APEA Psychiatric-Mental Health Nurse Practitioner PMHNP
Certification Exam Question Bank (Latest 2026/2027 Edition) –
100% Correct Questions, Answers & Detailed Rationales
Total Questions: 150
Time Allowed: 180 Minutes
Passing Score: 70%
Instructions: Select the BEST answer for each question based on psychiatric
assessment principles, DSM-5-TR criteria, evidence-based psychopharmacology, and
clinical judgment. For SATA questions, select all that apply.
SECTION 1: ADVANCED PSYCHIATRIC ASSESSMENT
Questions 1–45
Question 1
A 28-year-old woman presents with a 2-week history of depressed mood, anhedonia,
insomnia, fatigue, poor concentration, and feelings of worthlessness. She denies
suicidal ideation. Her symptoms began after she was fired from her job. Which
additional finding is REQUIRED to support a DSM-5-TR diagnosis of major depressive
disorder?
A. Psychomotor agitation or retardation
B. Significant weight change or appetite disturbance
C. Symptoms cause clinically significant distress or impairment
D. A history of at least one prior major depressive episode
Correct Answer: C
Rationale: Per DSM-5-TR, major depressive disorder requires five or more symptoms
present during the same 2-week period, at least one being depressed mood or
,anhedonia, AND the symptoms must cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning (Criterion C). While
weight/appetite changes (B) and psychomotor changes (A) are among the nine
symptom criteria, they are not required. A prior episode (D) is not required for a single
episode diagnosis.
Question 2
A PMHNP conducts a mental status examination on a 42-year-old man brought to the
emergency department by police. The patient is pacing, has a pressured speech pattern,
and reports feeling "on top of the world." He is easily distracted by ambient noise and
demonstrates flight of ideas. Which MSE finding is MOST consistent with his
presentation?
A. Restricted affect
B. Euthymic mood
C. Expansive affect
D. Blunted affect
Correct Answer: C
Rationale: Expansive affect is characterized by an uncontrolled and excessive display of
emotions, often seen in manic episodes where the patient feels grandiose and "on top
of the world." Pressured speech, flight of ideas, and distractibility are classic manic
symptoms. Restricted affect (A) implies limited range. Euthymic (B) indicates normal
mood. Blunted affect (D) indicates severe reduction in emotional expressiveness.
Question 3
A 19-year-old college student is evaluated after his roommate found him confused and
agitated. The patient has been using increasing amounts of a stimulant to study. He
now has paranoid ideation, tactile hallucinations, and marked psychomotor agitation.
Vital signs show HR 128, BP 162/98, temp 38.2°C. Which is the MOST likely diagnosis?
,A. Stimulant intoxication
B. Stimulant withdrawal
C. Brief psychotic disorder
D. Schizophreniform disorder
Correct Answer: A
Rationale: Stimulant intoxication (amphetamine/cocaine) presents with tachycardia,
hypertension, elevated temperature, agitation, paranoia, and formication (tactile
hallucinations of bugs crawling on skin). The temporal relationship to increasing use
and the presence of autonomic hyperactivity distinguish this from primary psychotic
disorders. Withdrawal (B) typically presents with fatigue, depression, and increased
appetite, not agitation and psychosis.
Question 4
During a comprehensive psychiatric evaluation of a 34-year-old woman, the PMHNP
notes that the patient makes poor eye contact, provides vague answers, and repeatedly
asks the clinician to repeat questions. She states she was "told to come here" but is
unsure why. Which response by the PMHNP BEST demonstrates trauma-informed care
principles?
A. "You seem uncomfortable. Let's reschedule when you're ready to talk."
B. "I notice you seem hesitant. Would you like to tell me what would help you feel safer?"
C. "Your answers are vague. I need specific details to help you."
D. "Who told you to come here? I need to know before we proceed."
Correct Answer: B
Rationale: Trauma-informed care emphasizes safety, trustworthiness, choice,
collaboration, and empowerment. Option B demonstrates these principles by
acknowledging the patient's discomfort, offering autonomy, and creating psychological
safety. Option A abandons the encounter. Option C is confrontational. Option D is
interrogative and may retraumatize.
, Question 5
A 67-year-old man with a history of hypertension and diabetes presents with a 6-month
history of progressive memory loss, difficulty finding words, and getting lost in familiar
neighborhoods. His wife notes he has become increasingly irritable and apathetic. MRI
shows cortical atrophy and white matter changes. Which assessment tool is MOST
appropriate to evaluate his cognitive decline?
A. Montreal Cognitive Assessment (MoCA)
B. Mini-Mental State Examination (MMSE)
C. Geriatric Depression Scale (GDS-15)
D. Clock Drawing Test alone
Correct Answer: A
Rationale: The MoCA is more sensitive than the MMSE for detecting mild cognitive
impairment and early dementia, assessing executive function, attention, and
visuospatial abilities. While the MMSE (B) is widely used, it has ceiling effects in mild
impairment. The GDS-15 (C) screens for depression, not cognition. The Clock Drawing
Test (D) alone is insufficient for comprehensive cognitive evaluation.
Question 6
A 14-year-old adolescent is referred by his school counselor for declining grades,
irritability, and social withdrawal over the past 3 months. He reports difficulty falling
asleep and states, "I just don't care anymore." Which screening instrument is MOST
appropriate for initial assessment?
A. Patient Health Questionnaire-9 (PHQ-9)
B. Columbia Suicide Severity Rating Scale (C-SSRS)
C. Generalized Anxiety Disorder-7 (GAD-7)
D. Vanderbilt ADHD Diagnostic Rating Scale
Correct Answer: A
Certification Exam Question Bank (Latest 2026/2027 Edition) –
100% Correct Questions, Answers & Detailed Rationales
Total Questions: 150
Time Allowed: 180 Minutes
Passing Score: 70%
Instructions: Select the BEST answer for each question based on psychiatric
assessment principles, DSM-5-TR criteria, evidence-based psychopharmacology, and
clinical judgment. For SATA questions, select all that apply.
SECTION 1: ADVANCED PSYCHIATRIC ASSESSMENT
Questions 1–45
Question 1
A 28-year-old woman presents with a 2-week history of depressed mood, anhedonia,
insomnia, fatigue, poor concentration, and feelings of worthlessness. She denies
suicidal ideation. Her symptoms began after she was fired from her job. Which
additional finding is REQUIRED to support a DSM-5-TR diagnosis of major depressive
disorder?
A. Psychomotor agitation or retardation
B. Significant weight change or appetite disturbance
C. Symptoms cause clinically significant distress or impairment
D. A history of at least one prior major depressive episode
Correct Answer: C
Rationale: Per DSM-5-TR, major depressive disorder requires five or more symptoms
present during the same 2-week period, at least one being depressed mood or
,anhedonia, AND the symptoms must cause clinically significant distress or impairment
in social, occupational, or other important areas of functioning (Criterion C). While
weight/appetite changes (B) and psychomotor changes (A) are among the nine
symptom criteria, they are not required. A prior episode (D) is not required for a single
episode diagnosis.
Question 2
A PMHNP conducts a mental status examination on a 42-year-old man brought to the
emergency department by police. The patient is pacing, has a pressured speech pattern,
and reports feeling "on top of the world." He is easily distracted by ambient noise and
demonstrates flight of ideas. Which MSE finding is MOST consistent with his
presentation?
A. Restricted affect
B. Euthymic mood
C. Expansive affect
D. Blunted affect
Correct Answer: C
Rationale: Expansive affect is characterized by an uncontrolled and excessive display of
emotions, often seen in manic episodes where the patient feels grandiose and "on top
of the world." Pressured speech, flight of ideas, and distractibility are classic manic
symptoms. Restricted affect (A) implies limited range. Euthymic (B) indicates normal
mood. Blunted affect (D) indicates severe reduction in emotional expressiveness.
Question 3
A 19-year-old college student is evaluated after his roommate found him confused and
agitated. The patient has been using increasing amounts of a stimulant to study. He
now has paranoid ideation, tactile hallucinations, and marked psychomotor agitation.
Vital signs show HR 128, BP 162/98, temp 38.2°C. Which is the MOST likely diagnosis?
,A. Stimulant intoxication
B. Stimulant withdrawal
C. Brief psychotic disorder
D. Schizophreniform disorder
Correct Answer: A
Rationale: Stimulant intoxication (amphetamine/cocaine) presents with tachycardia,
hypertension, elevated temperature, agitation, paranoia, and formication (tactile
hallucinations of bugs crawling on skin). The temporal relationship to increasing use
and the presence of autonomic hyperactivity distinguish this from primary psychotic
disorders. Withdrawal (B) typically presents with fatigue, depression, and increased
appetite, not agitation and psychosis.
Question 4
During a comprehensive psychiatric evaluation of a 34-year-old woman, the PMHNP
notes that the patient makes poor eye contact, provides vague answers, and repeatedly
asks the clinician to repeat questions. She states she was "told to come here" but is
unsure why. Which response by the PMHNP BEST demonstrates trauma-informed care
principles?
A. "You seem uncomfortable. Let's reschedule when you're ready to talk."
B. "I notice you seem hesitant. Would you like to tell me what would help you feel safer?"
C. "Your answers are vague. I need specific details to help you."
D. "Who told you to come here? I need to know before we proceed."
Correct Answer: B
Rationale: Trauma-informed care emphasizes safety, trustworthiness, choice,
collaboration, and empowerment. Option B demonstrates these principles by
acknowledging the patient's discomfort, offering autonomy, and creating psychological
safety. Option A abandons the encounter. Option C is confrontational. Option D is
interrogative and may retraumatize.
, Question 5
A 67-year-old man with a history of hypertension and diabetes presents with a 6-month
history of progressive memory loss, difficulty finding words, and getting lost in familiar
neighborhoods. His wife notes he has become increasingly irritable and apathetic. MRI
shows cortical atrophy and white matter changes. Which assessment tool is MOST
appropriate to evaluate his cognitive decline?
A. Montreal Cognitive Assessment (MoCA)
B. Mini-Mental State Examination (MMSE)
C. Geriatric Depression Scale (GDS-15)
D. Clock Drawing Test alone
Correct Answer: A
Rationale: The MoCA is more sensitive than the MMSE for detecting mild cognitive
impairment and early dementia, assessing executive function, attention, and
visuospatial abilities. While the MMSE (B) is widely used, it has ceiling effects in mild
impairment. The GDS-15 (C) screens for depression, not cognition. The Clock Drawing
Test (D) alone is insufficient for comprehensive cognitive evaluation.
Question 6
A 14-year-old adolescent is referred by his school counselor for declining grades,
irritability, and social withdrawal over the past 3 months. He reports difficulty falling
asleep and states, "I just don't care anymore." Which screening instrument is MOST
appropriate for initial assessment?
A. Patient Health Questionnaire-9 (PHQ-9)
B. Columbia Suicide Severity Rating Scale (C-SSRS)
C. Generalized Anxiety Disorder-7 (GAD-7)
D. Vanderbilt ADHD Diagnostic Rating Scale
Correct Answer: A
