Psychiatric Mental Health Board Certification
Exam 2026/2027 | Latest Update | Questions &
Answers | Graded A+
1. A 28-year-old female presents with a 2-week history of depressed mood,
anhedonia, fatigue, and difficulty concentrating. She reports these symptoms
are present most of the day, nearly every day. Which diagnosis is most likely?
A) Adjustment disorder
B) Major depressive disorder
C) Bipolar II disorder
D) Persistent depressive disorder
Answer B: Major depressive disorder
Rationale: Major depressive disorder requires ≥5 symptoms present for ≥2 weeks,
including depressed mood or anhedonia.
2. A 34-year-old male with a history of schizophrenia presents with delusions
of persecution and auditory hallucinations. He has been non-adherent to
medications. Which medication is first-line for acute psychosis?
A) Fluoxetine
B) Risperidone (atypical antipsychotic)
C) Lorazepam
D) Lithium
Answer B: Risperidone (atypical antipsychotic)
,Rationale: Atypical antipsychotics (risperidone, olanzapine, quetiapine) are first-
line for acute psychosis.
3. A client with bipolar I disorder is in a manic episode and has not slept for 3
days. The client is agitated, grandiose, and spending large amounts of
money. Which medication is most appropriate for acute mania?
A) Sertraline
B) Lithium or valproate
C) Bupropion
D) Clonazepam alone
Answer B: Lithium or valproate
Rationale: Lithium and valproate are first-line mood stabilizers for acute mania.
Antidepressants may worsen mania.
4. A 45-year-old male with a history of alcohol use disorder is prescribed
disulfiram. Which instruction is most important?
A) “Take this medication with food.”
B) “Avoid all alcohol, including mouthwash and cooking wine.”
C) “You may drink in moderation.”
D) “Take the medication only when you have cravings.”
Answer B: “Avoid all alcohol, including mouthwash and cooking wine.”
Rationale: Disulfiram causes a severe reaction (flushing, vomiting, hypotension)
with any alcohol ingestion.
,5. A client with generalized anxiety disorder is prescribed buspirone. Which
statement about buspirone is correct?
A) It works immediately like benzodiazepines.
B) It takes 2-4 weeks to work and has no abuse potential.
C) It is a controlled substance.
D) It should be taken as needed for panic attacks.
Answer B: It takes 2-4 weeks to work and has no abuse potential.
Rationale: Buspirone is a non-benzodiazepine anxiolytic with delayed onset and
no dependence.
6. A nurse is assessing a client with borderline personality disorder. Which
finding is most characteristic?
A) Grandiose sense of self-importance
B) Pattern of unstable relationships and intense anger
C) Social isolation and eccentric behavior
D) Lack of remorse for harmful actions
Answer B: Pattern of unstable relationships and intense anger
Rationale: Borderline personality disorder is characterized by instability in
relationships, affect, and self-image, with impulsivity.
, 7. A client with major depressive disorder has been on fluoxetine for 6 weeks
with partial improvement. The provider adds aripiprazole. What is the
mechanism of aripiprazole augmentation?
A) SSRI potentiation
B) Partial dopamine agonism
C) Serotonin antagonism
D) MAO inhibition
Answer B: Partial dopamine agonism
Rationale: Aripiprazole is a partial D2 agonist; augmentation can improve
antidepressant response.
8. A 22-year-old female presents with episodes of binge eating followed by
self-induced vomiting. She is at normal weight. Which diagnosis is most
likely?
A) Anorexia nervosa
B) Bulimia nervosa
C) Binge-eating disorder
D) Avoidant/restrictive food intake disorder
Answer B: Bulimia nervosa
Rationale: Bulimia nervosa involves recurrent binge eating and compensatory
behaviors (purging), with weight usually in normal range.
Exam 2026/2027 | Latest Update | Questions &
Answers | Graded A+
1. A 28-year-old female presents with a 2-week history of depressed mood,
anhedonia, fatigue, and difficulty concentrating. She reports these symptoms
are present most of the day, nearly every day. Which diagnosis is most likely?
A) Adjustment disorder
B) Major depressive disorder
C) Bipolar II disorder
D) Persistent depressive disorder
Answer B: Major depressive disorder
Rationale: Major depressive disorder requires ≥5 symptoms present for ≥2 weeks,
including depressed mood or anhedonia.
2. A 34-year-old male with a history of schizophrenia presents with delusions
of persecution and auditory hallucinations. He has been non-adherent to
medications. Which medication is first-line for acute psychosis?
A) Fluoxetine
B) Risperidone (atypical antipsychotic)
C) Lorazepam
D) Lithium
Answer B: Risperidone (atypical antipsychotic)
,Rationale: Atypical antipsychotics (risperidone, olanzapine, quetiapine) are first-
line for acute psychosis.
3. A client with bipolar I disorder is in a manic episode and has not slept for 3
days. The client is agitated, grandiose, and spending large amounts of
money. Which medication is most appropriate for acute mania?
A) Sertraline
B) Lithium or valproate
C) Bupropion
D) Clonazepam alone
Answer B: Lithium or valproate
Rationale: Lithium and valproate are first-line mood stabilizers for acute mania.
Antidepressants may worsen mania.
4. A 45-year-old male with a history of alcohol use disorder is prescribed
disulfiram. Which instruction is most important?
A) “Take this medication with food.”
B) “Avoid all alcohol, including mouthwash and cooking wine.”
C) “You may drink in moderation.”
D) “Take the medication only when you have cravings.”
Answer B: “Avoid all alcohol, including mouthwash and cooking wine.”
Rationale: Disulfiram causes a severe reaction (flushing, vomiting, hypotension)
with any alcohol ingestion.
,5. A client with generalized anxiety disorder is prescribed buspirone. Which
statement about buspirone is correct?
A) It works immediately like benzodiazepines.
B) It takes 2-4 weeks to work and has no abuse potential.
C) It is a controlled substance.
D) It should be taken as needed for panic attacks.
Answer B: It takes 2-4 weeks to work and has no abuse potential.
Rationale: Buspirone is a non-benzodiazepine anxiolytic with delayed onset and
no dependence.
6. A nurse is assessing a client with borderline personality disorder. Which
finding is most characteristic?
A) Grandiose sense of self-importance
B) Pattern of unstable relationships and intense anger
C) Social isolation and eccentric behavior
D) Lack of remorse for harmful actions
Answer B: Pattern of unstable relationships and intense anger
Rationale: Borderline personality disorder is characterized by instability in
relationships, affect, and self-image, with impulsivity.
, 7. A client with major depressive disorder has been on fluoxetine for 6 weeks
with partial improvement. The provider adds aripiprazole. What is the
mechanism of aripiprazole augmentation?
A) SSRI potentiation
B) Partial dopamine agonism
C) Serotonin antagonism
D) MAO inhibition
Answer B: Partial dopamine agonism
Rationale: Aripiprazole is a partial D2 agonist; augmentation can improve
antidepressant response.
8. A 22-year-old female presents with episodes of binge eating followed by
self-induced vomiting. She is at normal weight. Which diagnosis is most
likely?
A) Anorexia nervosa
B) Bulimia nervosa
C) Binge-eating disorder
D) Avoidant/restrictive food intake disorder
Answer B: Bulimia nervosa
Rationale: Bulimia nervosa involves recurrent binge eating and compensatory
behaviors (purging), with weight usually in normal range.
