The Unseen Wounds: A Psychiatric-
**
Mental Health Nurse Practitioner
(PMHNP) Certification Exam on Trauma,
Dissociative Disorders, and Somatic
Symptom Disorders**
---
1. A 32-year-old woman reports recurrent, involuntary, and intrusive memories of a sexual assault that
occurred 8 months ago. She avoids places that remind her of the event, has difficulty sleeping, and
experiences hypervigilance. These symptoms have lasted 4 months. Which diagnosis best fits this clinical
presentation?
A. Acute stress disorder
B. Posttraumatic stress disorder
C. Adjustment disorder
D. Generalized anxiety disorder
💫RATIONALE✔️✔️: PTSD requires symptoms lasting >1 month. Acute stress disorder (A) is diagnosed
within 3 days to 1 month of trauma. Adjustment disorder (C) is less severe. GAD (D) does not require a
trauma trigger.
💫ANSWER✔️✔️: B. Posttraumatic stress disorder
---
,2. A 45-year-old patient reports episodes of sudden, unexpected depersonalization (feeling detached
from his own body) and derealization (feeling that the world is unreal). He is distressed but has no
history of trauma. These episodes began after a stressful work event. Which medication should the
PMHNP consider first-line?
A. Sertraline
B. Lorazepam
C. Quetiapine
D. Lamotrigine
💫RATIONALE✔️✔️: Depersonalization/derealization disorder often responds to SSRIs such as sertraline.
Benzodiazepines (B) can worsen dissociation. Antipsychotics (C) and lamotrigine (D) are not first-line.
💫ANSWER✔️✔️: A. Sertraline
---
3. A 28-year-old man is brought to the emergency department by police after being found wandering in
a confused state. He cannot recall his name, address, or any personal information. He has no head
injury, no substance use, and neurological exam is normal. Twelve hours later, he suddenly "wakes up"
and remembers everything, but he has no memory of the wandering episode. This presentation is most
consistent with:
A. Dissociative amnesia with dissociative fugue
B. Factitious disorder
C. Temporal lobe seizure
D. Malingering
💫RATIONALE✔️✔️: Dissociative fugue involves sudden, unexpected travel with inability to recall identity
and amnesia for the episode. Factitious disorder (B) involves intentional symptom production. Seizure
(C) would show EEG changes. Malingering (D) has external incentive.
💫ANSWER✔️✔️: A. Dissociative amnesia with dissociative fugue
---
,4. A 38-year-old patient with a history of childhood physical abuse presents with multiple somatic
complaints including chronic pain, fatigue, and gastrointestinal distress. Extensive medical workup has
been negative. The patient becomes angry when the PMHNP suggests that stress may be contributing.
Which approach is most therapeutic initially?
A. Confront the patient's denial directly
B. Validate the patient's physical symptoms while exploring emotional stressors gently
C. Refer the patient to a neurologist for further testing
D. Prescribe a high-dose opioid for pain
💫RATIONALE✔️✔️: Somatic symptom disorder requires validation of distress and gradual introduction of
the mind-body connection. Confrontation (A) worsens rapport. Further testing (C) reinforces illness
behavior. Opioids (D) are not indicated.
💫ANSWER✔️✔️: B. Validate the patient's physical symptoms while exploring emotional stressors gently
---
5. A 22-year-old college student reports that she sometimes "loses time" and finds unfamiliar items in
her apartment. She has no memory of how they got there. On further questioning, she describes a
history of severe childhood emotional abuse. Which dissociative disorder should be ruled out?
A. Dissociative identity disorder (DID)
B. Depersonalization/derealization disorder
C. Dissociative amnesia
D. Borderline personality disorder
💫RATIONALE✔️✔️: "Losing time" and finding unfamiliar items are classic for dissociative identity disorder
(alternate identities taking executive control). Depersonalization (B) involves detachment, not memory
gaps. Amnesia (C) does not involve identity alteration. BPD (D) does not typically involve dissociative
amnesia for daily events.
💫ANSWER✔️✔️: A. Dissociative identity disorder (DID)
---
, 6. A 55-year-old patient presents with blindness that began suddenly after witnessing a traumatic car
accident. Ophthalmologic exam is normal, and visual evoked potentials are intact. The patient seems
unconcerned ("la belle indifférence"). Which diagnosis is most likely?
A. Conversion disorder (functional neurological symptom disorder)
B. Malingering
C. Factitious disorder
D. Major depressive disorder with psychotic features
💫RATIONALE✔️✔️: Conversion disorder presents with neurologic symptoms (blindness, weakness)
incompatible with medical findings, often after trauma, with la belle indifférence. Malingering (B) has
external incentive. Factitious disorder (C) involves intentional production but patient seeks sick role.
💫ANSWER✔️✔️: A. Conversion disorder (functional neurological symptom disorder)
---
7. A 30-year-old patient with a diagnosis of PTSD reports frequent nightmares of a combat event. Which
medication has FDA approval for PTSD-related nightmares?
A. Prazosin
B. Propranolol
C. Clonidine
D. Trazodone
💫RATIONALE✔️✔️: Prazosin (alpha-1 antagonist) is FDA-approved for PTSD-related nightmares.
Propranolol (B) is used for autonomic symptoms. Clonidine (C) is for hyperarousal. Trazodone (D) is for
insomnia but not specifically trauma nightmares.
💫ANSWER✔️✔️: A. Prazosin
---
8. A 42-year-old woman reports feeling "numb" and detached from others since her husband's death 18
months ago. She avoids visiting his grave and refuses to talk about him. She has not experienced
intrusive memories or hyperarousal. This presentation is most consistent with:
**
Mental Health Nurse Practitioner
(PMHNP) Certification Exam on Trauma,
Dissociative Disorders, and Somatic
Symptom Disorders**
---
1. A 32-year-old woman reports recurrent, involuntary, and intrusive memories of a sexual assault that
occurred 8 months ago. She avoids places that remind her of the event, has difficulty sleeping, and
experiences hypervigilance. These symptoms have lasted 4 months. Which diagnosis best fits this clinical
presentation?
A. Acute stress disorder
B. Posttraumatic stress disorder
C. Adjustment disorder
D. Generalized anxiety disorder
💫RATIONALE✔️✔️: PTSD requires symptoms lasting >1 month. Acute stress disorder (A) is diagnosed
within 3 days to 1 month of trauma. Adjustment disorder (C) is less severe. GAD (D) does not require a
trauma trigger.
💫ANSWER✔️✔️: B. Posttraumatic stress disorder
---
,2. A 45-year-old patient reports episodes of sudden, unexpected depersonalization (feeling detached
from his own body) and derealization (feeling that the world is unreal). He is distressed but has no
history of trauma. These episodes began after a stressful work event. Which medication should the
PMHNP consider first-line?
A. Sertraline
B. Lorazepam
C. Quetiapine
D. Lamotrigine
💫RATIONALE✔️✔️: Depersonalization/derealization disorder often responds to SSRIs such as sertraline.
Benzodiazepines (B) can worsen dissociation. Antipsychotics (C) and lamotrigine (D) are not first-line.
💫ANSWER✔️✔️: A. Sertraline
---
3. A 28-year-old man is brought to the emergency department by police after being found wandering in
a confused state. He cannot recall his name, address, or any personal information. He has no head
injury, no substance use, and neurological exam is normal. Twelve hours later, he suddenly "wakes up"
and remembers everything, but he has no memory of the wandering episode. This presentation is most
consistent with:
A. Dissociative amnesia with dissociative fugue
B. Factitious disorder
C. Temporal lobe seizure
D. Malingering
💫RATIONALE✔️✔️: Dissociative fugue involves sudden, unexpected travel with inability to recall identity
and amnesia for the episode. Factitious disorder (B) involves intentional symptom production. Seizure
(C) would show EEG changes. Malingering (D) has external incentive.
💫ANSWER✔️✔️: A. Dissociative amnesia with dissociative fugue
---
,4. A 38-year-old patient with a history of childhood physical abuse presents with multiple somatic
complaints including chronic pain, fatigue, and gastrointestinal distress. Extensive medical workup has
been negative. The patient becomes angry when the PMHNP suggests that stress may be contributing.
Which approach is most therapeutic initially?
A. Confront the patient's denial directly
B. Validate the patient's physical symptoms while exploring emotional stressors gently
C. Refer the patient to a neurologist for further testing
D. Prescribe a high-dose opioid for pain
💫RATIONALE✔️✔️: Somatic symptom disorder requires validation of distress and gradual introduction of
the mind-body connection. Confrontation (A) worsens rapport. Further testing (C) reinforces illness
behavior. Opioids (D) are not indicated.
💫ANSWER✔️✔️: B. Validate the patient's physical symptoms while exploring emotional stressors gently
---
5. A 22-year-old college student reports that she sometimes "loses time" and finds unfamiliar items in
her apartment. She has no memory of how they got there. On further questioning, she describes a
history of severe childhood emotional abuse. Which dissociative disorder should be ruled out?
A. Dissociative identity disorder (DID)
B. Depersonalization/derealization disorder
C. Dissociative amnesia
D. Borderline personality disorder
💫RATIONALE✔️✔️: "Losing time" and finding unfamiliar items are classic for dissociative identity disorder
(alternate identities taking executive control). Depersonalization (B) involves detachment, not memory
gaps. Amnesia (C) does not involve identity alteration. BPD (D) does not typically involve dissociative
amnesia for daily events.
💫ANSWER✔️✔️: A. Dissociative identity disorder (DID)
---
, 6. A 55-year-old patient presents with blindness that began suddenly after witnessing a traumatic car
accident. Ophthalmologic exam is normal, and visual evoked potentials are intact. The patient seems
unconcerned ("la belle indifférence"). Which diagnosis is most likely?
A. Conversion disorder (functional neurological symptom disorder)
B. Malingering
C. Factitious disorder
D. Major depressive disorder with psychotic features
💫RATIONALE✔️✔️: Conversion disorder presents with neurologic symptoms (blindness, weakness)
incompatible with medical findings, often after trauma, with la belle indifférence. Malingering (B) has
external incentive. Factitious disorder (C) involves intentional production but patient seeks sick role.
💫ANSWER✔️✔️: A. Conversion disorder (functional neurological symptom disorder)
---
7. A 30-year-old patient with a diagnosis of PTSD reports frequent nightmares of a combat event. Which
medication has FDA approval for PTSD-related nightmares?
A. Prazosin
B. Propranolol
C. Clonidine
D. Trazodone
💫RATIONALE✔️✔️: Prazosin (alpha-1 antagonist) is FDA-approved for PTSD-related nightmares.
Propranolol (B) is used for autonomic symptoms. Clonidine (C) is for hyperarousal. Trazodone (D) is for
insomnia but not specifically trauma nightmares.
💫ANSWER✔️✔️: A. Prazosin
---
8. A 42-year-old woman reports feeling "numb" and detached from others since her husband's death 18
months ago. She avoids visiting his grave and refuses to talk about him. She has not experienced
intrusive memories or hyperarousal. This presentation is most consistent with:
