Georgette Review PMHNP Exam 2026
Complete Test Bank | Latest Updated
Questions & Verified Answers Study Guide
Georgette Review PMHNP Exam 2026 — Complete Test Bank
• 200 high-yield practice questions covering all core PMHNP board exam domains
— use this material by reading each question carefully, selecting your answer
before revealing the correct one, then studying the EXPERT RATIONALE deeply to
reinforce clinical reasoning.
• Each question features a bolded stem, five lettered options (A–E), a bolded
correct answer with EXPERT RATIONALE immediately below — ideal for timed self-
testing or slow conceptual review.
1. A 34-year-old patient presents with persistent depressed mood, anhedonia,
hypersomnia, increased appetite, and leaden paralysis lasting 6 weeks. Which
specifier best describes this presentation?
A. With anxious distress
B. With mixed features
C. With melancholic features
D. With atypical features
E. With psychotic features
Correct Answer: D. With atypical features
EXPERT RATIONALE: Atypical features specifier includes mood reactivity plus two of the
following — increased appetite/weight gain, hypersomnia, leaden paralysis, or
interpersonal rejection sensitivity. This patient meets criteria with hypersomnia,
increased appetite, and leaden paralysis.
,2. A PMHNP is prescribing an antidepressant for a 28-year-old with MDD and
comorbid generalized anxiety. Which agent is FDA-approved for both
conditions and considered first-line?
A. Bupropion
B. Mirtazapine
C. Nortriptyline
D. Trazodone
E. Escitalopram
Correct Answer: E. Escitalopram
EXPERT RATIONALE: Escitalopram (Lexapro) is an SSRI with FDA approval for both MDD
and GAD. SSRIs and SNRIs are considered first-line for comorbid depression and anxiety.
Bupropion lacks evidence for anxiety and can worsen it.
3. Which of the following neurotransmitter changes is most associated with
the pathophysiology of schizophrenia?
A. Decreased serotonin in the prefrontal cortex
B. Increased norepinephrine in the locus coeruleus
C. Decreased GABA in the hippocampus
D. Increased acetylcholine in the basal ganglia
E. Hyperactivity of dopamine in the mesolimbic pathway
Correct Answer: E. Hyperactivity of dopamine in the mesolimbic pathway
EXPERT RATIONALE: The dopamine hypothesis of schizophrenia posits that positive
symptoms (hallucinations, delusions) result from excess dopaminergic activity in the
mesolimbic pathway. Antipsychotics block D2 receptors to reduce this hyperactivity.
,4. A 45-year-old male on clozapine develops a WBC of 2,800/mm³. What is the
most appropriate next step?
A. Continue clozapine and recheck WBC in 1 week
B. Reduce the clozapine dose by 50%
C. Add lithium to stimulate WBC production
D. Switch to olanzapine immediately
E. Discontinue clozapine immediately
Correct Answer: E. Discontinue clozapine immediately
EXPERT RATIONALE: Clozapine carries a black box warning for agranulocytosis. A WBC
below 3,000/mm³ requires immediate discontinuation. The patient must be enrolled in
the REMS program (CURES) and WBC must be monitored regularly.
5. A patient with bipolar I disorder is being started on lithium. Which baseline
lab work is most essential before initiation?
A. Liver function tests and CBC
B. Fasting glucose and HbA1c
C. Urine drug screen and prolactin
D. Thyroid function and ECG only
E. Renal function, thyroid function, CBC, and ECG
Correct Answer: E. Renal function, thyroid function, CBC, and ECG
EXPERT RATIONALE: Lithium is renally cleared and can cause hypothyroidism,
nephrogenic diabetes insipidus, and cardiac conduction changes. Baseline
BMP/creatinine, TSH, CBC, urinalysis, and ECG (especially in patients over 40) are
required before starting lithium.
, 6. A 22-year-old female presents with recurrent binge eating followed by self-
induced vomiting. Physical exam reveals dental erosions and parotid gland
enlargement. Which diagnosis is most appropriate?
A. Binge eating disorder
B. Anorexia nervosa, binge-purge type
C. Rumination disorder
D. Avoidant/restrictive food intake disorder
E. Bulimia nervosa
Correct Answer: E. Bulimia nervosa
EXPERT RATIONALE: Bulimia nervosa is characterized by recurrent binge eating
followed by compensatory behaviors (vomiting, laxatives). Physical signs include dental
enamel erosion from stomach acid and parotid hypertrophy. Unlike anorexia, weight is
typically within normal range.
7. Which medication is FDA-approved specifically for the treatment of bulimia
nervosa?
A. Sertraline
B. Topiramate
C. Naltrexone
D. Lisdexamfetamine
E. Fluoxetine
Correct Answer: E. Fluoxetine
EXPERT RATIONALE: Fluoxetine (Prozac) at 60 mg/day is the only FDA-approved
medication for bulimia nervosa. It reduces binge-purge frequency. Lisdexamfetamine is
FDA-approved for binge eating disorder, not bulimia.
Complete Test Bank | Latest Updated
Questions & Verified Answers Study Guide
Georgette Review PMHNP Exam 2026 — Complete Test Bank
• 200 high-yield practice questions covering all core PMHNP board exam domains
— use this material by reading each question carefully, selecting your answer
before revealing the correct one, then studying the EXPERT RATIONALE deeply to
reinforce clinical reasoning.
• Each question features a bolded stem, five lettered options (A–E), a bolded
correct answer with EXPERT RATIONALE immediately below — ideal for timed self-
testing or slow conceptual review.
1. A 34-year-old patient presents with persistent depressed mood, anhedonia,
hypersomnia, increased appetite, and leaden paralysis lasting 6 weeks. Which
specifier best describes this presentation?
A. With anxious distress
B. With mixed features
C. With melancholic features
D. With atypical features
E. With psychotic features
Correct Answer: D. With atypical features
EXPERT RATIONALE: Atypical features specifier includes mood reactivity plus two of the
following — increased appetite/weight gain, hypersomnia, leaden paralysis, or
interpersonal rejection sensitivity. This patient meets criteria with hypersomnia,
increased appetite, and leaden paralysis.
,2. A PMHNP is prescribing an antidepressant for a 28-year-old with MDD and
comorbid generalized anxiety. Which agent is FDA-approved for both
conditions and considered first-line?
A. Bupropion
B. Mirtazapine
C. Nortriptyline
D. Trazodone
E. Escitalopram
Correct Answer: E. Escitalopram
EXPERT RATIONALE: Escitalopram (Lexapro) is an SSRI with FDA approval for both MDD
and GAD. SSRIs and SNRIs are considered first-line for comorbid depression and anxiety.
Bupropion lacks evidence for anxiety and can worsen it.
3. Which of the following neurotransmitter changes is most associated with
the pathophysiology of schizophrenia?
A. Decreased serotonin in the prefrontal cortex
B. Increased norepinephrine in the locus coeruleus
C. Decreased GABA in the hippocampus
D. Increased acetylcholine in the basal ganglia
E. Hyperactivity of dopamine in the mesolimbic pathway
Correct Answer: E. Hyperactivity of dopamine in the mesolimbic pathway
EXPERT RATIONALE: The dopamine hypothesis of schizophrenia posits that positive
symptoms (hallucinations, delusions) result from excess dopaminergic activity in the
mesolimbic pathway. Antipsychotics block D2 receptors to reduce this hyperactivity.
,4. A 45-year-old male on clozapine develops a WBC of 2,800/mm³. What is the
most appropriate next step?
A. Continue clozapine and recheck WBC in 1 week
B. Reduce the clozapine dose by 50%
C. Add lithium to stimulate WBC production
D. Switch to olanzapine immediately
E. Discontinue clozapine immediately
Correct Answer: E. Discontinue clozapine immediately
EXPERT RATIONALE: Clozapine carries a black box warning for agranulocytosis. A WBC
below 3,000/mm³ requires immediate discontinuation. The patient must be enrolled in
the REMS program (CURES) and WBC must be monitored regularly.
5. A patient with bipolar I disorder is being started on lithium. Which baseline
lab work is most essential before initiation?
A. Liver function tests and CBC
B. Fasting glucose and HbA1c
C. Urine drug screen and prolactin
D. Thyroid function and ECG only
E. Renal function, thyroid function, CBC, and ECG
Correct Answer: E. Renal function, thyroid function, CBC, and ECG
EXPERT RATIONALE: Lithium is renally cleared and can cause hypothyroidism,
nephrogenic diabetes insipidus, and cardiac conduction changes. Baseline
BMP/creatinine, TSH, CBC, urinalysis, and ECG (especially in patients over 40) are
required before starting lithium.
, 6. A 22-year-old female presents with recurrent binge eating followed by self-
induced vomiting. Physical exam reveals dental erosions and parotid gland
enlargement. Which diagnosis is most appropriate?
A. Binge eating disorder
B. Anorexia nervosa, binge-purge type
C. Rumination disorder
D. Avoidant/restrictive food intake disorder
E. Bulimia nervosa
Correct Answer: E. Bulimia nervosa
EXPERT RATIONALE: Bulimia nervosa is characterized by recurrent binge eating
followed by compensatory behaviors (vomiting, laxatives). Physical signs include dental
enamel erosion from stomach acid and parotid hypertrophy. Unlike anorexia, weight is
typically within normal range.
7. Which medication is FDA-approved specifically for the treatment of bulimia
nervosa?
A. Sertraline
B. Topiramate
C. Naltrexone
D. Lisdexamfetamine
E. Fluoxetine
Correct Answer: E. Fluoxetine
EXPERT RATIONALE: Fluoxetine (Prozac) at 60 mg/day is the only FDA-approved
medication for bulimia nervosa. It reduces binge-purge frequency. Lisdexamfetamine is
FDA-approved for binge eating disorder, not bulimia.
