LMR - Georgette's 2023 Qbank Georgette's PMHNP Certification Exam Review; Latest 2024
Course
PMHNP Full Addendum
1. Question: A 25-year-old male presents with a history of feeling sad, fatigued, and unmotivated
for most of the day, nearly every day, for the past two months. He also reports difficulty sleeping
and feelings of worthlessness. What is the most likely diagnosis?
A) Bipolar I Disorder
B) Major Depressive Disorder
C) Generalized Anxiety Disorder
D) Persistent Depressive Disorder (Dysthymia)
Answer: B) Major Depressive Disorder
Rationale: Major Depressive Disorder (MDD) is characterized by a combination of depressive
symptoms lasting at least two weeks, including feelings of sadness, fatigue, sleep
disturbances, and low self-worth. The patient's presentation fits these criteria. Bipolar I
would include episodes of mania, and generalized anxiety disorder primarily involves
excessive worry, not mood disturbances like sadness.
2. Question: A PMHNP is treating a patient diagnosed with schizophrenia. The patient is
experiencing tremors and rigidity in addition to the typical positive symptoms. Which medication
class is most likely causing these side effects?
A) Antidepressants
B) Antipsychotics
C) Benzodiazepines
D) Anticonvulsants
Answer: B) Antipsychotics
Rationale: Tremors and rigidity are signs of extrapyramidal symptoms (EPS), which are
commonly associated with first-generation (typical) antipsychotics. These side effects can
include tremors, rigidity, and bradykinesia. Antidepressants and benzodiazepines are less
likely to cause these motor symptoms, and anticonvulsants do not typically cause them.
3. Question: Which of the following is a first-line treatment for generalized anxiety disorder (GAD)
in an adult patient?
A) Benzodiazepines
B) Cognitive Behavioral Therapy (CBT)
C) Antipsychotic medications
, D) Stimulants
Answer: B) Cognitive Behavioral Therapy (CBT)
Rationale: CBT is considered first-line treatment for generalized anxiety disorder, either
alone or in combination with medications such as SSRIs or SNRIs. While benzodiazepines are
sometimes used for short-term relief, they are not recommended for long-term treatment
due to dependency concerns. Antipsychotics and stimulants are not typically used for GAD.
4. Question: A 45-year-old female with a history of depression is started on an SSRI. She reports
feeling better, but she also notices occasional dizziness, especially when standing up. What is the
most likely cause of this symptom?
A) Hypotension
B) Serotonin syndrome
C) Anticholinergic effects
D) Common side effect of SSRIs
Answer: A) Hypotension
Rationale: Orthostatic hypotension (a drop in blood pressure when standing up) is a
common side effect of SSRIs, particularly in the early stages of treatment. This is generally
benign but should be monitored. Serotonin syndrome is a more severe condition that
includes symptoms like agitation, hyperreflexia, and high fever, which the patient is not
reporting. Anticholinergic effects are more common with tricyclic antidepressants.
5. Question: A patient with bipolar disorder is being started on lithium. Which of the following
laboratory tests should be closely monitored during treatment?
A) Liver function tests
B) Renal function tests and serum lithium levels
C) Complete blood count (CBC)
D) Prothrombin time (PT) and international normalized ratio (INR)
Answer: B) Renal function tests and serum lithium levels
Rationale: Lithium has a narrow therapeutic index, so it is important to monitor serum
lithium levels to avoid toxicity. It can also affect renal function, so kidney function tests are
necessary during treatment. Liver function tests, CBC, and PT/INR are not routine monitoring
tests for lithium therapy.
6. Question: A 32-year-old female diagnosed with post-traumatic stress disorder (PTSD) presents
with symptoms of hypervigilance, nightmares, and intrusive thoughts. Which of the following
medications is considered first-line for PTSD?
, A) SSRIs or SNRIs
B) Benzodiazepines
C) Antipsychotics
D) Lithium
Answer: A) SSRIs or SNRIs
Rationale: SSRIs and SNRIs are first-line pharmacological treatments for PTSD. They help
alleviate symptoms like anxiety, depression, and intrusive thoughts. Benzodiazepines can be
used for acute anxiety, but they are not first-line due to dependency concerns.
Antipsychotics and lithium are not typically used for PTSD.
7. Question: A PMHNP is treating a patient with ADHD. The patient reports feeling more focused
and less impulsive after starting a stimulant medication. However, the patient also reports feeling
increasingly anxious and unable to sleep. What is the most appropriate next step?
A) Discontinue the stimulant medication
B) Increase the dose of the stimulant medication
C) Add a non-stimulant medication (e.g., atomoxetine)
D) Increase the dosage of an antianxiety medication
Answer: C) Add a non-stimulant medication (e.g., atomoxetine)
Rationale: Stimulant medications can sometimes cause anxiety and sleep disturbances. A
non-stimulant medication like atomoxetine, which has a lower risk of these side effects, may
be a better option. Discontinuing the stimulant or increasing the dose may not address the
anxiety. Adding an antianxiety medication may not be as effective in treating the underlying
ADHD symptoms.
8. Question: A 55-year-old male patient with a history of alcohol use disorder has been sober for
several months and presents for a follow-up appointment. He is asking about medication options
to help prevent relapse. Which of the following medications would be most appropriate?
A) Disulfiram
B) Mirtazapine
C) Sertraline
D) Olanzapine
Answer: A) Disulfiram
Rationale: Disulfiram is used to help prevent relapse in individuals with alcohol use disorder.
It causes unpleasant symptoms when alcohol is consumed, which helps deter drinking.
Mirtazapine and sertraline are antidepressants, and olanzapine is an antipsychotic, neither of
which are typically used for alcohol relapse prevention.
, 9. Question: A patient presents with a history of severe mood swings, impulsive behavior, and
difficulty maintaining relationships. The patient reports intense feelings of emptiness and engages
in self-destructive behaviors. What is the most likely diagnosis?
A) Borderline Personality Disorder
B) Bipolar II Disorder
C) Antisocial Personality Disorder
D) Narcissistic Personality Disorder
Answer: A) Borderline Personality Disorder
Rationale: The patient’s symptoms, including mood swings, impulsivity, feelings of
emptiness, and self-destructive behavior, align with Borderline Personality Disorder (BPD).
BPD is characterized by instability in relationships, self-image, and emotions. Bipolar II
Disorder involves mood episodes but is distinct from BPD. Antisocial and narcissistic
personality disorders have different patterns of behavior.
10. Question: Which of the following medications is most appropriate for the treatment of
obsessive-compulsive disorder (OCD)?
A) Fluoxetine
B) Mirtazapine
C) Lorazepam
D) Quetiapine
Answer: A) Fluoxetine
Rationale: Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine are first-line
treatments for OCD. They help reduce obsessive thoughts and compulsive behaviors.
Mirtazapine is an antidepressant but not typically used for OCD. Lorazepam is a
benzodiazepine and is not appropriate for long-term management of OCD. Quetiapine is an
atypical antipsychotic and is not a first-line treatment for OCD.
11. Question: A 40-year-old woman presents with a history of panic attacks, which have been
occurring several times a week for the past six months. She reports sudden onset of intense fear,
difficulty breathing, and a racing heart. What is the most likely diagnosis?
A) Generalized Anxiety Disorder (GAD)
B) Panic Disorder
C) Social Anxiety Disorder
D) Post-Traumatic Stress Disorder (PTSD)
Answer: B) Panic Disorder
Course
PMHNP Full Addendum
1. Question: A 25-year-old male presents with a history of feeling sad, fatigued, and unmotivated
for most of the day, nearly every day, for the past two months. He also reports difficulty sleeping
and feelings of worthlessness. What is the most likely diagnosis?
A) Bipolar I Disorder
B) Major Depressive Disorder
C) Generalized Anxiety Disorder
D) Persistent Depressive Disorder (Dysthymia)
Answer: B) Major Depressive Disorder
Rationale: Major Depressive Disorder (MDD) is characterized by a combination of depressive
symptoms lasting at least two weeks, including feelings of sadness, fatigue, sleep
disturbances, and low self-worth. The patient's presentation fits these criteria. Bipolar I
would include episodes of mania, and generalized anxiety disorder primarily involves
excessive worry, not mood disturbances like sadness.
2. Question: A PMHNP is treating a patient diagnosed with schizophrenia. The patient is
experiencing tremors and rigidity in addition to the typical positive symptoms. Which medication
class is most likely causing these side effects?
A) Antidepressants
B) Antipsychotics
C) Benzodiazepines
D) Anticonvulsants
Answer: B) Antipsychotics
Rationale: Tremors and rigidity are signs of extrapyramidal symptoms (EPS), which are
commonly associated with first-generation (typical) antipsychotics. These side effects can
include tremors, rigidity, and bradykinesia. Antidepressants and benzodiazepines are less
likely to cause these motor symptoms, and anticonvulsants do not typically cause them.
3. Question: Which of the following is a first-line treatment for generalized anxiety disorder (GAD)
in an adult patient?
A) Benzodiazepines
B) Cognitive Behavioral Therapy (CBT)
C) Antipsychotic medications
, D) Stimulants
Answer: B) Cognitive Behavioral Therapy (CBT)
Rationale: CBT is considered first-line treatment for generalized anxiety disorder, either
alone or in combination with medications such as SSRIs or SNRIs. While benzodiazepines are
sometimes used for short-term relief, they are not recommended for long-term treatment
due to dependency concerns. Antipsychotics and stimulants are not typically used for GAD.
4. Question: A 45-year-old female with a history of depression is started on an SSRI. She reports
feeling better, but she also notices occasional dizziness, especially when standing up. What is the
most likely cause of this symptom?
A) Hypotension
B) Serotonin syndrome
C) Anticholinergic effects
D) Common side effect of SSRIs
Answer: A) Hypotension
Rationale: Orthostatic hypotension (a drop in blood pressure when standing up) is a
common side effect of SSRIs, particularly in the early stages of treatment. This is generally
benign but should be monitored. Serotonin syndrome is a more severe condition that
includes symptoms like agitation, hyperreflexia, and high fever, which the patient is not
reporting. Anticholinergic effects are more common with tricyclic antidepressants.
5. Question: A patient with bipolar disorder is being started on lithium. Which of the following
laboratory tests should be closely monitored during treatment?
A) Liver function tests
B) Renal function tests and serum lithium levels
C) Complete blood count (CBC)
D) Prothrombin time (PT) and international normalized ratio (INR)
Answer: B) Renal function tests and serum lithium levels
Rationale: Lithium has a narrow therapeutic index, so it is important to monitor serum
lithium levels to avoid toxicity. It can also affect renal function, so kidney function tests are
necessary during treatment. Liver function tests, CBC, and PT/INR are not routine monitoring
tests for lithium therapy.
6. Question: A 32-year-old female diagnosed with post-traumatic stress disorder (PTSD) presents
with symptoms of hypervigilance, nightmares, and intrusive thoughts. Which of the following
medications is considered first-line for PTSD?
, A) SSRIs or SNRIs
B) Benzodiazepines
C) Antipsychotics
D) Lithium
Answer: A) SSRIs or SNRIs
Rationale: SSRIs and SNRIs are first-line pharmacological treatments for PTSD. They help
alleviate symptoms like anxiety, depression, and intrusive thoughts. Benzodiazepines can be
used for acute anxiety, but they are not first-line due to dependency concerns.
Antipsychotics and lithium are not typically used for PTSD.
7. Question: A PMHNP is treating a patient with ADHD. The patient reports feeling more focused
and less impulsive after starting a stimulant medication. However, the patient also reports feeling
increasingly anxious and unable to sleep. What is the most appropriate next step?
A) Discontinue the stimulant medication
B) Increase the dose of the stimulant medication
C) Add a non-stimulant medication (e.g., atomoxetine)
D) Increase the dosage of an antianxiety medication
Answer: C) Add a non-stimulant medication (e.g., atomoxetine)
Rationale: Stimulant medications can sometimes cause anxiety and sleep disturbances. A
non-stimulant medication like atomoxetine, which has a lower risk of these side effects, may
be a better option. Discontinuing the stimulant or increasing the dose may not address the
anxiety. Adding an antianxiety medication may not be as effective in treating the underlying
ADHD symptoms.
8. Question: A 55-year-old male patient with a history of alcohol use disorder has been sober for
several months and presents for a follow-up appointment. He is asking about medication options
to help prevent relapse. Which of the following medications would be most appropriate?
A) Disulfiram
B) Mirtazapine
C) Sertraline
D) Olanzapine
Answer: A) Disulfiram
Rationale: Disulfiram is used to help prevent relapse in individuals with alcohol use disorder.
It causes unpleasant symptoms when alcohol is consumed, which helps deter drinking.
Mirtazapine and sertraline are antidepressants, and olanzapine is an antipsychotic, neither of
which are typically used for alcohol relapse prevention.
, 9. Question: A patient presents with a history of severe mood swings, impulsive behavior, and
difficulty maintaining relationships. The patient reports intense feelings of emptiness and engages
in self-destructive behaviors. What is the most likely diagnosis?
A) Borderline Personality Disorder
B) Bipolar II Disorder
C) Antisocial Personality Disorder
D) Narcissistic Personality Disorder
Answer: A) Borderline Personality Disorder
Rationale: The patient’s symptoms, including mood swings, impulsivity, feelings of
emptiness, and self-destructive behavior, align with Borderline Personality Disorder (BPD).
BPD is characterized by instability in relationships, self-image, and emotions. Bipolar II
Disorder involves mood episodes but is distinct from BPD. Antisocial and narcissistic
personality disorders have different patterns of behavior.
10. Question: Which of the following medications is most appropriate for the treatment of
obsessive-compulsive disorder (OCD)?
A) Fluoxetine
B) Mirtazapine
C) Lorazepam
D) Quetiapine
Answer: A) Fluoxetine
Rationale: Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine are first-line
treatments for OCD. They help reduce obsessive thoughts and compulsive behaviors.
Mirtazapine is an antidepressant but not typically used for OCD. Lorazepam is a
benzodiazepine and is not appropriate for long-term management of OCD. Quetiapine is an
atypical antipsychotic and is not a first-line treatment for OCD.
11. Question: A 40-year-old woman presents with a history of panic attacks, which have been
occurring several times a week for the past six months. She reports sudden onset of intense fear,
difficulty breathing, and a racing heart. What is the most likely diagnosis?
A) Generalized Anxiety Disorder (GAD)
B) Panic Disorder
C) Social Anxiety Disorder
D) Post-Traumatic Stress Disorder (PTSD)
Answer: B) Panic Disorder
