Psychiatric-Mental Health Nurse
Practitioner Exam 2024
**Target Question Count:** 75
**The Mind's Mosaic: NGN PMHNP Mastery**
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1. 28-year-old, depressed mood, anhedonia, hypersomnia, hyperphagia, leaden paralysis. Best SSRI?
💫RATIONALE✔️✔️: Atypical depression (reversed vegetative). MAOIs effective but SSRI first-line.
💫ANSWER✔️✔️: C. Sertraline
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2. Bipolar I, acute mania, agitation, psychosis. Lithium level 0.6. Next?
💫RATIONALE✔️✔️: Subtherapeutic. Add atypical antipsychotic (olanzapine or risperidone).
💫ANSWER✔️✔️: A. Olanzapine
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3. Treatment-resistant depression, failed 2 SSRIs, augmentation strategy?
💫RATIONALE✔️✔️: Add aripiprazole (FDA-approved) or switch to SNRI + mirtazapine.
💫ANSWER✔️✔️: D. Aripiprazole
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4. Panic disorder, agoraphobia, benzodiazepine daily for 2 years. Plan to taper?
💫RATIONALE✔️✔️: Slow taper over months. Switch to diazepam (long half-life) for smoother taper.
💫ANSWER✔️✔️: B. Convert to diazepam and reduce 10% weekly
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5. PTSD, nightmares, hyperarousal, failed SSRI. Next medication?
💫RATIONALE✔️✔️: Prazosin for nightmares, SNRIs (venlafaxine), or atypical antipsychotic.
💫ANSWER✔️✔️: C. Prazosin
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6. Generalized anxiety disorder, comorbid substance use disorder. Avoid?
💫RATIONALE✔️✔️: Benzodiazepines (abuse risk). Buspirone or SSRI preferred.
💫ANSWER✔️✔️: D. Alprazolam
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7. Social anxiety disorder, performance only. PRN medication?
💫RATIONALE✔️✔️: Propranolol 20-40 mg 1 hour before performance. Reduces autonomic symptoms.
💫ANSWER✔️✔️: A. Propranolol
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8. 20-year-old, first episode psychosis, auditory hallucinations, paranoia. Initial treatment?
💫RATIONALE✔️✔️: Antipsychotic monotherapy. Aripiprazole or risperidone. Avoid long-term high dose.
💫ANSWER✔️✔️: B. Aripiprazole
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9. Schizophrenia, clozapine for refractory symptoms. Mandatory monitoring frequency?
💫RATIONALE✔️✔️: ANC weekly x 6 months, then q2 weeks x 6 months, then q4 weeks.
💫ANSWER✔️✔️: D. Weekly for 6 months
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10. Tardive dyskinesia from long-term antipsychotic. FDA-approved treatment?
Practitioner Exam 2024
**Target Question Count:** 75
**The Mind's Mosaic: NGN PMHNP Mastery**
---
1. 28-year-old, depressed mood, anhedonia, hypersomnia, hyperphagia, leaden paralysis. Best SSRI?
💫RATIONALE✔️✔️: Atypical depression (reversed vegetative). MAOIs effective but SSRI first-line.
💫ANSWER✔️✔️: C. Sertraline
---
2. Bipolar I, acute mania, agitation, psychosis. Lithium level 0.6. Next?
💫RATIONALE✔️✔️: Subtherapeutic. Add atypical antipsychotic (olanzapine or risperidone).
💫ANSWER✔️✔️: A. Olanzapine
---
3. Treatment-resistant depression, failed 2 SSRIs, augmentation strategy?
💫RATIONALE✔️✔️: Add aripiprazole (FDA-approved) or switch to SNRI + mirtazapine.
💫ANSWER✔️✔️: D. Aripiprazole
---
4. Panic disorder, agoraphobia, benzodiazepine daily for 2 years. Plan to taper?
💫RATIONALE✔️✔️: Slow taper over months. Switch to diazepam (long half-life) for smoother taper.
💫ANSWER✔️✔️: B. Convert to diazepam and reduce 10% weekly
, ---
5. PTSD, nightmares, hyperarousal, failed SSRI. Next medication?
💫RATIONALE✔️✔️: Prazosin for nightmares, SNRIs (venlafaxine), or atypical antipsychotic.
💫ANSWER✔️✔️: C. Prazosin
---
6. Generalized anxiety disorder, comorbid substance use disorder. Avoid?
💫RATIONALE✔️✔️: Benzodiazepines (abuse risk). Buspirone or SSRI preferred.
💫ANSWER✔️✔️: D. Alprazolam
---
7. Social anxiety disorder, performance only. PRN medication?
💫RATIONALE✔️✔️: Propranolol 20-40 mg 1 hour before performance. Reduces autonomic symptoms.
💫ANSWER✔️✔️: A. Propranolol
---
8. 20-year-old, first episode psychosis, auditory hallucinations, paranoia. Initial treatment?
💫RATIONALE✔️✔️: Antipsychotic monotherapy. Aripiprazole or risperidone. Avoid long-term high dose.
💫ANSWER✔️✔️: B. Aripiprazole
---
9. Schizophrenia, clozapine for refractory symptoms. Mandatory monitoring frequency?
💫RATIONALE✔️✔️: ANC weekly x 6 months, then q2 weeks x 6 months, then q4 weeks.
💫ANSWER✔️✔️: D. Weekly for 6 months
---
10. Tardive dyskinesia from long-term antipsychotic. FDA-approved treatment?
