Psychiatric-Mental Health Nursing
Certification (PMH-BC™) ACTUAL
EXAM 2026/2027 | PMH-BC Core
Topics | Verified Q&A | Pass
Guaranteed - A+ Graded
DOMAIN I: ASSESSMENT, DIAGNOSIS, AND PLANNING (37 Questions)
Q1: A 32-year-old female patient with no prior psychiatric history is brought to the ED by her husband.
She has not slept in 4 days, speaks rapidly with pressured speech, reports feeling "on top of the world,"
and believes she has been chosen to negotiate a peace treaty with a foreign government. Which
assessment finding is most critical to evaluate within the next 15 minutes?
A. Presence of grandiose delusions.
B. Risk of physical aggression toward staff. [CORRECT]
C. Level of insight into her condition.
D. Recent changes in appetite or weight.
Correct Answer: B
Rationale: Acute mania with grandiosity, sleep deprivation, and agitation increases risk for sudden
physical aggression; patient and staff safety is the immediate priority. Choice A is a descriptive finding
but does not require immediate intervention. Choice C is relevant for long-term treatment but not
urgent. Choice D is part of a nutritional assessment that can be delayed.
Q2: A 68-year-old male is admitted for evaluation of confusion. His wife reports he was fine yesterday
but overnight became agitated, is picking at invisible objects, and does not recognize her. Vital signs
show temperature 101.2°F, HR 110, BP 142/88. What is the priority nursing action?
A. Obtain a detailed medication history from the wife.
B. Initiate fall precautions and one-to-one observation. [CORRECT]
C. Administer PRN haloperidol for agitation.
D. Schedule a CT scan of the head for the morning.
Correct Answer: B
Rationale: Acute onset confusion with fever suggests delirium; immediate safety interventions (fall
,precautions, observation) prevent injury while the underlying cause is investigated. Choice A is
important but secondary to safety. Choice C is inappropriate without first ruling out anticholinergic
toxicity or other causes. Choice D delays necessary urgent assessment.
Q3: A 24-year-old graduate student presents to the student health clinic stating, "I can't stop washing
my hands until they feel 'just right.' It takes hours and my skin is bleeding, but if I don't do it, something
terrible will happen to my family." Which diagnosis is most likely?
A. Generalized anxiety disorder.
B. Obsessive-compulsive disorder. [CORRECT]
C. Specific phobia.
D. Illness anxiety disorder.
Correct Answer: B
Rationale: The presence of ego-dystonic obsessions (fear of harm to family) and compulsions (hand
washing) performed to neutralize anxiety, causing significant distress and impairment, is classic for OCD.
Choice A lacks the specific obsessional content and compulsive rituals. Choice C involves avoidance, not
ritualistic behavior. Choice D focuses on health preoccupation without compulsions.
Q4: During a home visit, a psychiatric nurse observes a patient with schizophrenia sitting motionless,
maintaining a rigid posture for over 30 minutes, and resisting any movement by the examiner. Which
catatonic feature is being demonstrated?
A. Waxy flexibility.
B. Catalepsy. [CORRECT]
C. Stupor.
D. Negativism.
Correct Answer: B
Rationale: Catalepsy is the maintenance of fixed posture against gravity with passive resistance to
movement, as described. Choice A (waxy flexibility) allows positioning but maintains the new posture.
Choice C involves unresponsiveness and lack of movement. Choice D is active resistance to instructions,
not passive maintenance of posture.
Q5: A 45-year-old woman with major depressive disorder reports, "I don't see the point in anything
anymore. I've been giving away my jewelry to my neighbors because I won't need it." What is the
nurse's priority assessment?
A. Severity of anhedonia.
B. Presence of specific suicide plan. [CORRECT]
,C. Quality of sleep patterns.
D. Level of social support.
Correct Answer: B
Rationale: Giving away possessions is a high-risk warning sign for suicide; the nurse must immediately
assess for specific plan, intent, and means. Choice A is a symptom of depression but not immediately
life-threatening. Choice C and D are relevant to treatment planning but secondary to imminent safety
risk.
Q6: A 19-year-old male is brought to the ED by police after being found wandering traffic. He appears
fearful, has dilated pupils, tachycardia, and reports "spiders crawling under my skin." He admits to using
"bath salts" for three days. Which nursing diagnosis takes priority?
A. Acute confusion.
B. Risk for injury. [CORRECT]
C. Ineffective coping.
D. Disturbed sensory perception.
Correct Answer: B
Rationale: Stimulant intoxication with formication (tactile hallucinations), paranoia, and agitation
creates immediate risk for self-harm or accidental injury; safety is the priority. Choice A is present but
managed through safety. Choice C and D are accurate but less urgent than preventing injury during
acute intoxication.
Q7: A 52-year-old patient with bipolar I disorder is being assessed during a manic episode. Which finding
requires immediate intervention?
A. Spending $8,000 on online shopping in two days.
B. Sexual disinhibition with multiple partners.
C. Refusing to eat or drink for 36 hours due to hyperreligiosity. [CORRECT]
D. Decreased need for sleep with increased energy.
Correct Answer: C
Rationale: Refusing nutrition and hydration creates immediate medical risk for dehydration, electrolyte
imbalance, and cardiac complications; this requires urgent intervention. Choices A and B represent poor
judgment but not immediate physiological danger. Choice D is a core symptom of mania managed
through medication and structure.
Q8: A 28-year-old veteran presents with nightmares, hypervigilance, emotional numbing, and reports
avoiding fireworks because they trigger memories of combat. He admits to drinking "a few beers"
nightly to sleep. Which assessment tool is most appropriate for initial screening?
, A. Hamilton Depression Rating Scale.
B. PTSD Checklist for DSM-5 (PCL-5). [CORRECT]
C. Mini-Mental State Examination.
D. CAGE questionnaire.
Correct Answer: B
Rationale: The PCL-5 is the validated screening tool for PTSD symptoms including re-experiencing,
avoidance, negative alterations, and hyperarousal. Choice A screens for depression but not trauma-
specific symptoms. Choice C assesses cognitive function. Choice D screens for alcohol use disorder but
would not capture the full clinical picture.
Q9: During a mental status examination, a patient responds to the question "What would you do if you
found a stamped, addressed envelope on the street?" by stating, "I'd check for anthrax because the
government is monitoring my mail." This represents which cognitive abnormality?
A. Concrete thinking.
B. Paranoid ideation. [CORRECT]
C. Ideas of reference.
D. Loose associations.
Correct Answer: B
Rationale: The patient demonstrates paranoid ideation—fixed false beliefs of persecution or
surveillance without evidence. Choice A involves inability to abstract. Choice C involves believing neutral
events refer to oneself (less specific than paranoid delusion). Choice D involves illogical connections
between thoughts.
Q10: A 35-year-old patient with borderline personality disorder is admitted after a suicide attempt. On
the unit, she alternates between idealizing the nurse ("You're the only one who understands me") and
devaluing the same nurse ("You don't care about me at all"). This behavior exemplifies:
A. Splitting. [CORRECT]
B. Projection.
C. Projective identification.
D. Dissociation.
Correct Answer: A
Rationale: Splitting is the defense mechanism characterized by viewing others as all-good or all-bad
without integration, common in borderline personality disorder. Choice B attributes one's own feelings
to others. Choice C induces those feelings in others. Choice D involves disruption of consciousness or
memory.
Certification (PMH-BC™) ACTUAL
EXAM 2026/2027 | PMH-BC Core
Topics | Verified Q&A | Pass
Guaranteed - A+ Graded
DOMAIN I: ASSESSMENT, DIAGNOSIS, AND PLANNING (37 Questions)
Q1: A 32-year-old female patient with no prior psychiatric history is brought to the ED by her husband.
She has not slept in 4 days, speaks rapidly with pressured speech, reports feeling "on top of the world,"
and believes she has been chosen to negotiate a peace treaty with a foreign government. Which
assessment finding is most critical to evaluate within the next 15 minutes?
A. Presence of grandiose delusions.
B. Risk of physical aggression toward staff. [CORRECT]
C. Level of insight into her condition.
D. Recent changes in appetite or weight.
Correct Answer: B
Rationale: Acute mania with grandiosity, sleep deprivation, and agitation increases risk for sudden
physical aggression; patient and staff safety is the immediate priority. Choice A is a descriptive finding
but does not require immediate intervention. Choice C is relevant for long-term treatment but not
urgent. Choice D is part of a nutritional assessment that can be delayed.
Q2: A 68-year-old male is admitted for evaluation of confusion. His wife reports he was fine yesterday
but overnight became agitated, is picking at invisible objects, and does not recognize her. Vital signs
show temperature 101.2°F, HR 110, BP 142/88. What is the priority nursing action?
A. Obtain a detailed medication history from the wife.
B. Initiate fall precautions and one-to-one observation. [CORRECT]
C. Administer PRN haloperidol for agitation.
D. Schedule a CT scan of the head for the morning.
Correct Answer: B
Rationale: Acute onset confusion with fever suggests delirium; immediate safety interventions (fall
,precautions, observation) prevent injury while the underlying cause is investigated. Choice A is
important but secondary to safety. Choice C is inappropriate without first ruling out anticholinergic
toxicity or other causes. Choice D delays necessary urgent assessment.
Q3: A 24-year-old graduate student presents to the student health clinic stating, "I can't stop washing
my hands until they feel 'just right.' It takes hours and my skin is bleeding, but if I don't do it, something
terrible will happen to my family." Which diagnosis is most likely?
A. Generalized anxiety disorder.
B. Obsessive-compulsive disorder. [CORRECT]
C. Specific phobia.
D. Illness anxiety disorder.
Correct Answer: B
Rationale: The presence of ego-dystonic obsessions (fear of harm to family) and compulsions (hand
washing) performed to neutralize anxiety, causing significant distress and impairment, is classic for OCD.
Choice A lacks the specific obsessional content and compulsive rituals. Choice C involves avoidance, not
ritualistic behavior. Choice D focuses on health preoccupation without compulsions.
Q4: During a home visit, a psychiatric nurse observes a patient with schizophrenia sitting motionless,
maintaining a rigid posture for over 30 minutes, and resisting any movement by the examiner. Which
catatonic feature is being demonstrated?
A. Waxy flexibility.
B. Catalepsy. [CORRECT]
C. Stupor.
D. Negativism.
Correct Answer: B
Rationale: Catalepsy is the maintenance of fixed posture against gravity with passive resistance to
movement, as described. Choice A (waxy flexibility) allows positioning but maintains the new posture.
Choice C involves unresponsiveness and lack of movement. Choice D is active resistance to instructions,
not passive maintenance of posture.
Q5: A 45-year-old woman with major depressive disorder reports, "I don't see the point in anything
anymore. I've been giving away my jewelry to my neighbors because I won't need it." What is the
nurse's priority assessment?
A. Severity of anhedonia.
B. Presence of specific suicide plan. [CORRECT]
,C. Quality of sleep patterns.
D. Level of social support.
Correct Answer: B
Rationale: Giving away possessions is a high-risk warning sign for suicide; the nurse must immediately
assess for specific plan, intent, and means. Choice A is a symptom of depression but not immediately
life-threatening. Choice C and D are relevant to treatment planning but secondary to imminent safety
risk.
Q6: A 19-year-old male is brought to the ED by police after being found wandering traffic. He appears
fearful, has dilated pupils, tachycardia, and reports "spiders crawling under my skin." He admits to using
"bath salts" for three days. Which nursing diagnosis takes priority?
A. Acute confusion.
B. Risk for injury. [CORRECT]
C. Ineffective coping.
D. Disturbed sensory perception.
Correct Answer: B
Rationale: Stimulant intoxication with formication (tactile hallucinations), paranoia, and agitation
creates immediate risk for self-harm or accidental injury; safety is the priority. Choice A is present but
managed through safety. Choice C and D are accurate but less urgent than preventing injury during
acute intoxication.
Q7: A 52-year-old patient with bipolar I disorder is being assessed during a manic episode. Which finding
requires immediate intervention?
A. Spending $8,000 on online shopping in two days.
B. Sexual disinhibition with multiple partners.
C. Refusing to eat or drink for 36 hours due to hyperreligiosity. [CORRECT]
D. Decreased need for sleep with increased energy.
Correct Answer: C
Rationale: Refusing nutrition and hydration creates immediate medical risk for dehydration, electrolyte
imbalance, and cardiac complications; this requires urgent intervention. Choices A and B represent poor
judgment but not immediate physiological danger. Choice D is a core symptom of mania managed
through medication and structure.
Q8: A 28-year-old veteran presents with nightmares, hypervigilance, emotional numbing, and reports
avoiding fireworks because they trigger memories of combat. He admits to drinking "a few beers"
nightly to sleep. Which assessment tool is most appropriate for initial screening?
, A. Hamilton Depression Rating Scale.
B. PTSD Checklist for DSM-5 (PCL-5). [CORRECT]
C. Mini-Mental State Examination.
D. CAGE questionnaire.
Correct Answer: B
Rationale: The PCL-5 is the validated screening tool for PTSD symptoms including re-experiencing,
avoidance, negative alterations, and hyperarousal. Choice A screens for depression but not trauma-
specific symptoms. Choice C assesses cognitive function. Choice D screens for alcohol use disorder but
would not capture the full clinical picture.
Q9: During a mental status examination, a patient responds to the question "What would you do if you
found a stamped, addressed envelope on the street?" by stating, "I'd check for anthrax because the
government is monitoring my mail." This represents which cognitive abnormality?
A. Concrete thinking.
B. Paranoid ideation. [CORRECT]
C. Ideas of reference.
D. Loose associations.
Correct Answer: B
Rationale: The patient demonstrates paranoid ideation—fixed false beliefs of persecution or
surveillance without evidence. Choice A involves inability to abstract. Choice C involves believing neutral
events refer to oneself (less specific than paranoid delusion). Choice D involves illogical connections
between thoughts.
Q10: A 35-year-old patient with borderline personality disorder is admitted after a suicide attempt. On
the unit, she alternates between idealizing the nurse ("You're the only one who understands me") and
devaluing the same nurse ("You don't care about me at all"). This behavior exemplifies:
A. Splitting. [CORRECT]
B. Projection.
C. Projective identification.
D. Dissociation.
Correct Answer: A
Rationale: Splitting is the defense mechanism characterized by viewing others as all-good or all-bad
without integration, common in borderline personality disorder. Choice B attributes one's own feelings
to others. Choice C induces those feelings in others. Choice D involves disruption of consciousness or
memory.
