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APEA PMHNP COMPREHENSIVE PRACTICE
EXAMINATION 2026 PSYCHIATRIC-MENTAL
HEALTH NURSE PRACTITIONER
CERTIFICATION COMPLETE (125) CURRENT
TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
PMHNP
Prepare for the APEA PMHNP – Psychiatric Mental-Health Nurse
Practitioner Exam with focused review materials covering psychiatric
assessment & diagnosis, mood disorders, anxiety disorders, psychotic
disorders, personality disorders, trauma- and stressor-related disorders,
substance use disorders, neurocognitive disorders, and child/adolescent
and geriatric mental health considerations. Designed to build confidence
in conducting comprehensive psychiatric evaluations, formulating
accurate diagnoses, selecting appropriate pharmacologic and
nonpharmacologic interventions, and managing complex behavioral
health cases. Suitable for nurse practitioner students and candidates
preparing for the APEA PMHNP Psychiatric Mental-Health Nurse
Practitioner Exam.
MULTIPLE CHOICE.
SECTION 1: PSYCHIATRIC ASSESSMENT & DIAGNOSIS (Questions 1–
35)
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1. A charge nurse is discussing mental status exams with a newly
licensed nurse. Which statements indicate that the newly licensed
nurse has understood the teaching? (Select all that apply)
A) "To assess cognitive ability, I should ask the client to count backward
by sevens."
B) "To assess affect, I should observe the client's facial expression."
C) "To assess language ability, I should instruct the client to write a
sentence."
D) "To assess remote memory, I should have the client repeat a list of
objects."
E) "To assess the client's abstract thinking, I should ask the client to
identify our most recent presidents."
Correct answer: A, B, C
Rationale: Cognitive ability is assessed via serial 7s or spelling
"world" backward (A). Affect is observed via facial expression (B).
Language is assessed by sentence writing (C). Remote memory is
assessed with long-term recall, not by repeating a list which tests
immediate memory (D). Abstract thinking is tested by interpreting
proverbs or similarities, not by recall of facts which tests fund of
knowledge (E).
2. A 28-year-old patient presents with 2 weeks of depressed mood,
anhedonia, sleep disturbance, and suicidal ideation. Which
screening tool is most appropriate for initial assessment?
A) GAD-7
B) PHQ-9
C) CAGE questionnaire
D) AUDIT
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Correct answer: B. PHQ-9
Rationale: The PHQ-9 (Patient Health Questionnaire-9) is the most
appropriate screening tool for assessing depression severity. The
GAD-7 is for anxiety, the CAGE questionnaire and AUDIT are for
alcohol use disorders.
3. A 24-year-old client presents with difficulty sustaining attention,
frequent careless mistakes, fidgeting, interrupting others, and
impulsive decision-making. Symptoms have been present since
elementary school. Which assessment is most important for
confirming the diagnosis?
A) Symptom onset prior to age 12
B) Symptom onset in adulthood
C) Absence of hyperactivity
D) Presence of anxiety symptoms
Correct answer: A. Symptom onset prior to age 12
Rationale: DSM-5-TR diagnostic criteria for ADHD require several
inattentive or hyperactive-impulsive symptoms present before age
12 years. Retrospective assessment of childhood symptoms is
essential for differentiating adult-onset symptoms that may be
attributable to other conditions.
4. A 32-year-old client is brought to the emergency department by
police after being found wandering in traffic. The client is disheveled,
responding to internal stimuli, and unable to provide coherent
history. What is the priority assessment?
A) Complete blood count
B) Urine toxicology screen
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C) Immediate safety assessment and medical clearance
D) MRI of the brain
Correct answer: C. Immediate safety assessment and medical
clearance
Rationale: The priority is to ensure the client's immediate safety,
assess for medical emergencies, and obtain medical clearance
before conducting a psychiatric evaluation. Medical causes of
altered mental status must be ruled out first.
5. A 45-year-old patient with a history of major depressive disorder
presents with elevated mood, decreased need for sleep, grandiosity,
and impulsive spending for the past 5 days. The patient reports this is
"the best I've felt in years." What is the most likely diagnosis?
A) Major depressive disorder with atypical features
B) Bipolar I disorder, current episode manic
C) Cyclothymic disorder
D) Schizoaffective disorder
Correct answer: B. Bipolar I disorder, current episode manic
Rationale: The symptoms of elevated mood, decreased need for
sleep, grandiosity, and impulsivity lasting more than 4 days meet
criteria for a manic episode in Bipolar I disorder. The duration
distinguishes mania from hypomania (at least 4 days for hypomania,
7 days for mania).
6. A 16-year-old adolescent has lost 15 pounds in 2 months, has an
intense fear of gaining weight, and engages in excessive exercise.
The patient restricts food intake to fewer than 500 calories daily.
Which diagnosis is most likely?
APEA PMHNP COMPREHENSIVE PRACTICE
EXAMINATION 2026 PSYCHIATRIC-MENTAL
HEALTH NURSE PRACTITIONER
CERTIFICATION COMPLETE (125) CURRENT
TESTING QUESTIONS AND CORRECT
ANSWERS WITH DETAILED RATIONALES.
PMHNP
Prepare for the APEA PMHNP – Psychiatric Mental-Health Nurse
Practitioner Exam with focused review materials covering psychiatric
assessment & diagnosis, mood disorders, anxiety disorders, psychotic
disorders, personality disorders, trauma- and stressor-related disorders,
substance use disorders, neurocognitive disorders, and child/adolescent
and geriatric mental health considerations. Designed to build confidence
in conducting comprehensive psychiatric evaluations, formulating
accurate diagnoses, selecting appropriate pharmacologic and
nonpharmacologic interventions, and managing complex behavioral
health cases. Suitable for nurse practitioner students and candidates
preparing for the APEA PMHNP Psychiatric Mental-Health Nurse
Practitioner Exam.
MULTIPLE CHOICE.
SECTION 1: PSYCHIATRIC ASSESSMENT & DIAGNOSIS (Questions 1–
35)
, Page 2 of 66
1. A charge nurse is discussing mental status exams with a newly
licensed nurse. Which statements indicate that the newly licensed
nurse has understood the teaching? (Select all that apply)
A) "To assess cognitive ability, I should ask the client to count backward
by sevens."
B) "To assess affect, I should observe the client's facial expression."
C) "To assess language ability, I should instruct the client to write a
sentence."
D) "To assess remote memory, I should have the client repeat a list of
objects."
E) "To assess the client's abstract thinking, I should ask the client to
identify our most recent presidents."
Correct answer: A, B, C
Rationale: Cognitive ability is assessed via serial 7s or spelling
"world" backward (A). Affect is observed via facial expression (B).
Language is assessed by sentence writing (C). Remote memory is
assessed with long-term recall, not by repeating a list which tests
immediate memory (D). Abstract thinking is tested by interpreting
proverbs or similarities, not by recall of facts which tests fund of
knowledge (E).
2. A 28-year-old patient presents with 2 weeks of depressed mood,
anhedonia, sleep disturbance, and suicidal ideation. Which
screening tool is most appropriate for initial assessment?
A) GAD-7
B) PHQ-9
C) CAGE questionnaire
D) AUDIT
, Page 3 of 66
Correct answer: B. PHQ-9
Rationale: The PHQ-9 (Patient Health Questionnaire-9) is the most
appropriate screening tool for assessing depression severity. The
GAD-7 is for anxiety, the CAGE questionnaire and AUDIT are for
alcohol use disorders.
3. A 24-year-old client presents with difficulty sustaining attention,
frequent careless mistakes, fidgeting, interrupting others, and
impulsive decision-making. Symptoms have been present since
elementary school. Which assessment is most important for
confirming the diagnosis?
A) Symptom onset prior to age 12
B) Symptom onset in adulthood
C) Absence of hyperactivity
D) Presence of anxiety symptoms
Correct answer: A. Symptom onset prior to age 12
Rationale: DSM-5-TR diagnostic criteria for ADHD require several
inattentive or hyperactive-impulsive symptoms present before age
12 years. Retrospective assessment of childhood symptoms is
essential for differentiating adult-onset symptoms that may be
attributable to other conditions.
4. A 32-year-old client is brought to the emergency department by
police after being found wandering in traffic. The client is disheveled,
responding to internal stimuli, and unable to provide coherent
history. What is the priority assessment?
A) Complete blood count
B) Urine toxicology screen
, Page 4 of 66
C) Immediate safety assessment and medical clearance
D) MRI of the brain
Correct answer: C. Immediate safety assessment and medical
clearance
Rationale: The priority is to ensure the client's immediate safety,
assess for medical emergencies, and obtain medical clearance
before conducting a psychiatric evaluation. Medical causes of
altered mental status must be ruled out first.
5. A 45-year-old patient with a history of major depressive disorder
presents with elevated mood, decreased need for sleep, grandiosity,
and impulsive spending for the past 5 days. The patient reports this is
"the best I've felt in years." What is the most likely diagnosis?
A) Major depressive disorder with atypical features
B) Bipolar I disorder, current episode manic
C) Cyclothymic disorder
D) Schizoaffective disorder
Correct answer: B. Bipolar I disorder, current episode manic
Rationale: The symptoms of elevated mood, decreased need for
sleep, grandiosity, and impulsivity lasting more than 4 days meet
criteria for a manic episode in Bipolar I disorder. The duration
distinguishes mania from hypomania (at least 4 days for hypomania,
7 days for mania).
6. A 16-year-old adolescent has lost 15 pounds in 2 months, has an
intense fear of gaining weight, and engages in excessive exercise.
The patient restricts food intake to fewer than 500 calories daily.
Which diagnosis is most likely?
