10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The BCPP exam has 150 questions and runs 3 hours 45 minutes.
These 10 free BCPP questions are organized by exam domain, so you can see how each part of the Board Certified Psychiatric Pharmacist blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Mental Health 36% of exam
Question 1
Before an antidepressant is prescribed, a 29-year-old woman describes six weeks of depressed mood, anhedonia, insomnia, low energy, excessive guilt, and poor concentration that have kept her from working. Two years earlier, while taking no medications or substances, she had six consecutive days of unusually elevated mood, three hours of sleep without fatigue, rapid speech, and markedly increased goal-directed activity. Her family noticed the change, but she continued working, was not hospitalized, and had no psychosis or marked functional impairment. She reports no other elevated-mood episodes. Which longitudinal diagnosis best fits this history?
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Correct answer: A - Bipolar II disorder
Question 2
Five weeks after delivery, a woman reports recurrent images of accidentally drowning her infant during a bath. "The thoughts horrify me. I know they are thoughts, but I keep asking my partner whether having them means I am dangerous." She avoids bathing the infant and spends several hours each day checking and seeking reassurance. She denies any desire, intent, or plan to harm the infant. She recognizes that her precautions are excessive, has no hallucinations or fixed false beliefs, and has neither a sustained depressive syndrome nor elevated mood. How should the intrusive experiences and her responses to them be characterized?
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Correct answer: B - Obsessions with compulsive checking and reassurance seeking
Question 3
A 78-year-old man with Alzheimer disease had stable cognition and behavior for the past year. Oxybutynin was started three days ago for urinary urgency. Overnight, he began seeing children in his room. At 09:00 he cannot sustain attention long enough to follow a conversation and believes he is at work; at 13:00 he is more alert and recognizes his daughter but repeatedly loses track of questions. Vital signs, glucose, oxygen saturation, and electrolytes are unremarkable, and there is no focal neurologic deficit. The abrupt change is most consistent with:
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Correct answer: A - Delirium superimposed on Alzheimer disease
Question 4
A consultation note proposes schizoaffective disorder for a patient with 24 months of persistent delusions, auditory hallucinations, disorganized speech, and marked functional decline. A six-week major depressive episode occurred during that period and resolved, but the psychotic symptoms continued for many months afterward. No other major mood episodes, substance causes, or explanatory medical disorders are identified. Which feature is the strongest reason to reject the proposed diagnosis?
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Correct answer: C - A major mood episode occupied only a small minority of the total illness duration.
Domain 2: Therapeutics and Patient Management 49% of exam
Question 5
A man with treatment-resistant schizophrenia enters a smoke-free residential program while taking clozapine 450 mg nightly. He previously smoked one pack daily and now uses a 21-mg nicotine patch. Five days later, he has new daytime somnolence and increased salivation. A consistently timed clozapine trough has risen from 390 to 720 ng/mL. He is afebrile, his inflammatory markers are normal, and no other medications have changed. Which adjustment addresses the most likely cause?
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Correct answer: C - Reduce clozapine, continue nicotine replacement, and repeat a trough level.
Question 6
For seven years, paliperidone palmitate has prevented psychiatric admissions in a 61-year-old woman with schizophrenia; two previous dose reductions were followed by psychotic relapse. She now has persistent lip smacking and irregular tongue movements that interfere with eating and make her avoid meals with friends. Examination confirms tardive dyskinesia without rigidity, bradykinesia, or a dental cause. She wants treatment for the movements but is frightened of another relapse. What is the most appropriate medication strategy?
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Correct answer: D - Add valbenazine while continuing the effective paliperidone regimen.
Question 7
After eight weeks of treatment for major depressive disorder, a patient's PHQ-9 score has fallen from 22 to 8. She has returned to work but still reports low energy, impaired concentration, and disrupted sleep. All nine items were completed at both visits; the self-harm item is 0, and a direct safety assessment finds no suicidal intent. Her medication is well tolerated. Which treatment-outcome assessment is justified?
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Correct answer: C - Response without remission; residual symptoms remain a treatment target.
Question 8
The laboratory flags a lithium concentration of 1.3 mEq/L in a patient whose bipolar disorder has been stable for a year on immediate-release lithium 600 mg at 08:00 and 20:00. Medication reconciliation establishes that today's sample was collected at 10:00, after the morning dose. Previous 12-hour concentrations were approximately 0.8 mEq/L. Renal function and sodium are unchanged; he has no vomiting, diarrhea, new tremor, ataxia, or confusion, and no interacting medication has been added. Which recommendation is warranted before altering maintenance therapy?
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Correct answer: B - Obtain a 12-hour predose concentration while maintaining the current regimen.
Question 9
A veteran has completed trauma-focused psychotherapy and taken sertraline 200 mg daily for 14 weeks. Daytime avoidance and hyperarousal have improved substantially, but trauma-related nightmares still awaken him four nights each week. Seated blood pressure is 124/78 mm Hg and standing blood pressure is 120/76 mm Hg; he reports no dizziness and takes no antihypertensives. He requests a medication aimed at the nightmares rather than a change to the treatment that has helped his daytime symptoms. Which adjunct best matches that target?
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Correct answer: B - Prazosin
Domain 3: Professional Practice 15% of exam
Question 10
A randomized trial compares an enhanced relapse-prevention program with usual care in adults with schizophrenia. Over 12 months, 60 of 500 participants assigned to the program and 100 of 500 assigned to usual care have at least one psychiatric hospitalization. Follow-up is complete, and outcomes are analyzed by original treatment assignment. The clinical practice committee asks for the number needed to treat and its clinical meaning. Which statement correctly expresses the point estimate?
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Correct answer: D - Treating 13 patients for 12 months is expected to prevent one additional patient from being hospitalized.
That's 10 of 1,030
The full bank has 1,020 more BCPP questions with explanations.