinsonism
Answer: A. Akathisia
Rationale:
Akathisia is characterized by an uncomfortable sense of inner restlessness and an inability to
remain still. It may be mistaken for anxiety or worsening agitation.
7. Tardive Dyskinesia
A patient receiving long-term antipsychotic therapy develops repetitive lip smacking, tongue
movements, and facial grimacing. What condition should the PMHNP suspect?
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Neuroleptic malignant syndrome
Answer: C. Tardive dyskinesia
, Rationale:
Tardive dyskinesia involves involuntary repetitive movements, commonly affecting the mouth,
tongue, face, and sometimes limbs, after prolonged exposure to dopamine-receptor-blocking
agents.
8. Clozapine
A patient receiving clozapine develops fever and a sore throat. What is the most appropriate
response?
A. Reassure the patient that this is expected
B. Evaluate urgently for neutropenia
C. Increase the clozapine dose
D. Add an SSRI
Answer: B. Evaluate urgently for neutropenia
Rationale:
Clozapine can cause severe neutropenia. Fever or signs of infection require prompt assessment,
including appropriate blood-count monitoring according to current prescribing requirements.
9. Lithium Toxicity
A patient taking lithium reports worsening diarrhea, vomiting, coarse tremor, confusion, and
difficulty walking. What should the PMHNP suspect?
A. Therapeutic lithium response
B. Lithium toxicity
C. Serotonin syndrome
D. Anticholinergic toxicity
Answer: B. Lithium toxicity
Rationale:
Gastrointestinal symptoms, coarse tremor, neurologic changes, ataxia, and confusion are
concerning for lithium toxicity. Dehydration and changes in sodium balance can increase lithium
concentrations.
10. Lithium Monitoring
2026/2027 Questions and
Answers | 100% Corect.
Course
PMHNP
1. Major Depressive Disorder
A 35-year-old patient reports depressed mood, anhedonia, fatigue, insomnia, impaired
concentration, and feelings of worthlessness for 6 weeks. The symptoms significantly interfere
with occupational functioning. Which diagnosis is most appropriate?
A. Adjustment disorder
B. Major depressive disorder
C. Persistent depressive disorder
D. Bipolar II disorder
Answer: B. Major depressive disorder
Rationale:
The patient has multiple depressive symptoms lasting longer than 2 weeks with clinically
significant functional impairment. This presentation is consistent with a major depressive
episode and, in the absence of mania or hypomania, supports major depressive disorder.
2. Bipolar Disorder
A patient with bipolar I disorder presents with decreased need for sleep, pressured speech,
grandiosity, racing thoughts, and excessive spending for 10 days. Which feature most strongly
supports mania?
A. Symptoms lasting 2 days
B. Mild occupational impairment
C. Marked functional impairment requiring intervention
D. Depressed mood occurring most of the day
Answer: C. Marked functional impairment requiring intervention
Rationale:
A manic episode involves a distinct period of abnormally elevated, expansive, or irritable mood
,with increased energy/activity and associated symptoms. Significant impairment,
hospitalization, or psychotic features distinguishes mania from hypomania.
3. Antidepressant Safety
A patient taking an SSRI develops agitation, diaphoresis, diarrhea, tremor, hyperreflexia, and
clonus after starting another serotonergic medication. What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Tardive dyskinesia
Answer: B. Serotonin syndrome
Rationale:
Serotonin syndrome is characterized by mental-status changes, autonomic instability,
gastrointestinal symptoms, and neuromuscular hyperactivity such as clonus and hyperreflexia.
4. Neuroleptic Malignant Syndrome
A patient taking an antipsychotic develops high fever, severe muscle rigidity, altered mental
status, and autonomic instability. What is the priority concern?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Acute dystonia
D. Akathisia
Answer: B. Neuroleptic malignant syndrome
Rationale:
NMS is a potentially life-threatening reaction associated with dopamine blockade. Classic
findings include hyperthermia, severe rigidity, altered mental status, and autonomic
instability. The offending medication should be stopped and urgent medical management
initiated.
5. Acute Dystonia
,A patient develops painful neck spasms and upward deviation of the eyes several hours after
receiving an antipsychotic. Which treatment is most appropriate?
A. Propranolol
B. Benztropine
C. Fluoxetine
D. Lithium
Answer: B. Benztropine
Rationale:
Acute dystonia is an extrapyramidal adverse effect caused by dopamine blockade.
Anticholinergic medications such as benztropine or diphenhydramine are commonly used for
rapid treatment.
6. Akathisia
A patient recently started on an antipsychotic reports, “I feel like I cannot sit still,” and
repeatedly paces around the room. Which adverse effect is most likely?
A. Akathisia
B. Tardive dyskinesia
C. Acute dystonia
D. Parkinsonism
Answer: A. Akathisia
Rationale:
Akathisia is characterized by an uncomfortable sense of inner restlessness and an inability to
remain still. It may be mistaken for anxiety or worsening agitation.
7. Tardive Dyskinesia
A patient receiving long-term antipsychotic therapy develops repetitive lip smacking, tongue
movements, and facial grimacing. What condition should the PMHNP suspect?
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Neuroleptic malignant syndrome
Answer: C. Tardive dyskinesia
, Rationale:
Tardive dyskinesia involves involuntary repetitive movements, commonly affecting the mouth,
tongue, face, and sometimes limbs, after prolonged exposure to dopamine-receptor-blocking
agents.
8. Clozapine
A patient receiving clozapine develops fever and a sore throat. What is the most appropriate
response?
A. Reassure the patient that this is expected
B. Evaluate urgently for neutropenia
C. Increase the clozapine dose
D. Add an SSRI
Answer: B. Evaluate urgently for neutropenia
Rationale:
Clozapine can cause severe neutropenia. Fever or signs of infection require prompt assessment,
including appropriate blood-count monitoring according to current prescribing requirements.
9. Lithium Toxicity
A patient taking lithium reports worsening diarrhea, vomiting, coarse tremor, confusion, and
difficulty walking. What should the PMHNP suspect?
A. Therapeutic lithium response
B. Lithium toxicity
C. Serotonin syndrome
D. Anticholinergic toxicity
Answer: B. Lithium toxicity
Rationale:
Gastrointestinal symptoms, coarse tremor, neurologic changes, ataxia, and confusion are
concerning for lithium toxicity. Dehydration and changes in sodium balance can increase lithium
concentrations.
10. Lithium Monitoring
