PMHNP Lifespan II Practice Final Exam
(2026) 150 Questions with Verified Answers
and Detailed Rationales Complete Coverage
for ANCC Certification Success
DOMAIN I: SCIENTIFIC FOUNDATION
QUESTION 1
A 45-year-old patient with bipolar I disorder presents with elevated mood,
decreased need for sleep, and racing thoughts. Which medication is the most
appropriate first-line treatment for acute mania?
A. Fluoxetine
B. Lithium
C. Bupropion
D. Buspirone
Answer: B. Lithium
Rationale: Lithium is considered a first-line treatment for acute mania
in bipolar disorder. It has robust evidence for efficacy in manic
episodes and is the gold standard for bipolar maintenance. SSRIs like
fluoxetine can precipitate mania and are contraindicated in acute
manic episodes. Bupropion is an antidepressant with activating
properties that could worsen mania. Buspirone is an anxiolytic with
no role in treating acute mania .
,QUESTION 2
Which of the following laboratory tests must be monitored regularly for a
patient on valproic acid?
A. Renal function tests
B. Liver function tests
C. Thyroid levels
D. White blood cell count
Answer: B. Liver function tests
Rationale: Valproic acid can cause hepatotoxicity, so liver function
tests (AST, ALT) should be monitored at baseline and periodically
during treatment. It can also cause thrombocytopenia and
pancreatitis, so CBC with platelets and amylase/lipase may be
monitored. Renal function and thyroid levels are not primary
concerns with valproate. Lithium requires monitoring of renal
function and thyroid levels .
QUESTION 3
Which medication is contraindicated in a patient with a history of seizures?
A. Sertraline
B. Bupropion
C. Mirtazapine
D. Escitalopram
Answer: B. Bupropion
Rationale: Bupropion lowers the seizure threshold and is
contraindicated in patients with seizure disorders or conditions that
increase seizure risk (e.g., eating disorders, alcohol withdrawal). The
risk is dose-dependent and higher with immediate-release
,formulations. SSRIs (sertraline, escitalopram) and mirtazapine are
generally safe in patients with well-controlled seizure disorders .
QUESTION 4
A 12-year-old with ADHD is started on methylphenidate. What baseline
measurement is most important before starting treatment?
A. Weight
B. Blood pressure and heart rate
C. Blood glucose
D. Liver enzymes
Answer: B. Blood pressure and heart rate
Rationale: Stimulants like methylphenidate can increase blood
pressure and heart rate, so cardiovascular baseline assessment (BP,
HR) is crucial. Weight and growth should be monitored throughout
treatment as stimulants can suppress appetite and affect growth
velocity. Blood glucose and liver enzymes are not routinely required
before starting stimulants .
QUESTION 5
Which class of medications is most associated with metabolic syndrome in
patients with schizophrenia?
A. Typical antipsychotics
B. Atypical antipsychotics
C. SSRIs
D. Benzodiazepines
Answer: B. Atypical antipsychotics
Rationale: Atypical antipsychotics, particularly clozapine and
olanzapine, have higher risks of metabolic side effects including
, weight gain, dyslipidemia, and hyperglycemia. Metabolic monitoring
(weight, BMI, waist circumference, fasting glucose, lipid panel) is
essential at baseline and regularly during treatment. Typical
antipsychotics have higher EPS risk but lower metabolic risk .
QUESTION 6
A 75-year-old patient with dementia is prescribed an antipsychotic for
agitation. Which medication is most appropriate given the FDA black box
warning?
A. Haloperidol
B. Olanzapine
C. Risperidone
D. All antipsychotics carry a black box warning for elderly patients with
dementia
Answer: D. All antipsychotics carry a black box warning for elderly
patients with dementia
Rationale: All antipsychotics (both typical and atypical) carry an FDA
black box warning for increased risk of cerebrovascular events and
mortality in elderly patients with dementia-related psychosis. They
should be used only when non-pharmacologic measures fail and the
benefits outweigh the risks, at the lowest effective dose for the
shortest duration .
QUESTION 7
Which medication is FDA-approved for the treatment of nightmares
associated with PTSD?
A. Sertraline
B. Paroxetine
(2026) 150 Questions with Verified Answers
and Detailed Rationales Complete Coverage
for ANCC Certification Success
DOMAIN I: SCIENTIFIC FOUNDATION
QUESTION 1
A 45-year-old patient with bipolar I disorder presents with elevated mood,
decreased need for sleep, and racing thoughts. Which medication is the most
appropriate first-line treatment for acute mania?
A. Fluoxetine
B. Lithium
C. Bupropion
D. Buspirone
Answer: B. Lithium
Rationale: Lithium is considered a first-line treatment for acute mania
in bipolar disorder. It has robust evidence for efficacy in manic
episodes and is the gold standard for bipolar maintenance. SSRIs like
fluoxetine can precipitate mania and are contraindicated in acute
manic episodes. Bupropion is an antidepressant with activating
properties that could worsen mania. Buspirone is an anxiolytic with
no role in treating acute mania .
,QUESTION 2
Which of the following laboratory tests must be monitored regularly for a
patient on valproic acid?
A. Renal function tests
B. Liver function tests
C. Thyroid levels
D. White blood cell count
Answer: B. Liver function tests
Rationale: Valproic acid can cause hepatotoxicity, so liver function
tests (AST, ALT) should be monitored at baseline and periodically
during treatment. It can also cause thrombocytopenia and
pancreatitis, so CBC with platelets and amylase/lipase may be
monitored. Renal function and thyroid levels are not primary
concerns with valproate. Lithium requires monitoring of renal
function and thyroid levels .
QUESTION 3
Which medication is contraindicated in a patient with a history of seizures?
A. Sertraline
B. Bupropion
C. Mirtazapine
D. Escitalopram
Answer: B. Bupropion
Rationale: Bupropion lowers the seizure threshold and is
contraindicated in patients with seizure disorders or conditions that
increase seizure risk (e.g., eating disorders, alcohol withdrawal). The
risk is dose-dependent and higher with immediate-release
,formulations. SSRIs (sertraline, escitalopram) and mirtazapine are
generally safe in patients with well-controlled seizure disorders .
QUESTION 4
A 12-year-old with ADHD is started on methylphenidate. What baseline
measurement is most important before starting treatment?
A. Weight
B. Blood pressure and heart rate
C. Blood glucose
D. Liver enzymes
Answer: B. Blood pressure and heart rate
Rationale: Stimulants like methylphenidate can increase blood
pressure and heart rate, so cardiovascular baseline assessment (BP,
HR) is crucial. Weight and growth should be monitored throughout
treatment as stimulants can suppress appetite and affect growth
velocity. Blood glucose and liver enzymes are not routinely required
before starting stimulants .
QUESTION 5
Which class of medications is most associated with metabolic syndrome in
patients with schizophrenia?
A. Typical antipsychotics
B. Atypical antipsychotics
C. SSRIs
D. Benzodiazepines
Answer: B. Atypical antipsychotics
Rationale: Atypical antipsychotics, particularly clozapine and
olanzapine, have higher risks of metabolic side effects including
, weight gain, dyslipidemia, and hyperglycemia. Metabolic monitoring
(weight, BMI, waist circumference, fasting glucose, lipid panel) is
essential at baseline and regularly during treatment. Typical
antipsychotics have higher EPS risk but lower metabolic risk .
QUESTION 6
A 75-year-old patient with dementia is prescribed an antipsychotic for
agitation. Which medication is most appropriate given the FDA black box
warning?
A. Haloperidol
B. Olanzapine
C. Risperidone
D. All antipsychotics carry a black box warning for elderly patients with
dementia
Answer: D. All antipsychotics carry a black box warning for elderly
patients with dementia
Rationale: All antipsychotics (both typical and atypical) carry an FDA
black box warning for increased risk of cerebrovascular events and
mortality in elderly patients with dementia-related psychosis. They
should be used only when non-pharmacologic measures fail and the
benefits outweigh the risks, at the lowest effective dose for the
shortest duration .
QUESTION 7
Which medication is FDA-approved for the treatment of nightmares
associated with PTSD?
A. Sertraline
B. Paroxetine
