1
PMHNP Certification Exam
2026 – 2027 Questions with
Correct Verified Answers and
Detailed Rationales (Actual
test verified A+)
1. Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male,
white, depression): D. 68 y/o single white male with depression *5 risk
factors (age, male, white, depression)
Count the risk factors
2. When interview teenagers (16 y/o) that arrive with their parents
what should you do?: interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is
confiden- tial. Parents may be upset but remember you are advocating for
the child.
3. Which Ethnic group has the highest rate of suicide?: Native Americans
4. Example A patient is being treated for schizophrenia with
olanzapine. Which of the following is the most common side effect of
olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor
an- tagonism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also
least sedating), Geodon-if patient has metabolic syndrome consider
switching to one of the medications above. Or if the patient is overly
sedated try switching to ABILIFY
1/
,6. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
7. When presented with a question about typical vs atypical
antipsychotic the answer is usually to start of a: atypical
2
8. A client presents with complains of changes in appetite, feeling
fatigued, problems with sleep-rest cycle, and changes in libido. What is
the neu- roanatomical area of the brain that is responsible for the normal
regulation of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus: Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
3
9. When a patient is hesitant to participate in treatment you should encour- ag
10. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
11. When T4 and T3 are high and TSH is low what is the diagnosis:
HY- PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms
HEAT INTOLERANCE
12. Key symptoms of Heat Intolerance: Hyperthyroidism
13. When T4 and T3 are Low and TSH is high what is the diagnosis:
(HY- POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD
INTERANCE
14. Key symptoms of Cold Intolerance: Hypothyroidism
15. Hyperthyroid can mimic: Mania
16. Hypothyroid can mimic: Depression
17. A patient on depakote complains of RUQ pain and has
reddish/brown urine: Hepatoxicity
-Check LFTs
18. Signs of Depakote toxicity: Disorientation, confusion, lethargy
19. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
2/
,-Depakote Level
20. What herbal supplement can cause hepatoxicity?: Kava Kava
21. When taking Kava Kava in combinations with other
medications you should caution about: Risk of Hepatoxicity and
Sedation
22. TCAs carry a risk of: Hepatotoxicity
23. Signs of Stevens-Johnson Syndrome: -fever, mouth pain,
swelling, burning eyes, blisters, skin pain
24. two psychotropics known to cause steven johnson syndrome:
lamictal and tegretol
25. What nationality is most suseptible of getting steven johnson?:
Asians
26. When treating asians with tegretal screen for?: HLAB-1502 Allele
27. What two medications cause agranulocytosis?: Clozaril & Tegretal
28. Agranulocytosis when to discontinue medication: Less than 1000
4
29. When monitoring for agranulocytosis in patients look for s/s of what?: -
Infection
-Fever, sore throat, fatigue, chills
30. Before starting any mood stabilizer in a female of childbearing
age be sure to check?: HCG
31. Which two medications may decrease the risk of suicide?:
clozaril and lithium
32. Medications that increase lithium level: NSAID-ibuprofen,
INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-
lisinopril
33. Ace inhibitors are treatment of choice for?: Heart Failure
34. Certain medications are known to increase lithium level, but
HOW?: by reducing renal clearance
35. When educating a patient about lithium teach them about:
Hyponatremia Dehydration-hot days, exercise
36. Normal Lithium Level: 0.6-1.2
3/
, 37. Lithium Toxicity: 1.5 or
above Discontinue and re-order
lithium level
38. Lithium level of 1.4: Monitor for toxicity
39. Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to
check for presence of protein in the urine (4+ protein is concerning for
renal impair- ment)à4+ protein in urine=MONITOR FOR TOXICITY
40. 4+ protein in the urine of a patient on lithium: 4+ protein is
concerning for renal impairment
4+ protein in urine=MONITOR FOR TOXICITY
41. Lithium side effects: hypothyroid, leukocytosis, maculopapular
rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting,
anorexia)
-Some of these are also signs of toxicity
42. Signs of lithium toxicity: confusion, ataxia, GI upset, palpitation,
tremor
43. NMS: muscle rigidity, mutism (because of muscle rigidity),
increased CPK (caused by muscle contraction and muscle destruction),
increase WBC, increased WBC, myoglobinuria (also from muscle
destruction)
44. Cherry colored urine in a patient that exercises a lot: test for
myoglobinuria may be a sign of rhabdo
5
45. Serotonin Syndrome: With any drug that increases 5-HT (e.g.,
MAO in- hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus,
cardiovascular insta- bility, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
46. Treatment for NMS: Stop Offending Medication
-Dantrolene (muscle relaxer)
-Bromocriptine (Dopamine D2 agonist).
*In question focus on what they are asking for....dopamine agonist vs
muscle relaxer
47. Treatment for Serotonin Syndrome: Stop Med (1 or more SSRI,
SSNRI, TCA, MOAI)
-Cyproheptadine
48. Triptans: Used for MIGRAINES
4/
PMHNP Certification Exam
2026 – 2027 Questions with
Correct Verified Answers and
Detailed Rationales (Actual
test verified A+)
1. Which patient is at highest risk for SI
A. 30y/o married AA female with previous SI attempt *1 risk factor
B. 35 y/o single Asian male with previous SI attempt *3 risk factors
C. 38 y/o single AA male who is a manager of a bank *2 risk factors
D. 68 y/o single white male with depression *5 risk factors (age, male,
white, depression): D. 68 y/o single white male with depression *5 risk
factors (age, male, white, depression)
Count the risk factors
2. When interview teenagers (16 y/o) that arrive with their parents
what should you do?: interview them separately from parents.
-This helps Build therapeutic rapport with teens by telling them the info is
confiden- tial. Parents may be upset but remember you are advocating for
the child.
3. Which Ethnic group has the highest rate of suicide?: Native Americans
4. Example A patient is being treated for schizophrenia with
olanzapine. Which of the following is the most common side effect of
olanzapine?
A. Increased waist circumference
B. EPS (not as common in atypical antipsychotics d/t 5HT2A)-receptor
an- tagonism
C. Increased Lipids
D. Metabolic Syndrome: D. Metabolic Syndrome (UMBRELLA ANSWER)
5. Which antipsychotics have the least weight gain?: Latuda, Abilify, (also
least sedating), Geodon-if patient has metabolic syndrome consider
switching to one of the medications above. Or if the patient is overly
sedated try switching to ABILIFY
1/
,6. Which mood stabilizer have the least weight gain?: Lamictal
-But remember all mood stabilizers cause some weight gain
7. When presented with a question about typical vs atypical
antipsychotic the answer is usually to start of a: atypical
2
8. A client presents with complains of changes in appetite, feeling
fatigued, problems with sleep-rest cycle, and changes in libido. What is
the neu- roanatomical area of the brain that is responsible for the normal
regulation of these functions?
A. Thalamus
B. Hypothalamus
C. Limbic System
D. Hippocampus: Hypothalamus
A, B, & D are all part of the limbic system so you can rule that out
3
9. When a patient is hesitant to participate in treatment you should encour- ag
10. Thyroid-Stimulating hormone normal level: 0.5-5.0 Mu/L
11. When T4 and T3 are high and TSH is low what is the diagnosis:
HY- PERTHYROIDISM, TSH secretion decreases: TSH LOW à key symptoms
HEAT INTOLERANCE
12. Key symptoms of Heat Intolerance: Hyperthyroidism
13. When T4 and T3 are Low and TSH is high what is the diagnosis:
(HY- POTHYROIDISM) TSH secretion increased: TSH HIGH à COLD
INTERANCE
14. Key symptoms of Cold Intolerance: Hypothyroidism
15. Hyperthyroid can mimic: Mania
16. Hypothyroid can mimic: Depression
17. A patient on depakote complains of RUQ pain and has
reddish/brown urine: Hepatoxicity
-Check LFTs
18. Signs of Depakote toxicity: Disorientation, confusion, lethargy
19. You suspect depakote toxicity what do you do?: Check
-LFT
-Ammonia
2/
,-Depakote Level
20. What herbal supplement can cause hepatoxicity?: Kava Kava
21. When taking Kava Kava in combinations with other
medications you should caution about: Risk of Hepatoxicity and
Sedation
22. TCAs carry a risk of: Hepatotoxicity
23. Signs of Stevens-Johnson Syndrome: -fever, mouth pain,
swelling, burning eyes, blisters, skin pain
24. two psychotropics known to cause steven johnson syndrome:
lamictal and tegretol
25. What nationality is most suseptible of getting steven johnson?:
Asians
26. When treating asians with tegretal screen for?: HLAB-1502 Allele
27. What two medications cause agranulocytosis?: Clozaril & Tegretal
28. Agranulocytosis when to discontinue medication: Less than 1000
4
29. When monitoring for agranulocytosis in patients look for s/s of what?: -
Infection
-Fever, sore throat, fatigue, chills
30. Before starting any mood stabilizer in a female of childbearing
age be sure to check?: HCG
31. Which two medications may decrease the risk of suicide?:
clozaril and lithium
32. Medications that increase lithium level: NSAID-ibuprofen,
INDOCIN THIAZIDES-hydrochlorithiazide ACE INHIBITORS-
lisinopril
33. Ace inhibitors are treatment of choice for?: Heart Failure
34. Certain medications are known to increase lithium level, but
HOW?: by reducing renal clearance
35. When educating a patient about lithium teach them about:
Hyponatremia Dehydration-hot days, exercise
36. Normal Lithium Level: 0.6-1.2
3/
, 37. Lithium Toxicity: 1.5 or
above Discontinue and re-order
lithium level
38. Lithium level of 1.4: Monitor for toxicity
39. Labs before starting lithium: TSH, BUN, CREATININE, HCG, U/A to
check for presence of protein in the urine (4+ protein is concerning for
renal impair- ment)à4+ protein in urine=MONITOR FOR TOXICITY
40. 4+ protein in the urine of a patient on lithium: 4+ protein is
concerning for renal impairment
4+ protein in urine=MONITOR FOR TOXICITY
41. Lithium side effects: hypothyroid, leukocytosis, maculopapular
rash, t-wave inversion, Coarse Hand Tremor, GI upset (nausea, vomiting,
anorexia)
-Some of these are also signs of toxicity
42. Signs of lithium toxicity: confusion, ataxia, GI upset, palpitation,
tremor
43. NMS: muscle rigidity, mutism (because of muscle rigidity),
increased CPK (caused by muscle contraction and muscle destruction),
increase WBC, increased WBC, myoglobinuria (also from muscle
destruction)
44. Cherry colored urine in a patient that exercises a lot: test for
myoglobinuria may be a sign of rhabdo
5
45. Serotonin Syndrome: With any drug that increases 5-HT (e.g.,
MAO in- hibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus,
cardiovascular insta- bility, flushing, diarrhea, seizures.
-Treatment: cyproheptadine (5-HT2 receptor antagonist).
46. Treatment for NMS: Stop Offending Medication
-Dantrolene (muscle relaxer)
-Bromocriptine (Dopamine D2 agonist).
*In question focus on what they are asking for....dopamine agonist vs
muscle relaxer
47. Treatment for Serotonin Syndrome: Stop Med (1 or more SSRI,
SSNRI, TCA, MOAI)
-Cyproheptadine
48. Triptans: Used for MIGRAINES
4/
