PMHNP certification Exam (2026/2027)
Questions And Answers (Actual test
verified Grade A+).
Question 1:
Which patient is at highest risk for SI?
A. 30y/o married AA female with previous SI attempt
B. 35 y/o single Asian male with previous SI attempt
C. 38 y/o single AA male who is a manager of a bank
D. 68 y/o single white male with depression
Answer: D
Explanation: The 68-year-old single White male with depression has five significant
suicide risk factors: advanced age (elderly), male gender, unmarried status, White race,
and depression. Elderly White males have the highest completion rates for suicide. While
previous suicide attempt is a strong predictor (present in options A and B), the
combination of multiple risk factors in this patient creates greater cumulative risk.
Women attempt suicide more frequently, but men complete suicide more often due to
using more lethal means. Counting risk factors systematically helps identify highest-risk
patients.
Question 2:
What are the COWS scale components?
A. Nausea, tremor, paroxysmal sweats, anxiety, agitation
B. Pulse, sweating, restlessness, pupil size, body aches, rhinorrhea, lacrimation, GI upset,
yawning, tremors, anxiety, piloerection, insomnia
C. Heart rate, blood pressure, temperature, respiratory rate
D. Hallucinations, orientation, headache, tactile disturbances
Answer: B
,Explanation: The Clinical Opiate Withdrawal Scale (COWS) includes: pulse, sweating,
restlessness, pupil size (dilation indicates withdrawal; pinpoint indicates intoxication),
body aches, rhinorrhea (runny nose), lacrimation (eye tearing), GI upset
(nausea/vomiting/diarrhea), yawning, tremors, anxiety/irritability, piloerection
(gooseflesh skin), and insomnia. COWS is used to assess opioid withdrawal severity and
guide treatment decisions. Scores of 7 or above indicate need for PRN medications,
while scores of 13 or above suggest consideration for Subutex or Suboxone initiation.
Question 3:
What does COWS stand for?
A. Clinical Observation of Withdrawal Symptoms
B. Clinical Opiate Withdrawal Scale
C. Comprehensive Opioid Wellness Score
D. Controlled Opiate Withdrawal System
Answer: B
Explanation: COWS stands for Clinical Opiate Withdrawal Scale. It is a standardized
assessment tool used to evaluate the severity of opioid withdrawal symptoms and guide
medication management during detoxification. The scale helps clinicians determine
when to administer medications for withdrawal symptoms and when to initiate
medications like buprenorphine. Unlike CIWA (which assesses alcohol withdrawal),
COWS specifically measures opioid withdrawal phenomena including autonomic
hyperactivity, gastrointestinal distress, and subjective discomfort.
Question 4:
What does CIWA stand for?
A. Clinical Institute Withdrawal Assessment
B. Comprehensive Inpatient Withdrawal Algorithm
C. Chemical Intoxication Withdrawal Assessment
D. Controlled Intake Withdrawal Approach
Answer: A
,Explanation: CIWA stands for Clinical Institute Withdrawal Assessment. It is a validated
assessment tool specifically designed to evaluate alcohol withdrawal severity and guide
treatment decisions. The CIWA-Ar (revised version) is commonly used in clinical settings
to objectify withdrawal symptoms and determine when medications are needed for
alcohol detoxification. Understanding the difference between CIWA (alcohol) and COWS
(opioids) is essential for appropriate withdrawal management.
Question 5:
What does CIWA assess for?
A. Opioid withdrawal severity
B. Benzodiazepine dependence
C. Alcohol withdrawal and risk of DTs
D. Stimulant intoxication
Answer: C
Explanation: CIWA is used to determine the likelihood of alcohol withdrawal and
delirium tremens (DTs), which typically occur within the first 24-72 hours after cessation
of alcohol use. The scale helps clinicians determine when to administer medications for
alcohol withdrawal, with scores of 8 or above indicating need for PRN medications and
scores of 15 or above suggesting scheduled medications. Alcohol withdrawal can be
life-threatening, making appropriate CIWA-based management essential for patient
safety.
Question 6:
What does CIWA NOT test for?
A. Severity of alcohol withdrawal
B. Risk of delirium tremens
C. Alcohol Use Disorder
D. Need for withdrawal medication
Answer: C
, Explanation: CIWA assesses the severity of acute alcohol withdrawal symptoms and risk
of DTs, but it does NOT diagnose Alcohol Use Disorder. Alcohol Use Disorder is a
separate diagnosis based on DSM-5 criteria including patterns of use, tolerance,
withdrawal, and functional impairment. CIWA is a symptom-rating scale for current
physiological withdrawal, not a diagnostic tool for the underlying disorder. Patients may
have Alcohol Use Disorder without active withdrawal requiring CIWA monitoring.
Question 7:
What are the CIWA scale components?
A. Pulse, sweating, pupil size, body aches, yawning
B. N/V, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory
disturbances, visual disturbances, H/A, orientation
C. Mood, sleep, appetite, energy, concentration
D. Blood pressure, heart rate, temperature, respiratory rate
Answer: B
Explanation: CIWA components include: nausea/vomiting, tremor, paroxysmal sweats,
anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances,
headache, and orientation. Each component is scored from 0 (none) to 7 (severe), except
orientation which is scored from 0 (oriented ×4) to 4 (disoriented). Total scores guide
treatment: <10 very mild (start PRN at 8), 10-15 mild (scheduled + PRN), 16-20
moderate, >21 severe (consider diazepam, librium, or ativan).
Question 8:
When interviewing teenagers (16 y/o) that arrive with their parents, what should you do?
A. Interview the patient with parents present
B. Interview parents first, then the teen together
C. Interview them separately from parents
D. Have parents complete forms while observing the interview
Answer: C
Questions And Answers (Actual test
verified Grade A+).
Question 1:
Which patient is at highest risk for SI?
A. 30y/o married AA female with previous SI attempt
B. 35 y/o single Asian male with previous SI attempt
C. 38 y/o single AA male who is a manager of a bank
D. 68 y/o single white male with depression
Answer: D
Explanation: The 68-year-old single White male with depression has five significant
suicide risk factors: advanced age (elderly), male gender, unmarried status, White race,
and depression. Elderly White males have the highest completion rates for suicide. While
previous suicide attempt is a strong predictor (present in options A and B), the
combination of multiple risk factors in this patient creates greater cumulative risk.
Women attempt suicide more frequently, but men complete suicide more often due to
using more lethal means. Counting risk factors systematically helps identify highest-risk
patients.
Question 2:
What are the COWS scale components?
A. Nausea, tremor, paroxysmal sweats, anxiety, agitation
B. Pulse, sweating, restlessness, pupil size, body aches, rhinorrhea, lacrimation, GI upset,
yawning, tremors, anxiety, piloerection, insomnia
C. Heart rate, blood pressure, temperature, respiratory rate
D. Hallucinations, orientation, headache, tactile disturbances
Answer: B
,Explanation: The Clinical Opiate Withdrawal Scale (COWS) includes: pulse, sweating,
restlessness, pupil size (dilation indicates withdrawal; pinpoint indicates intoxication),
body aches, rhinorrhea (runny nose), lacrimation (eye tearing), GI upset
(nausea/vomiting/diarrhea), yawning, tremors, anxiety/irritability, piloerection
(gooseflesh skin), and insomnia. COWS is used to assess opioid withdrawal severity and
guide treatment decisions. Scores of 7 or above indicate need for PRN medications,
while scores of 13 or above suggest consideration for Subutex or Suboxone initiation.
Question 3:
What does COWS stand for?
A. Clinical Observation of Withdrawal Symptoms
B. Clinical Opiate Withdrawal Scale
C. Comprehensive Opioid Wellness Score
D. Controlled Opiate Withdrawal System
Answer: B
Explanation: COWS stands for Clinical Opiate Withdrawal Scale. It is a standardized
assessment tool used to evaluate the severity of opioid withdrawal symptoms and guide
medication management during detoxification. The scale helps clinicians determine
when to administer medications for withdrawal symptoms and when to initiate
medications like buprenorphine. Unlike CIWA (which assesses alcohol withdrawal),
COWS specifically measures opioid withdrawal phenomena including autonomic
hyperactivity, gastrointestinal distress, and subjective discomfort.
Question 4:
What does CIWA stand for?
A. Clinical Institute Withdrawal Assessment
B. Comprehensive Inpatient Withdrawal Algorithm
C. Chemical Intoxication Withdrawal Assessment
D. Controlled Intake Withdrawal Approach
Answer: A
,Explanation: CIWA stands for Clinical Institute Withdrawal Assessment. It is a validated
assessment tool specifically designed to evaluate alcohol withdrawal severity and guide
treatment decisions. The CIWA-Ar (revised version) is commonly used in clinical settings
to objectify withdrawal symptoms and determine when medications are needed for
alcohol detoxification. Understanding the difference between CIWA (alcohol) and COWS
(opioids) is essential for appropriate withdrawal management.
Question 5:
What does CIWA assess for?
A. Opioid withdrawal severity
B. Benzodiazepine dependence
C. Alcohol withdrawal and risk of DTs
D. Stimulant intoxication
Answer: C
Explanation: CIWA is used to determine the likelihood of alcohol withdrawal and
delirium tremens (DTs), which typically occur within the first 24-72 hours after cessation
of alcohol use. The scale helps clinicians determine when to administer medications for
alcohol withdrawal, with scores of 8 or above indicating need for PRN medications and
scores of 15 or above suggesting scheduled medications. Alcohol withdrawal can be
life-threatening, making appropriate CIWA-based management essential for patient
safety.
Question 6:
What does CIWA NOT test for?
A. Severity of alcohol withdrawal
B. Risk of delirium tremens
C. Alcohol Use Disorder
D. Need for withdrawal medication
Answer: C
, Explanation: CIWA assesses the severity of acute alcohol withdrawal symptoms and risk
of DTs, but it does NOT diagnose Alcohol Use Disorder. Alcohol Use Disorder is a
separate diagnosis based on DSM-5 criteria including patterns of use, tolerance,
withdrawal, and functional impairment. CIWA is a symptom-rating scale for current
physiological withdrawal, not a diagnostic tool for the underlying disorder. Patients may
have Alcohol Use Disorder without active withdrawal requiring CIWA monitoring.
Question 7:
What are the CIWA scale components?
A. Pulse, sweating, pupil size, body aches, yawning
B. N/V, tremor, paroxysmal sweats, anxiety, agitation, tactile disturbances, auditory
disturbances, visual disturbances, H/A, orientation
C. Mood, sleep, appetite, energy, concentration
D. Blood pressure, heart rate, temperature, respiratory rate
Answer: B
Explanation: CIWA components include: nausea/vomiting, tremor, paroxysmal sweats,
anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances,
headache, and orientation. Each component is scored from 0 (none) to 7 (severe), except
orientation which is scored from 0 (oriented ×4) to 4 (disoriented). Total scores guide
treatment: <10 very mild (start PRN at 8), 10-15 mild (scheduled + PRN), 16-20
moderate, >21 severe (consider diazepam, librium, or ativan).
Question 8:
When interviewing teenagers (16 y/o) that arrive with their parents, what should you do?
A. Interview the patient with parents present
B. Interview parents first, then the teen together
C. Interview them separately from parents
D. Have parents complete forms while observing the interview
Answer: C
