PMHNP Psychiatric Mental Health Nurse Practitioner Practice Exam
100 Multiple Choice Questions with Answers and Rationales
1. Before prescribing for depression, which history is especially important?
A. Past mania or hypomania
B. Shoe size
C. Hand dominance alone
D. Favorite color
Correct answer: A. Past mania or hypomania
Rationale: A history of elevated mood and increased energy may change the
diagnosis and treatment plan. Antidepressant selection should follow a full bipolar
assessment.
2. A patient has depressed mood, anhedonia, and four other depressive
symptoms for three weeks. What is needed next?
A. Assume normal bereavement excludes illness
B. Assess impairment, exclusions, and bipolar history
C. Ignore substance use
D. Diagnose solely from a screening score
Correct answer: B. Assess impairment, exclusions, and bipolar history
Rationale: Duration and symptom count support consideration of a major
depressive episode. Medical, substance-related, bipolar, and contextual factors still
require evaluation.
3. Eight days of elevated mood, markedly increased energy, and severe
impairment suggest which episode?
A. Normal enthusiasm
B. Specific phobia
C. Isolated insomnia
D. Mania
Correct answer: D. Mania
Rationale: Sustained activation with severe impairment supports mania when
diagnostic criteria and exclusions are met. Reduced sleep alone does not establish
this diagnosis.
4. Hypomania and major depression without mania suggest which diagnosis?
A. Bipolar II disorder
B. Specific learning disorder
C. Delirium
PMHNP Practice Exam | Page 1
,D. Bipolar I solely from depression
Correct answer: A. Bipolar II disorder
Rationale: Bipolar II requires hypomania and major depression without a manic
episode. Establishing the longitudinal history distinguishes it from unipolar
depression.
5. What is essential when evaluating new psychosis?
A. Medical, substance, medication, and psychiatric causes
B. Ignoring cognition
C. Assuming schizophrenia immediately
D. Using appearance alone
Correct answer: A. Medical, substance, medication, and psychiatric causes
Rationale: Psychosis has multiple possible causes. Timing, examination, collateral
information, and indicated testing help identify reversible illness and refine the
diagnosis.
6. Which experience is a hallucination?
A. An intrusive unwanted thought only
B. A deliberate lie
C. Hearing a voice without an external stimulus
D. A fixed false belief
Correct answer: C. Hearing a voice without an external stimulus
Rationale: Hallucinations are perceptions without an external stimulus.
Distinguishing perception from belief helps characterize symptoms without
prematurely assigning a disorder.
7. Fluctuating attention and acute confusion suggest what?
A. Uncomplicated grief alone
B. Delirium requiring medical evaluation
C. Stable personality traits
D. Routine aging
Correct answer: B. Delirium requiring medical evaluation
Rationale: An acute fluctuating disturbance of attention suggests delirium.
Identifying and treating the underlying medical cause takes priority over assuming a
primary psychiatric illness.
8. Fatigue, slowed thinking, and depression warrant consideration of what
medical mimic?
A. Hypothyroidism
B. Seasonal allergies alone
PMHNP Practice Exam | Page 2
, C. Myopia alone
D. Handedness
Correct answer: A. Hypothyroidism
Rationale: Thyroid disease can contribute to depressive symptoms. Testing should
follow the clinical history and examination rather than replacing a full diagnostic
assessment.
9. What is the role of a positive depression screening result?
A. Exclude bipolar disorder
B. Determine medication dose automatically
C. Establish the diagnosis by itself
D. Prompt diagnostic assessment
Correct answer: D. Prompt diagnostic assessment
Rationale: Screening identifies people needing further evaluation. Diagnosis also
requires assessment of symptoms, duration, impairment, differential diagnoses, and
safety.
10. New panic-like symptoms with chest pain require what?
A. Automatic attribution to anxiety
B. Immediate dismissal
C. Only a personality inventory
D. Assessment for medical causes and urgent risk
Correct answer: D. Assessment for medical causes and urgent risk
Rationale: Cardiac, respiratory, metabolic, and substance-related conditions may
resemble panic. Urgent features require medical assessment before psychiatric
attribution.
11. Persistent excessive worry across several domains most suggests what?
A. Generalized anxiety disorder when criteria are met
B. One isolated panic attack
C. A hallucination
D. Delirium
Correct answer: A. Generalized anxiety disorder when criteria are met
Rationale: Generalized anxiety involves difficult-to-control worry with associated
symptoms and impairment. Duration and exclusions must be established before
diagnosing.
12. Unwanted intrusive thoughts followed by rituals suggest what?
A. Mania by definition
B. Normal preference alone
PMHNP Practice Exam | Page 3
100 Multiple Choice Questions with Answers and Rationales
1. Before prescribing for depression, which history is especially important?
A. Past mania or hypomania
B. Shoe size
C. Hand dominance alone
D. Favorite color
Correct answer: A. Past mania or hypomania
Rationale: A history of elevated mood and increased energy may change the
diagnosis and treatment plan. Antidepressant selection should follow a full bipolar
assessment.
2. A patient has depressed mood, anhedonia, and four other depressive
symptoms for three weeks. What is needed next?
A. Assume normal bereavement excludes illness
B. Assess impairment, exclusions, and bipolar history
C. Ignore substance use
D. Diagnose solely from a screening score
Correct answer: B. Assess impairment, exclusions, and bipolar history
Rationale: Duration and symptom count support consideration of a major
depressive episode. Medical, substance-related, bipolar, and contextual factors still
require evaluation.
3. Eight days of elevated mood, markedly increased energy, and severe
impairment suggest which episode?
A. Normal enthusiasm
B. Specific phobia
C. Isolated insomnia
D. Mania
Correct answer: D. Mania
Rationale: Sustained activation with severe impairment supports mania when
diagnostic criteria and exclusions are met. Reduced sleep alone does not establish
this diagnosis.
4. Hypomania and major depression without mania suggest which diagnosis?
A. Bipolar II disorder
B. Specific learning disorder
C. Delirium
PMHNP Practice Exam | Page 1
,D. Bipolar I solely from depression
Correct answer: A. Bipolar II disorder
Rationale: Bipolar II requires hypomania and major depression without a manic
episode. Establishing the longitudinal history distinguishes it from unipolar
depression.
5. What is essential when evaluating new psychosis?
A. Medical, substance, medication, and psychiatric causes
B. Ignoring cognition
C. Assuming schizophrenia immediately
D. Using appearance alone
Correct answer: A. Medical, substance, medication, and psychiatric causes
Rationale: Psychosis has multiple possible causes. Timing, examination, collateral
information, and indicated testing help identify reversible illness and refine the
diagnosis.
6. Which experience is a hallucination?
A. An intrusive unwanted thought only
B. A deliberate lie
C. Hearing a voice without an external stimulus
D. A fixed false belief
Correct answer: C. Hearing a voice without an external stimulus
Rationale: Hallucinations are perceptions without an external stimulus.
Distinguishing perception from belief helps characterize symptoms without
prematurely assigning a disorder.
7. Fluctuating attention and acute confusion suggest what?
A. Uncomplicated grief alone
B. Delirium requiring medical evaluation
C. Stable personality traits
D. Routine aging
Correct answer: B. Delirium requiring medical evaluation
Rationale: An acute fluctuating disturbance of attention suggests delirium.
Identifying and treating the underlying medical cause takes priority over assuming a
primary psychiatric illness.
8. Fatigue, slowed thinking, and depression warrant consideration of what
medical mimic?
A. Hypothyroidism
B. Seasonal allergies alone
PMHNP Practice Exam | Page 2
, C. Myopia alone
D. Handedness
Correct answer: A. Hypothyroidism
Rationale: Thyroid disease can contribute to depressive symptoms. Testing should
follow the clinical history and examination rather than replacing a full diagnostic
assessment.
9. What is the role of a positive depression screening result?
A. Exclude bipolar disorder
B. Determine medication dose automatically
C. Establish the diagnosis by itself
D. Prompt diagnostic assessment
Correct answer: D. Prompt diagnostic assessment
Rationale: Screening identifies people needing further evaluation. Diagnosis also
requires assessment of symptoms, duration, impairment, differential diagnoses, and
safety.
10. New panic-like symptoms with chest pain require what?
A. Automatic attribution to anxiety
B. Immediate dismissal
C. Only a personality inventory
D. Assessment for medical causes and urgent risk
Correct answer: D. Assessment for medical causes and urgent risk
Rationale: Cardiac, respiratory, metabolic, and substance-related conditions may
resemble panic. Urgent features require medical assessment before psychiatric
attribution.
11. Persistent excessive worry across several domains most suggests what?
A. Generalized anxiety disorder when criteria are met
B. One isolated panic attack
C. A hallucination
D. Delirium
Correct answer: A. Generalized anxiety disorder when criteria are met
Rationale: Generalized anxiety involves difficult-to-control worry with associated
symptoms and impairment. Duration and exclusions must be established before
diagnosing.
12. Unwanted intrusive thoughts followed by rituals suggest what?
A. Mania by definition
B. Normal preference alone
PMHNP Practice Exam | Page 3
