LMR Georgette’s PMHNP
Certification Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A 28-year-old patient reports two weeks of depressed mood, loss
of interest, fatigue, insomnia, poor concentration, and feelings of
worthlessness. Symptoms significantly impair occupational
functioning. Which diagnosis is most appropriate?
A. Persistent depressive disorder
B. Adjustment disorder with depressed mood
C. Major depressive disorder
D. Cyclothymic disorder
Answer: C. Major depressive disorder
Rationale: Major depressive disorder is characterized by at least five
depressive symptoms occurring during the same two-week period,
including depressed mood or loss of interest/pleasure, with clinically
significant distress or impairment. The presentation described meets
these criteria. Persistent depressive disorder requires a substantially
longer duration, while adjustment disorder requires an identifiable
stressor with symptoms that do not meet criteria for another disorder.
2. Which neurotransmitter system is most directly associated with the
therapeutic action of selective serotonin reuptake inhibitors?
,A. Dopamine
B. Serotonin
C. Acetylcholine
D. Glutamate
Answer: B. Serotonin
Rationale: SSRIs primarily inhibit the serotonin transporter,
increasing serotonin availability in the synaptic cleft. Common SSRIs
include fluoxetine, sertraline, escitalopram, paroxetine, and
citalopram. Although downstream effects involve multiple
neurotransmitter systems, serotonergic modulation is the primary
pharmacologic mechanism.
3. A patient taking lithium develops coarse tremor, vomiting,
diarrhea, ataxia, and confusion. What is the priority interpretation?
A. Expected therapeutic effects
B. Serotonin syndrome
C. Neuroleptic malignant syndrome
D. Lithium toxicity
Answer: D. Lithium toxicity
Rationale: Coarse tremor, gastrointestinal symptoms, ataxia,
confusion, and neurologic changes are concerning for lithium toxicity.
Lithium has a narrow therapeutic index, and toxicity can become
serious or life-threatening. Dehydration, renal impairment, sodium
depletion, and interacting medications can increase lithium
concentrations. The medication should be withheld while urgent
clinical assessment and serum lithium testing are arranged.
4. Which medication is generally considered a first-line
pharmacologic option for generalized anxiety disorder?
,A. An SSRI
B. A stimulant
C. A typical antipsychotic
D. A mood stabilizer only
Answer: A. An SSRI
Rationale: SSRIs are commonly used as first-line pharmacologic
treatment for generalized anxiety disorder. SNRIs are also first-line
options. Treatment should be individualized based on comorbidities,
adverse-effect profiles, previous response, and patient preference.
Benzodiazepines may provide short-term relief but are generally not
preferred as the primary long-term treatment because of dependence,
tolerance, and other risks.
5. A patient with bipolar I disorder presents with elevated mood,
decreased need for sleep, grandiosity, pressured speech, and
impulsive spending lasting 10 days with marked functional
impairment. Which episode is most consistent with this
presentation?
A. Hypomanic episode
B. Mixed anxiety episode
C. Manic episode
D. Cyclothymic episode
Answer: C. Manic episode
Rationale: Bipolar I disorder requires at least one manic episode.
Mania involves a distinct period of abnormally elevated, expansive, or
irritable mood accompanied by increased energy and associated
symptoms such as decreased need for sleep, grandiosity, pressured
speech, and risky behavior. Marked impairment, hospitalization, or
psychotic features may occur.
, 6. Which finding most strongly suggests serotonin syndrome?
A. Bradycardia and hypothermia
B. Lead-pipe rigidity and hyperthermia
C. Isolated dry mouth
D. Clonus, hyperreflexia, agitation, and hyperthermia
Answer: D. Clonus, hyperreflexia, agitation, and hyperthermia
Rationale: Serotonin syndrome results from excessive serotonergic
activity and classically includes mental-status changes, autonomic
instability, and neuromuscular abnormalities. Hyperreflexia and
clonus are particularly useful distinguishing findings. Causes include
combinations or excessive doses of serotonergic medications.
Management involves stopping serotonergic agents, supportive care,
and treatment appropriate to severity.
7. A patient taking an antipsychotic develops severe muscle rigidity,
fever, altered mental status, autonomic instability, and elevated
creatine kinase. What condition should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Acute dystonia
D. Panic disorder
Answer: A. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a potentially life-
threatening reaction associated particularly with dopamine-blocking
medications. Cardinal features include severe rigidity, hyperthermia,
altered mental status, autonomic instability, and elevated creatine
kinase. Immediate discontinuation of the causative medication and
urgent medical management are required.
Certification Questions And Correct
Answers (Verified Answers) Plus
Rationales 2026 Q&A | Instant
Download Pdf
1. A 28-year-old patient reports two weeks of depressed mood, loss
of interest, fatigue, insomnia, poor concentration, and feelings of
worthlessness. Symptoms significantly impair occupational
functioning. Which diagnosis is most appropriate?
A. Persistent depressive disorder
B. Adjustment disorder with depressed mood
C. Major depressive disorder
D. Cyclothymic disorder
Answer: C. Major depressive disorder
Rationale: Major depressive disorder is characterized by at least five
depressive symptoms occurring during the same two-week period,
including depressed mood or loss of interest/pleasure, with clinically
significant distress or impairment. The presentation described meets
these criteria. Persistent depressive disorder requires a substantially
longer duration, while adjustment disorder requires an identifiable
stressor with symptoms that do not meet criteria for another disorder.
2. Which neurotransmitter system is most directly associated with the
therapeutic action of selective serotonin reuptake inhibitors?
,A. Dopamine
B. Serotonin
C. Acetylcholine
D. Glutamate
Answer: B. Serotonin
Rationale: SSRIs primarily inhibit the serotonin transporter,
increasing serotonin availability in the synaptic cleft. Common SSRIs
include fluoxetine, sertraline, escitalopram, paroxetine, and
citalopram. Although downstream effects involve multiple
neurotransmitter systems, serotonergic modulation is the primary
pharmacologic mechanism.
3. A patient taking lithium develops coarse tremor, vomiting,
diarrhea, ataxia, and confusion. What is the priority interpretation?
A. Expected therapeutic effects
B. Serotonin syndrome
C. Neuroleptic malignant syndrome
D. Lithium toxicity
Answer: D. Lithium toxicity
Rationale: Coarse tremor, gastrointestinal symptoms, ataxia,
confusion, and neurologic changes are concerning for lithium toxicity.
Lithium has a narrow therapeutic index, and toxicity can become
serious or life-threatening. Dehydration, renal impairment, sodium
depletion, and interacting medications can increase lithium
concentrations. The medication should be withheld while urgent
clinical assessment and serum lithium testing are arranged.
4. Which medication is generally considered a first-line
pharmacologic option for generalized anxiety disorder?
,A. An SSRI
B. A stimulant
C. A typical antipsychotic
D. A mood stabilizer only
Answer: A. An SSRI
Rationale: SSRIs are commonly used as first-line pharmacologic
treatment for generalized anxiety disorder. SNRIs are also first-line
options. Treatment should be individualized based on comorbidities,
adverse-effect profiles, previous response, and patient preference.
Benzodiazepines may provide short-term relief but are generally not
preferred as the primary long-term treatment because of dependence,
tolerance, and other risks.
5. A patient with bipolar I disorder presents with elevated mood,
decreased need for sleep, grandiosity, pressured speech, and
impulsive spending lasting 10 days with marked functional
impairment. Which episode is most consistent with this
presentation?
A. Hypomanic episode
B. Mixed anxiety episode
C. Manic episode
D. Cyclothymic episode
Answer: C. Manic episode
Rationale: Bipolar I disorder requires at least one manic episode.
Mania involves a distinct period of abnormally elevated, expansive, or
irritable mood accompanied by increased energy and associated
symptoms such as decreased need for sleep, grandiosity, pressured
speech, and risky behavior. Marked impairment, hospitalization, or
psychotic features may occur.
, 6. Which finding most strongly suggests serotonin syndrome?
A. Bradycardia and hypothermia
B. Lead-pipe rigidity and hyperthermia
C. Isolated dry mouth
D. Clonus, hyperreflexia, agitation, and hyperthermia
Answer: D. Clonus, hyperreflexia, agitation, and hyperthermia
Rationale: Serotonin syndrome results from excessive serotonergic
activity and classically includes mental-status changes, autonomic
instability, and neuromuscular abnormalities. Hyperreflexia and
clonus are particularly useful distinguishing findings. Causes include
combinations or excessive doses of serotonergic medications.
Management involves stopping serotonergic agents, supportive care,
and treatment appropriate to severity.
7. A patient taking an antipsychotic develops severe muscle rigidity,
fever, altered mental status, autonomic instability, and elevated
creatine kinase. What condition should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Acute dystonia
D. Panic disorder
Answer: A. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a potentially life-
threatening reaction associated particularly with dopamine-blocking
medications. Cardinal features include severe rigidity, hyperthermia,
altered mental status, autonomic instability, and elevated creatine
kinase. Immediate discontinuation of the causative medication and
urgent medical management are required.
