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PMHNP Exam Prep: Assessment & Diagnostic Process 2026-2027
BANK QUESTIONS WITH DETAILED VERIFIED ANSWERS
EXAM QUESTIONS WILL COME FROM HERE (100%
CORRECT ANSWERS A+ GRADED
1. During a mental status examination, a patient states, "The feds are
tracking my thoughts through the television. They beam them right out
of my head." This statement is best documented as which of the
following?
A. Paranoia
B. Thought broadcasting
C. Thought insertion
D. Tangentiality
Answer: B. Thought broadcasting. This is defined as the belief that one's
thoughts are being transmitted to others, often via electronic means,
which the patient directly describes. Paranoia is a broader term for
pervasive distrust. Thought insertion is the belief that thoughts are
being put into one's mind. Tangentiality is a pattern of speech where
the person goes off-topic without returning.
2. A 45-year-old patient presents with depressed mood, anhedonia,
significant weight loss, and early morning awakenings. They report
feeling this way for the last 3 months after losing their job. During the
interview, they also describe discrete periods, lasting about a week, of
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elevated mood, decreased need for sleep, and excessive involvement in
risky business investments. These episodes occurred twice in the past
year, independent of substance use. What is the most likely diagnosis?
A. Major Depressive Disorder, Recurrent
B. Bipolar I Disorder, Current Episode Depressed
C. Bipolar II Disorder, Current Episode Depressed
D. Cyclothymic Disorder
Answer: B. Bipolar I Disorder, Current Episode Depressed. The patient
meets criteria for a current major depressive episode. The history of
discrete periods of elevated, expansive mood with decreased need for
sleep and risky behaviors lasting at least one week meets criteria for a
manic episode. The presence of a full manic episode, regardless of
depressive history, rules in Bipolar I Disorder.
3. The PMHNP is assessing a 22-year-old veteran who reports frequent
intrusive memories, hypervigilance, and difficulty sleeping. The patient
also admits to having thoughts of wanting to be dead, has acquired a
firearm, and states, "My family would be better off without the burden
of me." What is the most critical next step in the assessment?
A. Administer the Hamilton Depression Rating Scale
B. Inquire about a specific suicide plan, intent, and means
C. Obtain a detailed sleep log for the next two weeks
D. Ask about combat exposure and specific traumatic events
Answer: B. Inquire about a specific suicide plan, intent, and means.
Although all options are relevant to a comprehensive assessment, the
patient has expressed passive death wishes, acquired a lethal means
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(firearm), and made statements suggesting active suicidal ideation. A
detailed suicide risk assessment, including plan, intent, means, and
access to means, is the immediate priority to determine safety and the
appropriate level of care.
4. A 55-year-old man presents with fatigue, low libido, and difficulty
concentrating. He denies feeling sad but says, "I just don't enjoy
anything anymore." He has a history of hypertension and type 2
diabetes. Which of the following laboratory tests is most critical to rule
out an organic cause for his psychiatric symptoms?
A. Vitamin B12 level
B. Thyroid-stimulating hormone (TSH)
C. Rapid plasma reagin (RPR)
D. Urine toxicology
Answer: B. Thyroid-stimulating hormone (TSH). Hypothyroidism can
present with symptoms identical to depression, including fatigue,
decreased libido, and concentration difficulties. While B12 deficiency
can cause fatigue and cognitive changes, and RPR is relevant in some
clinical contexts, TSH is the first-line, essential screening test for mood
disorders, especially in a patient with multiple medical comorbidities
where nonspecific symptoms overlap.
5. During an interview, a patient with suspected schizophrenia says,
"The car was ready to go to Chicago, you know, the windy city where
my aunt lives, she's a gardener, planting seeds is important for the
earth's future, future, futuristic..." This pattern of speech is best
characterized as:
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A. Circumstantiality
B. Loose associations
C. Flight of ideas
D. Pressured speech
Answer: B. Loose associations. This speech pattern demonstrates a
derailment where ideas shift from one subject to a completely
unrelated or obliquely related subject, with no logical connection. "Car
to Chicago" to "windy city" to "aunt" to "gardener" to "earth's future"
shows a breakdown in the associative threads. Circumstantiality
eventually reaches the point. Flight of ideas involves rapid shifts that
are often triggered by stimuli or clang associations. Pressured speech
describes the pace and intensity, not the logical coherence.
6. A 25-year-old graduate student reports an intense fear of being
negatively evaluated by others. This fear causes significant distress
when they have to give presentations in class, leading to tachycardia,
sweating, and trembling. The anxiety is confined to these performance
situations. What is the most accurate diagnosis?
A. Social Anxiety Disorder (Social Phobia)
B. Generalized Anxiety Disorder
C. Panic Disorder
D. Agoraphobia
Answer: A. Social Anxiety Disorder (Social Phobia). The hallmark is a
marked fear of social situations where the individual is exposed to
possible scrutiny by others, with the fear of acting in a way that will be
humiliating or embarrassing. The specifier "performance only" would
PMHNP Exam Prep: Assessment & Diagnostic Process 2026-2027
BANK QUESTIONS WITH DETAILED VERIFIED ANSWERS
EXAM QUESTIONS WILL COME FROM HERE (100%
CORRECT ANSWERS A+ GRADED
1. During a mental status examination, a patient states, "The feds are
tracking my thoughts through the television. They beam them right out
of my head." This statement is best documented as which of the
following?
A. Paranoia
B. Thought broadcasting
C. Thought insertion
D. Tangentiality
Answer: B. Thought broadcasting. This is defined as the belief that one's
thoughts are being transmitted to others, often via electronic means,
which the patient directly describes. Paranoia is a broader term for
pervasive distrust. Thought insertion is the belief that thoughts are
being put into one's mind. Tangentiality is a pattern of speech where
the person goes off-topic without returning.
2. A 45-year-old patient presents with depressed mood, anhedonia,
significant weight loss, and early morning awakenings. They report
feeling this way for the last 3 months after losing their job. During the
interview, they also describe discrete periods, lasting about a week, of
,2|Page
elevated mood, decreased need for sleep, and excessive involvement in
risky business investments. These episodes occurred twice in the past
year, independent of substance use. What is the most likely diagnosis?
A. Major Depressive Disorder, Recurrent
B. Bipolar I Disorder, Current Episode Depressed
C. Bipolar II Disorder, Current Episode Depressed
D. Cyclothymic Disorder
Answer: B. Bipolar I Disorder, Current Episode Depressed. The patient
meets criteria for a current major depressive episode. The history of
discrete periods of elevated, expansive mood with decreased need for
sleep and risky behaviors lasting at least one week meets criteria for a
manic episode. The presence of a full manic episode, regardless of
depressive history, rules in Bipolar I Disorder.
3. The PMHNP is assessing a 22-year-old veteran who reports frequent
intrusive memories, hypervigilance, and difficulty sleeping. The patient
also admits to having thoughts of wanting to be dead, has acquired a
firearm, and states, "My family would be better off without the burden
of me." What is the most critical next step in the assessment?
A. Administer the Hamilton Depression Rating Scale
B. Inquire about a specific suicide plan, intent, and means
C. Obtain a detailed sleep log for the next two weeks
D. Ask about combat exposure and specific traumatic events
Answer: B. Inquire about a specific suicide plan, intent, and means.
Although all options are relevant to a comprehensive assessment, the
patient has expressed passive death wishes, acquired a lethal means
,3|Page
(firearm), and made statements suggesting active suicidal ideation. A
detailed suicide risk assessment, including plan, intent, means, and
access to means, is the immediate priority to determine safety and the
appropriate level of care.
4. A 55-year-old man presents with fatigue, low libido, and difficulty
concentrating. He denies feeling sad but says, "I just don't enjoy
anything anymore." He has a history of hypertension and type 2
diabetes. Which of the following laboratory tests is most critical to rule
out an organic cause for his psychiatric symptoms?
A. Vitamin B12 level
B. Thyroid-stimulating hormone (TSH)
C. Rapid plasma reagin (RPR)
D. Urine toxicology
Answer: B. Thyroid-stimulating hormone (TSH). Hypothyroidism can
present with symptoms identical to depression, including fatigue,
decreased libido, and concentration difficulties. While B12 deficiency
can cause fatigue and cognitive changes, and RPR is relevant in some
clinical contexts, TSH is the first-line, essential screening test for mood
disorders, especially in a patient with multiple medical comorbidities
where nonspecific symptoms overlap.
5. During an interview, a patient with suspected schizophrenia says,
"The car was ready to go to Chicago, you know, the windy city where
my aunt lives, she's a gardener, planting seeds is important for the
earth's future, future, futuristic..." This pattern of speech is best
characterized as:
, 4|Page
A. Circumstantiality
B. Loose associations
C. Flight of ideas
D. Pressured speech
Answer: B. Loose associations. This speech pattern demonstrates a
derailment where ideas shift from one subject to a completely
unrelated or obliquely related subject, with no logical connection. "Car
to Chicago" to "windy city" to "aunt" to "gardener" to "earth's future"
shows a breakdown in the associative threads. Circumstantiality
eventually reaches the point. Flight of ideas involves rapid shifts that
are often triggered by stimuli or clang associations. Pressured speech
describes the pace and intensity, not the logical coherence.
6. A 25-year-old graduate student reports an intense fear of being
negatively evaluated by others. This fear causes significant distress
when they have to give presentations in class, leading to tachycardia,
sweating, and trembling. The anxiety is confined to these performance
situations. What is the most accurate diagnosis?
A. Social Anxiety Disorder (Social Phobia)
B. Generalized Anxiety Disorder
C. Panic Disorder
D. Agoraphobia
Answer: A. Social Anxiety Disorder (Social Phobia). The hallmark is a
marked fear of social situations where the individual is exposed to
possible scrutiny by others, with the fear of acting in a way that will be
humiliating or embarrassing. The specifier "performance only" would
