NUR 670 PMHNP APEA Exam Prep: 200 Practice
Questions with Detailed Rationales (2026/2027
Update)
PMHNP APEA-STYLE PRACTICE EXAM (200 Questions & Explanations)
Section 1: Assessment & Diagnostic Reasoning (Questions 1-40)
1. A 32-year-old female presents with a 2-week history of excessive worry, fatigue, and
difficulty sleeping. She reports her mind "goes blank" when she tries to make decisions. What
is the most appropriate initial screening tool?
• A) PHQ-9
• B) GAD-7
• C) MDQ
• D) CAGE-AID
Answer: B) GAD-7
Explanation: The GAD-7 is a validated 7-item tool specifically designed to screen for
Generalized Anxiety Disorder. While the PHQ-9 screens for depression, the patient's
primary symptoms are anxiety-based.
2. A 45-year-old male with a history of bipolar I disorder is currently in a depressive episode.
Which symptom would be MOST indicative of a bipolar depressive episode rather than
unipolar depression?
• A) Anhedonia
• B) Hypersomnia
• C) Psychomotor retardation
• D) Guilt
Answer: B) Hypersomnia
Explanation: Hypersomnia (sleeping >10 hours) and hyperphagia (increased appetite)
are classic "atypical" features more common in bipolar depression compared to unipolar
depression.
,3. A 68-year-old patient presents with memory loss. The PMHNP administers the MoCA
(Montreal Cognitive Assessment). The patient scores a 22/30. Which cognitive domain is
MOST likely impaired?
• A) Orientation
• B) Visuospatial/Executive
• C) Registration
• D) Recall
Answer: B) Visuospatial/Executive
Explanation: The MoCA is more sensitive to mild cognitive impairment (MCI) and tests
visuospatial/executive function (clock drawing, trail making). A score <26 suggests
impairment.
4. During a MSE, the patient speaks with a limited vocabulary and gives short, concrete
Answers. This describes:
• A) Poverty of content
• B) Poverty of speech
• C) Blocking
• D) Tangentiality
Answer: B) Poverty of speech
Explanation: Poverty of speech refers to a reduction in the amount of spontaneous
speech. Poverty of content refers to speech that is adequate in amount but vague and
repetitive.
5. A 22-year-old college student reports feeling sad, but denies suicidal ideation. She reports
sleeping 14 hours a day and has gained 15 lbs. Which medication is most likely to exacerbate
these symptoms?
• A) Bupropion
• B) Fluoxetine
• C) Sertraline
• D) Venlafaxine
Answer: B) Fluoxetine
Explanation: While all SSRIs can cause weight gain, this patient is describing "atypical
depression" features (hypersomnia, hyperphagia). Bupropion is often preferred for
, atypical depression because it is activating and weight-neutral, whereas fluoxetine can
initially cause insomnia but is less likely to cause the specific weight gain seen with other
SSRIs like paroxetine.
6. A 70-year-old male is brought in by his wife for "forgetfulness." He is unable to recall the
names of his grandchildren. His gait is wide-based and he has trouble maintaining balance.
Which condition should be at the top of the differential?
• A) Alzheimer's Disease
• B) Vascular Dementia
• C) Normal Pressure Hydrocephalus (NPH)
• D) Delirium
Answer: C) Normal Pressure Hydrocephalus (NPH)
Explanation: The triad of NPH is dementia (memory loss), gait disturbance (apraxic gait),
and urinary incontinence. Alzheimer's typically does not present with early gait
disturbance.
7. A patient with PTSD reports hypervigilance and exaggerated startle response. These
symptoms are primarily due to dysregulation of which neurotransmitter?
• A) Dopamine
• B) Norepinephrine
• C) Serotonin
• D) GABA
Answer: B) Norepinephrine
Explanation: Hyperarousal symptoms in PTSD are associated with heightened
noradrenergic activity in the locus coeruleus. Alpha-2 agonists like prazosin are used to
target these symptoms.
8. Which laboratory finding is most commonly associated with Wernicke-Korsakoff Syndrome?
• A) Elevated B12
• B) Thiamine deficiency
• C) Elevated Ammonia
• D) Niacin deficiency
Answer: B) Thiamine deficiency
, Explanation: Wernicke-Korsakoff is caused by severe thiamine (B1) deficiency, often seen
in chronic alcohol use disorder.
9. A 16-year-old female is brought in by her parents for "mood swings." She is irritable, has
difficulty concentrating, and has been sleeping less. She reports feeling "on top of the world"
for 2 days, followed by 2 weeks of crying spells. What is the most likely diagnosis?
• A) Bipolar I Disorder
• B) Disruptive Mood Dysregulation Disorder (DMDD)
• C) Cyclothymic Disorder
• D) Borderline Personality Disorder
Answer: B) Disruptive Mood Dysregulation Disorder (DMDD)
Explanation: DMDD is characterized by severe, recurrent temper outbursts and
persistent irritable mood between outbursts. The mood episodes must be present for at
least 12 months. Bipolar I requires distinct manic episodes lasting at least 7 days.
10. Which of the following is a "positive" symptom of schizophrenia?
• A) Anhedonia
• B) Avolition
• C) Alogia
• D) Hallucinations
Answer: D) Hallucinations
Explanation: Positive symptoms are an excess or distortion of normal functions
(hallucinations, delusions, disorganized speech). Negative symptoms are deficits
(anhedonia, avolition, alogia).
11. A 55-year-old with Parkinson's disease is experiencing visual hallucinations. He is on
carbidopa-levodopa. What is the best next step?
• A) Increase levodopa
• B) Add risperidone
• C) Add quetiapine
• D) Reduce levodopa
Answer: C) Add quetiapine
Explanation: Quetiapine is the antipsychotic of choice for psychosis in Parkinson's
Questions with Detailed Rationales (2026/2027
Update)
PMHNP APEA-STYLE PRACTICE EXAM (200 Questions & Explanations)
Section 1: Assessment & Diagnostic Reasoning (Questions 1-40)
1. A 32-year-old female presents with a 2-week history of excessive worry, fatigue, and
difficulty sleeping. She reports her mind "goes blank" when she tries to make decisions. What
is the most appropriate initial screening tool?
• A) PHQ-9
• B) GAD-7
• C) MDQ
• D) CAGE-AID
Answer: B) GAD-7
Explanation: The GAD-7 is a validated 7-item tool specifically designed to screen for
Generalized Anxiety Disorder. While the PHQ-9 screens for depression, the patient's
primary symptoms are anxiety-based.
2. A 45-year-old male with a history of bipolar I disorder is currently in a depressive episode.
Which symptom would be MOST indicative of a bipolar depressive episode rather than
unipolar depression?
• A) Anhedonia
• B) Hypersomnia
• C) Psychomotor retardation
• D) Guilt
Answer: B) Hypersomnia
Explanation: Hypersomnia (sleeping >10 hours) and hyperphagia (increased appetite)
are classic "atypical" features more common in bipolar depression compared to unipolar
depression.
,3. A 68-year-old patient presents with memory loss. The PMHNP administers the MoCA
(Montreal Cognitive Assessment). The patient scores a 22/30. Which cognitive domain is
MOST likely impaired?
• A) Orientation
• B) Visuospatial/Executive
• C) Registration
• D) Recall
Answer: B) Visuospatial/Executive
Explanation: The MoCA is more sensitive to mild cognitive impairment (MCI) and tests
visuospatial/executive function (clock drawing, trail making). A score <26 suggests
impairment.
4. During a MSE, the patient speaks with a limited vocabulary and gives short, concrete
Answers. This describes:
• A) Poverty of content
• B) Poverty of speech
• C) Blocking
• D) Tangentiality
Answer: B) Poverty of speech
Explanation: Poverty of speech refers to a reduction in the amount of spontaneous
speech. Poverty of content refers to speech that is adequate in amount but vague and
repetitive.
5. A 22-year-old college student reports feeling sad, but denies suicidal ideation. She reports
sleeping 14 hours a day and has gained 15 lbs. Which medication is most likely to exacerbate
these symptoms?
• A) Bupropion
• B) Fluoxetine
• C) Sertraline
• D) Venlafaxine
Answer: B) Fluoxetine
Explanation: While all SSRIs can cause weight gain, this patient is describing "atypical
depression" features (hypersomnia, hyperphagia). Bupropion is often preferred for
, atypical depression because it is activating and weight-neutral, whereas fluoxetine can
initially cause insomnia but is less likely to cause the specific weight gain seen with other
SSRIs like paroxetine.
6. A 70-year-old male is brought in by his wife for "forgetfulness." He is unable to recall the
names of his grandchildren. His gait is wide-based and he has trouble maintaining balance.
Which condition should be at the top of the differential?
• A) Alzheimer's Disease
• B) Vascular Dementia
• C) Normal Pressure Hydrocephalus (NPH)
• D) Delirium
Answer: C) Normal Pressure Hydrocephalus (NPH)
Explanation: The triad of NPH is dementia (memory loss), gait disturbance (apraxic gait),
and urinary incontinence. Alzheimer's typically does not present with early gait
disturbance.
7. A patient with PTSD reports hypervigilance and exaggerated startle response. These
symptoms are primarily due to dysregulation of which neurotransmitter?
• A) Dopamine
• B) Norepinephrine
• C) Serotonin
• D) GABA
Answer: B) Norepinephrine
Explanation: Hyperarousal symptoms in PTSD are associated with heightened
noradrenergic activity in the locus coeruleus. Alpha-2 agonists like prazosin are used to
target these symptoms.
8. Which laboratory finding is most commonly associated with Wernicke-Korsakoff Syndrome?
• A) Elevated B12
• B) Thiamine deficiency
• C) Elevated Ammonia
• D) Niacin deficiency
Answer: B) Thiamine deficiency
, Explanation: Wernicke-Korsakoff is caused by severe thiamine (B1) deficiency, often seen
in chronic alcohol use disorder.
9. A 16-year-old female is brought in by her parents for "mood swings." She is irritable, has
difficulty concentrating, and has been sleeping less. She reports feeling "on top of the world"
for 2 days, followed by 2 weeks of crying spells. What is the most likely diagnosis?
• A) Bipolar I Disorder
• B) Disruptive Mood Dysregulation Disorder (DMDD)
• C) Cyclothymic Disorder
• D) Borderline Personality Disorder
Answer: B) Disruptive Mood Dysregulation Disorder (DMDD)
Explanation: DMDD is characterized by severe, recurrent temper outbursts and
persistent irritable mood between outbursts. The mood episodes must be present for at
least 12 months. Bipolar I requires distinct manic episodes lasting at least 7 days.
10. Which of the following is a "positive" symptom of schizophrenia?
• A) Anhedonia
• B) Avolition
• C) Alogia
• D) Hallucinations
Answer: D) Hallucinations
Explanation: Positive symptoms are an excess or distortion of normal functions
(hallucinations, delusions, disorganized speech). Negative symptoms are deficits
(anhedonia, avolition, alogia).
11. A 55-year-old with Parkinson's disease is experiencing visual hallucinations. He is on
carbidopa-levodopa. What is the best next step?
• A) Increase levodopa
• B) Add risperidone
• C) Add quetiapine
• D) Reduce levodopa
Answer: C) Add quetiapine
Explanation: Quetiapine is the antipsychotic of choice for psychosis in Parkinson's
