LMR Georgette’s PMHNP Certification
REAL Exam – Complete 100-Question
Study Guide with Verified Answers and
Rationales (2026 Edition)
Overview:
This comprehensive study guide is designed for nurse practitioners preparing for the Psychiatric-
Mental Health Nurse Practitioner (PMHNP) certification exam. It includes:
100 carefully curated questions covering key PMHNP content areas including
psychiatric disorders, psychopharmacology, therapeutic modalities, and clinical decision-
making.
Verified correct answers for each question to reinforce learning and accuracy.
Detailed rationales explaining the reasoning behind each answer, helping deepen
understanding of core concepts.
High-yield topics including mood disorders, anxiety disorders, psychotic disorders,
personality disorders, child/adolescent psychiatry, and substance use disorders.
Evidence-based practice recommendations, aligning with current PMHNP standards
and guidelines.
Study-friendly format for quick review, practice exams, and confidence building.
1. Which neurotransmitter is most closely associated with depression?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. Acetylcholine
Answer: C
Rationale: Serotonin deficiency is strongly linked to depressive symptoms; many
antidepressants (SSRIs) target serotonin reuptake.
,2. First-line pharmacologic treatment for generalized anxiety disorder (GAD)
is:
A. Benzodiazepines
B. SSRIs
C. MAO inhibitors
D. Tricyclic antidepressants
Answer: B
Rationale: SSRIs (e.g., sertraline, escitalopram) are first-line for GAD due to
efficacy and safety.
3. Which disorder is characterized by persistent feelings of sadness lasting at
least 2 weeks?
A. Major depressive disorder
B. Bipolar I disorder
C. Dysthymia
D. Cyclothymia
Answer: A
Rationale: MDD diagnosis requires ≥2 weeks of depressed mood or anhedonia
plus associated symptoms.
4. Which lab test is necessary before starting lithium therapy?
A. CBC
B. Liver function tests
C. Serum creatinine and thyroid function
D. Blood glucose
Answer: C
Rationale: Lithium affects renal and thyroid function; baseline labs are essential.
,5. A patient presents with auditory hallucinations and delusions for 1 month.
Most likely diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Brief psychotic disorder
D. Bipolar disorder
Answer: C
Rationale: Brief psychotic disorder lasts 1 day to 1 month, whereas schizophrenia
requires ≥6 months.
6. Which medication class is first-line for acute mania?
A. SSRIs
B. Mood stabilizers (e.g., lithium, valproate)
C. Benzodiazepines
D. MAO inhibitors
Answer: B
Rationale: Mood stabilizers control mania; lithium and valproate are commonly
used.
7. Which therapy focuses on identifying and modifying maladaptive thoughts?
A. Psychoanalysis
B. Cognitive Behavioral Therapy (CBT)
C. Interpersonal Therapy (IPT)
D. Motivational Interviewing
Answer: B
Rationale: CBT targets negative thought patterns to improve mood and behavior.
8. Which personality disorder is characterized by attention-seeking and
excessive emotionality?
, A. Narcissistic
B. Histrionic
C. Borderline
D. Antisocial
Answer: B
Rationale: Histrionic personality disorder involves dramatic, attention-seeking
behavior.
9. Which symptom is part of the positive symptoms of schizophrenia?
A. Flat affect
B. Alogia
C. Hallucinations
D. Anhedonia
Answer: C
Rationale: Positive symptoms include hallucinations, delusions, and disorganized
speech; negative symptoms involve affective flattening and social withdrawal.
10. The mechanism of action of SSRIs is:
A. Dopamine receptor antagonism
B. Inhibition of serotonin reuptake
C. MAO inhibition
D. GABA enhancement
Answer: B
Rationale: SSRIs prevent reuptake of serotonin, increasing its synaptic
availability.
11. First-line treatment for PTSD includes:
A. Benzodiazepines
B. SSRIs
REAL Exam – Complete 100-Question
Study Guide with Verified Answers and
Rationales (2026 Edition)
Overview:
This comprehensive study guide is designed for nurse practitioners preparing for the Psychiatric-
Mental Health Nurse Practitioner (PMHNP) certification exam. It includes:
100 carefully curated questions covering key PMHNP content areas including
psychiatric disorders, psychopharmacology, therapeutic modalities, and clinical decision-
making.
Verified correct answers for each question to reinforce learning and accuracy.
Detailed rationales explaining the reasoning behind each answer, helping deepen
understanding of core concepts.
High-yield topics including mood disorders, anxiety disorders, psychotic disorders,
personality disorders, child/adolescent psychiatry, and substance use disorders.
Evidence-based practice recommendations, aligning with current PMHNP standards
and guidelines.
Study-friendly format for quick review, practice exams, and confidence building.
1. Which neurotransmitter is most closely associated with depression?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. Acetylcholine
Answer: C
Rationale: Serotonin deficiency is strongly linked to depressive symptoms; many
antidepressants (SSRIs) target serotonin reuptake.
,2. First-line pharmacologic treatment for generalized anxiety disorder (GAD)
is:
A. Benzodiazepines
B. SSRIs
C. MAO inhibitors
D. Tricyclic antidepressants
Answer: B
Rationale: SSRIs (e.g., sertraline, escitalopram) are first-line for GAD due to
efficacy and safety.
3. Which disorder is characterized by persistent feelings of sadness lasting at
least 2 weeks?
A. Major depressive disorder
B. Bipolar I disorder
C. Dysthymia
D. Cyclothymia
Answer: A
Rationale: MDD diagnosis requires ≥2 weeks of depressed mood or anhedonia
plus associated symptoms.
4. Which lab test is necessary before starting lithium therapy?
A. CBC
B. Liver function tests
C. Serum creatinine and thyroid function
D. Blood glucose
Answer: C
Rationale: Lithium affects renal and thyroid function; baseline labs are essential.
,5. A patient presents with auditory hallucinations and delusions for 1 month.
Most likely diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Brief psychotic disorder
D. Bipolar disorder
Answer: C
Rationale: Brief psychotic disorder lasts 1 day to 1 month, whereas schizophrenia
requires ≥6 months.
6. Which medication class is first-line for acute mania?
A. SSRIs
B. Mood stabilizers (e.g., lithium, valproate)
C. Benzodiazepines
D. MAO inhibitors
Answer: B
Rationale: Mood stabilizers control mania; lithium and valproate are commonly
used.
7. Which therapy focuses on identifying and modifying maladaptive thoughts?
A. Psychoanalysis
B. Cognitive Behavioral Therapy (CBT)
C. Interpersonal Therapy (IPT)
D. Motivational Interviewing
Answer: B
Rationale: CBT targets negative thought patterns to improve mood and behavior.
8. Which personality disorder is characterized by attention-seeking and
excessive emotionality?
, A. Narcissistic
B. Histrionic
C. Borderline
D. Antisocial
Answer: B
Rationale: Histrionic personality disorder involves dramatic, attention-seeking
behavior.
9. Which symptom is part of the positive symptoms of schizophrenia?
A. Flat affect
B. Alogia
C. Hallucinations
D. Anhedonia
Answer: C
Rationale: Positive symptoms include hallucinations, delusions, and disorganized
speech; negative symptoms involve affective flattening and social withdrawal.
10. The mechanism of action of SSRIs is:
A. Dopamine receptor antagonism
B. Inhibition of serotonin reuptake
C. MAO inhibition
D. GABA enhancement
Answer: B
Rationale: SSRIs prevent reuptake of serotonin, increasing its synaptic
availability.
11. First-line treatment for PTSD includes:
A. Benzodiazepines
B. SSRIs
