I extend the formulation of pseudo-Hermitian quantum mechanics to η(+)-pseudo-Hermitian Hamiltonian operators H with an unbounded metric operator η(+). In particular, I give the details of the construction of the physical Hilbert space, observables and equivalent Hermitian Hamiltonian for the case that H has a real and discrete spectrum and its eigenvectors belong to the domain of η(+) and consequently √η(+).