GEORGETTE REVIEW PMHNP 2026 – VERIFIED
ACTUAL EXAM QUESTIONS & ANSWERS | A+
RATED PSYCHIATRIC NURSE PRACTITIONER
STUDY GUIDE
GEORGETTE REVIEW PMHNP 2026
VERIFIED ACTUAL EXAM QUESTIONS & ANSWERS | A+ RATED
PSYCHIATRIC NURSE PRACTITIONER STUDY GUIDE
QUESTION 1
A 32-year-old patient presents with persistent sadness, anhedonia, hypersomnia,
and increased appetite for 6 weeks. Which diagnosis is MOST appropriate?
A. Bipolar II Disorder
B. Persistent Depressive Disorder (Dysthymia)
C. Major Depressive Disorder (MDD)
D. Adjustment Disorder with Depressed Mood
E. Cyclothymic Disorder
CORRECT ANSWER: C. Major Depressive Disorder (MDD)
RATIONALE: MDD is characterized by at least 5 symptoms lasting ≥2 weeks,
including depressed mood or anhedonia. This patient has sadness, anhedonia,
hypersomnia, and appetite changes for 6 weeks — meeting full MDD criteria. Dysthymia
requires symptoms for ≥2 years. Adjustment disorder follows a clear stressor. Bipolar II
requires hypomanic episodes.
QUESTION 2
Which neurotransmitter is MOST implicated in the pathophysiology of
schizophrenia?
A. Serotonin
B. GABA
,C. Norepinephrine
D. Dopamine
E. Acetylcholine
CORRECT ANSWER: D. Dopamine
RATIONALE: The dopamine hypothesis of schizophrenia proposes that hyperactivity
of dopamine in the mesolimbic pathway causes positive symptoms (hallucinations,
delusions), while hypoactivity in the mesocortical pathway causes negative symptoms.
All antipsychotics work primarily by blocking D2 receptors, supporting dopamine's
central role.
QUESTION 3
A patient on lithium therapy presents with coarse tremors, confusion, and ataxia.
Serum lithium level is 2.4 mEq/L. What is the PRIORITY nursing action?
A. Administer activated charcoal
B. Reduce the lithium dose by half
C. Encourage increased oral fluids
D. Switch to valproate immediately
E. Discontinue lithium and initiate hemodialysis
CORRECT ANSWER: E. Discontinue lithium and initiate hemodialysis
RATIONALE: Lithium toxicity is severe at levels >2.0 mEq/L. Symptoms of coarse
tremor, confusion, and ataxia indicate severe toxicity. The priority is to discontinue
lithium immediately. Levels >2.5 mEq/L with neurological symptoms require
hemodialysis as lithium is not protein-bound and is dialyzable.
QUESTION 4
A 45-year-old patient reports feeling "empty," intense fear of abandonment, self-
mutilation, and unstable relationships. Which personality disorder is MOST
likely?
A. Narcissistic Personality Disorder
B. Histrionic Personality Disorder
,C. Antisocial Personality Disorder
D. Dependent Personality Disorder
E. Borderline Personality Disorder
CORRECT ANSWER: E. Borderline Personality Disorder
RATIONALE: Borderline Personality Disorder (BPD) is characterized by fear of
abandonment, identity disturbance, emotional instability, self-mutilating behavior, and
unstable relationships. The "emptiness" and self-harm are hallmark features
distinguishing BPD from other Cluster B disorders. DBT is the gold-standard treatment.
QUESTION 5
Which medication is FDA-approved as first-line treatment for Obsessive-
Compulsive Disorder (OCD)?
A. Buspirone
B. Lorazepam
C. Bupropion
D. Fluvoxamine
E. Mirtazapine
CORRECT ANSWER: D. Fluvoxamine
RATIONALE: SSRIs are first-line for OCD. FDA-approved SSRIs for OCD include
fluvoxamine, fluoxetine, sertraline, and paroxetine, as well as the TCA clomipramine.
Fluvoxamine is particularly noted for OCD treatment. Buspirone is for GAD; lorazepam
is a benzodiazepine with no role in OCD; bupropion and mirtazapine are not indicated.
QUESTION 6
A patient taking an MAOI is brought to the ED with hypertensive crisis after eating
aged cheese. This is an example of which interaction?
A. Pharmacokinetic interaction
B. Additive effect
C. Synergistic toxicity
, D. Receptor downregulation
E. Tyramine-MAOI interaction
CORRECT ANSWER: E. Tyramine-MAOI interaction
RATIONALE: MAOIs inhibit monoamine oxidase, which normally breaks down
tyramine in the gut and liver. When tyramine-rich foods (aged cheese, cured meats,
wine) are consumed, tyramine accumulates causing massive norepinephrine release,
leading to severe hypertensive crisis. This is a classic pharmacodynamic food-drug
interaction.
QUESTION 7
Which of the following is the gold-standard psychotherapy for Borderline
Personality Disorder?
A. Cognitive Behavioral Therapy (CBT)
B. Psychodynamic Therapy
C. Supportive Therapy
D. Interpersonal Therapy (IPT)
E. Dialectical Behavior Therapy (DBT)
CORRECT ANSWER: E. Dialectical Behavior Therapy (DBT)
RATIONALE: DBT, developed by Marsha Linehan, is the evidence-based gold
standard for BPD. It combines CBT with mindfulness and focuses on four skill modules:
distress tolerance, emotional regulation, interpersonal effectiveness, and mindfulness. It
significantly reduces self-harm and suicidal behavior in BPD patients.
QUESTION 8
A 28-year-old presents with recurrent unexpected panic attacks, persistent worry
about future attacks, and avoidance of crowded places. Which diagnosis is MOST
appropriate?
A. Specific Phobia
B. Social Anxiety Disorder
C. Generalized Anxiety Disorder
ACTUAL EXAM QUESTIONS & ANSWERS | A+
RATED PSYCHIATRIC NURSE PRACTITIONER
STUDY GUIDE
GEORGETTE REVIEW PMHNP 2026
VERIFIED ACTUAL EXAM QUESTIONS & ANSWERS | A+ RATED
PSYCHIATRIC NURSE PRACTITIONER STUDY GUIDE
QUESTION 1
A 32-year-old patient presents with persistent sadness, anhedonia, hypersomnia,
and increased appetite for 6 weeks. Which diagnosis is MOST appropriate?
A. Bipolar II Disorder
B. Persistent Depressive Disorder (Dysthymia)
C. Major Depressive Disorder (MDD)
D. Adjustment Disorder with Depressed Mood
E. Cyclothymic Disorder
CORRECT ANSWER: C. Major Depressive Disorder (MDD)
RATIONALE: MDD is characterized by at least 5 symptoms lasting ≥2 weeks,
including depressed mood or anhedonia. This patient has sadness, anhedonia,
hypersomnia, and appetite changes for 6 weeks — meeting full MDD criteria. Dysthymia
requires symptoms for ≥2 years. Adjustment disorder follows a clear stressor. Bipolar II
requires hypomanic episodes.
QUESTION 2
Which neurotransmitter is MOST implicated in the pathophysiology of
schizophrenia?
A. Serotonin
B. GABA
,C. Norepinephrine
D. Dopamine
E. Acetylcholine
CORRECT ANSWER: D. Dopamine
RATIONALE: The dopamine hypothesis of schizophrenia proposes that hyperactivity
of dopamine in the mesolimbic pathway causes positive symptoms (hallucinations,
delusions), while hypoactivity in the mesocortical pathway causes negative symptoms.
All antipsychotics work primarily by blocking D2 receptors, supporting dopamine's
central role.
QUESTION 3
A patient on lithium therapy presents with coarse tremors, confusion, and ataxia.
Serum lithium level is 2.4 mEq/L. What is the PRIORITY nursing action?
A. Administer activated charcoal
B. Reduce the lithium dose by half
C. Encourage increased oral fluids
D. Switch to valproate immediately
E. Discontinue lithium and initiate hemodialysis
CORRECT ANSWER: E. Discontinue lithium and initiate hemodialysis
RATIONALE: Lithium toxicity is severe at levels >2.0 mEq/L. Symptoms of coarse
tremor, confusion, and ataxia indicate severe toxicity. The priority is to discontinue
lithium immediately. Levels >2.5 mEq/L with neurological symptoms require
hemodialysis as lithium is not protein-bound and is dialyzable.
QUESTION 4
A 45-year-old patient reports feeling "empty," intense fear of abandonment, self-
mutilation, and unstable relationships. Which personality disorder is MOST
likely?
A. Narcissistic Personality Disorder
B. Histrionic Personality Disorder
,C. Antisocial Personality Disorder
D. Dependent Personality Disorder
E. Borderline Personality Disorder
CORRECT ANSWER: E. Borderline Personality Disorder
RATIONALE: Borderline Personality Disorder (BPD) is characterized by fear of
abandonment, identity disturbance, emotional instability, self-mutilating behavior, and
unstable relationships. The "emptiness" and self-harm are hallmark features
distinguishing BPD from other Cluster B disorders. DBT is the gold-standard treatment.
QUESTION 5
Which medication is FDA-approved as first-line treatment for Obsessive-
Compulsive Disorder (OCD)?
A. Buspirone
B. Lorazepam
C. Bupropion
D. Fluvoxamine
E. Mirtazapine
CORRECT ANSWER: D. Fluvoxamine
RATIONALE: SSRIs are first-line for OCD. FDA-approved SSRIs for OCD include
fluvoxamine, fluoxetine, sertraline, and paroxetine, as well as the TCA clomipramine.
Fluvoxamine is particularly noted for OCD treatment. Buspirone is for GAD; lorazepam
is a benzodiazepine with no role in OCD; bupropion and mirtazapine are not indicated.
QUESTION 6
A patient taking an MAOI is brought to the ED with hypertensive crisis after eating
aged cheese. This is an example of which interaction?
A. Pharmacokinetic interaction
B. Additive effect
C. Synergistic toxicity
, D. Receptor downregulation
E. Tyramine-MAOI interaction
CORRECT ANSWER: E. Tyramine-MAOI interaction
RATIONALE: MAOIs inhibit monoamine oxidase, which normally breaks down
tyramine in the gut and liver. When tyramine-rich foods (aged cheese, cured meats,
wine) are consumed, tyramine accumulates causing massive norepinephrine release,
leading to severe hypertensive crisis. This is a classic pharmacodynamic food-drug
interaction.
QUESTION 7
Which of the following is the gold-standard psychotherapy for Borderline
Personality Disorder?
A. Cognitive Behavioral Therapy (CBT)
B. Psychodynamic Therapy
C. Supportive Therapy
D. Interpersonal Therapy (IPT)
E. Dialectical Behavior Therapy (DBT)
CORRECT ANSWER: E. Dialectical Behavior Therapy (DBT)
RATIONALE: DBT, developed by Marsha Linehan, is the evidence-based gold
standard for BPD. It combines CBT with mindfulness and focuses on four skill modules:
distress tolerance, emotional regulation, interpersonal effectiveness, and mindfulness. It
significantly reduces self-harm and suicidal behavior in BPD patients.
QUESTION 8
A 28-year-old presents with recurrent unexpected panic attacks, persistent worry
about future attacks, and avoidance of crowded places. Which diagnosis is MOST
appropriate?
A. Specific Phobia
B. Social Anxiety Disorder
C. Generalized Anxiety Disorder
