PMHNP Board Certification Exam Official
Practice Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
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SECTION 1: PSYCHIATRIC ASSESSMENT & DIAGNOSTIC REASONING Q1 – Q10
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Question 1 of 50
A 42-year-old woman presents to the outpatient clinic reporting persistent sadness, difficulty
concentrating, and fatigue over the past three weeks. She scores 14 on the PHQ-9 and 8 on
the GAD-7. Her medical history includes hypothyroidism, and her most recent TSH was
elevated at 8.2 mIU/L. She is currently taking levothyroxine 75 mcg daily.
A. Increase the levothyroxine dose and reassess mood symptoms in 6–8 weeks ✓ CORRECT
B. Start sertraline 50 mg daily for major depressive disorder
C. Start cognitive behavioral therapy as the sole intervention
D. Order a brain MRI to rule out organic causes
Correct Answer: A
Rationale: Elevated TSH indicates undertreated hypothyroidism, which commonly presents
with depressive symptoms, fatigue, and cognitive slowing. Optimizing thyroid replacement
should precede or accompany psychiatric treatment. Starting an antidepressant before
addressing a clear medical contributor would be premature, and CBT alone is unlikely to
resolve symptoms driven by endocrine dysfunction.
Question 2 of 50
A 19-year-old college freshman is brought to the emergency department by campus security
after being found wandering outside his dormitory at 3 a.m., speaking incoherently. He has no
prior psychiatric history. On exam, he is tachycardic at 118 bpm, blood pressure 162/94
mmHg, pupils dilated at 6 mm, and skin is diaphoretic. He is agitated and reports seeing
"colors dancing on the walls."
A. Acute alcohol intoxication
B. Acute amphetamine intoxication ✓ CORRECT
,C. Acute cannabis intoxication
D. Acute benzodiazepine intoxication
Correct Answer: B
Rationale: The combination of mydriasis, tachycardia, hypertension, diaphoresis, agitation,
and visual hallucinations is classic for amphetamine intoxication. Alcohol and
benzodiazepine intoxication typically cause CNS depression with miosis, not stimulation.
Cannabis intoxication may cause tachycardia but does not produce this degree of
sympathetic hyperactivity or visual hallucinations.
Question 3 of 50
A 28-year-old man with a history of bipolar I disorder presents for a routine follow-up. He
reports feeling "great" for the past week, sleeping only 3 hours nightly without daytime
fatigue, and spending $3,000 on online shopping—far more than his budget allows. His
speech is rapid and difficult to interrupt. He denies suicidal ideation. His lithium level is 0.4
mEq/L.
A. Increase lithium to achieve a therapeutic level of 0.6–1.2 mEq/L ✓ CORRECT
B. Start an SSRI to address residual depressive symptoms
C. Add a benzodiazepine for sleep and monitor
D. Reduce lithium and add quetiapine for mood stabilization
Correct Answer: A
Rationale: A lithium level of 0.4 mEq/L is subtherapeutic for acute mania, where levels of
0.6–1.2 mEq/L are typically required. The patient's presentation with decreased need for
sleep, pressured speech, and excessive spending meets criteria for a manic episode. Starting
an SSRI in mania risks worsening mood elevation, and benzodiazepines alone do not treat the
underlying mood episode.
Question 4 of 50
A 67-year-old man with a history of hypertension and type 2 diabetes is referred by his primary
care provider for evaluation of memory decline. His wife reports he has become increasingly
forgetful over the past 18 months, repeating questions and getting lost while driving familiar
routes. On the MMSE, he scores 22/30, losing points on orientation, recall, and visuospatial
construction. His mood is euthymic.
A. Major depressive disorder with pseudodementia
B. Major neurocognitive disorder due to probable Alzheimer's disease ✓ CORRECT
C. Mild neurocognitive disorder
D. Delirium superimposed on dementia
Correct Answer: B
, Rationale: An MMSE score of 22/30 with progressive memory impairment, functional decline
in familiar activities, and an 18-month course in an older adult is consistent with major
neurocognitive disorder. The insidious onset and gradual progression favor Alzheimer's
pathology over depression, which would typically show more prominent mood symptoms and
variable cognitive performance. Delirium is ruled out by the stable, chronic course.
Question 5 of 50
A 35-year-old woman presents with a 6-month history of intrusive thoughts about harming her
infant, which she finds terrifying and attempts to suppress. She has never acted on these
thoughts and has no desire to harm her child. She spends hours each day checking that the
baby is safe and avoiding sharp objects. She scores 28 on the Yale-Brown Obsessive
Compulsive Scale.
A. Postpartum psychosis
B. Obsessive-compulsive disorder with postpartum onset ✓ CORRECT
C. Generalized anxiety disorder
D. Adjustment disorder with anxiety
Correct Answer: B
Rationale: The presence of ego-dystonic intrusive thoughts, compulsive checking behaviors,
and significant time spent on rituals with insight that the thoughts are her own and unwanted
is diagnostic of OCD. Postpartum psychosis would involve delusions, confusion, and loss of
reality testing. The specific content (harm obsessions) is common in postpartum OCD and
does not indicate actual risk to the infant.
Question 6 of 50
A 24-year-old man is evaluated after his third emergency department visit for panic attacks in
two months. Each episode involves sudden palpitations, chest tightness, dizziness, and a fear
of dying, peaking within 10 minutes. Between episodes, he worries constantly about having
another attack and has begun avoiding public transportation. He drinks 4–5 cups of coffee
daily.
A. Panic disorder with agoraphobic avoidance ✓ CORRECT
B. Generalized anxiety disorder with panic attacks
C. Acute stress disorder
D. Cardiac arrhythmia requiring cardiology referral
Correct Answer: A
Rationale: Recurrent unexpected panic attacks with persistent worry about future attacks and
avoidance of situations where escape might be difficult meet DSM-5-TR criteria for panic
disorder with agoraphobia. The abrupt onset, crescendo pattern, and absence of a specific
Practice Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
══════════════════════════════════════
SECTION 1: PSYCHIATRIC ASSESSMENT & DIAGNOSTIC REASONING Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 42-year-old woman presents to the outpatient clinic reporting persistent sadness, difficulty
concentrating, and fatigue over the past three weeks. She scores 14 on the PHQ-9 and 8 on
the GAD-7. Her medical history includes hypothyroidism, and her most recent TSH was
elevated at 8.2 mIU/L. She is currently taking levothyroxine 75 mcg daily.
A. Increase the levothyroxine dose and reassess mood symptoms in 6–8 weeks ✓ CORRECT
B. Start sertraline 50 mg daily for major depressive disorder
C. Start cognitive behavioral therapy as the sole intervention
D. Order a brain MRI to rule out organic causes
Correct Answer: A
Rationale: Elevated TSH indicates undertreated hypothyroidism, which commonly presents
with depressive symptoms, fatigue, and cognitive slowing. Optimizing thyroid replacement
should precede or accompany psychiatric treatment. Starting an antidepressant before
addressing a clear medical contributor would be premature, and CBT alone is unlikely to
resolve symptoms driven by endocrine dysfunction.
Question 2 of 50
A 19-year-old college freshman is brought to the emergency department by campus security
after being found wandering outside his dormitory at 3 a.m., speaking incoherently. He has no
prior psychiatric history. On exam, he is tachycardic at 118 bpm, blood pressure 162/94
mmHg, pupils dilated at 6 mm, and skin is diaphoretic. He is agitated and reports seeing
"colors dancing on the walls."
A. Acute alcohol intoxication
B. Acute amphetamine intoxication ✓ CORRECT
,C. Acute cannabis intoxication
D. Acute benzodiazepine intoxication
Correct Answer: B
Rationale: The combination of mydriasis, tachycardia, hypertension, diaphoresis, agitation,
and visual hallucinations is classic for amphetamine intoxication. Alcohol and
benzodiazepine intoxication typically cause CNS depression with miosis, not stimulation.
Cannabis intoxication may cause tachycardia but does not produce this degree of
sympathetic hyperactivity or visual hallucinations.
Question 3 of 50
A 28-year-old man with a history of bipolar I disorder presents for a routine follow-up. He
reports feeling "great" for the past week, sleeping only 3 hours nightly without daytime
fatigue, and spending $3,000 on online shopping—far more than his budget allows. His
speech is rapid and difficult to interrupt. He denies suicidal ideation. His lithium level is 0.4
mEq/L.
A. Increase lithium to achieve a therapeutic level of 0.6–1.2 mEq/L ✓ CORRECT
B. Start an SSRI to address residual depressive symptoms
C. Add a benzodiazepine for sleep and monitor
D. Reduce lithium and add quetiapine for mood stabilization
Correct Answer: A
Rationale: A lithium level of 0.4 mEq/L is subtherapeutic for acute mania, where levels of
0.6–1.2 mEq/L are typically required. The patient's presentation with decreased need for
sleep, pressured speech, and excessive spending meets criteria for a manic episode. Starting
an SSRI in mania risks worsening mood elevation, and benzodiazepines alone do not treat the
underlying mood episode.
Question 4 of 50
A 67-year-old man with a history of hypertension and type 2 diabetes is referred by his primary
care provider for evaluation of memory decline. His wife reports he has become increasingly
forgetful over the past 18 months, repeating questions and getting lost while driving familiar
routes. On the MMSE, he scores 22/30, losing points on orientation, recall, and visuospatial
construction. His mood is euthymic.
A. Major depressive disorder with pseudodementia
B. Major neurocognitive disorder due to probable Alzheimer's disease ✓ CORRECT
C. Mild neurocognitive disorder
D. Delirium superimposed on dementia
Correct Answer: B
, Rationale: An MMSE score of 22/30 with progressive memory impairment, functional decline
in familiar activities, and an 18-month course in an older adult is consistent with major
neurocognitive disorder. The insidious onset and gradual progression favor Alzheimer's
pathology over depression, which would typically show more prominent mood symptoms and
variable cognitive performance. Delirium is ruled out by the stable, chronic course.
Question 5 of 50
A 35-year-old woman presents with a 6-month history of intrusive thoughts about harming her
infant, which she finds terrifying and attempts to suppress. She has never acted on these
thoughts and has no desire to harm her child. She spends hours each day checking that the
baby is safe and avoiding sharp objects. She scores 28 on the Yale-Brown Obsessive
Compulsive Scale.
A. Postpartum psychosis
B. Obsessive-compulsive disorder with postpartum onset ✓ CORRECT
C. Generalized anxiety disorder
D. Adjustment disorder with anxiety
Correct Answer: B
Rationale: The presence of ego-dystonic intrusive thoughts, compulsive checking behaviors,
and significant time spent on rituals with insight that the thoughts are her own and unwanted
is diagnostic of OCD. Postpartum psychosis would involve delusions, confusion, and loss of
reality testing. The specific content (harm obsessions) is common in postpartum OCD and
does not indicate actual risk to the infant.
Question 6 of 50
A 24-year-old man is evaluated after his third emergency department visit for panic attacks in
two months. Each episode involves sudden palpitations, chest tightness, dizziness, and a fear
of dying, peaking within 10 minutes. Between episodes, he worries constantly about having
another attack and has begun avoiding public transportation. He drinks 4–5 cups of coffee
daily.
A. Panic disorder with agoraphobic avoidance ✓ CORRECT
B. Generalized anxiety disorder with panic attacks
C. Acute stress disorder
D. Cardiac arrhythmia requiring cardiology referral
Correct Answer: A
Rationale: Recurrent unexpected panic attacks with persistent worry about future attacks and
avoidance of situations where escape might be difficult meet DSM-5-TR criteria for panic
disorder with agoraphobia. The abrupt onset, crescendo pattern, and absence of a specific
