Georgette Review PMHNP Exam
ACTUAL EXAM 2026/2027 | Psychiatric-
Mental Health Nurse Practitioner
Certification Prep | Verified Q&A | Pass
Guaranteed - A+ Graded
Domain 1 – Assessment, Diagnosis & Differential Diagnosis (40 questions)
Q1: A 28-year-old female presents with 2 weeks of depressed mood, anhedonia, insomnia, fatigue, and
feelings of worthlessness. She reports similar episodes 6 months ago lasting 3 weeks. Currently denies
manic symptoms. Which diagnosis is most likely?
A. Major depressive disorder, recurrent
B. Persistent depressive disorder (dysthymia)
C. Bipolar II disorder
D. Cyclothymic disorder [CORRECT]
Correct Answer: A
Rationale: Recurrent major depressive disorder requires two or more distinct major depressive episodes
separated by at least 2 months of remission. The incorrect suggestion of bipolar II disorder requires
history of hypomanic episodes, which are absent.
Q2: A 35-year-old male presents with 1 week of elevated mood, decreased need for sleep, pressured
speech, racing thoughts, and impulsive spending. He was hospitalized 2 years ago for similar symptoms
with psychotic features. Which diagnosis is indicated?
A. Bipolar II disorder
B. Bipolar I disorder [CORRECT]
C. Cyclothymic disorder
D. Schizoaffective disorder
Correct Answer: B
Rationale: History of manic episode with psychotic features and current manic symptoms establishes
,bipolar I disorder. The incorrect suggestion of bipolar II disorder requires hypomania, not full mania or
psychosis.
Q3: A 42-year-old female reports 6 months of excessive worry about multiple domains, restlessness,
muscle tension, and difficulty concentrating. Symptoms cause significant distress. Which diagnosis is
most likely?
A. Generalized anxiety disorder [CORRECT]
B. Panic disorder
C. Social anxiety disorder
D. Adjustment disorder with anxiety
Correct Answer: A
Rationale: GAD requires excessive anxiety/worry >6 months with three or more associated symptoms
(restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance). The
incorrect suggestion of panic disorder requires panic attacks, which are absent.
Q4: A 19-year-old college student presents with sudden onset of intense fear, palpitations, sweating,
trembling, and fear of dying, lasting 15 minutes. She has had 4 similar episodes this month and fears
leaving campus. Which diagnosis is indicated?
A. Generalized anxiety disorder
B. Panic disorder with agoraphobia [CORRECT]
C. Social anxiety disorder
D. Acute stress disorder
Correct Answer: B
Rationale: Recurrent unexpected panic attacks with fear of additional attacks and agoraphobic
avoidance establishes panic disorder with agoraphobia. The incorrect suggestion of GAD lacks discrete
panic attack episodes.
Q5: A 26-year-old veteran reports recurrent intrusive memories, nightmares, hypervigilance, emotional
numbing, and avoidance of reminders 8 months after combat deployment. Which diagnosis is indicated?
A. Acute stress disorder
B. Posttraumatic stress disorder [CORRECT]
C. Adjustment disorder
D. Generalized anxiety disorder
,Correct Answer: B
Rationale: PTSD requires >1 month of intrusion, avoidance, negative alterations in cognition/mood, and
marked alterations in arousal/reactivity following trauma. The incorrect suggestion of acute stress
disorder requires symptoms <1 month duration.
Q6: A 14-year-old male presents with 6 months of intrusive thoughts about contamination,
handwashing rituals 50+ times daily, and avoidance of public spaces. He recognizes thoughts are
excessive. Which diagnosis is indicated?
A. Obsessive-compulsive disorder [CORRECT]
B. Generalized anxiety disorder
C. Autism spectrum disorder
D. Schizophrenia
Correct Answer: A
Rationale: OCD requires obsessions (intrusive thoughts) and/or compulsions (handwashing rituals)
causing significant distress, time-consuming (>1 hour), with insight. The incorrect suggestion of
schizophrenia requires psychosis, not intact insight.
Q7: A 22-year-old female presents with restricted eating, fear of weight gain, body image distortion, and
amenorrhea for 3 months. BMI is 17.5. Which diagnosis is indicated?
A. Bulimia nervosa
B. Anorexia nervosa, restricting type [CORRECT]
C. Binge eating disorder
D. Avoidant/restrictive food intake disorder
Correct Answer: B
Rationale: Anorexia nervosa requires restriction of energy intake, significantly low weight, intense fear
of weight gain, and disturbed body image. The incorrect suggestion of bulimia nervosa requires binge
eating and compensatory behaviors.
Q8: A 32-year-old male reports recurrent episodes of binge eating (eating large amounts rapidly with
loss of control) 3 times weekly for 4 months, with distress but no compensatory behaviors. Which
diagnosis is indicated?
A. Anorexia nervosa
B. Bulimia nervosa
, C. Binge eating disorder [CORRECT]
D. Night eating syndrome
Correct Answer: C
Rationale: Binge eating disorder requires recurrent binge episodes (≥1x/week for 3 months) with
distress and absence of compensatory behaviors. The incorrect suggestion of bulimia nervosa requires
compensatory behaviors (purging, fasting, exercise).
Q9: A 45-year-old female presents with depressed mood, fatigue, weight gain, and constipation. TSH is
12.5 mIU/L. Which medical mimicker must be addressed?
A. Hyperthyroidism
B. Hypothyroidism [CORRECT]
C. Cushing syndrome
D. Addison disease
Correct Answer: B
Rationale: Hypothyroidism presents with depression-like symptoms, fatigue, weight gain, and
constipation; elevated TSH confirms diagnosis. The incorrect suggestion of hyperthyroidism would
present with anxiety, weight loss, and heat intolerance.
Q10: A 58-year-old male presents with 6 months of depressed mood, apathy, and cognitive slowing.
MoCA score is 22/30. Wife reports loud snoring and daytime sleepiness. Which assessment is priority?
A. Polysomnography for obstructive sleep apnea [CORRECT]
B. PET scan for Alzheimer's disease
C. Lumbar puncture for neurosyphilis
D. Trial of antidepressant medication
Correct Answer: A
Rationale: Sleep apnea causes neurocognitive symptoms and depression; polysomnography is
diagnostic priority. The incorrect suggestion of immediate PET scan is premature without ruling out
reversible causes.
Q11: A 24-year-old female presents with mood lability, self-harm (cutting), chronic emptiness, fear of
abandonment, and unstable relationships. Which diagnosis is indicated?
A. Bipolar II disorder
B. Borderline personality disorder [CORRECT]
ACTUAL EXAM 2026/2027 | Psychiatric-
Mental Health Nurse Practitioner
Certification Prep | Verified Q&A | Pass
Guaranteed - A+ Graded
Domain 1 – Assessment, Diagnosis & Differential Diagnosis (40 questions)
Q1: A 28-year-old female presents with 2 weeks of depressed mood, anhedonia, insomnia, fatigue, and
feelings of worthlessness. She reports similar episodes 6 months ago lasting 3 weeks. Currently denies
manic symptoms. Which diagnosis is most likely?
A. Major depressive disorder, recurrent
B. Persistent depressive disorder (dysthymia)
C. Bipolar II disorder
D. Cyclothymic disorder [CORRECT]
Correct Answer: A
Rationale: Recurrent major depressive disorder requires two or more distinct major depressive episodes
separated by at least 2 months of remission. The incorrect suggestion of bipolar II disorder requires
history of hypomanic episodes, which are absent.
Q2: A 35-year-old male presents with 1 week of elevated mood, decreased need for sleep, pressured
speech, racing thoughts, and impulsive spending. He was hospitalized 2 years ago for similar symptoms
with psychotic features. Which diagnosis is indicated?
A. Bipolar II disorder
B. Bipolar I disorder [CORRECT]
C. Cyclothymic disorder
D. Schizoaffective disorder
Correct Answer: B
Rationale: History of manic episode with psychotic features and current manic symptoms establishes
,bipolar I disorder. The incorrect suggestion of bipolar II disorder requires hypomania, not full mania or
psychosis.
Q3: A 42-year-old female reports 6 months of excessive worry about multiple domains, restlessness,
muscle tension, and difficulty concentrating. Symptoms cause significant distress. Which diagnosis is
most likely?
A. Generalized anxiety disorder [CORRECT]
B. Panic disorder
C. Social anxiety disorder
D. Adjustment disorder with anxiety
Correct Answer: A
Rationale: GAD requires excessive anxiety/worry >6 months with three or more associated symptoms
(restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep disturbance). The
incorrect suggestion of panic disorder requires panic attacks, which are absent.
Q4: A 19-year-old college student presents with sudden onset of intense fear, palpitations, sweating,
trembling, and fear of dying, lasting 15 minutes. She has had 4 similar episodes this month and fears
leaving campus. Which diagnosis is indicated?
A. Generalized anxiety disorder
B. Panic disorder with agoraphobia [CORRECT]
C. Social anxiety disorder
D. Acute stress disorder
Correct Answer: B
Rationale: Recurrent unexpected panic attacks with fear of additional attacks and agoraphobic
avoidance establishes panic disorder with agoraphobia. The incorrect suggestion of GAD lacks discrete
panic attack episodes.
Q5: A 26-year-old veteran reports recurrent intrusive memories, nightmares, hypervigilance, emotional
numbing, and avoidance of reminders 8 months after combat deployment. Which diagnosis is indicated?
A. Acute stress disorder
B. Posttraumatic stress disorder [CORRECT]
C. Adjustment disorder
D. Generalized anxiety disorder
,Correct Answer: B
Rationale: PTSD requires >1 month of intrusion, avoidance, negative alterations in cognition/mood, and
marked alterations in arousal/reactivity following trauma. The incorrect suggestion of acute stress
disorder requires symptoms <1 month duration.
Q6: A 14-year-old male presents with 6 months of intrusive thoughts about contamination,
handwashing rituals 50+ times daily, and avoidance of public spaces. He recognizes thoughts are
excessive. Which diagnosis is indicated?
A. Obsessive-compulsive disorder [CORRECT]
B. Generalized anxiety disorder
C. Autism spectrum disorder
D. Schizophrenia
Correct Answer: A
Rationale: OCD requires obsessions (intrusive thoughts) and/or compulsions (handwashing rituals)
causing significant distress, time-consuming (>1 hour), with insight. The incorrect suggestion of
schizophrenia requires psychosis, not intact insight.
Q7: A 22-year-old female presents with restricted eating, fear of weight gain, body image distortion, and
amenorrhea for 3 months. BMI is 17.5. Which diagnosis is indicated?
A. Bulimia nervosa
B. Anorexia nervosa, restricting type [CORRECT]
C. Binge eating disorder
D. Avoidant/restrictive food intake disorder
Correct Answer: B
Rationale: Anorexia nervosa requires restriction of energy intake, significantly low weight, intense fear
of weight gain, and disturbed body image. The incorrect suggestion of bulimia nervosa requires binge
eating and compensatory behaviors.
Q8: A 32-year-old male reports recurrent episodes of binge eating (eating large amounts rapidly with
loss of control) 3 times weekly for 4 months, with distress but no compensatory behaviors. Which
diagnosis is indicated?
A. Anorexia nervosa
B. Bulimia nervosa
, C. Binge eating disorder [CORRECT]
D. Night eating syndrome
Correct Answer: C
Rationale: Binge eating disorder requires recurrent binge episodes (≥1x/week for 3 months) with
distress and absence of compensatory behaviors. The incorrect suggestion of bulimia nervosa requires
compensatory behaviors (purging, fasting, exercise).
Q9: A 45-year-old female presents with depressed mood, fatigue, weight gain, and constipation. TSH is
12.5 mIU/L. Which medical mimicker must be addressed?
A. Hyperthyroidism
B. Hypothyroidism [CORRECT]
C. Cushing syndrome
D. Addison disease
Correct Answer: B
Rationale: Hypothyroidism presents with depression-like symptoms, fatigue, weight gain, and
constipation; elevated TSH confirms diagnosis. The incorrect suggestion of hyperthyroidism would
present with anxiety, weight loss, and heat intolerance.
Q10: A 58-year-old male presents with 6 months of depressed mood, apathy, and cognitive slowing.
MoCA score is 22/30. Wife reports loud snoring and daytime sleepiness. Which assessment is priority?
A. Polysomnography for obstructive sleep apnea [CORRECT]
B. PET scan for Alzheimer's disease
C. Lumbar puncture for neurosyphilis
D. Trial of antidepressant medication
Correct Answer: A
Rationale: Sleep apnea causes neurocognitive symptoms and depression; polysomnography is
diagnostic priority. The incorrect suggestion of immediate PET scan is premature without ruling out
reversible causes.
Q11: A 24-year-old female presents with mood lability, self-harm (cutting), chronic emptiness, fear of
abandonment, and unstable relationships. Which diagnosis is indicated?
A. Bipolar II disorder
B. Borderline personality disorder [CORRECT]
