2026 LMR - GEORGETTE'S PMHNP CERTIFICATION EXAM
LATEST 2026 REAL EXAM 100+ QUESTIONS AND
CORRECT ANSWERS|AGRADE
COMPREHENSIVE PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER
EXAMINATION
Pharmacology, Neurobiology, Disorders, and Clinical Management
Total Questions: 100
Time Allowed: 150 minutes
SECTION 1: FOUNDATIONS OF CLINICAL PRACTICE
Questions 1-10
Question 1
What does the acronym ADPIE stand for in the nursing process?
A. Assessment, Diagnosis, Planning, Implementation, Evaluation
B. Admission, Documentation, Prescribing, Intervention, Education
C. Analysis, Development, Preparation, Integration, Evaluation
D. Assessment, Data collection, Prescription, Implementation, Examination
Correct Answer-: A. Assessment, Diagnosis, Planning, Implementation,
Evaluation
Rationale: ADPIE represents the five standard steps of the nursing process:
, • Assessment: Systematic collection of client data
• Diagnosis: Clinical judgment about client responses to health problems
• Planning: Development of goals and outcomes with interventions
• Implementation: Execution of the planned interventions
• Evaluation: Assessment of progress toward goals and outcomes
This framework guides clinical reasoning and documentation in nursing practice.
Question 2
A mother reports that her child woke up screaming in the middle of the night.
What is the most appropriate initial response?
A. Reassure her that this is normal and nothing to worry about
B. Ask her if this has happened before to assess for sleep issue patterns
C. Recommend an immediate sleep study
D. Prescribe a low-dose sleep aid
Correct Answer-: B. Ask her if this has happened before to assess for sleep issue
patterns
Rationale: When a parent reports a child waking with screaming, the priority is to
gather more information to determine if this is an isolated incident or a pattern.
Asking about previous occurrences helps differentiate between night terrors,
nightmares, or other sleep disturbances. Assessment always precedes
intervention.
• A: Premature reassurance may miss underlying issues
• C: Sleep studies are not first-line for a single reported incident
• D: Medication is never the first response without complete assessment
Question 3
,A patient presents with a fungal infection on their toenail. What is the
appropriate next step?
A. Prescribe an oral antifungal medication immediately
B. Scrape the nail and send for testing
C. Recommend over-the-counter topical cream only
D. Refer to podiatry without further assessment
Correct Answer-: B. Scrape the nail and send for testing
Rationale: Before treating a suspected fungal nail infection, it is essential to
confirm the diagnosis through diagnostic testing. Nail scrapings for KOH
preparation or culture can confirm fungal elements and identify the specific
organism. This prevents unnecessary treatment and ensures appropriate therapy.
• A: Prescribing without confirmation may be ineffective or inappropriate
• C: OTC treatments may be insufficient without confirmed diagnosis
• D: Referral may be appropriate but testing should be done first
Question 4
A patient on lithium presents with dark brown urine. What should the PMHNP
do?
A. Reassure the patient this is a normal side effect
B. Check renal function
C. Increase the lithium dose
D. Discontinue lithium immediately
Correct Answer-: B. Check renal function
Rationale: Dark brown urine in a patient taking lithium may indicate renal
impairment or rhabdomyolysis, both of which require immediate evaluation.
Lithium is excreted by the kidneys, and any sign of renal dysfunction requires
, assessment of renal function (BUN, creatinine, urinalysis) and possibly a lithium
level.
• A: Dark brown urine is NOT a normal side effect
• C: Increasing dose could worsen toxicity
• D: Discontinuation requires evaluation first; the provider needs assessment
data
Question 5
A patient on Clozaril (clozapine) presents with fever. What should the PMHNP do?
A. Prescribe acetaminophen and monitor
B. Check ANC level to assess for agranulocytosis
C. Discontinue Clozaril immediately
D. Reassure the patient this is common
Correct Answer-: B. Check ANC level to assess for agranulocytosis
Rationale: Fever in a patient taking clozapine is a potential sign of
agranulocytosis, a life-threatening drop in white blood cells. Clozapine requires
regular monitoring of Absolute Neutrophil Count (ANC). Any sign of infection
(fever, sore throat, mouth sores) requires immediate ANC assessment.
• A: Symptomatic treatment without evaluation could miss agranulocytosis
• C: Discontinuation may be needed but requires confirmation first
• D: Fever is not a benign side effect with clozapine
Question 6
Which substances can cause serotonin syndrome? (Select all that apply)
A. Antidepressants (SSRIs, SNRIs, MAOIs)
B. St. John's Wort
LATEST 2026 REAL EXAM 100+ QUESTIONS AND
CORRECT ANSWERS|AGRADE
COMPREHENSIVE PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER
EXAMINATION
Pharmacology, Neurobiology, Disorders, and Clinical Management
Total Questions: 100
Time Allowed: 150 minutes
SECTION 1: FOUNDATIONS OF CLINICAL PRACTICE
Questions 1-10
Question 1
What does the acronym ADPIE stand for in the nursing process?
A. Assessment, Diagnosis, Planning, Implementation, Evaluation
B. Admission, Documentation, Prescribing, Intervention, Education
C. Analysis, Development, Preparation, Integration, Evaluation
D. Assessment, Data collection, Prescription, Implementation, Examination
Correct Answer-: A. Assessment, Diagnosis, Planning, Implementation,
Evaluation
Rationale: ADPIE represents the five standard steps of the nursing process:
, • Assessment: Systematic collection of client data
• Diagnosis: Clinical judgment about client responses to health problems
• Planning: Development of goals and outcomes with interventions
• Implementation: Execution of the planned interventions
• Evaluation: Assessment of progress toward goals and outcomes
This framework guides clinical reasoning and documentation in nursing practice.
Question 2
A mother reports that her child woke up screaming in the middle of the night.
What is the most appropriate initial response?
A. Reassure her that this is normal and nothing to worry about
B. Ask her if this has happened before to assess for sleep issue patterns
C. Recommend an immediate sleep study
D. Prescribe a low-dose sleep aid
Correct Answer-: B. Ask her if this has happened before to assess for sleep issue
patterns
Rationale: When a parent reports a child waking with screaming, the priority is to
gather more information to determine if this is an isolated incident or a pattern.
Asking about previous occurrences helps differentiate between night terrors,
nightmares, or other sleep disturbances. Assessment always precedes
intervention.
• A: Premature reassurance may miss underlying issues
• C: Sleep studies are not first-line for a single reported incident
• D: Medication is never the first response without complete assessment
Question 3
,A patient presents with a fungal infection on their toenail. What is the
appropriate next step?
A. Prescribe an oral antifungal medication immediately
B. Scrape the nail and send for testing
C. Recommend over-the-counter topical cream only
D. Refer to podiatry without further assessment
Correct Answer-: B. Scrape the nail and send for testing
Rationale: Before treating a suspected fungal nail infection, it is essential to
confirm the diagnosis through diagnostic testing. Nail scrapings for KOH
preparation or culture can confirm fungal elements and identify the specific
organism. This prevents unnecessary treatment and ensures appropriate therapy.
• A: Prescribing without confirmation may be ineffective or inappropriate
• C: OTC treatments may be insufficient without confirmed diagnosis
• D: Referral may be appropriate but testing should be done first
Question 4
A patient on lithium presents with dark brown urine. What should the PMHNP
do?
A. Reassure the patient this is a normal side effect
B. Check renal function
C. Increase the lithium dose
D. Discontinue lithium immediately
Correct Answer-: B. Check renal function
Rationale: Dark brown urine in a patient taking lithium may indicate renal
impairment or rhabdomyolysis, both of which require immediate evaluation.
Lithium is excreted by the kidneys, and any sign of renal dysfunction requires
, assessment of renal function (BUN, creatinine, urinalysis) and possibly a lithium
level.
• A: Dark brown urine is NOT a normal side effect
• C: Increasing dose could worsen toxicity
• D: Discontinuation requires evaluation first; the provider needs assessment
data
Question 5
A patient on Clozaril (clozapine) presents with fever. What should the PMHNP do?
A. Prescribe acetaminophen and monitor
B. Check ANC level to assess for agranulocytosis
C. Discontinue Clozaril immediately
D. Reassure the patient this is common
Correct Answer-: B. Check ANC level to assess for agranulocytosis
Rationale: Fever in a patient taking clozapine is a potential sign of
agranulocytosis, a life-threatening drop in white blood cells. Clozapine requires
regular monitoring of Absolute Neutrophil Count (ANC). Any sign of infection
(fever, sore throat, mouth sores) requires immediate ANC assessment.
• A: Symptomatic treatment without evaluation could miss agranulocytosis
• C: Discontinuation may be needed but requires confirmation first
• D: Fever is not a benign side effect with clozapine
Question 6
Which substances can cause serotonin syndrome? (Select all that apply)
A. Antidepressants (SSRIs, SNRIs, MAOIs)
B. St. John's Wort
