LMR Georgette PMHNP Board Exam Review 2026/2027 – Complete
Exam-Actual Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
──────────────────────────────
SECTION 1: DSM-5-TR DIAGNOSIS & DIFFERENTIAL (Q1–Q8)
──────────────────────────────
Question 1
A 34-year-old woman presents to the PMHNP clinic with a 6-month history of persistent
worry about multiple domains including work performance, her children's safety, and
finances. She reports difficulty controlling the worry, muscle tension, fatigue, and sleep
disturbance. She denies panic attacks, mood episodes, or substance use. Her medical
history is unremarkable. What is the most likely diagnosis?
A. Panic Disorder
B. Major Depressive Disorder
C. Generalized Anxiety Disorder ✓
D. Social Anxiety Disorder
Correct Answer: C
Rationale:
GAD is characterized by excessive anxiety and worry about multiple domains occurring
more days than not for at least 6 months, accompanied by difficulty controlling worry
and physical symptoms (muscle tension, fatigue, sleep disturbance). Panic disorder
requires recurrent unexpected panic attacks. MDD requires persistent depressed mood
or anhedonia. Social anxiety is limited to social/performance situations.
Question 2
,A 28-year-old man is evaluated after his wife reports he has become increasingly
suspicious over the past year. He believes neighbors are monitoring his movements
through hidden cameras, hears his name called when alone, and has quit his job
because he thinks coworkers are plotting against him. He denies depressed mood or
elevated energy. His affect is flat. He has no substance use history. What is the most
likely diagnosis?
A. Schizoaffective Disorder
B. Delusional Disorder
C. Schizophrenia ✓
D. Bipolar I Disorder with Psychotic Features
Correct Answer: C
Rationale:
This presentation meets DSM-5-TR criteria for schizophrenia: two or more characteristic
symptoms (delusions, hallucinations, disorganized speech implied by flat affect and
occupational decline) present for at least 6 months with significant functional
impairment. Schizoaffective requires a mood episode concurrent with psychotic
symptoms. Delusional disorder lacks hallucinations and functional decline. Bipolar I
requires a manic episode.
Question 3
A 42-year-old woman presents with a 2-week history of depressed mood, anhedonia,
hypersomnia, psychomotor retardation, and feelings of worthlessness. She reports
similar episodes every 2-3 years since age 25, each lasting 6-8 weeks, with full
remission between episodes. She denies elevated or irritable mood periods. What
specifier best characterizes this presentation?
A. With Peripartum Onset
B. With Seasonal Pattern
C. With Recurrent Episodes ✓
,D. With Psychotic Features
Correct Answer: C
Rationale:
The "with recurrent episodes" specifier applies when there are at least two distinct
MDEs separated by at least 2 months of remission. This patient has a clear pattern of
recurrent depressive episodes with full inter-episode recovery. There is no evidence of
seasonal pattern, peripartum timing, or psychotic features.
Question 4
A 19-year-old college student is brought to the emergency department by campus police
after being found wandering campus at 3 AM wearing only shorts in December. He is
agitated, speaking rapidly, and claims he has discovered the "unified theory of
everything." He has not slept in 4 days, has maxed out his credit cards on electronics,
and was discharged from a psychiatric hospital 3 months ago after a similar episode.
What is the most likely diagnosis?
A. Bipolar II Disorder
B. Bipolar I Disorder ✓
C. Cyclothymic Disorder
D. Schizoaffective Disorder, Bipolar Type
Correct Answer: B
Rationale:
This presentation meets criteria for Bipolar I Disorder: a current manic episode
(elevated/expansive mood, decreased need for sleep, pressured speech, grandiosity,
excessive spending, psychomotor agitation) with previous hospitalization for a manic
episode. Bipolar II requires hypomania and major depression. Cyclothymia requires 2
years of subthreshold symptoms. Schizoaffective requires mood symptoms only during
active psychotic periods.
, Question 5
A 31-year-old veteran presents with recurrent intrusive memories of combat,
nightmares, hypervigilance, exaggerated startle response, and avoidance of crowded
places. Symptoms began 8 months after deployment and have persisted for 14 months.
He denies substance use. What is the most likely diagnosis?
A. Acute Stress Disorder
B. Adjustment Disorder
C. Posttraumatic Stress Disorder ✓
D. Generalized Anxiety Disorder
Correct Answer: C
Rationale:
PTSD requires exposure to actual or threatened death/serious injury, intrusive
symptoms, avoidance, negative alterations in cognition/mood, and marked alterations
in arousal/reactivity, lasting more than 1 month. This patient's symptoms began after
combat exposure and have persisted for 14 months. Acute stress disorder lasts 3 days
to 1 month. Adjustment disorder follows a stressor but lacks PTSD-specific symptoms.
GAD lacks trauma exposure criterion.
Question 6
A 25-year-old woman reports recurrent episodes of binge eating (consuming a large
pizza and a pint of ice cream in 2 hours) followed by self-induced vomiting. She
exercises excessively and uses laxatives. She is of normal weight but is preoccupied
with body shape and weight. What is the most likely diagnosis?
A. Binge-Eating Disorder
B. Bulimia Nervosa ✓
C. Anorexia Nervosa, Binge/Purge Type
D. Avoidant/Restrictive Food Intake Disorder
Correct Answer: B
Exam-Actual Questions with Detailed Rationales | 100% Verified –
Pass Guaranteed – A+ Graded
──────────────────────────────
SECTION 1: DSM-5-TR DIAGNOSIS & DIFFERENTIAL (Q1–Q8)
──────────────────────────────
Question 1
A 34-year-old woman presents to the PMHNP clinic with a 6-month history of persistent
worry about multiple domains including work performance, her children's safety, and
finances. She reports difficulty controlling the worry, muscle tension, fatigue, and sleep
disturbance. She denies panic attacks, mood episodes, or substance use. Her medical
history is unremarkable. What is the most likely diagnosis?
A. Panic Disorder
B. Major Depressive Disorder
C. Generalized Anxiety Disorder ✓
D. Social Anxiety Disorder
Correct Answer: C
Rationale:
GAD is characterized by excessive anxiety and worry about multiple domains occurring
more days than not for at least 6 months, accompanied by difficulty controlling worry
and physical symptoms (muscle tension, fatigue, sleep disturbance). Panic disorder
requires recurrent unexpected panic attacks. MDD requires persistent depressed mood
or anhedonia. Social anxiety is limited to social/performance situations.
Question 2
,A 28-year-old man is evaluated after his wife reports he has become increasingly
suspicious over the past year. He believes neighbors are monitoring his movements
through hidden cameras, hears his name called when alone, and has quit his job
because he thinks coworkers are plotting against him. He denies depressed mood or
elevated energy. His affect is flat. He has no substance use history. What is the most
likely diagnosis?
A. Schizoaffective Disorder
B. Delusional Disorder
C. Schizophrenia ✓
D. Bipolar I Disorder with Psychotic Features
Correct Answer: C
Rationale:
This presentation meets DSM-5-TR criteria for schizophrenia: two or more characteristic
symptoms (delusions, hallucinations, disorganized speech implied by flat affect and
occupational decline) present for at least 6 months with significant functional
impairment. Schizoaffective requires a mood episode concurrent with psychotic
symptoms. Delusional disorder lacks hallucinations and functional decline. Bipolar I
requires a manic episode.
Question 3
A 42-year-old woman presents with a 2-week history of depressed mood, anhedonia,
hypersomnia, psychomotor retardation, and feelings of worthlessness. She reports
similar episodes every 2-3 years since age 25, each lasting 6-8 weeks, with full
remission between episodes. She denies elevated or irritable mood periods. What
specifier best characterizes this presentation?
A. With Peripartum Onset
B. With Seasonal Pattern
C. With Recurrent Episodes ✓
,D. With Psychotic Features
Correct Answer: C
Rationale:
The "with recurrent episodes" specifier applies when there are at least two distinct
MDEs separated by at least 2 months of remission. This patient has a clear pattern of
recurrent depressive episodes with full inter-episode recovery. There is no evidence of
seasonal pattern, peripartum timing, or psychotic features.
Question 4
A 19-year-old college student is brought to the emergency department by campus police
after being found wandering campus at 3 AM wearing only shorts in December. He is
agitated, speaking rapidly, and claims he has discovered the "unified theory of
everything." He has not slept in 4 days, has maxed out his credit cards on electronics,
and was discharged from a psychiatric hospital 3 months ago after a similar episode.
What is the most likely diagnosis?
A. Bipolar II Disorder
B. Bipolar I Disorder ✓
C. Cyclothymic Disorder
D. Schizoaffective Disorder, Bipolar Type
Correct Answer: B
Rationale:
This presentation meets criteria for Bipolar I Disorder: a current manic episode
(elevated/expansive mood, decreased need for sleep, pressured speech, grandiosity,
excessive spending, psychomotor agitation) with previous hospitalization for a manic
episode. Bipolar II requires hypomania and major depression. Cyclothymia requires 2
years of subthreshold symptoms. Schizoaffective requires mood symptoms only during
active psychotic periods.
, Question 5
A 31-year-old veteran presents with recurrent intrusive memories of combat,
nightmares, hypervigilance, exaggerated startle response, and avoidance of crowded
places. Symptoms began 8 months after deployment and have persisted for 14 months.
He denies substance use. What is the most likely diagnosis?
A. Acute Stress Disorder
B. Adjustment Disorder
C. Posttraumatic Stress Disorder ✓
D. Generalized Anxiety Disorder
Correct Answer: C
Rationale:
PTSD requires exposure to actual or threatened death/serious injury, intrusive
symptoms, avoidance, negative alterations in cognition/mood, and marked alterations
in arousal/reactivity, lasting more than 1 month. This patient's symptoms began after
combat exposure and have persisted for 14 months. Acute stress disorder lasts 3 days
to 1 month. Adjustment disorder follows a stressor but lacks PTSD-specific symptoms.
GAD lacks trauma exposure criterion.
Question 6
A 25-year-old woman reports recurrent episodes of binge eating (consuming a large
pizza and a pint of ice cream in 2 hours) followed by self-induced vomiting. She
exercises excessively and uses laxatives. She is of normal weight but is preoccupied
with body shape and weight. What is the most likely diagnosis?
A. Binge-Eating Disorder
B. Bulimia Nervosa ✓
C. Anorexia Nervosa, Binge/Purge Type
D. Avoidant/Restrictive Food Intake Disorder
Correct Answer: B
