PMHNP Exam ACTUAL EXAM 2026/2027 | Newest Reported
Questions | Verified by Expert | Complete Q&A | Pass
Guaranteed - A+ Graded
DOMAIN 1: ASSESSMENT AND DIAGNOSIS (45 Questions)
Q1
A 28-year-old female presents with 6 months of excessive worry about multiple
domains (work, health, finances), difficulty controlling the worry, restlessness, muscle
tension, and sleep disturbance. She reports no panic attacks or phobias. Which is the
most likely diagnosis?
A. Panic disorder
B. Generalized anxiety disorder
C. Social anxiety disorder
D. Adjustment disorder with anxiety
Correct Answer: B [CORRECT]
Rationale: This presentation meets DSM-5-TR criteria for Generalized Anxiety Disorder
(GAD): excessive anxiety/worry occurring more days than not for ≥6 months about
,multiple domains, difficulty controlling worry, and ≥3 associated symptoms
(restlessness, muscle tension, sleep disturbance). Panic disorder (A) requires recurrent
unexpected panic attacks with worry about future attacks. Social anxiety disorder (C)
requires fear of social situations with scrutiny by others. Adjustment disorder (D)
requires identifiable stressor within 3 months and symptoms do not meet criteria for
another disorder.
Q2
A 19-year-old college student is brought to the emergency department by campus police
after being found wandering campus at 3 AM, speaking incoherently about "receiving
messages from the television." He has been increasingly isolative over 2 months,
stopped attending classes, and his roommate reports he has been talking to himself. On
examination, he displays loose associations, inappropriate affect, and reports hearing a
voice commenting on his actions. Which diagnosis is most appropriate?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
D. Schizoaffective disorder
Correct Answer: C [CORRECT]
,Rationale: This patient meets DSM-5-TR criteria for Schizophrenia: ≥2 symptoms
(delusions, hallucinations, disorganized speech, grossly disorganized/catatonic
behavior, negative symptoms) present for significant portion of 1 month, with
continuous signs of disturbance persisting ≥6 months (prodromal phase of isolation
and functional decline). The duration >6 months excludes brief psychotic disorder (A, <1
month) and schizophreniform disorder (B, 1-6 months). No mood episode is described,
excluding schizoaffective disorder (D).
Q3
A 45-year-old male presents with 2 weeks of elevated mood, decreased need for sleep
(2-3 hours/night), increased goal-directed activity (starting 3 new business ventures),
pressured speech, and grandiose delusions that he is "chosen by God to save humanity."
His wife reports he spent $20,000 on religious artifacts in 3 days. He has no prior
psychiatric history. Which is the most likely diagnosis?
A. Bipolar I disorder, current episode manic
B. Bipolar II disorder, current episode hypomanic
C. Cyclothymic disorder
D. Schizoaffective disorder, bipolar type
Correct Answer: A [CORRECT]
, Rationale: This patient meets criteria for Bipolar I disorder, manic episode: abnormally
elevated/expansive/irritable mood + increased activity/energy + ≥3 symptoms
(decreased sleep, pressured speech, flight of ideas/racing thoughts, increased
goal-directed activity, grandiosity, psychosis) for ≥1 week causing marked impairment
and psychosis. The presence of psychosis during mood episode confirms Bipolar I (not
II). Duration and severity exceed cyclothymia (C, ≥2 years of numerous hypomanic and
depressive periods without meeting full criteria). Mood symptoms are prominent with
psychosis congruent with mood, making schizoaffective (D) less likely.
Q4
A 35-year-old female presents with depressed mood, anhedonia, fatigue, hypersomnia,
weight gain (15 lbs in 2 months), and leaden paralysis. She reports her depression is
"worse in the evening" and she has been hypersensitive to rejection by coworkers.
Which antidepressant class is most appropriate for first-line treatment?
A. Selective serotonin reuptake inhibitor (SSRI)
B. Serotonin-norepinephrine reuptake inhibitor (SNRI)
C. Monoamine oxidase inhibitor (MAOI)
D. Tricyclic antidepressant (TCA)
Correct Answer: C [CORRECT]
Questions | Verified by Expert | Complete Q&A | Pass
Guaranteed - A+ Graded
DOMAIN 1: ASSESSMENT AND DIAGNOSIS (45 Questions)
Q1
A 28-year-old female presents with 6 months of excessive worry about multiple
domains (work, health, finances), difficulty controlling the worry, restlessness, muscle
tension, and sleep disturbance. She reports no panic attacks or phobias. Which is the
most likely diagnosis?
A. Panic disorder
B. Generalized anxiety disorder
C. Social anxiety disorder
D. Adjustment disorder with anxiety
Correct Answer: B [CORRECT]
Rationale: This presentation meets DSM-5-TR criteria for Generalized Anxiety Disorder
(GAD): excessive anxiety/worry occurring more days than not for ≥6 months about
,multiple domains, difficulty controlling worry, and ≥3 associated symptoms
(restlessness, muscle tension, sleep disturbance). Panic disorder (A) requires recurrent
unexpected panic attacks with worry about future attacks. Social anxiety disorder (C)
requires fear of social situations with scrutiny by others. Adjustment disorder (D)
requires identifiable stressor within 3 months and symptoms do not meet criteria for
another disorder.
Q2
A 19-year-old college student is brought to the emergency department by campus police
after being found wandering campus at 3 AM, speaking incoherently about "receiving
messages from the television." He has been increasingly isolative over 2 months,
stopped attending classes, and his roommate reports he has been talking to himself. On
examination, he displays loose associations, inappropriate affect, and reports hearing a
voice commenting on his actions. Which diagnosis is most appropriate?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
D. Schizoaffective disorder
Correct Answer: C [CORRECT]
,Rationale: This patient meets DSM-5-TR criteria for Schizophrenia: ≥2 symptoms
(delusions, hallucinations, disorganized speech, grossly disorganized/catatonic
behavior, negative symptoms) present for significant portion of 1 month, with
continuous signs of disturbance persisting ≥6 months (prodromal phase of isolation
and functional decline). The duration >6 months excludes brief psychotic disorder (A, <1
month) and schizophreniform disorder (B, 1-6 months). No mood episode is described,
excluding schizoaffective disorder (D).
Q3
A 45-year-old male presents with 2 weeks of elevated mood, decreased need for sleep
(2-3 hours/night), increased goal-directed activity (starting 3 new business ventures),
pressured speech, and grandiose delusions that he is "chosen by God to save humanity."
His wife reports he spent $20,000 on religious artifacts in 3 days. He has no prior
psychiatric history. Which is the most likely diagnosis?
A. Bipolar I disorder, current episode manic
B. Bipolar II disorder, current episode hypomanic
C. Cyclothymic disorder
D. Schizoaffective disorder, bipolar type
Correct Answer: A [CORRECT]
, Rationale: This patient meets criteria for Bipolar I disorder, manic episode: abnormally
elevated/expansive/irritable mood + increased activity/energy + ≥3 symptoms
(decreased sleep, pressured speech, flight of ideas/racing thoughts, increased
goal-directed activity, grandiosity, psychosis) for ≥1 week causing marked impairment
and psychosis. The presence of psychosis during mood episode confirms Bipolar I (not
II). Duration and severity exceed cyclothymia (C, ≥2 years of numerous hypomanic and
depressive periods without meeting full criteria). Mood symptoms are prominent with
psychosis congruent with mood, making schizoaffective (D) less likely.
Q4
A 35-year-old female presents with depressed mood, anhedonia, fatigue, hypersomnia,
weight gain (15 lbs in 2 months), and leaden paralysis. She reports her depression is
"worse in the evening" and she has been hypersensitive to rejection by coworkers.
Which antidepressant class is most appropriate for first-line treatment?
A. Selective serotonin reuptake inhibitor (SSRI)
B. Serotonin-norepinephrine reuptake inhibitor (SNRI)
C. Monoamine oxidase inhibitor (MAOI)
D. Tricyclic antidepressant (TCA)
Correct Answer: C [CORRECT]
