LMR GEORGETTE PMHNP BOARD EXAM – QUESTIONS AND ANSWERS |
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD
AND PASS | LATEST EXAM UPDATE 2026/2027
Core Domains
Advanced Pathophysiology
Pharmacotherapeutics for Psychiatric Disorders
Psychiatric Assessment and Diagnosis
Therapeutic Communication and Patient-Centered Care
Clinical Management of Acute and Chronic Psychiatric Conditions
Psychiatric Emergencies and Crisis Intervention
Legal, Ethical, and Professional Standards in PMHNP Practice
Quality Improvement, Safety, and Evidence-Based Practice in Behavioral Health
Interprofessional Collaboration and Care Coordination
Introduction
This comprehensive examination is designed to rigorously assess the knowledge,
clinical reasoning, and decision-making skills essential for the Psychiatric-Mental
Health Nurse Practitioner (PMHNP). The assessment covers a broad spectrum of
core competencies, including advanced pathophysiology, psychopharmacology,
diagnostic evaluation, and the application of evidence-based therapeutic
interventions. Through a series of multiple-choice and carefully constructed
scenario-based questions, candidates will demonstrate their ability to integrate
theoretical foundations with real-world clinical application. This exam emphasizes
the critical thinking necessary for safe, effective, and ethical patient management,
,preparing the PMHNP to deliver high-quality, patient-centered care across diverse
settings and populations.
SECTION ONE: QUESTIONS 1 – 50
1. A 34-year-old patient with schizophrenia has been stable on paliperidone
palmitate for 18 months. At a routine visit, the patient reports a 10-pound
weight gain over the last three months, increased thirst, and frequent urination.
Which of the following is the most appropriate initial action for the PMHNP?
A. Switch the patient to aripiprazole due to its lower metabolic profile.
B. Order a fasting plasma glucose and hemoglobin A1c test.
C. Reassure the patient that weight gain is an expected side effect.
D. Recommend a low-calorie diet and exercise plan.
🟢 Correct Answer: B. Order a fasting plasma glucose and hemoglobin A1c test.
🔴 Explanation: The patient's symptoms (weight gain, polyuria, polydipsia) are
classic signs of new-onset diabetes mellitus, a known adverse effect of atypical
antipsychotics, particularly paliperidone. While dietary changes and medication
adjustments are possible long-term strategies, the immediate priority is to
evaluate for hyperglycemia with a metabolic panel.
2. A PMHNP is considering a diagnosis of post-traumatic stress disorder (PTSD)
for a 28-year-old combat veteran. According to DSM-5 criteria, which of the
following symptom clusters is essential for this diagnosis?
A. Depressed mood, anhedonia, and fatigue.
B. Exposure to actual or threatened death, serious injury, or sexual violence.
C. Persistent inability to experience positive emotions and feelings of detachment.
,D. Recurrent, involuntary, and intrusive distressing memories of the traumatic
event.
🟢 Correct Answer: B. Exposure to actual or threatened death, serious injury, or
sexual violence.
🔴 Explanation: Criterion A for PTSD requires direct or indirect exposure to an
event involving actual or threatened death, serious injury, or sexual violence.
While options C and D are symptom clusters (negative alterations in
cognition/mood and intrusion symptoms), they are not the primary diagnostic
criterion for establishing the presence of a traumatic event.
3. A 72-year-old patient with a history of Alzheimer's disease is started on
donepezil 5 mg daily. Two weeks later, the patient's spouse reports increased
confusion, vivid dreams, and muscle cramps. What is the most appropriate next
step?
A. Increase the dose to 10 mg daily to improve cognitive symptoms.
B. Discontinue the medication and consider memantine.
C. Administer the medication in the morning instead of at bedtime.
D. Order a complete blood count and basic metabolic panel.
🟢 Correct Answer: C. Administer the medication in the morning instead of at
bedtime.
🔴 Explanation: Donepezil can cause vivid dreams, insomnia, and muscle cramps,
which are often dose-related and more prominent when taken at night. Switching
the dose to the morning can often alleviate these side effects. Increasing the dose
would likely worsen symptoms.
, 4. A patient with borderline personality disorder frequently self-harms and
exhibits intense, unstable relationships. Which of the following therapeutic
approaches is considered first-line, evidence-based treatment?
A. Cognitive Behavioral Therapy (CBT)
B. Psychodynamic Therapy
C. Dialectical Behavior Therapy (DBT)
D. Interpersonal Therapy (IPT)
🟢 Correct Answer: C. Dialectical Behavior Therapy (DBT)
🔴 Explanation: DBT is a specific, evidence-based form of CBT developed for
borderline personality disorder. It directly addresses emotional dysregulation,
self-harm, and interpersonal chaos through skills training in mindfulness, distress
tolerance, emotion regulation, and interpersonal effectiveness.
5. A 45-year-old patient with major depressive disorder has not responded to
two adequate trials of SSRIs. The PMHNP is considering a monoamine oxidase
inhibitor (MAOI). What is a critical patient teaching point regarding this
medication class?
A. "You will need to avoid foods that contain tyramine."
B. "You should take this medication only at bedtime."
C. "You must have your blood drawn weekly for the first month."
D. "You cannot take this medication with any other psychiatric drugs."
🟢 Correct Answer: A. "You will need to avoid foods that contain tyramine."
🔴 Explanation: MAOIs interact with tyramine, an amino acid found in aged
cheeses, cured meats, and fermented foods, leading to a hypertensive crisis. This
is a potentially fatal side effect and the most critical teaching point for patient
safety.
VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD
AND PASS | LATEST EXAM UPDATE 2026/2027
Core Domains
Advanced Pathophysiology
Pharmacotherapeutics for Psychiatric Disorders
Psychiatric Assessment and Diagnosis
Therapeutic Communication and Patient-Centered Care
Clinical Management of Acute and Chronic Psychiatric Conditions
Psychiatric Emergencies and Crisis Intervention
Legal, Ethical, and Professional Standards in PMHNP Practice
Quality Improvement, Safety, and Evidence-Based Practice in Behavioral Health
Interprofessional Collaboration and Care Coordination
Introduction
This comprehensive examination is designed to rigorously assess the knowledge,
clinical reasoning, and decision-making skills essential for the Psychiatric-Mental
Health Nurse Practitioner (PMHNP). The assessment covers a broad spectrum of
core competencies, including advanced pathophysiology, psychopharmacology,
diagnostic evaluation, and the application of evidence-based therapeutic
interventions. Through a series of multiple-choice and carefully constructed
scenario-based questions, candidates will demonstrate their ability to integrate
theoretical foundations with real-world clinical application. This exam emphasizes
the critical thinking necessary for safe, effective, and ethical patient management,
,preparing the PMHNP to deliver high-quality, patient-centered care across diverse
settings and populations.
SECTION ONE: QUESTIONS 1 – 50
1. A 34-year-old patient with schizophrenia has been stable on paliperidone
palmitate for 18 months. At a routine visit, the patient reports a 10-pound
weight gain over the last three months, increased thirst, and frequent urination.
Which of the following is the most appropriate initial action for the PMHNP?
A. Switch the patient to aripiprazole due to its lower metabolic profile.
B. Order a fasting plasma glucose and hemoglobin A1c test.
C. Reassure the patient that weight gain is an expected side effect.
D. Recommend a low-calorie diet and exercise plan.
🟢 Correct Answer: B. Order a fasting plasma glucose and hemoglobin A1c test.
🔴 Explanation: The patient's symptoms (weight gain, polyuria, polydipsia) are
classic signs of new-onset diabetes mellitus, a known adverse effect of atypical
antipsychotics, particularly paliperidone. While dietary changes and medication
adjustments are possible long-term strategies, the immediate priority is to
evaluate for hyperglycemia with a metabolic panel.
2. A PMHNP is considering a diagnosis of post-traumatic stress disorder (PTSD)
for a 28-year-old combat veteran. According to DSM-5 criteria, which of the
following symptom clusters is essential for this diagnosis?
A. Depressed mood, anhedonia, and fatigue.
B. Exposure to actual or threatened death, serious injury, or sexual violence.
C. Persistent inability to experience positive emotions and feelings of detachment.
,D. Recurrent, involuntary, and intrusive distressing memories of the traumatic
event.
🟢 Correct Answer: B. Exposure to actual or threatened death, serious injury, or
sexual violence.
🔴 Explanation: Criterion A for PTSD requires direct or indirect exposure to an
event involving actual or threatened death, serious injury, or sexual violence.
While options C and D are symptom clusters (negative alterations in
cognition/mood and intrusion symptoms), they are not the primary diagnostic
criterion for establishing the presence of a traumatic event.
3. A 72-year-old patient with a history of Alzheimer's disease is started on
donepezil 5 mg daily. Two weeks later, the patient's spouse reports increased
confusion, vivid dreams, and muscle cramps. What is the most appropriate next
step?
A. Increase the dose to 10 mg daily to improve cognitive symptoms.
B. Discontinue the medication and consider memantine.
C. Administer the medication in the morning instead of at bedtime.
D. Order a complete blood count and basic metabolic panel.
🟢 Correct Answer: C. Administer the medication in the morning instead of at
bedtime.
🔴 Explanation: Donepezil can cause vivid dreams, insomnia, and muscle cramps,
which are often dose-related and more prominent when taken at night. Switching
the dose to the morning can often alleviate these side effects. Increasing the dose
would likely worsen symptoms.
, 4. A patient with borderline personality disorder frequently self-harms and
exhibits intense, unstable relationships. Which of the following therapeutic
approaches is considered first-line, evidence-based treatment?
A. Cognitive Behavioral Therapy (CBT)
B. Psychodynamic Therapy
C. Dialectical Behavior Therapy (DBT)
D. Interpersonal Therapy (IPT)
🟢 Correct Answer: C. Dialectical Behavior Therapy (DBT)
🔴 Explanation: DBT is a specific, evidence-based form of CBT developed for
borderline personality disorder. It directly addresses emotional dysregulation,
self-harm, and interpersonal chaos through skills training in mindfulness, distress
tolerance, emotion regulation, and interpersonal effectiveness.
5. A 45-year-old patient with major depressive disorder has not responded to
two adequate trials of SSRIs. The PMHNP is considering a monoamine oxidase
inhibitor (MAOI). What is a critical patient teaching point regarding this
medication class?
A. "You will need to avoid foods that contain tyramine."
B. "You should take this medication only at bedtime."
C. "You must have your blood drawn weekly for the first month."
D. "You cannot take this medication with any other psychiatric drugs."
🟢 Correct Answer: A. "You will need to avoid foods that contain tyramine."
🔴 Explanation: MAOIs interact with tyramine, an amino acid found in aged
cheeses, cured meats, and fermented foods, leading to a hypertensive crisis. This
is a potentially fatal side effect and the most critical teaching point for patient
safety.
