PMHNP LMR Georgette Certification Actual Exam
2026/2027 | Complete Questions & Detailed
Rationales | Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Psychiatric Assessment and Diagnosis | Q1 – Q10
Section 2 | Psychopharmacology and Medication Management | Q11 – Q20
Section 3 | Psychotherapy and Therapeutic Interventions | Q21 – Q30
Section 4 | Comorbid Medical Conditions and Special Populations | Q31 – Q40
Section 5 | Ethics, Law, and Professional Role Integration | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: PSYCHIATRIC ASSESSMENT AND DIAGNOSIS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 24-year-old graduate student is brought to the emergency department by campus
police after running through the library shouting that he has decoded a government
conspiracy. He has not slept in four days, has spent $3,000 on rare books in the past
week, and believes his thoughts are being broadcast on the radio. His mother reports he
was withdrawn and depressed for two weeks last month, but then "became a
completely different person." On exam, he is hyperverbal, sexually provocative with staff,
and shows marked psychomotor agitation. Urine drug screen is negative. What is the
most appropriate diagnosis?
A. Major depressive disorder with psychotic features
B. Schizoaffective disorder, bipolar type
C. Bipolar I disorder, current episode manic with psychotic features ✓ CORRECT
D. Schizophreniform disorder
,Correct Answer: C
Rationale: The patient presents with a distinct manic episode featuring elevated mood,
decreased need for sleep, hypersexuality, grandiosity, psychomotor agitation, and
psychotic features (thought broadcasting), preceded by a depressive episode, which is
classic for Bipolar I disorder. Schizoaffective disorder would require psychotic
symptoms to persist for two or more weeks in the absence of mood symptoms, which
is not described here. In clinical practice, the temporal relationship between mood and
psychotic symptoms is the key diagnostic differentiator.
Question 2 of 50
A 38-year-old woman presents to the outpatient clinic complaining of persistent
sadness, fatigue, and difficulty concentrating for the past six months. She denies
suicidal ideation but reports a 15-pound weight gain, sleeping 10 hours per night yet still
feeling exhausted, and feeling "numb" during activities she used to enjoy. She had a
similar episode at age 29 that lasted nearly a year and resolved without treatment. Her
PHQ-9 score is 14. What additional screening is most important before initiating
pharmacotherapy?
A. Thyroid-stimulating hormone (TSH) and free T4
B. Fasting lipid panel and hemoglobin A1c
C. Comprehensive metabolic panel and complete blood count
D. Vitamin D level and B12 ✓ CORRECT
Correct Answer: D
Rationale: This patient presents with atypical depression characterized by hypersomnia,
weight gain, and leaden paralysis, which is strongly associated with vitamin D deficiency
and B12 deficiency, both of which can mimic or exacerbate depressive symptoms.
While thyroid screening is important, her symptom pattern and history of spontaneous
remission make nutritional deficiencies a higher-yield initial workup. Clinicians often
,overlook that correcting these deficiencies can produce significant mood improvement
before exposing patients to antidepressant side effects.
Question 3 of 50
A 19-year-old college freshman is evaluated after her roommate found her cutting her
forearms with a razor. The patient states she does this "when everything gets too loud
in my head" and reports feeling immediate relief afterward. She describes chronic
feelings of emptiness, unstable relationships where she alternates between idealizing
and devaluing partners, and intense fear of abandonment. She denies any intent to die
and has never required medical attention for her cuts. What is the most likely diagnosis?
A. Post-traumatic stress disorder
B. Borderline personality disorder ✓ CORRECT
C. Major depressive disorder with nonsuicidal self-injury
D. Adjustment disorder with depressed mood
Correct Answer: B
Rationale: The pattern of affective instability, unstable interpersonal relationships,
identity disturbance, chronic emptiness, and nonsuicidal self-injury used for emotional
regulation is characteristic of borderline personality disorder. While nonsuicidal
self-injury can occur in major depression, the pervasive interpersonal chaos and use of
cutting specifically for relief rather than suicidal intent points toward a personality
disorder. These patients often present first in college when increased independence
stresses their limited coping capacity.
Question 4 of 50
A 52-year-old man is referred by his primary care provider for psychiatric evaluation.
Over the past year, his wife has noticed he becomes confused and agitated in the late
afternoon, sees "children playing in the backyard" when none are there, and has fallen
twice while trying to get out of bed quickly. He has lost his sense of smell and his
, handwriting has become much smaller. On cognitive testing, he scores 22/30 on the
MoCA with particular difficulty on executive function tasks. What is the most likely
diagnosis?
A. Alzheimer's disease with behavioral disturbance
B. Dementia with Lewy bodies ✓ CORRECT
C. Vascular dementia
D. Major neurocognitive disorder due to Parkinson's disease
Correct Answer: B
Rationale: The combination of visual hallucinations, fluctuating cognition with
sundowning, REM sleep behavior disorder suggested by falling from bed, parkinsonism
evidenced by micrographia and falls, and anosmia is the classic tetrad for dementia
with Lewy bodies. Alzheimer's typically presents with prominent memory impairment
early, while this patient's executive dysfunction and perceptual disturbances
predominate. Accurate diagnosis is critical because neuroleptics can cause severe
sensitivity reactions in DLB.
Question 5 of 50
A 31-year-old veteran presents for an initial evaluation, stating he has been "on edge"
since returning from deployment six months ago. He reports recurrent nightmares
about an IED explosion, avoids driving near construction sites because the noise
reminds him of gunfire, and describes feeling detached from his wife and children. He
startles violently at unexpected sounds and has begun drinking six beers nightly to fall
asleep. What is the most appropriate next step in assessment?
A. Administer the PCL-5 and screen for traumatic brain injury ✓ CORRECT
B. Order an immediate MRI of the brain
C. Begin prolonged exposure therapy within the first session
D. Prescribe prazosin 2 mg at bedtime
Correct Answer: A
2026/2027 | Complete Questions & Detailed
Rationales | Pass Guaranteed - A+ Graded
TABLE OF CONTENTS
Section 1 | Psychiatric Assessment and Diagnosis | Q1 – Q10
Section 2 | Psychopharmacology and Medication Management | Q11 – Q20
Section 3 | Psychotherapy and Therapeutic Interventions | Q21 – Q30
Section 4 | Comorbid Medical Conditions and Special Populations | Q31 – Q40
Section 5 | Ethics, Law, and Professional Role Integration | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: PSYCHIATRIC ASSESSMENT AND DIAGNOSIS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 24-year-old graduate student is brought to the emergency department by campus
police after running through the library shouting that he has decoded a government
conspiracy. He has not slept in four days, has spent $3,000 on rare books in the past
week, and believes his thoughts are being broadcast on the radio. His mother reports he
was withdrawn and depressed for two weeks last month, but then "became a
completely different person." On exam, he is hyperverbal, sexually provocative with staff,
and shows marked psychomotor agitation. Urine drug screen is negative. What is the
most appropriate diagnosis?
A. Major depressive disorder with psychotic features
B. Schizoaffective disorder, bipolar type
C. Bipolar I disorder, current episode manic with psychotic features ✓ CORRECT
D. Schizophreniform disorder
,Correct Answer: C
Rationale: The patient presents with a distinct manic episode featuring elevated mood,
decreased need for sleep, hypersexuality, grandiosity, psychomotor agitation, and
psychotic features (thought broadcasting), preceded by a depressive episode, which is
classic for Bipolar I disorder. Schizoaffective disorder would require psychotic
symptoms to persist for two or more weeks in the absence of mood symptoms, which
is not described here. In clinical practice, the temporal relationship between mood and
psychotic symptoms is the key diagnostic differentiator.
Question 2 of 50
A 38-year-old woman presents to the outpatient clinic complaining of persistent
sadness, fatigue, and difficulty concentrating for the past six months. She denies
suicidal ideation but reports a 15-pound weight gain, sleeping 10 hours per night yet still
feeling exhausted, and feeling "numb" during activities she used to enjoy. She had a
similar episode at age 29 that lasted nearly a year and resolved without treatment. Her
PHQ-9 score is 14. What additional screening is most important before initiating
pharmacotherapy?
A. Thyroid-stimulating hormone (TSH) and free T4
B. Fasting lipid panel and hemoglobin A1c
C. Comprehensive metabolic panel and complete blood count
D. Vitamin D level and B12 ✓ CORRECT
Correct Answer: D
Rationale: This patient presents with atypical depression characterized by hypersomnia,
weight gain, and leaden paralysis, which is strongly associated with vitamin D deficiency
and B12 deficiency, both of which can mimic or exacerbate depressive symptoms.
While thyroid screening is important, her symptom pattern and history of spontaneous
remission make nutritional deficiencies a higher-yield initial workup. Clinicians often
,overlook that correcting these deficiencies can produce significant mood improvement
before exposing patients to antidepressant side effects.
Question 3 of 50
A 19-year-old college freshman is evaluated after her roommate found her cutting her
forearms with a razor. The patient states she does this "when everything gets too loud
in my head" and reports feeling immediate relief afterward. She describes chronic
feelings of emptiness, unstable relationships where she alternates between idealizing
and devaluing partners, and intense fear of abandonment. She denies any intent to die
and has never required medical attention for her cuts. What is the most likely diagnosis?
A. Post-traumatic stress disorder
B. Borderline personality disorder ✓ CORRECT
C. Major depressive disorder with nonsuicidal self-injury
D. Adjustment disorder with depressed mood
Correct Answer: B
Rationale: The pattern of affective instability, unstable interpersonal relationships,
identity disturbance, chronic emptiness, and nonsuicidal self-injury used for emotional
regulation is characteristic of borderline personality disorder. While nonsuicidal
self-injury can occur in major depression, the pervasive interpersonal chaos and use of
cutting specifically for relief rather than suicidal intent points toward a personality
disorder. These patients often present first in college when increased independence
stresses their limited coping capacity.
Question 4 of 50
A 52-year-old man is referred by his primary care provider for psychiatric evaluation.
Over the past year, his wife has noticed he becomes confused and agitated in the late
afternoon, sees "children playing in the backyard" when none are there, and has fallen
twice while trying to get out of bed quickly. He has lost his sense of smell and his
, handwriting has become much smaller. On cognitive testing, he scores 22/30 on the
MoCA with particular difficulty on executive function tasks. What is the most likely
diagnosis?
A. Alzheimer's disease with behavioral disturbance
B. Dementia with Lewy bodies ✓ CORRECT
C. Vascular dementia
D. Major neurocognitive disorder due to Parkinson's disease
Correct Answer: B
Rationale: The combination of visual hallucinations, fluctuating cognition with
sundowning, REM sleep behavior disorder suggested by falling from bed, parkinsonism
evidenced by micrographia and falls, and anosmia is the classic tetrad for dementia
with Lewy bodies. Alzheimer's typically presents with prominent memory impairment
early, while this patient's executive dysfunction and perceptual disturbances
predominate. Accurate diagnosis is critical because neuroleptics can cause severe
sensitivity reactions in DLB.
Question 5 of 50
A 31-year-old veteran presents for an initial evaluation, stating he has been "on edge"
since returning from deployment six months ago. He reports recurrent nightmares
about an IED explosion, avoids driving near construction sites because the noise
reminds him of gunfire, and describes feeling detached from his wife and children. He
startles violently at unexpected sounds and has begun drinking six beers nightly to fall
asleep. What is the most appropriate next step in assessment?
A. Administer the PCL-5 and screen for traumatic brain injury ✓ CORRECT
B. Order an immediate MRI of the brain
C. Begin prolonged exposure therapy within the first session
D. Prescribe prazosin 2 mg at bedtime
Correct Answer: A
