LMR Georgette’s PMHNP Certification REAL 2025”2026 EXAM REVIEW
150 QUESTIONS AND CORRECT ANSWERS WITH RATIONALES
GUARANTEE A+ GRADE PASSMARK
1. Which of the following is a first-line treatment for major depressive disorder in adults?
A) Benzodiazepines
B) Haloperidol
C) SSRIs (Selective Serotonin Reuptake Inhibitors)
D) Lithium
Rationale: SSRIs are the recommended first-line pharmacologic treatment due to efficacy and
tolerability.
2. A patient presents with persistent sadness, anhedonia, and fatigue for more than 2 weeks.
The most likely diagnosis is:
A) Generalized Anxiety Disorder
B) Major Depressive Disorder
C) Bipolar I Disorder
D) Adjustment Disorder
Rationale: Symptoms lasting at least 2 weeks with functional impairment indicate MDD.
3. Which medication requires regular monitoring of thyroid and liver function?
A) Fluoxetine
B) Lithium
C) Sertraline
D) Bupropion
Rationale: Lithium can affect renal, thyroid, and hepatic function; regular labs are essential.
4. A 25-year-old patient reports excessive worry, restlessness, and difficulty concentrating. The
most likely diagnosis is:
A) Major Depressive Disorder
B) Generalized Anxiety Disorder
C) Schizophrenia
D) Panic Disorder
Rationale: Persistent excessive worry and associated symptoms for at least 6 months suggest
GAD.
,5. Which antipsychotic is FDA-approved for treatment-resistant depression augmentation?
A) Haloperidol
B) Aripiprazole
C) Risperidone (low dose)
D) Clozapine
Rationale: Aripiprazole is approved as an adjunct to antidepressants in resistant depression.
6. A patient with bipolar I disorder presents in a manic episode. The most appropriate initial
pharmacologic treatment is:
A) SSRI
B) Mood stabilizer (e.g., lithium or valproate)
C) Benzodiazepine only
D) Antidepressant monotherapy
Rationale: Antidepressants alone can worsen mania; mood stabilizers are first-line.
7. Which of the following is a hallmark feature of schizophrenia?
A) Excessive worry
B) Delusions and hallucinations
C) Rapid mood swings
D) Memory loss
Rationale: Schizophrenia is characterized by psychotic symptoms such as delusions and
hallucinations.
8. What is the first-line therapy for PTSD?
A) Benzodiazepines
B) Trauma-focused psychotherapy (e.g., CBT, EMDR)
C) Antipsychotics
D) Mood stabilizers
Rationale: Evidence supports trauma-focused therapy as first-line treatment for PTSD.
9. Which side effect is most associated with atypical antipsychotics?
A) Dry mouth only
B) Sedation only
C) Metabolic syndrome (weight gain, dyslipidemia, hyperglycemia)
D) Alopecia
Rationale: Metabolic effects are common with atypical antipsychotics and require monitoring.
,10. Which of the following is a contraindication for bupropion use?
A) History of insomnia
B) Anxiety
C) Seizure disorder
D) Mild depression
Rationale: Bupropion lowers seizure threshold and is contraindicated in seizure disorders.
11. A 15-year-old patient presents with irritability, sleep disturbance, and social withdrawal.
Which diagnosis is most appropriate?
A) Bipolar I Disorder
B) Major Depressive Disorder (adolescent presentation)
C) ADHD
D) Schizophrenia
Rationale: Adolescents may present with irritability rather than sadness; MDD is common.
12. Which assessment tool is commonly used to screen for depression in adults?
A) MMSE
B) PHQ-9
C) GAD-7
D) CAGE
B) PHQ-9
Rationale: PHQ-9 is validated for adult depression screening and monitoring treatment
response.
13. Which intervention is recommended for acute suicidal ideation?
A) Start SSRI immediately
B) Encourage journaling
C) Ensure patient safety, assess risk, and consider hospitalization if needed
D) Schedule routine follow-up in 3 months
Rationale: Safety and immediate risk assessment are critical in suicidal ideation.
14. Which neurotransmitter is most associated with anxiety disorders?
A) Dopamine
B) GABA
, C) Acetylcholine
D) Histamine
Rationale: GABA dysfunction is implicated in anxiety disorders; benzodiazepines enhance GABA
activity.
15. The most common side effect of SSRIs is:
A) Hepatotoxicity
B) Gastrointestinal upset (nausea, diarrhea)
C) Seizures
D) Bradycardia
Rationale: SSRIs often cause mild GI upset, especially early in treatment.
16. Which disorder is characterized by persistent intrusive thoughts and repetitive behaviors?
A) PTSD
B) Obsessive-Compulsive Disorder
C) Bipolar II Disorder
D) Panic Disorder
Rationale: OCD involves obsessions (intrusive thoughts) and compulsions (repetitive behaviors).
17. Which of the following medications requires monitoring of serum levels for efficacy and
toxicity?
A) Sertraline
B) Lithium
C) Fluoxetine
D) Buspirone
Rationale: Lithium has a narrow therapeutic window; serum levels must be monitored.
18. A patient with chronic insomnia and anxiety may benefit most from:
A) Benzodiazepine PRN for short-term use
B) Long-term barbiturates
C) Cognitive-behavioral therapy for insomnia (CBT-I)
D) SSRIs only
Rationale: CBT-I is first-line for chronic insomnia; benzodiazepines are short-term adjuncts.
150 QUESTIONS AND CORRECT ANSWERS WITH RATIONALES
GUARANTEE A+ GRADE PASSMARK
1. Which of the following is a first-line treatment for major depressive disorder in adults?
A) Benzodiazepines
B) Haloperidol
C) SSRIs (Selective Serotonin Reuptake Inhibitors)
D) Lithium
Rationale: SSRIs are the recommended first-line pharmacologic treatment due to efficacy and
tolerability.
2. A patient presents with persistent sadness, anhedonia, and fatigue for more than 2 weeks.
The most likely diagnosis is:
A) Generalized Anxiety Disorder
B) Major Depressive Disorder
C) Bipolar I Disorder
D) Adjustment Disorder
Rationale: Symptoms lasting at least 2 weeks with functional impairment indicate MDD.
3. Which medication requires regular monitoring of thyroid and liver function?
A) Fluoxetine
B) Lithium
C) Sertraline
D) Bupropion
Rationale: Lithium can affect renal, thyroid, and hepatic function; regular labs are essential.
4. A 25-year-old patient reports excessive worry, restlessness, and difficulty concentrating. The
most likely diagnosis is:
A) Major Depressive Disorder
B) Generalized Anxiety Disorder
C) Schizophrenia
D) Panic Disorder
Rationale: Persistent excessive worry and associated symptoms for at least 6 months suggest
GAD.
,5. Which antipsychotic is FDA-approved for treatment-resistant depression augmentation?
A) Haloperidol
B) Aripiprazole
C) Risperidone (low dose)
D) Clozapine
Rationale: Aripiprazole is approved as an adjunct to antidepressants in resistant depression.
6. A patient with bipolar I disorder presents in a manic episode. The most appropriate initial
pharmacologic treatment is:
A) SSRI
B) Mood stabilizer (e.g., lithium or valproate)
C) Benzodiazepine only
D) Antidepressant monotherapy
Rationale: Antidepressants alone can worsen mania; mood stabilizers are first-line.
7. Which of the following is a hallmark feature of schizophrenia?
A) Excessive worry
B) Delusions and hallucinations
C) Rapid mood swings
D) Memory loss
Rationale: Schizophrenia is characterized by psychotic symptoms such as delusions and
hallucinations.
8. What is the first-line therapy for PTSD?
A) Benzodiazepines
B) Trauma-focused psychotherapy (e.g., CBT, EMDR)
C) Antipsychotics
D) Mood stabilizers
Rationale: Evidence supports trauma-focused therapy as first-line treatment for PTSD.
9. Which side effect is most associated with atypical antipsychotics?
A) Dry mouth only
B) Sedation only
C) Metabolic syndrome (weight gain, dyslipidemia, hyperglycemia)
D) Alopecia
Rationale: Metabolic effects are common with atypical antipsychotics and require monitoring.
,10. Which of the following is a contraindication for bupropion use?
A) History of insomnia
B) Anxiety
C) Seizure disorder
D) Mild depression
Rationale: Bupropion lowers seizure threshold and is contraindicated in seizure disorders.
11. A 15-year-old patient presents with irritability, sleep disturbance, and social withdrawal.
Which diagnosis is most appropriate?
A) Bipolar I Disorder
B) Major Depressive Disorder (adolescent presentation)
C) ADHD
D) Schizophrenia
Rationale: Adolescents may present with irritability rather than sadness; MDD is common.
12. Which assessment tool is commonly used to screen for depression in adults?
A) MMSE
B) PHQ-9
C) GAD-7
D) CAGE
B) PHQ-9
Rationale: PHQ-9 is validated for adult depression screening and monitoring treatment
response.
13. Which intervention is recommended for acute suicidal ideation?
A) Start SSRI immediately
B) Encourage journaling
C) Ensure patient safety, assess risk, and consider hospitalization if needed
D) Schedule routine follow-up in 3 months
Rationale: Safety and immediate risk assessment are critical in suicidal ideation.
14. Which neurotransmitter is most associated with anxiety disorders?
A) Dopamine
B) GABA
, C) Acetylcholine
D) Histamine
Rationale: GABA dysfunction is implicated in anxiety disorders; benzodiazepines enhance GABA
activity.
15. The most common side effect of SSRIs is:
A) Hepatotoxicity
B) Gastrointestinal upset (nausea, diarrhea)
C) Seizures
D) Bradycardia
Rationale: SSRIs often cause mild GI upset, especially early in treatment.
16. Which disorder is characterized by persistent intrusive thoughts and repetitive behaviors?
A) PTSD
B) Obsessive-Compulsive Disorder
C) Bipolar II Disorder
D) Panic Disorder
Rationale: OCD involves obsessions (intrusive thoughts) and compulsions (repetitive behaviors).
17. Which of the following medications requires monitoring of serum levels for efficacy and
toxicity?
A) Sertraline
B) Lithium
C) Fluoxetine
D) Buspirone
Rationale: Lithium has a narrow therapeutic window; serum levels must be monitored.
18. A patient with chronic insomnia and anxiety may benefit most from:
A) Benzodiazepine PRN for short-term use
B) Long-term barbiturates
C) Cognitive-behavioral therapy for insomnia (CBT-I)
D) SSRIs only
Rationale: CBT-I is first-line for chronic insomnia; benzodiazepines are short-term adjuncts.
