PMHNP Certification Exam 2026 | Psychiatric Mental Health NP
Q&A
A PMHNP is assessing a client with major depressive disorder who reports loss of pleasure in
activities, fatigue, and feelings of worthlessness for the past month. Which symptom is
considered a core feature of depression?
A. Hallucinations
B. Mania
C. Anhedonia
D. Flight of ideas
Answer: C. Anhedonia
Rationale: Anhedonia, or loss of interest and pleasure in previously enjoyable activities, is
one of the hallmark symptoms of major depressive disorder. Hallucinations are more
associated with psychotic disorders, while mania and flight of ideas are characteristic of
bipolar disorder.
A patient diagnosed with generalized anxiety disorder asks the PMHNP what physical
symptoms commonly occur with anxiety. Which response is most accurate?
A. “Anxiety only affects emotions.”
B. “Common symptoms include palpitations and muscle tension.”
C. “Anxiety mainly causes hallucinations.”
D. “Physical symptoms are uncommon.”
Answer: B. “Common symptoms include palpitations and muscle tension.”
Rationale: Anxiety disorders frequently present with physical symptoms such as sweating,
tachycardia, muscle tension, restlessness, and gastrointestinal distress. Anxiety affects both
the body and mind.
A client with schizophrenia is experiencing auditory hallucinations. Which nursing
intervention is most therapeutic?
A. Arguing that the voices are not real
B. Encouraging the patient to obey the voices
C. Acknowledging the experience without reinforcing the hallucination
D. Ignoring the patient’s report
Answer: C. Acknowledging the experience without reinforcing the hallucination
,Rationale: Therapeutic communication involves validating the patient’s feelings while
presenting reality. The PMHNP should avoid reinforcing delusions or hallucinations but
should not dismiss the client’s experience.
Which neurotransmitter is most associated with schizophrenia according to the dopamine
hypothesis?
A. Serotonin
B. Dopamine
C. Acetylcholine
D. GABA
Answer: B. Dopamine
Rationale: The dopamine hypothesis suggests that excess dopamine activity, especially in the
mesolimbic pathway, contributes to positive symptoms of schizophrenia such as
hallucinations and delusions.
A patient taking lithium for bipolar disorder reports tremors, diarrhea, and confusion. What
is the PMHNP’s priority action?
A. Reassure the patient these are expected effects
B. Advise the patient to skip one dose only
C. Assess for lithium toxicity and obtain serum levels
D. Encourage caffeine intake
Answer: C. Assess for lithium toxicity and obtain serum levels
Rationale: Tremors, diarrhea, and confusion may indicate lithium toxicity, which can become
life-threatening. Serum lithium levels should be checked immediately.
Which medication class is considered first-line treatment for obsessive-compulsive disorder
(OCD)?
A. Benzodiazepines
B. SSRIs
C. Mood stabilizers
D. Antipsychotics
Answer: B. SSRIs
Rationale: Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacologic
treatment for OCD and are often combined with cognitive behavioral therapy.
, A client with panic disorder suddenly develops chest pain, dizziness, and fear of dying. What
is the PMHNP’s initial intervention?
A. Leave the patient alone
B. Encourage deep, slow breathing
C. Restrain the patient
D. Administer stimulants
Answer: B. Encourage deep, slow breathing
Rationale: Panic attacks can cause hyperventilation and intense fear. Calm reassurance and
breathing techniques help reduce symptoms and promote relaxation.
Which symptom best differentiates mania from hypomania?
A. Elevated mood
B. Increased energy
C. Psychotic features and severe impairment
D. Decreased sleep
Answer: C. Psychotic features and severe impairment
Rationale: Mania causes marked functional impairment and may include psychosis, while
hypomania is less severe and does not significantly impair functioning.
A patient taking clozapine develops fever and sore throat. What laboratory test is the
priority?
A. Liver enzymes
B. Blood glucose
C. Absolute neutrophil count (ANC)
D. Potassium level
Answer: C. Absolute neutrophil count (ANC)
Rationale: Clozapine may cause agranulocytosis, a potentially fatal drop in white blood cells.
Fever and sore throat can indicate infection related to neutropenia.
Which defense mechanism involves refusing to accept reality?
A. Projection
B. Rationalization
Q&A
A PMHNP is assessing a client with major depressive disorder who reports loss of pleasure in
activities, fatigue, and feelings of worthlessness for the past month. Which symptom is
considered a core feature of depression?
A. Hallucinations
B. Mania
C. Anhedonia
D. Flight of ideas
Answer: C. Anhedonia
Rationale: Anhedonia, or loss of interest and pleasure in previously enjoyable activities, is
one of the hallmark symptoms of major depressive disorder. Hallucinations are more
associated with psychotic disorders, while mania and flight of ideas are characteristic of
bipolar disorder.
A patient diagnosed with generalized anxiety disorder asks the PMHNP what physical
symptoms commonly occur with anxiety. Which response is most accurate?
A. “Anxiety only affects emotions.”
B. “Common symptoms include palpitations and muscle tension.”
C. “Anxiety mainly causes hallucinations.”
D. “Physical symptoms are uncommon.”
Answer: B. “Common symptoms include palpitations and muscle tension.”
Rationale: Anxiety disorders frequently present with physical symptoms such as sweating,
tachycardia, muscle tension, restlessness, and gastrointestinal distress. Anxiety affects both
the body and mind.
A client with schizophrenia is experiencing auditory hallucinations. Which nursing
intervention is most therapeutic?
A. Arguing that the voices are not real
B. Encouraging the patient to obey the voices
C. Acknowledging the experience without reinforcing the hallucination
D. Ignoring the patient’s report
Answer: C. Acknowledging the experience without reinforcing the hallucination
,Rationale: Therapeutic communication involves validating the patient’s feelings while
presenting reality. The PMHNP should avoid reinforcing delusions or hallucinations but
should not dismiss the client’s experience.
Which neurotransmitter is most associated with schizophrenia according to the dopamine
hypothesis?
A. Serotonin
B. Dopamine
C. Acetylcholine
D. GABA
Answer: B. Dopamine
Rationale: The dopamine hypothesis suggests that excess dopamine activity, especially in the
mesolimbic pathway, contributes to positive symptoms of schizophrenia such as
hallucinations and delusions.
A patient taking lithium for bipolar disorder reports tremors, diarrhea, and confusion. What
is the PMHNP’s priority action?
A. Reassure the patient these are expected effects
B. Advise the patient to skip one dose only
C. Assess for lithium toxicity and obtain serum levels
D. Encourage caffeine intake
Answer: C. Assess for lithium toxicity and obtain serum levels
Rationale: Tremors, diarrhea, and confusion may indicate lithium toxicity, which can become
life-threatening. Serum lithium levels should be checked immediately.
Which medication class is considered first-line treatment for obsessive-compulsive disorder
(OCD)?
A. Benzodiazepines
B. SSRIs
C. Mood stabilizers
D. Antipsychotics
Answer: B. SSRIs
Rationale: Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacologic
treatment for OCD and are often combined with cognitive behavioral therapy.
, A client with panic disorder suddenly develops chest pain, dizziness, and fear of dying. What
is the PMHNP’s initial intervention?
A. Leave the patient alone
B. Encourage deep, slow breathing
C. Restrain the patient
D. Administer stimulants
Answer: B. Encourage deep, slow breathing
Rationale: Panic attacks can cause hyperventilation and intense fear. Calm reassurance and
breathing techniques help reduce symptoms and promote relaxation.
Which symptom best differentiates mania from hypomania?
A. Elevated mood
B. Increased energy
C. Psychotic features and severe impairment
D. Decreased sleep
Answer: C. Psychotic features and severe impairment
Rationale: Mania causes marked functional impairment and may include psychosis, while
hypomania is less severe and does not significantly impair functioning.
A patient taking clozapine develops fever and sore throat. What laboratory test is the
priority?
A. Liver enzymes
B. Blood glucose
C. Absolute neutrophil count (ANC)
D. Potassium level
Answer: C. Absolute neutrophil count (ANC)
Rationale: Clozapine may cause agranulocytosis, a potentially fatal drop in white blood cells.
Fever and sore throat can indicate infection related to neutropenia.
Which defense mechanism involves refusing to accept reality?
A. Projection
B. Rationalization
