PSYCHIATRIC MENTAL HEALTH NURSE
PRACTITIONER FINAL EXAM STUDY GUIDE LATEST
2026 UPDATE 100 QUESTIONS AND DETAILED
VERIFIED ANSWERS FROM ACTUAL EXAMS TEST
GRADE A+
1. A patient with major depressive disorder reports early morning awakening,
anhedonia, and feelings of guilt. Which neurotransmitter imbalance is most
associated with these symptoms?
A. Dopamine excess
B. Serotonin and norepinephrine deficiency
C. Acetylcholine excess
D. GABA excess
Answer: B. Serotonin and norepinephrine deficiency
Rationale: Major depressive disorder is strongly associated with decreased
serotonin and norepinephrine activity, contributing to mood disturbance, sleep
disruption, and loss of pleasure.
2. Which defense mechanism is demonstrated when a patient who is angry
with a supervisor goes home and yells at family members?
A. Projection
B. Sublimation
C. Displacement
D. Rationalization
Answer: C. Displacement
Rationale: Displacement occurs when emotions are redirected from the original
source to a safer substitute target.
, 3. A patient taking lithium develops coarse tremors, vomiting, and confusion.
What is the PMHNP’s priority action?
A. Encourage fluid restriction
B. Hold lithium and obtain serum lithium level
C. Administer the next scheduled dose
D. Reassure the patient symptoms are temporary
Answer: B. Hold lithium and obtain serum lithium level
Rationale: These symptoms suggest lithium toxicity, requiring immediate
discontinuation and serum level assessment.
4. Which symptom is considered a positive symptom of schizophrenia?
A. Flat affect
B. Avolition
C. Social withdrawal
D. Auditory hallucinations
Answer: D. Auditory hallucinations
Rationale: Positive symptoms are excesses or distortions of normal function,
including hallucinations and delusions.
5. A patient experiencing a panic attack is hyperventilating and trembling.
What is the most appropriate initial intervention?
A. Teach cognitive restructuring
B. Encourage exploration of childhood trauma
C. Stay with the patient and use calm reassurance
D. Leave the patient alone to decrease stimulation
Answer: C. Stay with the patient and use calm reassurance
,Rationale: During a panic attack, the immediate priority is safety, support, and
reduction of anxiety through calm presence.
6. Which medication requires monitoring for agranulocytosis?
A. Fluoxetine
B. Clozapine
C. Haloperidol
D. Buspirone
Answer: B. Clozapine
Rationale: Clozapine carries a risk for agranulocytosis, requiring regular absolute
neutrophil count monitoring.
7. A patient with bipolar I disorder presents with pressured speech,
grandiosity, and decreased need for sleep. Which phase is the patient
experiencing?
A. Hypomania
B. Mania
C. Cyclothymia
D. Dysthymia
Answer: B. Mania
Rationale: Mania involves severe functional impairment and symptoms such as
grandiosity, decreased sleep, and pressured speech.
8. Which statement best describes transference?
A. The clinician projects emotions onto the patient
B. The patient unconsciously redirects feelings toward the clinician
C. The clinician avoids emotional involvement
D. The patient consciously manipulates the clinician
, Answer: B. The patient unconsciously redirects feelings toward the clinician
Rationale: Transference occurs when feelings related to past relationships are
unconsciously directed toward the provider.
9. A patient on an MAOI should avoid which food?
A. Yogurt
B. Fresh chicken
C. Aged cheese
D. Apples
Answer: C. Aged cheese
Rationale: Foods high in tyramine, such as aged cheese, can trigger hypertensive
crisis when combined with MAOIs.
10.Which finding is most characteristic of delirium?
A. Stable cognition
B. Gradual onset
C. Fluctuating level of consciousness
D. Intact attention span
Answer: C. Fluctuating level of consciousness
Rationale: Delirium is characterized by acute onset, fluctuating consciousness, and
impaired attention.
11.A patient says, “I hear voices telling me I am evil.” What is the PMHNP’s
best response?
A. “The voices are not real.”
B. “What are the voices saying to you?”
C. “Ignore the voices.”
D. “You should not talk about hallucinations.”
PRACTITIONER FINAL EXAM STUDY GUIDE LATEST
2026 UPDATE 100 QUESTIONS AND DETAILED
VERIFIED ANSWERS FROM ACTUAL EXAMS TEST
GRADE A+
1. A patient with major depressive disorder reports early morning awakening,
anhedonia, and feelings of guilt. Which neurotransmitter imbalance is most
associated with these symptoms?
A. Dopamine excess
B. Serotonin and norepinephrine deficiency
C. Acetylcholine excess
D. GABA excess
Answer: B. Serotonin and norepinephrine deficiency
Rationale: Major depressive disorder is strongly associated with decreased
serotonin and norepinephrine activity, contributing to mood disturbance, sleep
disruption, and loss of pleasure.
2. Which defense mechanism is demonstrated when a patient who is angry
with a supervisor goes home and yells at family members?
A. Projection
B. Sublimation
C. Displacement
D. Rationalization
Answer: C. Displacement
Rationale: Displacement occurs when emotions are redirected from the original
source to a safer substitute target.
, 3. A patient taking lithium develops coarse tremors, vomiting, and confusion.
What is the PMHNP’s priority action?
A. Encourage fluid restriction
B. Hold lithium and obtain serum lithium level
C. Administer the next scheduled dose
D. Reassure the patient symptoms are temporary
Answer: B. Hold lithium and obtain serum lithium level
Rationale: These symptoms suggest lithium toxicity, requiring immediate
discontinuation and serum level assessment.
4. Which symptom is considered a positive symptom of schizophrenia?
A. Flat affect
B. Avolition
C. Social withdrawal
D. Auditory hallucinations
Answer: D. Auditory hallucinations
Rationale: Positive symptoms are excesses or distortions of normal function,
including hallucinations and delusions.
5. A patient experiencing a panic attack is hyperventilating and trembling.
What is the most appropriate initial intervention?
A. Teach cognitive restructuring
B. Encourage exploration of childhood trauma
C. Stay with the patient and use calm reassurance
D. Leave the patient alone to decrease stimulation
Answer: C. Stay with the patient and use calm reassurance
,Rationale: During a panic attack, the immediate priority is safety, support, and
reduction of anxiety through calm presence.
6. Which medication requires monitoring for agranulocytosis?
A. Fluoxetine
B. Clozapine
C. Haloperidol
D. Buspirone
Answer: B. Clozapine
Rationale: Clozapine carries a risk for agranulocytosis, requiring regular absolute
neutrophil count monitoring.
7. A patient with bipolar I disorder presents with pressured speech,
grandiosity, and decreased need for sleep. Which phase is the patient
experiencing?
A. Hypomania
B. Mania
C. Cyclothymia
D. Dysthymia
Answer: B. Mania
Rationale: Mania involves severe functional impairment and symptoms such as
grandiosity, decreased sleep, and pressured speech.
8. Which statement best describes transference?
A. The clinician projects emotions onto the patient
B. The patient unconsciously redirects feelings toward the clinician
C. The clinician avoids emotional involvement
D. The patient consciously manipulates the clinician
, Answer: B. The patient unconsciously redirects feelings toward the clinician
Rationale: Transference occurs when feelings related to past relationships are
unconsciously directed toward the provider.
9. A patient on an MAOI should avoid which food?
A. Yogurt
B. Fresh chicken
C. Aged cheese
D. Apples
Answer: C. Aged cheese
Rationale: Foods high in tyramine, such as aged cheese, can trigger hypertensive
crisis when combined with MAOIs.
10.Which finding is most characteristic of delirium?
A. Stable cognition
B. Gradual onset
C. Fluctuating level of consciousness
D. Intact attention span
Answer: C. Fluctuating level of consciousness
Rationale: Delirium is characterized by acute onset, fluctuating consciousness, and
impaired attention.
11.A patient says, “I hear voices telling me I am evil.” What is the PMHNP’s
best response?
A. “The voices are not real.”
B. “What are the voices saying to you?”
C. “Ignore the voices.”
D. “You should not talk about hallucinations.”
