PMHNP COMPREHENSIVE TEST BANK FINAL EXAM 2026 -2027||
ACTUAL STUDY GUIDE EXAM AND PRACTICE QUESTIONS
COMPLETE REAL QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (100% CORRECT VERIFIED SOLUTIONS)
CURRENTLY UPDATED VERSION 2026 EDITION |GUARANTEED
SUCCESS
1. A 28-year-old female with a history of bipolar I disorder presents to the clinic
at 8 weeks gestation. She has been maintained on lithium 900 mg daily with a
therapeutic level of 0.9 mEq/L. She reports that her obstetrician recommended
stopping lithium due to fetal risk. The PMHNP's best response is:
A) Discontinue lithium immediately and switch to valproic acid
B) Continue lithium at the current dose throughout pregnancy and monitor
levels closely
C) Discontinue lithium abruptly and start lamotrigine
D) Reduce lithium dose by 50% and monitor levels weekly
Correct Answer: B
Rationale: Lithium is associated with Ebstein's anomaly, but the absolute risk is
relatively low (0.05-0.1%). For a patient with bipolar I disorder, the risk of
relapse without treatment is substantial. Current guidelines recommend
weighing the risks and benefits, and if lithium is continued, monitoring levels
closely, especially in the third trimester and postpartum period when renal
clearance changes. Valproic acid (A) is more teratogenic (neural tube defects).
Abrupt discontinuation (C) risks relapse. Empiric 50% reduction (D) is not
standard; dose adjustments should be guided by serum levels.
,2. A 45-year-old male with schizophrenia on clozapine 400 mg daily presents
with fever, sore throat, and malaise. His WBC is 3,200/mm³ and ANC is
1,200/mm³. The PMHNP should:
A) Continue clozapine and recheck CBC in 1 week
B) Discontinue clozapine immediately and obtain stat CBC with differential
C) Reduce clozapine dose by 50% and recheck in 3 days
D) Add filgrastim and continue clozapine
Correct Answer: B
Rationale: The patient has symptoms of infection and a declining WBC. While
WBC 3,200 and ANC 1,200 do not yet meet the threshold for mandatory
discontinuation (WBC <2,000 or ANC <1,000), the presence of fever and sore
throat in a clozapine patient warrants immediate discontinuation and stat CBC.
Waiting (A) or reducing dose (C) could be dangerous. Filgrastim (D) is used for
severe neutropenia but clozapine must be stopped first.
3. A 32-year-old female with major depressive disorder and fibromyalgia has
failed trials of sertraline and fluoxetine. She reports ongoing pain and
depression. The PMHNP should consider:
A) Switch to paroxetine
B) Augment with gabapentin
C) Switch to duloxetine
D) Add pregabalin to current SSRI
,Correct Answer: C
Rationale: Duloxetine is an SNRI with FDA approval for both major depressive
disorder and chronic musculoskeletal pain (including fibromyalgia). It targets
both serotonin and norepinephrine, addressing both conditions. Paroxetine (A)
is an SSRI with no pain benefit. Gabapentin (B) and pregabalin (D) help with pain
but do not treat depression. Switching to an SNRI is the most comprehensive
approach.
4. A 58-year-old male on lithium for bipolar disorder presents with confusion,
coarse hand tremors, ataxia, and vomiting. His lithium level is 2.1 mEq/L. His
medications include hydrochlorothiazide for hypertension. The PMHNP should
recognize that:
A) The lithium level is therapeutic and symptoms are unrelated
B) Hydrochlorothiazide decreases lithium levels
C) Hydrochlorothiazide increases lithium levels and contributed to toxicity
D) The patient has serotonin syndrome
Correct Answer: C
Rationale: Thiazide diuretics (HCTZ) reduce renal lithium clearance by causing
sodium depletion, leading to increased proximal tubular reabsorption of
lithium. This can precipitate lithium toxicity. The level of 2.1 mEq/L is toxic
(therapeutic range 0.6-1.2). The patient's symptoms are classic for lithium
toxicity. Treatment includes holding lithium, IV fluids, and possibly
hemodialysis.
, 5. A 24-year-old male with first-episode psychosis is started on risperidone. Two
days later, he develops severe muscle spasms of the neck and eyes, with his
head twisted to one side. The PMHNP should:
A) Administer benztropine or diphenhydramine
B) Discontinue risperidone permanently
C) Add haloperidol
D) Reassure the patient this is self-limiting
Correct Answer: A
Rationale: The patient has acute dystonia, an extrapyramidal side effect
characterized by sustained muscle contractions, often of the neck (torticollis),
eyes (oculogyric crisis), or jaw. Treatment is with anticholinergics (benztropine)
or antihistamines (diphenhydramine). It is not a reason to permanently
discontinue antipsychotics (B). Adding haloperidol (C) would worsen it.
Reassurance alone (D) is inadequate as it causes significant distress.
6. A 35-year-old female with bipolar II disorder has been stable on lamotrigine
200 mg daily for 2 years. She now requires treatment for a major depressive
episode. The PMHNP should:
A) Add fluoxetine
B) Add venlafaxine
C) Add bupropion
D) Add quetiapine
ACTUAL STUDY GUIDE EXAM AND PRACTICE QUESTIONS
COMPLETE REAL QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES (100% CORRECT VERIFIED SOLUTIONS)
CURRENTLY UPDATED VERSION 2026 EDITION |GUARANTEED
SUCCESS
1. A 28-year-old female with a history of bipolar I disorder presents to the clinic
at 8 weeks gestation. She has been maintained on lithium 900 mg daily with a
therapeutic level of 0.9 mEq/L. She reports that her obstetrician recommended
stopping lithium due to fetal risk. The PMHNP's best response is:
A) Discontinue lithium immediately and switch to valproic acid
B) Continue lithium at the current dose throughout pregnancy and monitor
levels closely
C) Discontinue lithium abruptly and start lamotrigine
D) Reduce lithium dose by 50% and monitor levels weekly
Correct Answer: B
Rationale: Lithium is associated with Ebstein's anomaly, but the absolute risk is
relatively low (0.05-0.1%). For a patient with bipolar I disorder, the risk of
relapse without treatment is substantial. Current guidelines recommend
weighing the risks and benefits, and if lithium is continued, monitoring levels
closely, especially in the third trimester and postpartum period when renal
clearance changes. Valproic acid (A) is more teratogenic (neural tube defects).
Abrupt discontinuation (C) risks relapse. Empiric 50% reduction (D) is not
standard; dose adjustments should be guided by serum levels.
,2. A 45-year-old male with schizophrenia on clozapine 400 mg daily presents
with fever, sore throat, and malaise. His WBC is 3,200/mm³ and ANC is
1,200/mm³. The PMHNP should:
A) Continue clozapine and recheck CBC in 1 week
B) Discontinue clozapine immediately and obtain stat CBC with differential
C) Reduce clozapine dose by 50% and recheck in 3 days
D) Add filgrastim and continue clozapine
Correct Answer: B
Rationale: The patient has symptoms of infection and a declining WBC. While
WBC 3,200 and ANC 1,200 do not yet meet the threshold for mandatory
discontinuation (WBC <2,000 or ANC <1,000), the presence of fever and sore
throat in a clozapine patient warrants immediate discontinuation and stat CBC.
Waiting (A) or reducing dose (C) could be dangerous. Filgrastim (D) is used for
severe neutropenia but clozapine must be stopped first.
3. A 32-year-old female with major depressive disorder and fibromyalgia has
failed trials of sertraline and fluoxetine. She reports ongoing pain and
depression. The PMHNP should consider:
A) Switch to paroxetine
B) Augment with gabapentin
C) Switch to duloxetine
D) Add pregabalin to current SSRI
,Correct Answer: C
Rationale: Duloxetine is an SNRI with FDA approval for both major depressive
disorder and chronic musculoskeletal pain (including fibromyalgia). It targets
both serotonin and norepinephrine, addressing both conditions. Paroxetine (A)
is an SSRI with no pain benefit. Gabapentin (B) and pregabalin (D) help with pain
but do not treat depression. Switching to an SNRI is the most comprehensive
approach.
4. A 58-year-old male on lithium for bipolar disorder presents with confusion,
coarse hand tremors, ataxia, and vomiting. His lithium level is 2.1 mEq/L. His
medications include hydrochlorothiazide for hypertension. The PMHNP should
recognize that:
A) The lithium level is therapeutic and symptoms are unrelated
B) Hydrochlorothiazide decreases lithium levels
C) Hydrochlorothiazide increases lithium levels and contributed to toxicity
D) The patient has serotonin syndrome
Correct Answer: C
Rationale: Thiazide diuretics (HCTZ) reduce renal lithium clearance by causing
sodium depletion, leading to increased proximal tubular reabsorption of
lithium. This can precipitate lithium toxicity. The level of 2.1 mEq/L is toxic
(therapeutic range 0.6-1.2). The patient's symptoms are classic for lithium
toxicity. Treatment includes holding lithium, IV fluids, and possibly
hemodialysis.
, 5. A 24-year-old male with first-episode psychosis is started on risperidone. Two
days later, he develops severe muscle spasms of the neck and eyes, with his
head twisted to one side. The PMHNP should:
A) Administer benztropine or diphenhydramine
B) Discontinue risperidone permanently
C) Add haloperidol
D) Reassure the patient this is self-limiting
Correct Answer: A
Rationale: The patient has acute dystonia, an extrapyramidal side effect
characterized by sustained muscle contractions, often of the neck (torticollis),
eyes (oculogyric crisis), or jaw. Treatment is with anticholinergics (benztropine)
or antihistamines (diphenhydramine). It is not a reason to permanently
discontinue antipsychotics (B). Adding haloperidol (C) would worsen it.
Reassurance alone (D) is inadequate as it causes significant distress.
6. A 35-year-old female with bipolar II disorder has been stable on lamotrigine
200 mg daily for 2 years. She now requires treatment for a major depressive
episode. The PMHNP should:
A) Add fluoxetine
B) Add venlafaxine
C) Add bupropion
D) Add quetiapine
