PMHNP CERTIFICATION EXAM
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES GRADED A+
LATEST
1. A 28-year-old woman presents with a 2-month history of low mood, fatigue,
hypersomnia, and feelings of worthlessness. She reports difficulty
concentrating and has gained 10 pounds. She denies suicidal ideation. Which
of the following is the most appropriate next step?
A. Start sertraline 50 mg daily
B. Order thyroid function tests
C. Begin cognitive behavioral therapy only
D. Start bupropion 150 mg daily
Correct Answer: B
Rationale: Symptoms of depression may be due to an underlying medical
condition such as hypothyroidism. Thyroid function tests should be obtained
before initiating pharmacotherapy.
2. A 55-year-old man with major depressive disorder is started on sertraline.
Two weeks later, he reports worsening insomnia and anxiety. What is the
most appropriate management?
A. Increase the sertraline dose
B. Add alprazolam
C. Continue current dose and reassess in 2–4 weeks
D. Switch to fluoxetine
Correct Answer: C
Rationale: Early activation symptoms (insomnia, anxiety) are common and may
improve within 2–4 weeks. Continue current dose unless symptoms are severe.
,3. A patient with bipolar I disorder is currently taking lithium. Which of the
following lab results would be most concerning?
A. TSH 5.6 mIU/L
B. Serum creatinine 1.2 mg/dL
C. Lithium level 0.8 mEq/L
D. Urinalysis showing mild proteinuria
Correct Answer: A
Rationale: Lithium can cause hypothyroidism. A TSH of 5.6 is elevated and
should prompt thyroid evaluation and possible adjustment of therapy.
4. A 20-year-old college student presents with panic attacks occurring
unexpectedly. She fears having another attack and avoids leaving her dorm.
What is the most likely diagnosis?
A. Social anxiety disorder
B. Panic disorder
C. Generalized anxiety disorder
D. Agoraphobia
Correct Answer: B
Rationale: Recurrent unexpected panic attacks with persistent worry about
additional attacks is characteristic of panic disorder.
,5. A patient with schizophrenia has been stable on risperidone 4 mg daily for 2
years. He reports new onset of breast tenderness and galactorrhea. What is
the best next step?
A. Increase risperidone dose
B. Switch to clozapine
C. Switch to aripiprazole
D. Add bromocriptine
Correct Answer: C
Rationale: Risperidone can elevate prolactin causing galactorrhea. Switching to a
prolactin-sparing agent like aripiprazole is appropriate.
6. Which of the following medications is contraindicated in a patient with a
history of narrow-angle glaucoma?
A. Bupropion
B. Paroxetine
C. Sertraline
D. Escitalopram
Correct Answer: B
Rationale: Paroxetine has anticholinergic effects that can precipitate narrow-angle
glaucoma.
7. A patient with PTSD reports nightmares, hypervigilance, and avoidance for
8 months following a motor vehicle accident. Which medication is first-line?
A. Propranolol
B. Prazosin
C. Sertraline
D. Alprazolam
Correct Answer: C
Rationale: SSRIs (sertraline, paroxetine) are first-line for PTSD. Prazosin may
help nightmares but is not first-line monotherapy.
, 8. A 30-year-old woman with anorexia nervosa has a BMI of 16.5 and
amenorrhea. She reports fear of gaining weight. Which lab finding is most
concerning?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Magnesium 2.0 mg/dL
D. Glucose 90 mg/dL
Correct Answer: B
Rationale: Hypokalemia is life-threatening and indicates purging behavior or
severe malnutrition requiring urgent intervention.
9. Which of the following is the most appropriate treatment for acute manic
episode in a patient with bipolar I disorder?
A. Fluoxetine
B. Lithium + antipsychotic
C. Sertraline
D. Bupropion
Correct Answer: B
Rationale: Acute mania is treated with mood stabilizer (lithium) plus an
antipsychotic. Antidepressants alone can worsen mania.
10. A patient with ADHD is started on methylphenidate. Which side effect is
most common?
A. Weight gain
B. Sedation
C. Decreased appetite
D. Bradycardia
Correct Answer: C
Rationale: Stimulants commonly cause decreased appetite and weight loss.
QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES GRADED A+
LATEST
1. A 28-year-old woman presents with a 2-month history of low mood, fatigue,
hypersomnia, and feelings of worthlessness. She reports difficulty
concentrating and has gained 10 pounds. She denies suicidal ideation. Which
of the following is the most appropriate next step?
A. Start sertraline 50 mg daily
B. Order thyroid function tests
C. Begin cognitive behavioral therapy only
D. Start bupropion 150 mg daily
Correct Answer: B
Rationale: Symptoms of depression may be due to an underlying medical
condition such as hypothyroidism. Thyroid function tests should be obtained
before initiating pharmacotherapy.
2. A 55-year-old man with major depressive disorder is started on sertraline.
Two weeks later, he reports worsening insomnia and anxiety. What is the
most appropriate management?
A. Increase the sertraline dose
B. Add alprazolam
C. Continue current dose and reassess in 2–4 weeks
D. Switch to fluoxetine
Correct Answer: C
Rationale: Early activation symptoms (insomnia, anxiety) are common and may
improve within 2–4 weeks. Continue current dose unless symptoms are severe.
,3. A patient with bipolar I disorder is currently taking lithium. Which of the
following lab results would be most concerning?
A. TSH 5.6 mIU/L
B. Serum creatinine 1.2 mg/dL
C. Lithium level 0.8 mEq/L
D. Urinalysis showing mild proteinuria
Correct Answer: A
Rationale: Lithium can cause hypothyroidism. A TSH of 5.6 is elevated and
should prompt thyroid evaluation and possible adjustment of therapy.
4. A 20-year-old college student presents with panic attacks occurring
unexpectedly. She fears having another attack and avoids leaving her dorm.
What is the most likely diagnosis?
A. Social anxiety disorder
B. Panic disorder
C. Generalized anxiety disorder
D. Agoraphobia
Correct Answer: B
Rationale: Recurrent unexpected panic attacks with persistent worry about
additional attacks is characteristic of panic disorder.
,5. A patient with schizophrenia has been stable on risperidone 4 mg daily for 2
years. He reports new onset of breast tenderness and galactorrhea. What is
the best next step?
A. Increase risperidone dose
B. Switch to clozapine
C. Switch to aripiprazole
D. Add bromocriptine
Correct Answer: C
Rationale: Risperidone can elevate prolactin causing galactorrhea. Switching to a
prolactin-sparing agent like aripiprazole is appropriate.
6. Which of the following medications is contraindicated in a patient with a
history of narrow-angle glaucoma?
A. Bupropion
B. Paroxetine
C. Sertraline
D. Escitalopram
Correct Answer: B
Rationale: Paroxetine has anticholinergic effects that can precipitate narrow-angle
glaucoma.
7. A patient with PTSD reports nightmares, hypervigilance, and avoidance for
8 months following a motor vehicle accident. Which medication is first-line?
A. Propranolol
B. Prazosin
C. Sertraline
D. Alprazolam
Correct Answer: C
Rationale: SSRIs (sertraline, paroxetine) are first-line for PTSD. Prazosin may
help nightmares but is not first-line monotherapy.
, 8. A 30-year-old woman with anorexia nervosa has a BMI of 16.5 and
amenorrhea. She reports fear of gaining weight. Which lab finding is most
concerning?
A. Sodium 138 mEq/L
B. Potassium 2.9 mEq/L
C. Magnesium 2.0 mg/dL
D. Glucose 90 mg/dL
Correct Answer: B
Rationale: Hypokalemia is life-threatening and indicates purging behavior or
severe malnutrition requiring urgent intervention.
9. Which of the following is the most appropriate treatment for acute manic
episode in a patient with bipolar I disorder?
A. Fluoxetine
B. Lithium + antipsychotic
C. Sertraline
D. Bupropion
Correct Answer: B
Rationale: Acute mania is treated with mood stabilizer (lithium) plus an
antipsychotic. Antidepressants alone can worsen mania.
10. A patient with ADHD is started on methylphenidate. Which side effect is
most common?
A. Weight gain
B. Sedation
C. Decreased appetite
D. Bradycardia
Correct Answer: C
Rationale: Stimulants commonly cause decreased appetite and weight loss.
