PMHNP CERTIFICATION EXAM 2026/2027
PSYCHIATRIC–MENTAL HEALTH NURSE
PRACTITIONER BOARD-STYLE PRACTICE
EXAM QUESTIONS AND 100% VERIFIED
ANSWERS WITH RATIONALES GRADED A+
LATEST
Question 1
A 28-year-old patient presents with a 2-week history of elevated mood, decreased
need for sleep, pressured speech, and increased goal-directed activity. There is no
history of substance use. Which diagnosis is most appropriate?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder with mixed features
Correct Answer: A
Rationale: Bipolar I disorder is diagnosed when at least one manic episode is
present. Bipolar II requires hypomania and major depression without mania.
Question 2
Which neurotransmitter imbalance is most strongly associated with obsessive-
compulsive disorder?
A. Dopamine
B. Serotonin
C. Norepinephrine
D. GABA
Correct Answer: B
,Rationale: OCD is primarily linked to serotonergic dysregulation, supported by
the effectiveness of SSRIs.
Question 3
A patient with schizophrenia is stable on risperidone but develops gynecomastia
and galactorrhea. The most likely cause is:
A. Anticholinergic effects
B. Dopamine blockade in the tuberoinfundibular pathway
C. Serotonin antagonism
D. Alpha-1 receptor blockade
Correct Answer: B
Rationale: Prolactin elevation results from dopamine blockade in the
tuberoinfundibular pathway.
Question 4
Which medication is considered first-line for acute mania?
A. Fluoxetine
B. Lithium
C. Bupropion
D. Clonazepam
Correct Answer: B
Rationale: Lithium is a first-line mood stabilizer for acute mania and long-term
maintenance.
,Question 5
A patient reports recurrent intrusive thoughts about contamination and performs
handwashing rituals for relief. Insight is intact. This presentation is most consistent
with:
A. Generalized anxiety disorder
B. Obsessive-compulsive disorder
C. Delusional disorder
D. Somatic symptom disorder
Correct Answer: B
Rationale: Intrusive obsessions with compulsive behaviors and preserved insight
are classic for OCD.
Question 6
Which symptom is required for a diagnosis of major depressive disorder?
A. Anhedonia or depressed mood
B. Insomnia
C. Fatigue
D. Feelings of guilt
Correct Answer: A
Rationale: DSM criteria require either depressed mood or loss of
interest/pleasure.
Question 7
A patient taking clozapine presents with fever, sore throat, and fatigue. The priority
action is to:
A. Reduce the dose
B. Add benztropine
C. Obtain a CBC immediately
D. Discontinue lithium
, Correct Answer: C
Rationale: Clozapine carries a risk of agranulocytosis; symptoms suggest
neutropenia and require urgent CBC.
Question 8
Which adverse effect is most associated with long-term SSRI use?
A. Tardive dyskinesia
B. Sexual dysfunction
C. Agranulocytosis
D. Hypertension
Correct Answer: B
Rationale: SSRIs commonly cause sexual dysfunction, including decreased libido
and anorgasmia.
Question 9
A 70-year-old patient presents with fluctuating levels of consciousness, visual
hallucinations, and acute onset confusion. This presentation suggests:
A. Dementia
B. Delirium
C. Major depressive disorder
D. Psychotic disorder
Correct Answer: B
Rationale: Delirium is characterized by acute onset, fluctuating consciousness,
and perceptual disturbances.
PSYCHIATRIC–MENTAL HEALTH NURSE
PRACTITIONER BOARD-STYLE PRACTICE
EXAM QUESTIONS AND 100% VERIFIED
ANSWERS WITH RATIONALES GRADED A+
LATEST
Question 1
A 28-year-old patient presents with a 2-week history of elevated mood, decreased
need for sleep, pressured speech, and increased goal-directed activity. There is no
history of substance use. Which diagnosis is most appropriate?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder with mixed features
Correct Answer: A
Rationale: Bipolar I disorder is diagnosed when at least one manic episode is
present. Bipolar II requires hypomania and major depression without mania.
Question 2
Which neurotransmitter imbalance is most strongly associated with obsessive-
compulsive disorder?
A. Dopamine
B. Serotonin
C. Norepinephrine
D. GABA
Correct Answer: B
,Rationale: OCD is primarily linked to serotonergic dysregulation, supported by
the effectiveness of SSRIs.
Question 3
A patient with schizophrenia is stable on risperidone but develops gynecomastia
and galactorrhea. The most likely cause is:
A. Anticholinergic effects
B. Dopamine blockade in the tuberoinfundibular pathway
C. Serotonin antagonism
D. Alpha-1 receptor blockade
Correct Answer: B
Rationale: Prolactin elevation results from dopamine blockade in the
tuberoinfundibular pathway.
Question 4
Which medication is considered first-line for acute mania?
A. Fluoxetine
B. Lithium
C. Bupropion
D. Clonazepam
Correct Answer: B
Rationale: Lithium is a first-line mood stabilizer for acute mania and long-term
maintenance.
,Question 5
A patient reports recurrent intrusive thoughts about contamination and performs
handwashing rituals for relief. Insight is intact. This presentation is most consistent
with:
A. Generalized anxiety disorder
B. Obsessive-compulsive disorder
C. Delusional disorder
D. Somatic symptom disorder
Correct Answer: B
Rationale: Intrusive obsessions with compulsive behaviors and preserved insight
are classic for OCD.
Question 6
Which symptom is required for a diagnosis of major depressive disorder?
A. Anhedonia or depressed mood
B. Insomnia
C. Fatigue
D. Feelings of guilt
Correct Answer: A
Rationale: DSM criteria require either depressed mood or loss of
interest/pleasure.
Question 7
A patient taking clozapine presents with fever, sore throat, and fatigue. The priority
action is to:
A. Reduce the dose
B. Add benztropine
C. Obtain a CBC immediately
D. Discontinue lithium
, Correct Answer: C
Rationale: Clozapine carries a risk of agranulocytosis; symptoms suggest
neutropenia and require urgent CBC.
Question 8
Which adverse effect is most associated with long-term SSRI use?
A. Tardive dyskinesia
B. Sexual dysfunction
C. Agranulocytosis
D. Hypertension
Correct Answer: B
Rationale: SSRIs commonly cause sexual dysfunction, including decreased libido
and anorgasmia.
Question 9
A 70-year-old patient presents with fluctuating levels of consciousness, visual
hallucinations, and acute onset confusion. This presentation suggests:
A. Dementia
B. Delirium
C. Major depressive disorder
D. Psychotic disorder
Correct Answer: B
Rationale: Delirium is characterized by acute onset, fluctuating consciousness,
and perceptual disturbances.
