PMHNP Board Review 2026 Complete Questions and Answers Solved 100%

1. Title protection as an NP

2. Determines Scope of Practice

3. Sets credentialing requirements

4. Determines grounds for discipline

Nurse Practice Act

(specific to that state)

x4 fundamentals guaranteed by HIPAA:

1. Right to be ___ r/t HIPAA privacy protection

2. Right to access ___

3. Right to request ___ of personal health information

4. Right to require permission for the ___ of patient health information

1. Right to be EDUCATED

2. Right to access MEDICAL RECORDS

3. Right to request AMENDMENT of personal health information

4. Right to require permission for the DISCLOSURE of patient health information

Duty to Warn/Duty to Protect is based off of the ___ decision

the TARASOFF decision

Elements of Informed Consent

B

A

D

-Benefits & Risks

-Alternative Tx

-Diagnosis & Prognosis

The action is good or bad based upon the act and irrospective of the outcome

Deontological

The action is good/bad based upon the outcome

Telelogical

___ is commonly caused by combining SSRI with an MAOI, but can occur if the patient is self medicating with SSRI & herbal/street/___

Serotonin Syndrome

St. John's wort

Freud's Psychosexual Stages

oral stage

anal stage

phallic stage

latency stage

genital stage

Freud's Psychosexual Stages

oral stage. Schizophrenia/ SUDS

anal stage. Depression

phallic stage. Sexual Identity 3-6 y/o

latency stage. 6-puberty

genital stage. Puberty-aldulthood

Stopping SSRIs abruptly can lead to ___ syndrome with ___ symptoms (i.e. N/V, lethargy, myalgia and ___ to the point of 'shock like' sensations) due to a sudden ___ rebound

Increased ___ activity can increase release of ___ postganglionic adrenergic neurons as well as the adrenal medulla (20% ___ release 80% ___ release)

Discontinuation Syndrome

Flu-like symptoms

Parathesia

Cholinergic

NE

20% NE

80% EPI

Persistent depressive disorder is when the Pt has chronically depressed mood for most days for at least ___ in adults and ___ in kids, but in kids the symptoms usually present as ___ instead of depression

2 yrs

1 yr

irritability

Seratonin Syndrome

Head -

Heart -

Body -

Belly -

Head - Confusion / Xerostomia

Heart - Hypertensive

Body - Diaphoresis / SPASTIC REFLEXES

Belly - N/V-Diarrhea

Dysphoric symptoms that occur generally ___ prior to menses (Luteal Phase) and resolve ___ following the beginning of mences is ___ Disorder

x1 week

1-2 days

Premenstrual Dysphoric Disorder

For a Pt with Bipolar 1, the Pt will have a Hx of an elevated, IRRITABLE, or expansive mood for ___, and 60% of people with Bipolar 1 will have an episode of ___ preceding/following the manic state.

Shifts from depressive to manic states occurring at a rate of ___ per year is referred to as ___ which occurs mainly in ___ (90%) and has a worse prognosis

>1 week

MDD

x4

Rapid Cycling

Women

The gold standard for Tx of ___ is Lithium (Lithobid) which has ___ effects, but a narrow therapeutic window of ___ mEq/l and is monitored at x12 hrs after the prior dose (___ level) and is dosed ___ for acute mania and ___ in maintenance dose.

Mania

Antisuicidal Effect

.5-1.2 mEq/l

Trough Level

1,200-2,400 mg - Manic State

900-1,200 mg - Maintenance

Carbamazepine (Tegretol) is an anticonvulsant medication that is dosed ___ <6 y/o & ___ >6 y/o and has black box warnings for (x2) ans puts Asians at risk for ___

<6 y/o = 10-20 mg

>6 y/o = 400-1200 ,g

Agranulocytosis

Aplastic Anemia

Steven Johnson's Syndrome

Disorder Age of Onset

Intellectual disability

MDDD

ADHD

Schizophrenia

Dementia

Disorder Age of Onset

Intellectual disability. Infancy

MDDD. Late Teens

ADHD. Early childhood

Dementia. >85 y/o

Schizophrenia. Men 18-25 y/o

Women 25-35 y/o

The Id

Hunger / Sex / Aggression

The Ego

Rational Mind (Executive Function)

The Superego

Moral Center (right vs. Wrong)

The therapeutic nurse-client relationship is central to nursing

Orientation Phase

Working Phase

Termination Phase

Interpersonal Relations Theory

(Peplau)

Defense Mechanism

Overcompensation where unacceptable thoughts and behaviors are pushed from conscious awareness and the opposite thoughts and behaviors are displayed.

Reaction Formation

Defense Mechanism

Behaviors there in time to make up for unacceptable actions / feelings

Undoing

Defense Mechanism

Unconscious process of substituting socially acceptable activities for unacceptable impulses.

Sublimation

Defense Mechanism

Meeting the needs of others in response to conflicts / stressors

Altruism

In research if the results demonstrated by the sample can be ___ to the population this is referred to as ___ validity

Generalized

External Validity

The P value is the level of ___ and describes the probability that the findings resulted by ___

(i.e. P=.05 means P=5% and a P value >.05 fails to reject the ___)

Level of SIGNIFICANCE

Chance

Null Hypothesis

Assesses whether the ___ of two groups are statistically different from each others.

Mean

T test

Tests the difference among 3 or more groups is ___

ANOVA = Analysis of Variance

Tests the relationship between x2 variables is a ___ correlation.

Pearson's R correlation

The National Committee for Quality Assurance has developed x11 behavioral health related HEDIS measures (i.e. diabetic monitoring for Pts with diabetes & schizophrenia)

Health Effectiveness Data and Information Sets

The ___ nervous system is responsible for conveying information from the CNS to the skeletal muscles to control ___ movement

Somatic Nervous System

Voluntary Movement

The working part of the brain made up of dendrites and neuronal cell bodies

Gray Matter

x4 make up the limbic system

Hippocampus

Hypothalamus

Amydala

Thalamus

The ___ signals the globus pallidus to prevent the ___ from hyperstimulating the motor cortex leading to ___

Basal Ganglia

Thalamus

Involuntary Movement (i.e. EPS)

The Romberg test (hold position eyes open/closed) is an effect means to test ___ function of the brain stem

Cerebellum Function

The synapse converts the action potential (___ signal) into neurotransmission (___ signal)

Electrical Signal

Chemical Signal

The precursor of the monoamine DA is ___ and DA is produced in the VTA and ___ and DA is removed from the synapse by the ___ enzyme

Tyrosine

Substantia Nigra

MAO enzyme

The precursor of the monoamine NE is ___ and NE is produced in the ___ of the ___

Tyrosine

Locus Coruleus

Pons

The precursor of the indole 5HT is ___ and 5HT is produced in the ___ of the ___

Tyrosine

Raphe Nuclei

Brain Stem

The monoamines DA, NE & EPI are ____ and 5HT is ___

Catecholamines

Indole

Another excitatory ____ that works with Glutimate is ___

Another inhibitory ___ that works with y-aminobutryc acid (GABA) is ____

Amino Acid

Aspartate

Amino Acid

Glycine

Marfan Syndrome is an example of a ____ disorder meaning offspring of one affected parent have a 50% chance of transmitting it to their child

Autosomal Dominant

Valproic Acid (Depakote) is dosed

Mania ___

Migraine ___

Epilepsy ___

Valproic Acid is more effect than Lithium (Lithobid) at Tx of ___/mixed bipolar and has black box warnings for (x2)

___ the doseage of Valproic Acid (Depakote) if the Pt is also taking ___

Mania 1,200-1,500 mg

Migraine 500-1000 mg

Epilepsy 10-60 mg

Rapid Cycling

Hepatotoxicity

Pancreatitis

Half Doseage

Lamotrignine (Lamictal)

Healthy defense mechanism that is a conscious denial of disturbing feelings

Suppression

Defense mechanisms are best viewed as a function of the Ego to ___

Resolve Conflict

Beta Blockers can exacerbate ___.

Depression

Valproate (Depakote) has a teratogenic risk for (x2)

Spina Bifida & Autism

Lithium has a teratogenic risk for ___ and Lithium can ___ thyroid horome levels and ___ levels and lithium will be retained if ___ levels are low.

eBstein Anomaly

Increase

Ca2+

Na2+

Dysdiadochokinesia

inability to perform rapid alternating movements

Lamotrignine (Lamictal) does not require ___ but is titrated slowly at ___ for x2 weeks and then ___ for x2 weeks and long term is dosed ___. The levels of Lamotrignine (Lamictal) may double if used with ___.

Lamotrignine (Lamictal) is effective at Tx of ___ phase for bipolar Pt, but has black box warning for ___ although HLA-B 1502 antigen testing is not required

Blood Monitoring

25 mg

50 mg

100-200 mg

Valproic Acid (Depakote)

Depressive Phase

Steven Johnson's Syndrome

Agraphesthesia

inability to recognize symbols, letters or numbers traced on the skin

Astereognosis is the inability to judge ___ and results from a lesion of the ___ lobe

Inability to judge the form of an object by touch

Parietal Lobe

Loss of coordinated neuromuscular contraction and is tested by finger to nose

Dyssynergia

The ability to recognize objects by feeling their form, size, and weight while the eyes are closed

Stereognosis

A ___ of the toes and ___ of the great toe is positive ___ sign and is typical in infants up to ___ y/o

Fanning

Dorsiflexion

Positive Babinski Sign

2 y/o

Tarasoff Decision

Duty to Warn / Duty to Protect

Quatiapine (Seroquel) puts the patient at risk of developing ___

Schizophrenia 400-800 mg

Bipolar 300 mg

Sedation 25-50 mg

Cataracts

The function of the thyroid is to remove ___ from the blood stream and combine it with ___ to convert it into T3/T4 which is released into the bloodstream when the anterior pituitary to release ___

Iodine

tyrosine

TSH

Gamma-glutamyl transferase (___) 0-45 u/L is an enzyme that assists with the transfer of amino acids/peptides across cellular membranes, but is ___ when a Pt abusing ETOH and elevations of ___ can also be an indicator of ___ damage

GGT

Elevated

ETOH

GGT

Hepatic Damage

Self-Disclosure takes the focus away from the Pt and is only helpful if it is able to have an identifiable ___ outcome such as ___

Therapeutic Outcome

Role Modeling (integral part of interpersonal psychotherapy)

The degree to which people believe that they have control over the outcome of events in their lives, as opposed to an external forces beyond their control

(i.e. the grade you get is the grade you earn)

locus of control

___ therapies are used in CONJUNCTION with traditional medical practice and ___ therapies are used in REPLACEMENT of traditional medical practice.

Complementary Therapies

Alternative Therapies

The earlier the that MDD presents the worse the symptoms and the more episodes the greater the likelihood of future episodes (i.e. x1 episode of MDD has a ___% chance of another episode)

Symptoms such as loss of appetite, lethargy, or sleep disturbance are all considered ___ symptoms of MDD

60%

Neurovegetative Symptoms

Aaron Beck theorized that ___ resulted from ___ experiences that sensitized a person to respond to stressful events.

The ___ was often grounded in a poor sense of self (i.e. ___).

MDD

Developmental Experiences

MDD

Low Self Esteem

In the elderly patients highly ___ medications are more unpredictable due to diminished ___ function

Oxidized

Diminished Liver Enzyme Function

P

I

N

Pregnancy Category D

Paroxetine (Paxil) 20-50 mg (depression) 7.5 mg (vasomotor symptoms - dosed at bedtime)

Impramine (Tofranil) 75-300 mg

Norpramine (Pamelor) 10-150 mg

Phenelzine (Nardil) 30-90 mg (A/B)

Isocarboxazid (Marplan) 10-60 mg (A/B)

Selegline (EMSAM) 6-12 mg (<6 A 6-12 A/B)

Tranylcypromine (Parnate) 30-60 mg (A/B)

All MAOI's require dietary restriction for ___ rich foods because of risk for ___ except ___ becasue it is administered ___

Catecholamine Biosynthesis Pathway

Phenylalanine

|

L-Tyrosine

|

___

|

___

|

NE

|

Epi

Tyrosine (Smoked cheese/meat, fermented drinks)

Hypertensive Crisis

Low Dose Selegline (EMSAM)

Transdermal

L-Dopa (LevoDopa)

Dopamine

Hypertensive Crisis

Head

Eyes

Neck

Heart

Body

Head - Severe Headache

Eyes - Dilated Pupils

Neck - Stiff Neck

Heart - Palpitations / Increased BP (obliviously...)

Body - Diaphoresis

TCA s/e include (x4)

Anticholinergic Effect

Antiadrenergic Effect - orthostatic hypotension

Antihistamine Effect - Sedation/Weight Gain

Dysrhythmias

SSRI (or any serotonergic medication) used in combination with ___ can lead to Seratonin Syndrome

Head -

Heart -

Body -

Mood -

Tx with (x2)

MAOI

Head - Headache / Confusion

Heart - Tackycardia

Body - Myoclonic Jerking / FEVER / Diaphoresis

Mood - Agitated

Cyproheptadine (Periactin) 4 mg & Anticonvulsant

electroconvulsive therapy (ECT) is utilized in 6-12 sessions of inducing ___ to increase release of ___

Grand mal seizures

DA / NE / 5HT

Trazidone (Desryl) is dosed ___ hypnotic effect and ___ antidepressant effect and is a SARI but doesn't have much of an 5HT effect at <___.

Trazidone (Desryl) it most commonly used as a hypnotic but in men can cause ___, and in women it is a good option for ___

50-200 mg hypnotic

150-600 mg antidepressant

<150 mg

Priaprism

Pregnancy (Category B)

In children, adolescents and young adults with MDD monitor for increased ___

suicidal thoughts if on SSRIs

Fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic

Agoraphobia

Selective Mutism

DSM-5

Anxiety Related Disorders

Hoarding Disorder

DSM-5

Obsessive Compulsive Related Disorders

Dissociative Amnesia

Trauma and Stressor Related Disorders

Latino cultural syndrome due to disruption of family bond causing trembling, crying & screaming is ___ and is best Tx with ___

Ataques de Nervios

Psychotherapy (BRIEF & Supportive)

First line treatment for anxiety for children & teens.

Psychotherapy

GAD are Dx when symptoms impair functioning and occur on more days than not for a period of at least ___

x6 months

While ___ are considered 1st line Tx for anxiety, benzodiazepines have a more rapid acting GABAergic effect.

Benzos with ___ (including Alprolazam (Xanax) 2-6 mg or Lorazepam (Ativan) 2-6 mg) have increased risk for addiction, more severe ___ and greater likelihood for ___

SSRIs

Shorter Half-Lives

More Severe Withdrawal

Rebound Anxiety

Buspirone (Buspar) is dosed ___ mg but up to ___ mg

20-30 mg, but up to 60 mg

Tiagabine (___) is an anti-epileptic that is used off-label in the Tx of ___ and dosed ___ mg daily

Tiagabine (Gabitril)

Anxiety

4-56 mg

Propanalol (Inderal) is used off-label for anticipatory anxiety (such as performance anxiety). It is dosed ___, but can have ___ s/e

40-400 mg

Hypotensive s/e

Panic Disorder has a sudden onset peaking within ___ and 2/3 of cases has prior/subsiquent episode of ___

10 minutes

MDD

Gabapentin (Neurotin) is used off-label to Tx anxiety and is dosed ___

900-1,800 mg

In peds Pts anxiety can be treated off label by (x2) which are ___

Clonidine (Catapress) {.1-.4 mg for ADHD & .1 Q3D for opioid withdrawal}

Guanfacine (Intuniv ER) {1-4 mg}

Alpha 2 Agonists (decrease release of NE resulting in hypotensive response)

Like Pts with panic attacks, ___ can be Tx with SSRI and short-term benzos, but also ___ for discreet episodes of social anxiety

Agoraphobia

Beta Blockers Propranolol (Inderal) 40-400 mg

Situational type of ___ is the most common type (i.e. fear of bridges), other types of ___ are environmental type (i.e. fear of storms) or animal type (fear of dogs / dog bite)

Specific Phobia

Separation Anxiety Disorder

Developmentally inappropriate distress occurring with the separation from a major attachment figure at ___ y/o

4 y/o

If a pediatric patient suddenly presents with ___-like symptoms following a beta-hemolytic streptococcal infection (i.e. Scarlet Fever / Strep Throat), screen for PANDAS

OCD-like Symptoms

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

Medications with FDA approval for OCD

Anafranil (Clomipramine) 100-200 mg

LuVox (FluVoxamine 100-300 mg

Prosac (Fluoxetine) 10-80 mg (60-80 mg for Tx of Bulimia)

Paxil (Parioxetine) 20-50 mg (7.5 mg Tx for Vasomotor Symptoms)

Zoloft (Sertraline) 50-200 mg

If the Pt is presenting with PTSD symptoms, but it is <1 month since the traumatic experience this is Dx as ___

If the symptoms present >6 months after the traumatic event this is a ____ of symptoms

Acute Stress Disorder

Delayed Onset

Medications with FDA approval for PTSD

Paroxetine (Paxil) 20-50 mg (7.5 mg Tx for Vasomotor Symptoms)

Sertraline (Zoloft) 50-200 mg

State immediately preceding waking up.

Hypnopomic

There is a ___% risk of schizophrenia within the general population, but the risk increases to ___% in monozygotic twins when one of the twins is Dx.

1%

50%

Neurobiological defects have been noted in schizophrenics including enlarged ___, but smaller (x2) and (x3) atrophy... all of these factors leading to a decrease in the volume of white and gray matter

These changes are thought to be the reason for a DA increase within the ___ pathway and a DA deficit within the ___ pathway.

Enlarged Ventricles

Smaller Frontal/Temporal Lobes

Cortical / Hippocampus / Amygdala Atrophy

Mesolimbic Pathway

Mesocortical Pathway

NMS

S & H

A - (loss of power for voluntary movement)

L

T

Sweating (Diaphoresis) & Hyperthermia

Akinesia (loss of power for voluntary movement)

Lead Pipe Stiffening

Tackycardia

Schizophrenia (negative symptoms)

Negative symptoms tend to appear first, persist and are more debilitating.

Affect Flattening

Alogia

Avolition

Apathy

Anhedonia

Attention Deficit

Schizophrenia positive symptoms include Disorganized Speech, Delusions, Hallucinations, & (x4), and positive symptoms appear to decrease over time.

Mania

Hostility

Grandiosity

Suspiciousness