Page 1 of 173
Georgette Review. PMHNP- 388
QUESTIONS- WITH COMPLETE SOLUTIONS
2026 Update |GUARANTEED PASS|
1. A patient on clozapine presents with fever, tachycardia,
and rigidity. What is the priority intervention?
A. Administer benztropine
B. Stop clozapine and check CK
C. Increase clozapine dose
D. Start aripiprazole
,Page 2 of 173
Answer: B
Rationale: Suspect neuroleptic malignant syndrome (NMS).
Clozapine can cause NMS. Stop the drug immediately and
check creatine kinase (CK). Benztropine is for EPS, not NMS.
2. Which receptor profile explains olanzapine’s weight gain?
A. High D2 affinity
B. High 5-HT2A antagonism
C. High H1 antagonism
D. High sigma-1 agonism
Answer: C
Rationale: Histamine-1 (H1) receptor antagonism increases
appetite and sedation, leading to weight gain and metabolic
syndrome.
3. A patient on fluoxetine reports bruising and nosebleeds.
What lab should be drawn?
A. INR/PTT
B. Platelet count
,Page 3 of 173
C. LFTs
D. BUN/Cr
Answer: B
Rationale: SSRIs inhibit serotonin reuptake in platelets,
impairing aggregation and increasing bleeding risk. Check
platelet count and function.
4. Which antidepressant is most lethal in overdose?
A. Sertraline
B. Escitalopram
C. Venlafaxine
D. Mirtazapine
Answer: C
Rationale: Venlafaxine causes cardiotoxicity (QT
prolongation), seizures, and serotonin syndrome in overdose.
SSRIs are safer.
5. A patient on lithium develops polyuria, polydipsia. What is
the likely cause?
, Page 4 of 173
A. Diabetes mellitus
B. Nephrogenic diabetes insipidus
C. SIADH
D. Psychogenic polydipsia
Answer: B
Rationale: Lithium inhibits ADH action on renal collecting ducts
→ nephrogenic diabetes insipidus. Check urine specific gravity
(<1.005).
6. What is the minimum time to assess response to fluoxetine?
A. 2–4 days
B. 1–2 weeks
C. 4–6 weeks
D. 8–10 weeks
Answer: C
Rationale: Fluoxetine has a long half-life (4–6 days) plus
active metabolite norfluoxetine (up to 16 days). Full response
takes 4–6 weeks.
Georgette Review. PMHNP- 388
QUESTIONS- WITH COMPLETE SOLUTIONS
2026 Update |GUARANTEED PASS|
1. A patient on clozapine presents with fever, tachycardia,
and rigidity. What is the priority intervention?
A. Administer benztropine
B. Stop clozapine and check CK
C. Increase clozapine dose
D. Start aripiprazole
,Page 2 of 173
Answer: B
Rationale: Suspect neuroleptic malignant syndrome (NMS).
Clozapine can cause NMS. Stop the drug immediately and
check creatine kinase (CK). Benztropine is for EPS, not NMS.
2. Which receptor profile explains olanzapine’s weight gain?
A. High D2 affinity
B. High 5-HT2A antagonism
C. High H1 antagonism
D. High sigma-1 agonism
Answer: C
Rationale: Histamine-1 (H1) receptor antagonism increases
appetite and sedation, leading to weight gain and metabolic
syndrome.
3. A patient on fluoxetine reports bruising and nosebleeds.
What lab should be drawn?
A. INR/PTT
B. Platelet count
,Page 3 of 173
C. LFTs
D. BUN/Cr
Answer: B
Rationale: SSRIs inhibit serotonin reuptake in platelets,
impairing aggregation and increasing bleeding risk. Check
platelet count and function.
4. Which antidepressant is most lethal in overdose?
A. Sertraline
B. Escitalopram
C. Venlafaxine
D. Mirtazapine
Answer: C
Rationale: Venlafaxine causes cardiotoxicity (QT
prolongation), seizures, and serotonin syndrome in overdose.
SSRIs are safer.
5. A patient on lithium develops polyuria, polydipsia. What is
the likely cause?
, Page 4 of 173
A. Diabetes mellitus
B. Nephrogenic diabetes insipidus
C. SIADH
D. Psychogenic polydipsia
Answer: B
Rationale: Lithium inhibits ADH action on renal collecting ducts
→ nephrogenic diabetes insipidus. Check urine specific gravity
(<1.005).
6. What is the minimum time to assess response to fluoxetine?
A. 2–4 days
B. 1–2 weeks
C. 4–6 weeks
D. 8–10 weeks
Answer: C
Rationale: Fluoxetine has a long half-life (4–6 days) plus
active metabolite norfluoxetine (up to 16 days). Full response
takes 4–6 weeks.
