Advanced PMHNP Exam Questions with Verified
Correct Answers
Assessment of the optic disc is a component of the evaluation of cranial nerve:
I.
II.
III.
IV.
II.
Of the following, which should be performed initially in assessing a 48-year-old woman with
suicidal ideation?
a. Does she have someone at home to stay with her?
b. What is the content of her thoughts?
c. Does she have access to a firearm?
d. Has she attempted suicide in the past?
b. What is the content of her thoughts?
An 8-year-old boy presents for an evaluation for possible attention-deficit/hyperactivity
disorder (ADHD). His parents report him to be a healthy 3rd-grader with "plenty of good
friends." They are concerned he could have ADHD because he is "hyperactive" and because
his father had ADHD. The Vanderbilt screening tools completed by his parents strongly
indicate inattention, with moderate hyperactivity symptoms. Your next best action is to:
a. Prescribe a low dose of methylphenidate.
b. Arrange for parents to obtain Vanderbilt screening tool or other written feedback from his
teacher and return in 2 weeks.
c. Order a screening head computed topography (CT), complete blood count (CBC) and
thyroid-stimulating hormone (TSH).
d. Advise to restrict refined carbohydrates, especially high sugar cereals in the morning prior
to school.
,b. Arrange for parents to obtain Vanderbilt screening tool or other written feedback from his
teacher and return in 2 weeks.
You have been asked by the director of a large primary care office to serve as a consultant to a
primary care clinic to improve access to mental health care services for their patients. Which
of the following actions by the PMHNP is recognized as an innovative, best practice model?
a. Schedule lunch and learn sessions to advise the providers about how to improve treatment
of mental health disorders with their patients.
b. Provide the nursing staff with a list of referral agencies.
c. Collaborate with the director to plan for implementation of on-site behavioral health
specialists imbedded into the primary care clinic.
d. Arrange your psychiatric clinic to have 2 appointments per week available for the primary
care patients.
c. Collaborate with the director to plan for implementation of on-site behavioral health
specialists imbedded into the primary care clinic.
A 60-year-old female who is being treated for stable major depressive disorder and
generalized anxiety disorder presents for a follow-up appointment. She mentions that she
sometimes forgets where she has left her car keys. The NP's next step is to:
a. Refer for neuropsychological testing.
b. Administer a Montreal cognitive assessment (MoCA) test.
c. Increase the dose of her SSRI.
d. Schedule laboratory testing for TSH, CBC.
b. Administer a Montreal cognitive assessment (MoCA) test.
For a patient receiving valproate therapy, regular monitoring for all of the following is
recommended except:
a. ALT and AST.
b. Bilirubin.
c. TSH.
d. Platelet count.
c. TSH.
A 76-year-old woman presents with worsening fatigue during the past 6 months. She is
currently being treated with an SSRI for major depressive disorder. Her laboratory results are
as follows:
,Hb=9.3 g/dL (13-17) (93 g/L [130-170])
MCV=71 fL (80-96 fL)
This most likely represents:
a. Folate-deficiency anemia.
b. Pernicious anemia.
c. Drug-induced anemia.
d. Iron-deficiency anemia.
d. Iron-deficiency anemia.
A potential laboratory indicator for alcohol abuse is:
a. Elevated ALT.
b. Diminished creatinine.
c. Elevated alkaline phosphatase.
d. Elevated creatine kinase.
a. Elevated ALT.
The most accurate laboratory measurement for kidney function is:
a. Calculated glomerular filtration rate (GFR).
b. Serum creatinine.
c. Blood urea nitrogen (BUN).
d. Serum creatine kinase (CK).
a. Calculated glomerular filtration rate (GFR).
Which of the following medications does not require initial laboratory testing before
implementing therapy?
a. Carbamazepine
b. Lamotrigine
c. Valproate
d. Lithium
b. Lamotrigine
, Ms. Roberts, 36-year-old woman, is stably treated for schizoaffective disorder on olanzapine
and lithium. Staff at residential care facility calls you as she has been sleeping 3 extra hours at
night and has taken more naps during the day for the past few days. She continues to shower,
eat meals and engage in scheduled activities as she has in the past, staff noted no other
changes in her mental status. Her mental status exam is unchanged since last 6 weeks ago.
She was seen yesterday by PCP for a urinary tract infection, she finishes a 7-day course of
ciprofloxacin tomorrow. You consider that one possible cause of her extra napping, a drug-
drug interaction with the addition of ciprofloxacin to her medication regimen. The
ciprofloxacin may be doing which of the following?
a. Inducing of the CYP219 pathway
b. Inhibiting of the CYP3A4 pathway
c. Inhibition of the CYP1A2 pathway
d. Inducing of the CYP1A2 pathway
c. Inhibition of the CYP1A2 pathway
What is the PMHNPs next best course of action?
a. Refer her to the emergency department for a delirium work up
b. Have her stop her ciprofloxacin and call urology in the morning.
c. Reassure her of the increased symptoms and schedule a follow-up in 3 days.
d. Schedule her for a sleep study.
c. Reassure her of the increased symptoms and schedule a follow-up in 3 days.
With which of the following medications should an alternative to oral contraceptive pills
(OCPs) be used as a method of contraception?
a. Duloxetine
b. Valproic acid
c. Oxcarbazepine
d. Lithium
c. Oxcarbazepine
The PMHNP recognizes a potential drug interaction because the above-mentioned medication
is a/an?
a. Inhibitor of CYP3A4
Correct Answers
Assessment of the optic disc is a component of the evaluation of cranial nerve:
I.
II.
III.
IV.
II.
Of the following, which should be performed initially in assessing a 48-year-old woman with
suicidal ideation?
a. Does she have someone at home to stay with her?
b. What is the content of her thoughts?
c. Does she have access to a firearm?
d. Has she attempted suicide in the past?
b. What is the content of her thoughts?
An 8-year-old boy presents for an evaluation for possible attention-deficit/hyperactivity
disorder (ADHD). His parents report him to be a healthy 3rd-grader with "plenty of good
friends." They are concerned he could have ADHD because he is "hyperactive" and because
his father had ADHD. The Vanderbilt screening tools completed by his parents strongly
indicate inattention, with moderate hyperactivity symptoms. Your next best action is to:
a. Prescribe a low dose of methylphenidate.
b. Arrange for parents to obtain Vanderbilt screening tool or other written feedback from his
teacher and return in 2 weeks.
c. Order a screening head computed topography (CT), complete blood count (CBC) and
thyroid-stimulating hormone (TSH).
d. Advise to restrict refined carbohydrates, especially high sugar cereals in the morning prior
to school.
,b. Arrange for parents to obtain Vanderbilt screening tool or other written feedback from his
teacher and return in 2 weeks.
You have been asked by the director of a large primary care office to serve as a consultant to a
primary care clinic to improve access to mental health care services for their patients. Which
of the following actions by the PMHNP is recognized as an innovative, best practice model?
a. Schedule lunch and learn sessions to advise the providers about how to improve treatment
of mental health disorders with their patients.
b. Provide the nursing staff with a list of referral agencies.
c. Collaborate with the director to plan for implementation of on-site behavioral health
specialists imbedded into the primary care clinic.
d. Arrange your psychiatric clinic to have 2 appointments per week available for the primary
care patients.
c. Collaborate with the director to plan for implementation of on-site behavioral health
specialists imbedded into the primary care clinic.
A 60-year-old female who is being treated for stable major depressive disorder and
generalized anxiety disorder presents for a follow-up appointment. She mentions that she
sometimes forgets where she has left her car keys. The NP's next step is to:
a. Refer for neuropsychological testing.
b. Administer a Montreal cognitive assessment (MoCA) test.
c. Increase the dose of her SSRI.
d. Schedule laboratory testing for TSH, CBC.
b. Administer a Montreal cognitive assessment (MoCA) test.
For a patient receiving valproate therapy, regular monitoring for all of the following is
recommended except:
a. ALT and AST.
b. Bilirubin.
c. TSH.
d. Platelet count.
c. TSH.
A 76-year-old woman presents with worsening fatigue during the past 6 months. She is
currently being treated with an SSRI for major depressive disorder. Her laboratory results are
as follows:
,Hb=9.3 g/dL (13-17) (93 g/L [130-170])
MCV=71 fL (80-96 fL)
This most likely represents:
a. Folate-deficiency anemia.
b. Pernicious anemia.
c. Drug-induced anemia.
d. Iron-deficiency anemia.
d. Iron-deficiency anemia.
A potential laboratory indicator for alcohol abuse is:
a. Elevated ALT.
b. Diminished creatinine.
c. Elevated alkaline phosphatase.
d. Elevated creatine kinase.
a. Elevated ALT.
The most accurate laboratory measurement for kidney function is:
a. Calculated glomerular filtration rate (GFR).
b. Serum creatinine.
c. Blood urea nitrogen (BUN).
d. Serum creatine kinase (CK).
a. Calculated glomerular filtration rate (GFR).
Which of the following medications does not require initial laboratory testing before
implementing therapy?
a. Carbamazepine
b. Lamotrigine
c. Valproate
d. Lithium
b. Lamotrigine
, Ms. Roberts, 36-year-old woman, is stably treated for schizoaffective disorder on olanzapine
and lithium. Staff at residential care facility calls you as she has been sleeping 3 extra hours at
night and has taken more naps during the day for the past few days. She continues to shower,
eat meals and engage in scheduled activities as she has in the past, staff noted no other
changes in her mental status. Her mental status exam is unchanged since last 6 weeks ago.
She was seen yesterday by PCP for a urinary tract infection, she finishes a 7-day course of
ciprofloxacin tomorrow. You consider that one possible cause of her extra napping, a drug-
drug interaction with the addition of ciprofloxacin to her medication regimen. The
ciprofloxacin may be doing which of the following?
a. Inducing of the CYP219 pathway
b. Inhibiting of the CYP3A4 pathway
c. Inhibition of the CYP1A2 pathway
d. Inducing of the CYP1A2 pathway
c. Inhibition of the CYP1A2 pathway
What is the PMHNPs next best course of action?
a. Refer her to the emergency department for a delirium work up
b. Have her stop her ciprofloxacin and call urology in the morning.
c. Reassure her of the increased symptoms and schedule a follow-up in 3 days.
d. Schedule her for a sleep study.
c. Reassure her of the increased symptoms and schedule a follow-up in 3 days.
With which of the following medications should an alternative to oral contraceptive pills
(OCPs) be used as a method of contraception?
a. Duloxetine
b. Valproic acid
c. Oxcarbazepine
d. Lithium
c. Oxcarbazepine
The PMHNP recognizes a potential drug interaction because the above-mentioned medication
is a/an?
a. Inhibitor of CYP3A4
