LMR Georgette’s PMHNP Certification Exam
LMR GEORGETTE’S PMHNP CERTIFICATION EXAM LATEST
2025/2026 ACTUAL EXAM COMPLETE 300 QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES GRADED A+
GUARANTEED PASS- ACE YOUR EXAM
This examination is designed to simulate the clinical reasoning, diagnostic
precision, and psychopharmacologic decision-making required for PMHNP board
certification. Each item presents a realistic clinical scenario requiring advanced
assessment, diagnosis, treatment selection, safety evaluation, or differential
analysis. Select the best answer for each case. Rationales follow each question for
in-depth review.
A 28-year-old woman presents with decreased need for sleep, increased goal-
directed activity, pressured speech, and excessive spending for 8 days. She denies
substance use. There is no psychosis. Symptoms cause occupational impairment.
What is the most likely diagnosis?
a) Bipolar II disorder
b) Cyclothymic disorder
c) Bipolar I disorder
d) Borderline personality disorder
Correct Answer: c) Bipolar I disorder
Rationale: A manic episode lasting at least 7 days (or requiring hospitalization)
with marked impairment qualifies for Bipolar I disorder. Hypomania (Bipolar II)
does not cause marked impairment. The duration and severity here meet full
mania criteria.
1|Page
, LMR Georgette’s PMHNP Certification Exam
A 42-year-old man with schizophrenia stabilized on risperidone develops breast
tenderness and galactorrhea. Which mechanism explains this side effect?
a) Dopamine D2 receptor blockade in the nigrostriatal pathway
b) Dopamine D2 receptor blockade in the tuberoinfundibular pathway
c) Serotonin 5-HT2A antagonism
d) Muscarinic receptor antagonism
Correct Answer: b) Dopamine D2 receptor blockade in the tuberoinfundibular
pathway
Rationale: Dopamine inhibits prolactin release. D2 blockade in the
tuberoinfundibular pathway increases prolactin, leading to galactorrhea,
gynecomastia, and sexual dysfunction.
A 35-year-old woman reports excessive worry occurring more days than not for 8
months about finances, health, and work. She has muscle tension and poor sleep.
What is first-line pharmacologic treatment?
a) Alprazolam
b) Propranolol
c) Sertraline
d) Quetiapine
Correct Answer: c) Sertraline
Rationale: SSRIs are first-line for generalized anxiety disorder. Benzodiazepines are
not first-line due to dependence risk. Propranolol is used for performance anxiety.
Quetiapine is not first-line.
A 19-year-old college student presents with recurrent binge eating followed by
self-induced vomiting twice weekly for 4 months. BMI is 22. What is the most
appropriate diagnosis?
2|Page
, LMR Georgette’s PMHNP Certification Exam
a) Anorexia nervosa, binge/purge type
b) Avoidant/restrictive food intake disorder
c) Bulimia nervosa
d) Binge eating disorder
Correct Answer: c) Bulimia nervosa
Rationale: Recurrent binge eating with compensatory behaviors occurring at least
once weekly for 3 months with normal BMI indicates bulimia nervosa. Anorexia
requires low body weight.
A patient taking lithium presents with tremor, diarrhea, vomiting, and confusion.
Level is 2.1 mEq/L. What is the next best step?
a) Administer activated charcoal
b) Increase hydration and recheck level in 24 hours
c) Start valproate
d) Send to emergency department for possible hemodialysis
Correct Answer: d) Send to emergency department for possible hemodialysis
Rationale: Lithium level >2.0 with neurologic symptoms indicates severe toxicity
requiring emergency management and possible hemodialysis.
A 7-year-old boy has difficulty sustaining attention, interrupts frequently, and
symptoms are present both at school and home for over 1 year. What is first-line
treatment?
a) Atomoxetine
b) Methylphenidate
c) Guanfacine
d) Fluoxetine
Correct Answer: b) Methylphenidate
3|Page
, LMR Georgette’s PMHNP Certification Exam
Rationale: Stimulants are first-line for ADHD in school-aged children unless
contraindicated.
A 30-year-old combat veteran reports nightmares, hypervigilance, and avoidance
for 5 months after deployment. What is first-line medication for core PTSD
symptoms?
a) Clonazepam
b) Sertraline
c) Haloperidol
d) Buspirone
Correct Answer: b) Sertraline
Rationale: SSRIs (sertraline, paroxetine) are FDA-approved first-line pharmacologic
treatments for PTSD.
A patient with major depressive disorder reports improvement in mood after 2
weeks of fluoxetine but develops agitation, insomnia, and impulsivity. What
should the clinician suspect?
a) Serotonin syndrome
b) Bipolar spectrum disorder
c) Akathisia
d) Borderline personality disorder
Correct Answer: b) Bipolar spectrum disorder
Rationale: Antidepressant-induced activation may unmask underlying bipolar
disorder, especially when mood improves but impulsivity and agitation emerge.
4|Page
LMR GEORGETTE’S PMHNP CERTIFICATION EXAM LATEST
2025/2026 ACTUAL EXAM COMPLETE 300 QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES GRADED A+
GUARANTEED PASS- ACE YOUR EXAM
This examination is designed to simulate the clinical reasoning, diagnostic
precision, and psychopharmacologic decision-making required for PMHNP board
certification. Each item presents a realistic clinical scenario requiring advanced
assessment, diagnosis, treatment selection, safety evaluation, or differential
analysis. Select the best answer for each case. Rationales follow each question for
in-depth review.
A 28-year-old woman presents with decreased need for sleep, increased goal-
directed activity, pressured speech, and excessive spending for 8 days. She denies
substance use. There is no psychosis. Symptoms cause occupational impairment.
What is the most likely diagnosis?
a) Bipolar II disorder
b) Cyclothymic disorder
c) Bipolar I disorder
d) Borderline personality disorder
Correct Answer: c) Bipolar I disorder
Rationale: A manic episode lasting at least 7 days (or requiring hospitalization)
with marked impairment qualifies for Bipolar I disorder. Hypomania (Bipolar II)
does not cause marked impairment. The duration and severity here meet full
mania criteria.
1|Page
, LMR Georgette’s PMHNP Certification Exam
A 42-year-old man with schizophrenia stabilized on risperidone develops breast
tenderness and galactorrhea. Which mechanism explains this side effect?
a) Dopamine D2 receptor blockade in the nigrostriatal pathway
b) Dopamine D2 receptor blockade in the tuberoinfundibular pathway
c) Serotonin 5-HT2A antagonism
d) Muscarinic receptor antagonism
Correct Answer: b) Dopamine D2 receptor blockade in the tuberoinfundibular
pathway
Rationale: Dopamine inhibits prolactin release. D2 blockade in the
tuberoinfundibular pathway increases prolactin, leading to galactorrhea,
gynecomastia, and sexual dysfunction.
A 35-year-old woman reports excessive worry occurring more days than not for 8
months about finances, health, and work. She has muscle tension and poor sleep.
What is first-line pharmacologic treatment?
a) Alprazolam
b) Propranolol
c) Sertraline
d) Quetiapine
Correct Answer: c) Sertraline
Rationale: SSRIs are first-line for generalized anxiety disorder. Benzodiazepines are
not first-line due to dependence risk. Propranolol is used for performance anxiety.
Quetiapine is not first-line.
A 19-year-old college student presents with recurrent binge eating followed by
self-induced vomiting twice weekly for 4 months. BMI is 22. What is the most
appropriate diagnosis?
2|Page
, LMR Georgette’s PMHNP Certification Exam
a) Anorexia nervosa, binge/purge type
b) Avoidant/restrictive food intake disorder
c) Bulimia nervosa
d) Binge eating disorder
Correct Answer: c) Bulimia nervosa
Rationale: Recurrent binge eating with compensatory behaviors occurring at least
once weekly for 3 months with normal BMI indicates bulimia nervosa. Anorexia
requires low body weight.
A patient taking lithium presents with tremor, diarrhea, vomiting, and confusion.
Level is 2.1 mEq/L. What is the next best step?
a) Administer activated charcoal
b) Increase hydration and recheck level in 24 hours
c) Start valproate
d) Send to emergency department for possible hemodialysis
Correct Answer: d) Send to emergency department for possible hemodialysis
Rationale: Lithium level >2.0 with neurologic symptoms indicates severe toxicity
requiring emergency management and possible hemodialysis.
A 7-year-old boy has difficulty sustaining attention, interrupts frequently, and
symptoms are present both at school and home for over 1 year. What is first-line
treatment?
a) Atomoxetine
b) Methylphenidate
c) Guanfacine
d) Fluoxetine
Correct Answer: b) Methylphenidate
3|Page
, LMR Georgette’s PMHNP Certification Exam
Rationale: Stimulants are first-line for ADHD in school-aged children unless
contraindicated.
A 30-year-old combat veteran reports nightmares, hypervigilance, and avoidance
for 5 months after deployment. What is first-line medication for core PTSD
symptoms?
a) Clonazepam
b) Sertraline
c) Haloperidol
d) Buspirone
Correct Answer: b) Sertraline
Rationale: SSRIs (sertraline, paroxetine) are FDA-approved first-line pharmacologic
treatments for PTSD.
A patient with major depressive disorder reports improvement in mood after 2
weeks of fluoxetine but develops agitation, insomnia, and impulsivity. What
should the clinician suspect?
a) Serotonin syndrome
b) Bipolar spectrum disorder
c) Akathisia
d) Borderline personality disorder
Correct Answer: b) Bipolar spectrum disorder
Rationale: Antidepressant-induced activation may unmask underlying bipolar
disorder, especially when mood improves but impulsivity and agitation emerge.
4|Page
