PMH-BC™ ACTUAL EXAM 2026/2027 | Version 1 | Detailed
Rationales | Psychiatric Nursing | Pass Guaranteed - A+
Graded
Domain 1: Assessment (30 Questions – 20%)
Q1: A 19-year-old college student is brought to the emergency department by campus
security after being found wandering outside in 30°F weather wearing only a t-shirt and
shorts. The student is speaking rapidly, reports needing no sleep for 4 days to "finish a
revolutionary invention," and has maxed out three credit cards in 48 hours. Which
assessment finding would be the priority for the psychiatric-mental health nurse to
evaluate?
A. Presence of auditory hallucinations
B. Current suicidal ideation with plan or intent
C. Family history of bipolar disorder
D. Academic performance decline this semester
Correct Answer: B
Rationale: While all options are relevant to a comprehensive assessment, suicidal
ideation with plan or intent represents an immediate safety threat requiring priority
intervention. The patient presents with classic manic symptoms (decreased need for
sleep, grandiosity, hyperactivity, poor judgment/impulsivity with financial recklessness,
,and inappropriate clothing for weather indicating loss of inhibition). Manic episodes
carry significantly elevated suicide risk, particularly during mixed features or when
psychomotor agitation is present. The nurse must complete a suicide risk assessment
using a validated tool such as the Columbia-Suicide Severity Rating Scale (C-SSRS)
before addressing other assessment components.
Why A is incorrect: While hallucinations may occur in severe mania with psychotic
features, they do not represent an immediate life threat compared to suicidal intent.
Additionally, the stem does not indicate perceptual disturbances.
Why C is incorrect: Family history is important for diagnostic formulation and long-term
treatment planning, but it does not require immediate assessment in the emergency
setting.
Why D is incorrect: Academic decline may have preceded the manic episode but is not a
safety priority in the acute presentation.
Safety Alert: Manic patients often lack insight (anosognosia) and may not recognize
their impaired state. The combination of impulsivity, grandiosity, and impaired judgment
creates high risk for self-harm or accidental death.
Q2: A 67-year-old patient with vascular dementia is admitted to the inpatient psychiatric
unit for severe agitation. On day 3, the nurse notes the patient is suddenly lethargic, has
slurred speech, and is picking at invisible objects in the air. Vital signs show
temperature 101.2°F, HR 118, BP 162/94. Which condition should the nurse first
suspect?
,A. Worsening dementia requiring increased antipsychotic dosing
B. Neuroleptic malignant syndrome (NMS) from recent haloperidol administration
C. Delirium superimposed on dementia (DSD)
D. Acute stroke with new neurological deficits
Correct Answer: C
Rationale: The presentation of acute onset fluctuating consciousness, visual
hallucinations (picking at air), autonomic instability (fever, tachycardia, hypertension),
and new neurological symptoms in a patient with baseline dementia is classic for
Delirium Superimposed on Dementia (DSD). This is a medical emergency requiring
immediate physician notification and workup for underlying causes (infection,
metabolic derangement, medication toxicity). The temporal relationship (day 3 of
admission) and acute change from baseline strongly support delirium rather than
progression of underlying dementia.
Why A is incorrect: Increasing antipsychotics in this presentation is dangerous and
contraindicated. The symptoms suggest delirium, which requires treating the underlying
cause, not suppressing symptoms with more antipsychotics.
Why B is incorrect: While NMS is a critical consideration with antipsychotic use, the
patient lacks the hallmark "lead pipe" rigidity and severe muscle breakdown (marked CK
elevation). The visual hallucinations and fluctuating consciousness are more
characteristic of delirium.
Why D is incorrect: While stroke must be ruled out, the combination of fever, fluctuating
consciousness, and visual hallucinations is more consistent with delirium. However,
neuroimaging may be indicated to rule out stroke as an underlying cause.
, Therapeutic Communication Tip: When communicating with delirious patients, use
frequent reorientation, clear simple statements, ensure sensory aids (glasses/hearing
aids) are available, and maintain consistent caregivers when possible.
Q3: During an initial assessment of a 34-year-old patient with suspected borderline
personality disorder (BPD), which statement by the patient would the nurse document
as consistent with the DSM-5-TR diagnostic criteria for this disorder?
A. "I get really uncomfortable when I'm not the center of attention at parties."
B. "When my therapist went on vacation, I felt abandoned and started cutting myself."
C. "I need everything to be perfectly organized or I can't function."
D. "I believe the FBI is monitoring my thoughts through my television."
Correct Answer: B
Rationale: This statement demonstrates two core features of Borderline Personality
Disorder: (1) frantic efforts to avoid real or imagined abandonment (response to
therapist vacation), and (2) recurrent suicidal behavior, gestures, or self-mutilating
behavior (cutting). The DSM-5-TR criteria for BPD require a pervasive pattern of
instability in interpersonal relationships, self-image, and affects, with marked impulsivity
beginning by early adulthood. The specific criteria demonstrated here include the
abandonment fear (criterion 1) and self-harm (criterion 5).
Why A is incorrect: This describes histrionic personality disorder (attention-seeking,
uncomfortable when not center of attention), not borderline personality disorder.
Rationales | Psychiatric Nursing | Pass Guaranteed - A+
Graded
Domain 1: Assessment (30 Questions – 20%)
Q1: A 19-year-old college student is brought to the emergency department by campus
security after being found wandering outside in 30°F weather wearing only a t-shirt and
shorts. The student is speaking rapidly, reports needing no sleep for 4 days to "finish a
revolutionary invention," and has maxed out three credit cards in 48 hours. Which
assessment finding would be the priority for the psychiatric-mental health nurse to
evaluate?
A. Presence of auditory hallucinations
B. Current suicidal ideation with plan or intent
C. Family history of bipolar disorder
D. Academic performance decline this semester
Correct Answer: B
Rationale: While all options are relevant to a comprehensive assessment, suicidal
ideation with plan or intent represents an immediate safety threat requiring priority
intervention. The patient presents with classic manic symptoms (decreased need for
sleep, grandiosity, hyperactivity, poor judgment/impulsivity with financial recklessness,
,and inappropriate clothing for weather indicating loss of inhibition). Manic episodes
carry significantly elevated suicide risk, particularly during mixed features or when
psychomotor agitation is present. The nurse must complete a suicide risk assessment
using a validated tool such as the Columbia-Suicide Severity Rating Scale (C-SSRS)
before addressing other assessment components.
Why A is incorrect: While hallucinations may occur in severe mania with psychotic
features, they do not represent an immediate life threat compared to suicidal intent.
Additionally, the stem does not indicate perceptual disturbances.
Why C is incorrect: Family history is important for diagnostic formulation and long-term
treatment planning, but it does not require immediate assessment in the emergency
setting.
Why D is incorrect: Academic decline may have preceded the manic episode but is not a
safety priority in the acute presentation.
Safety Alert: Manic patients often lack insight (anosognosia) and may not recognize
their impaired state. The combination of impulsivity, grandiosity, and impaired judgment
creates high risk for self-harm or accidental death.
Q2: A 67-year-old patient with vascular dementia is admitted to the inpatient psychiatric
unit for severe agitation. On day 3, the nurse notes the patient is suddenly lethargic, has
slurred speech, and is picking at invisible objects in the air. Vital signs show
temperature 101.2°F, HR 118, BP 162/94. Which condition should the nurse first
suspect?
,A. Worsening dementia requiring increased antipsychotic dosing
B. Neuroleptic malignant syndrome (NMS) from recent haloperidol administration
C. Delirium superimposed on dementia (DSD)
D. Acute stroke with new neurological deficits
Correct Answer: C
Rationale: The presentation of acute onset fluctuating consciousness, visual
hallucinations (picking at air), autonomic instability (fever, tachycardia, hypertension),
and new neurological symptoms in a patient with baseline dementia is classic for
Delirium Superimposed on Dementia (DSD). This is a medical emergency requiring
immediate physician notification and workup for underlying causes (infection,
metabolic derangement, medication toxicity). The temporal relationship (day 3 of
admission) and acute change from baseline strongly support delirium rather than
progression of underlying dementia.
Why A is incorrect: Increasing antipsychotics in this presentation is dangerous and
contraindicated. The symptoms suggest delirium, which requires treating the underlying
cause, not suppressing symptoms with more antipsychotics.
Why B is incorrect: While NMS is a critical consideration with antipsychotic use, the
patient lacks the hallmark "lead pipe" rigidity and severe muscle breakdown (marked CK
elevation). The visual hallucinations and fluctuating consciousness are more
characteristic of delirium.
Why D is incorrect: While stroke must be ruled out, the combination of fever, fluctuating
consciousness, and visual hallucinations is more consistent with delirium. However,
neuroimaging may be indicated to rule out stroke as an underlying cause.
, Therapeutic Communication Tip: When communicating with delirious patients, use
frequent reorientation, clear simple statements, ensure sensory aids (glasses/hearing
aids) are available, and maintain consistent caregivers when possible.
Q3: During an initial assessment of a 34-year-old patient with suspected borderline
personality disorder (BPD), which statement by the patient would the nurse document
as consistent with the DSM-5-TR diagnostic criteria for this disorder?
A. "I get really uncomfortable when I'm not the center of attention at parties."
B. "When my therapist went on vacation, I felt abandoned and started cutting myself."
C. "I need everything to be perfectly organized or I can't function."
D. "I believe the FBI is monitoring my thoughts through my television."
Correct Answer: B
Rationale: This statement demonstrates two core features of Borderline Personality
Disorder: (1) frantic efforts to avoid real or imagined abandonment (response to
therapist vacation), and (2) recurrent suicidal behavior, gestures, or self-mutilating
behavior (cutting). The DSM-5-TR criteria for BPD require a pervasive pattern of
instability in interpersonal relationships, self-image, and affects, with marked impulsivity
beginning by early adulthood. The specific criteria demonstrated here include the
abandonment fear (criterion 1) and self-harm (criterion 5).
Why A is incorrect: This describes histrionic personality disorder (attention-seeking,
uncomfortable when not center of attention), not borderline personality disorder.
