GEORGETTE REVIEW PMHNP EXAM Questions & Answers
(Verified 2025) Complete Psychiatric Mental Health Nurse
Practitioner Board Review
Pass your ANCC psychiatric-mental health nurse practitioner boards on your very first
try with this definitive Georgette Review PMHNP practice exam bank. This
comprehensive preparation guide features high-yield exam questions paired with 100%
verified answers and rigorous clinical rationales covering advanced
psychopharmacology, DSM-5-TR diagnostic criteria, neurobiology, and
psychotherapeutic modalities. It is an indispensable resource for graduate nursing
students looking to streamline their study routines, build absolute clinical diagnostic
confidence, and secure a passing score.
1. A 24-year-old female with a history of depression presents with excessive
sleepiness, increased appetite, and heavy sensations in her arms and legs during
depressive episodes. She reports that her mood improves significantly in the
spring and summer months. Which specifier best describes her depressive
episodes?
A) Melancholic features
B) Atypical features
C) Catatonic features
D) Mixed features
Correct Answer: B) Atypical features
Rationale: Atypical features of major depressive disorder include mood reactivity (mood
improves in response to positive events), increased appetite/weight gain, hypersomnia,
leaden paralysis (heavy sensations in limbs), and interpersonal rejection sensitivity. These
features are more common in younger patients and those with bipolar disorder.
2. A 45-year-old male with bipolar I disorder is currently experiencing a severe
depressive episode. He has a history of rapid cycling and has failed trials of
lithium, valproic acid, and quetiapine. Which of the following is the MOST
appropriate next step?
A) Start sertraline as monotherapy
B) Start lamotrigine and titrate slowly
C) Start a high-dose stimulant
D) Initiate ECT
Correct Answer: D) Initiate ECT
,Rationale: Electroconvulsive therapy (ECT) is highly effective for treatment-resistant
bipolar depression, particularly in patients with rapid cycling or those who have failed
multiple medication trials. Antidepressant monotherapy may induce mania or rapid
cycling. Lamotrigine is effective for bipolar depression prevention but takes weeks to
titrate.
3. A 55-year-old female presents with progressive memory loss, difficulty finding
words, and apathy over the past 2 years. Her Mini-Mental State Examination score
is 18/30. She has no motor symptoms or visual hallucinations. Which type of
dementia is MOST likely?
A) Dementia with Lewy Bodies
B) Frontotemporal Dementia
C) Alzheimer's Disease
D) Vascular Dementia
Correct Answer: C) Alzheimer's Disease
Rationale: Alzheimer's disease is the most common cause of dementia, characterized by
progressive memory loss, language difficulties (word-finding), apathy, and impairment in
activities of daily living. The absence of motor symptoms and visual hallucinations makes
Lewy body dementia less likely. Stepwise decline suggests vascular dementia, and early
behavioral changes suggest FTD.
4. A 16-year-old male is brought to the clinic by his parents after a 3-month
history of aggressive behavior toward others, destruction of property, and stealing
from stores. He has been suspended from school multiple times. Which diagnosis
is MOST consistent with this presentation?
A) Oppositional Defiant Disorder
B) Conduct Disorder
C) Intermittent Explosive Disorder
D) Adjustment Disorder
Correct Answer: B) Conduct Disorder
Rationale: Conduct Disorder is characterized by a repetitive and persistent pattern of
behavior that violates the rights of others or societal norms. This includes aggression to
people/animals, destruction of property, deceitfulness/theft, and serious rule violations.
ODD involves argumentative/defiant behavior without the severity of rule violations seen
in conduct disorder.
,5. A 38-year-old female reports difficulty falling asleep, frequent awakenings, and
non-restorative sleep for the past 4 months. She also reports irritability, difficulty
concentrating, and decreased energy. The symptoms occur in the context of
financial stress and family conflict. What is the MOST appropriate diagnosis?
A) Major Depressive Disorder
B) Generalized Anxiety Disorder
C) Insomnia Disorder
D) Adjustment Disorder
Correct Answer: C) Insomnia Disorder
Rationale: Insomnia Disorder is characterized by dissatisfaction with sleep quantity or
quality, with difficulty initiating or maintaining sleep, occurring at least 3 nights per week
for at least 3 months. The sleep disturbance causes clinically significant distress or
impairment. While the patient has other symptoms, the primary complaint is sleep-
related.
6. A 60-year-old male with chronic obstructive pulmonary disease (COPD) and
depression is started on an antidepressant. Which medication should be AVOIDED
due to potential respiratory depression?
A) Sertraline
B) Bupropion
C) Trazodone
D) Mirtazapine
Correct Answer: C) Trazodone
Rationale: Trazodone has alpha-1 adrenergic blocking activity that can cause orthostatic
hypotension and sedation. In patients with COPD, sedating medications should be used
cautiously. However, SSRIs (sertraline) and bupropion are generally preferred in patients
with respiratory disease due to their lower sedative profile. Mirtazapine may be helpful as
it stimulates appetite.
7. A 30-year-old male with schizophrenia is prescribed clozapine. Which of the
following is a BLACK BOX warning associated with this medication?
A) Weight gain and metabolic syndrome
B) Agranulocytosis and myocarditis
C) Hyperprolactinemia
D) Tardive dyskinesia
, Correct Answer: B) Agranulocytosis and myocarditis
Rationale: Clozapine has multiple black box warnings including agranulocytosis (severe
neutropenia), myocarditis, cardiomyopathy, and seizures. It requires enrollment in the
Clozapine REMS program with regular ANC monitoring. Metabolic side effects (weight
gain, diabetes) are also significant but do not carry a black box warning.
8. A 42-year-old female with depression and chronic pain is started on duloxetine.
What is the mechanism of action of this medication?
A) Selective serotonin reuptake inhibition
B) Serotonin and norepinephrine reuptake inhibition
C) Dopamine and norepinephrine reuptake inhibition
D) Monoamine oxidase inhibition
Correct Answer: B) Serotonin and norepinephrine reuptake inhibition
Rationale: Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI). It is FDA-
approved for major depressive disorder, generalized anxiety disorder, diabetic peripheral
neuropathy, fibromyalgia, and chronic musculoskeletal pain. This dual mechanism makes
it effective for both depression and neuropathic pain.
9. A 48-year-old male with bipolar disorder is started on lithium. Which of the
following baseline assessments is REQUIRED before initiating therapy?
A) EKG
B) Thyroid function tests and renal function tests
C) Liver function tests
D) Complete blood count
Correct Answer: B) Thyroid function tests and renal function tests
Rationale: Before starting lithium, thyroid function tests (TSH) and renal function tests
(creatinine, BUN) are required. Lithium can cause hypothyroidism and nephrogenic
diabetes insipidus. For females of childbearing age, a pregnancy test is recommended. EKG
is recommended for patients over 50 or those with cardiac risk factors.
10. A 70-year-old female with Alzheimer's disease is started on donepezil. Which
of the following is a common side effect of cholinesterase inhibitors?
A) Hypertension
B) Bradycardia
(Verified 2025) Complete Psychiatric Mental Health Nurse
Practitioner Board Review
Pass your ANCC psychiatric-mental health nurse practitioner boards on your very first
try with this definitive Georgette Review PMHNP practice exam bank. This
comprehensive preparation guide features high-yield exam questions paired with 100%
verified answers and rigorous clinical rationales covering advanced
psychopharmacology, DSM-5-TR diagnostic criteria, neurobiology, and
psychotherapeutic modalities. It is an indispensable resource for graduate nursing
students looking to streamline their study routines, build absolute clinical diagnostic
confidence, and secure a passing score.
1. A 24-year-old female with a history of depression presents with excessive
sleepiness, increased appetite, and heavy sensations in her arms and legs during
depressive episodes. She reports that her mood improves significantly in the
spring and summer months. Which specifier best describes her depressive
episodes?
A) Melancholic features
B) Atypical features
C) Catatonic features
D) Mixed features
Correct Answer: B) Atypical features
Rationale: Atypical features of major depressive disorder include mood reactivity (mood
improves in response to positive events), increased appetite/weight gain, hypersomnia,
leaden paralysis (heavy sensations in limbs), and interpersonal rejection sensitivity. These
features are more common in younger patients and those with bipolar disorder.
2. A 45-year-old male with bipolar I disorder is currently experiencing a severe
depressive episode. He has a history of rapid cycling and has failed trials of
lithium, valproic acid, and quetiapine. Which of the following is the MOST
appropriate next step?
A) Start sertraline as monotherapy
B) Start lamotrigine and titrate slowly
C) Start a high-dose stimulant
D) Initiate ECT
Correct Answer: D) Initiate ECT
,Rationale: Electroconvulsive therapy (ECT) is highly effective for treatment-resistant
bipolar depression, particularly in patients with rapid cycling or those who have failed
multiple medication trials. Antidepressant monotherapy may induce mania or rapid
cycling. Lamotrigine is effective for bipolar depression prevention but takes weeks to
titrate.
3. A 55-year-old female presents with progressive memory loss, difficulty finding
words, and apathy over the past 2 years. Her Mini-Mental State Examination score
is 18/30. She has no motor symptoms or visual hallucinations. Which type of
dementia is MOST likely?
A) Dementia with Lewy Bodies
B) Frontotemporal Dementia
C) Alzheimer's Disease
D) Vascular Dementia
Correct Answer: C) Alzheimer's Disease
Rationale: Alzheimer's disease is the most common cause of dementia, characterized by
progressive memory loss, language difficulties (word-finding), apathy, and impairment in
activities of daily living. The absence of motor symptoms and visual hallucinations makes
Lewy body dementia less likely. Stepwise decline suggests vascular dementia, and early
behavioral changes suggest FTD.
4. A 16-year-old male is brought to the clinic by his parents after a 3-month
history of aggressive behavior toward others, destruction of property, and stealing
from stores. He has been suspended from school multiple times. Which diagnosis
is MOST consistent with this presentation?
A) Oppositional Defiant Disorder
B) Conduct Disorder
C) Intermittent Explosive Disorder
D) Adjustment Disorder
Correct Answer: B) Conduct Disorder
Rationale: Conduct Disorder is characterized by a repetitive and persistent pattern of
behavior that violates the rights of others or societal norms. This includes aggression to
people/animals, destruction of property, deceitfulness/theft, and serious rule violations.
ODD involves argumentative/defiant behavior without the severity of rule violations seen
in conduct disorder.
,5. A 38-year-old female reports difficulty falling asleep, frequent awakenings, and
non-restorative sleep for the past 4 months. She also reports irritability, difficulty
concentrating, and decreased energy. The symptoms occur in the context of
financial stress and family conflict. What is the MOST appropriate diagnosis?
A) Major Depressive Disorder
B) Generalized Anxiety Disorder
C) Insomnia Disorder
D) Adjustment Disorder
Correct Answer: C) Insomnia Disorder
Rationale: Insomnia Disorder is characterized by dissatisfaction with sleep quantity or
quality, with difficulty initiating or maintaining sleep, occurring at least 3 nights per week
for at least 3 months. The sleep disturbance causes clinically significant distress or
impairment. While the patient has other symptoms, the primary complaint is sleep-
related.
6. A 60-year-old male with chronic obstructive pulmonary disease (COPD) and
depression is started on an antidepressant. Which medication should be AVOIDED
due to potential respiratory depression?
A) Sertraline
B) Bupropion
C) Trazodone
D) Mirtazapine
Correct Answer: C) Trazodone
Rationale: Trazodone has alpha-1 adrenergic blocking activity that can cause orthostatic
hypotension and sedation. In patients with COPD, sedating medications should be used
cautiously. However, SSRIs (sertraline) and bupropion are generally preferred in patients
with respiratory disease due to their lower sedative profile. Mirtazapine may be helpful as
it stimulates appetite.
7. A 30-year-old male with schizophrenia is prescribed clozapine. Which of the
following is a BLACK BOX warning associated with this medication?
A) Weight gain and metabolic syndrome
B) Agranulocytosis and myocarditis
C) Hyperprolactinemia
D) Tardive dyskinesia
, Correct Answer: B) Agranulocytosis and myocarditis
Rationale: Clozapine has multiple black box warnings including agranulocytosis (severe
neutropenia), myocarditis, cardiomyopathy, and seizures. It requires enrollment in the
Clozapine REMS program with regular ANC monitoring. Metabolic side effects (weight
gain, diabetes) are also significant but do not carry a black box warning.
8. A 42-year-old female with depression and chronic pain is started on duloxetine.
What is the mechanism of action of this medication?
A) Selective serotonin reuptake inhibition
B) Serotonin and norepinephrine reuptake inhibition
C) Dopamine and norepinephrine reuptake inhibition
D) Monoamine oxidase inhibition
Correct Answer: B) Serotonin and norepinephrine reuptake inhibition
Rationale: Duloxetine is a serotonin-norepinephrine reuptake inhibitor (SNRI). It is FDA-
approved for major depressive disorder, generalized anxiety disorder, diabetic peripheral
neuropathy, fibromyalgia, and chronic musculoskeletal pain. This dual mechanism makes
it effective for both depression and neuropathic pain.
9. A 48-year-old male with bipolar disorder is started on lithium. Which of the
following baseline assessments is REQUIRED before initiating therapy?
A) EKG
B) Thyroid function tests and renal function tests
C) Liver function tests
D) Complete blood count
Correct Answer: B) Thyroid function tests and renal function tests
Rationale: Before starting lithium, thyroid function tests (TSH) and renal function tests
(creatinine, BUN) are required. Lithium can cause hypothyroidism and nephrogenic
diabetes insipidus. For females of childbearing age, a pregnancy test is recommended. EKG
is recommended for patients over 50 or those with cardiac risk factors.
10. A 70-year-old female with Alzheimer's disease is started on donepezil. Which
of the following is a common side effect of cholinesterase inhibitors?
A) Hypertension
B) Bradycardia
