PMHNP-BC — Psychiatric Mental Health Nurse
Practitioner Board Certified,, WITH CORRECT
ACTUAL QUESTIONS AND CORRECTLY WELL
DEFINED ANSWERS LATEST ALREADY GRADED A+
(2025/2026)
1. A 28-year-old patient presents with depressed mood, anhedonia,
fatigue, hypersomnia, and increased appetite. Symptoms began 2
months ago. Which is the most appropriate first-line
pharmacotherapy?
A) Bupropion
B) Sertraline (SSRI)
C) Venlafaxine
D) Amitriptyline
Correct ,,,,Answer,,,,: B – Sertraline (SSRI)
Rationale: First-line for major depressive disorder: SSRIs (sertraline,
escitalopram, fluoxetine). Bupropion may be activating; venlafaxine is
second-line; amitriptyline is older TCA with more side effects.
2. A patient with bipolar I disorder is currently manic with psychotic
features. He is taking lithium 1200 mg/day (level 0.8 mEq/L) but is still
symptomatic. Which medication should be added?
A) Bupropion
B) Olanzapine
,C) Fluoxetine
D) Lamotrigine
Correct ,,,,Answer,,,,: B – Olanzapine (atypical antipsychotic)
Rationale: Acute mania treatment: lithium or valproate + an atypical
antipsychotic (olanzapine, risperidone, quetiapine). Antidepressants may
worsen mania.
3. A 65-year-old with Parkinson’s disease develops visual
hallucinations of small animals and paranoid delusions. He is
otherwise cognitively intact. Which antipsychotic is safest?
A) Haloperidol
B) Risperidone
C) Quetiapine
D) Clozapine
Correct ,,,,Answer,,,,: C – Quetiapine (low dose) or pimavanserin
(specialized) but quetiapine is commonly used
Rationale: Parkinson’s disease psychosis: avoid high-potency
antipsychotics (haloperidol) which worsen motor symptoms. Quetiapine
and clozapine are least likely to cause extrapyramidal symptoms.
Pimavanserin is approved but quetiapine is often used.
4. A patient with generalized anxiety disorder (GAD) has failed first-line
SSRI and SNRI trials. Which medication is a reasonable next option?
A) Buspirone
B) Propranolol
,C) Hydroxyzine
D) Pregabalin (or gabapentin)
Correct ,,,,Answer,,,,: A – Buspirone (also pregabalin, but buspirone is
FDA-approved for GAD)
Rationale: Buspirone (5-HT1A agonist) is effective for GAD, especially as
adjunct or second-line. Propranolol for performance anxiety; hydroxyzine
for acute anxiety.
5. A patient with social anxiety disorder reports palpitations and
sweating when speaking in public. Which beta-blocker is used for
performance anxiety?
A) Metoprolol
B) Propranolol
C) Atenolol
D) Carvedilol
Correct ,,,,Answer,,,,: B – Propranolol (20–40 mg PRN)
Rationale: Propranolol blocks peripheral autonomic symptoms
(tachycardia, tremor) in performance anxiety. Taken 1 hour before event.
6. A 22-year-old with schizophrenia has been on clozapine for 6
months. Which lab monitoring is required?
A) Complete blood count (CBC) with absolute neutrophil count (ANC)
weekly for 6 months, then every 2 weeks for 6 months, then monthly
B) Liver function tests monthly
, C) Renal function weekly
D) Thyroid panel quarterly
Correct ,,,,Answer,,,,: A – CBC with ANC (clozapine REMS program)
Rationale: Clozapine causes agranulocytosis (0.7–1%). Mandatory
monitoring: weekly for first 6 months, then biweekly for 6 months, then
monthly.
7. A patient with bipolar II disorder is stable on lamotrigine. She
becomes pregnant. What is the recommended action regarding
lamotrigine?
A) Discontinue immediately
B) Continue lamotrigine (risk of neural tube defects is low, but monitor
levels – they may drop in pregnancy)
C) Switch to valproate
D) Switch to lithium
Correct ,,,,Answer,,,,: B – Continue lamotrigine (risk lower than valproate)
Rationale: Valproate is teratogenic (neural tube defects). Lamotrigine is
generally safer. Dose may need adjustment due to increased clearance in
pregnancy.
8. A patient with PTSD has recurrent nightmares and hyperarousal.
Which medication has evidence for reducing nightmares?
A) Prazosin
B) Clonidine
Practitioner Board Certified,, WITH CORRECT
ACTUAL QUESTIONS AND CORRECTLY WELL
DEFINED ANSWERS LATEST ALREADY GRADED A+
(2025/2026)
1. A 28-year-old patient presents with depressed mood, anhedonia,
fatigue, hypersomnia, and increased appetite. Symptoms began 2
months ago. Which is the most appropriate first-line
pharmacotherapy?
A) Bupropion
B) Sertraline (SSRI)
C) Venlafaxine
D) Amitriptyline
Correct ,,,,Answer,,,,: B – Sertraline (SSRI)
Rationale: First-line for major depressive disorder: SSRIs (sertraline,
escitalopram, fluoxetine). Bupropion may be activating; venlafaxine is
second-line; amitriptyline is older TCA with more side effects.
2. A patient with bipolar I disorder is currently manic with psychotic
features. He is taking lithium 1200 mg/day (level 0.8 mEq/L) but is still
symptomatic. Which medication should be added?
A) Bupropion
B) Olanzapine
,C) Fluoxetine
D) Lamotrigine
Correct ,,,,Answer,,,,: B – Olanzapine (atypical antipsychotic)
Rationale: Acute mania treatment: lithium or valproate + an atypical
antipsychotic (olanzapine, risperidone, quetiapine). Antidepressants may
worsen mania.
3. A 65-year-old with Parkinson’s disease develops visual
hallucinations of small animals and paranoid delusions. He is
otherwise cognitively intact. Which antipsychotic is safest?
A) Haloperidol
B) Risperidone
C) Quetiapine
D) Clozapine
Correct ,,,,Answer,,,,: C – Quetiapine (low dose) or pimavanserin
(specialized) but quetiapine is commonly used
Rationale: Parkinson’s disease psychosis: avoid high-potency
antipsychotics (haloperidol) which worsen motor symptoms. Quetiapine
and clozapine are least likely to cause extrapyramidal symptoms.
Pimavanserin is approved but quetiapine is often used.
4. A patient with generalized anxiety disorder (GAD) has failed first-line
SSRI and SNRI trials. Which medication is a reasonable next option?
A) Buspirone
B) Propranolol
,C) Hydroxyzine
D) Pregabalin (or gabapentin)
Correct ,,,,Answer,,,,: A – Buspirone (also pregabalin, but buspirone is
FDA-approved for GAD)
Rationale: Buspirone (5-HT1A agonist) is effective for GAD, especially as
adjunct or second-line. Propranolol for performance anxiety; hydroxyzine
for acute anxiety.
5. A patient with social anxiety disorder reports palpitations and
sweating when speaking in public. Which beta-blocker is used for
performance anxiety?
A) Metoprolol
B) Propranolol
C) Atenolol
D) Carvedilol
Correct ,,,,Answer,,,,: B – Propranolol (20–40 mg PRN)
Rationale: Propranolol blocks peripheral autonomic symptoms
(tachycardia, tremor) in performance anxiety. Taken 1 hour before event.
6. A 22-year-old with schizophrenia has been on clozapine for 6
months. Which lab monitoring is required?
A) Complete blood count (CBC) with absolute neutrophil count (ANC)
weekly for 6 months, then every 2 weeks for 6 months, then monthly
B) Liver function tests monthly
, C) Renal function weekly
D) Thyroid panel quarterly
Correct ,,,,Answer,,,,: A – CBC with ANC (clozapine REMS program)
Rationale: Clozapine causes agranulocytosis (0.7–1%). Mandatory
monitoring: weekly for first 6 months, then biweekly for 6 months, then
monthly.
7. A patient with bipolar II disorder is stable on lamotrigine. She
becomes pregnant. What is the recommended action regarding
lamotrigine?
A) Discontinue immediately
B) Continue lamotrigine (risk of neural tube defects is low, but monitor
levels – they may drop in pregnancy)
C) Switch to valproate
D) Switch to lithium
Correct ,,,,Answer,,,,: B – Continue lamotrigine (risk lower than valproate)
Rationale: Valproate is teratogenic (neural tube defects). Lamotrigine is
generally safer. Dose may need adjustment due to increased clearance in
pregnancy.
8. A patient with PTSD has recurrent nightmares and hyperarousal.
Which medication has evidence for reducing nightmares?
A) Prazosin
B) Clonidine
