REAL PMHNP ANCC Certification Exam:
Recommended 200 Practice Questions & Answers
Psychiatric-Mental Health Nurse Practitioner Board
Review – 2025-2026 Edition |
1. A patient with schizophrenia has been stable on risperidone for 2 years. Which
assessment finding warrants immediate concern?
A) Mild weight gain of 5 pounds over 6 months
B) Occasional dry mouth managed with hard candy
C) New-onset repetitive lip smacking and tongue thrusting
D) Sedation that improves with morning coffee
Answer: C
Rationale: Repetitive lip smacking and tongue thrusting are signs of tardive dyskinesia
(TD), a potentially irreversible movement disorder associated with long-term antipsychotic
use. This requires immediate evaluation using the AIMS scale. Weight gain and dry mouth
are common but less urgent; sedation is typical but manageable .
2. The PMHNP is evaluating a patient with bipolar I disorder who presents with
pressured speech, decreased need for sleep, and grandiose delusions. Which
medication is most appropriate for acute management?
A) Lithium monotherapy
B) Valproate plus an atypical antipsychotic
C) Sertraline monotherapy
D) Bupropion extended-release
Answer: B
Rationale: Acute mania is best treated with a mood stabilizer (valproate or lithium)
combined with an atypical antipsychotic (quetiapine, risperidone, or olanzapine).
Antidepressants like sertraline or bupropion may worsen mania and are not first-line for
acute episodes .
3. A 16-year-old patient reports recurrent, uncontrollable worries about school
performance and family safety for the past 8 months. She has difficulty sleeping and
concentrating. Which diagnosis is most likely?
A) Panic disorder
,B) Social anxiety disorder
C) Generalized anxiety disorder
D) Adjustment disorder with anxiety
Answer: C
Rationale: GAD is characterized by excessive, uncontrollable worry occurring more
days than not for ≥6 months, along with sleep disturbance and concentration difficulties.
Panic disorder involves discrete panic attacks; social anxiety involves fear of scrutiny;
adjustment disorder occurs within 3 months of a stressor .
4. The PMHNP is considering switching a patient from fluoxetine to phenelzine. What
is the minimum washout period required to avoid serotonin syndrome?
A) 7 days
B) 14 days
C) 21 days
D) 28 days
Answer: D
*Rationale: Fluoxetine has a long half-life due to its active metabolite norfluoxetine (up
to 16 days). A minimum 5-week (35 days) washout is recommended before starting an
MAOI. Four weeks (28 days) is the absolute minimum to prevent serotonin syndrome .*
5. A patient with chronic insomnia reports improved sleep with zolpidem but now
requires higher doses to achieve the same effect. Which term best describes this
phenomenon?
A) Tolerance
B) Dependence
C) Withdrawal
D) Kindling
Answer: A
Rationale: Tolerance is the need for increasing doses to achieve the same therapeutic
effect. Dependence refers to physiologic adaptation; withdrawal occurs when the drug is
stopped; kindling refers to sensitization to withdrawal seizures with repeated detoxifications
.
6. The PMHNP is treating a patient with posttraumatic stress disorder (PTSD) related
to military combat. Which psychotherapy is most strongly recommended as first-line
treatment?
A) Interpersonal therapy (IPT)
B) Supportive therapy
,C) Prolonged exposure therapy
D) Psychoanalytic therapy
Answer: C
Rationale: Prolonged exposure therapy and cognitive processing therapy (CPT) are
trauma-focused CBTs with the strongest evidence base for PTSD. IPT is more effective for
mood disorders; supportive therapy is adjunctive .
7. A patient with bipolar II disorder reports persistent low mood, anhedonia, low
energy, and feeling "slowed down" for the past 6 weeks. She is currently taking
lamotrigine 200 mg daily. Which additional medication is most appropriate?
A) Escitalopram 10 mg daily
B) Quetiapine XR 150 mg at bedtime
C) Methylphenidate ER 18 mg daily
D) Buspirone 15 mg twice daily
Answer: B
Rationale: Bipolar depression often requires additional treatment beyond lamotrigine.
Quetiapine has FDA approval for bipolar depression as monotherapy or adjunct.
Antidepressants like escitalopram may increase the risk of mood destabilization and are not
first-line .
8. A 72-year-old patient with Alzheimer's disease is started on donepezil. Which side
effect is most common during dose titration?
A) Hepatotoxicity
B) Nephrotoxicity
C) Gastrointestinal distress (nausea, diarrhea)
D) Prolonged QT interval
Answer: C
Rationale: GI side effects (nausea, diarrhea, vomiting, anorexia) are most common with
cholinesterase inhibitors, especially during dose titration. Starting at low doses and titrating
slowly, and administering with food, can improve tolerability .
9. The PMHNP is assessing a patient who recently emigrated from Southeast Asia
and reports "thinking too much" with fatigue, poor concentration, and rumination.
How should the PMHNP approach this symptom?
A) Dismiss it as a cultural idiom not requiring treatment
B) Explore the symptom within the patient's cultural framework while assessing for
underlying depression or anxiety
C) Prescribe an antipsychotic for thought disorder
, D) Refer to a cultural healer only
Answer: B
*Rationale: "Thinking too much" is a cultural idiom of distress common in many Asian
cultures, often representing depression or anxiety. The PMHNP should validate the
symptom, explore its meaning, and assess for underlying DSM-5 disorders while remaining
culturally sensitive .*
10. A patient with alcohol use disorder is admitted for detoxification. Which
medication is most effective for preventing progression to Wernicke
encephalopathy?
A) Naltrexone
B) Disulfiram
C) Thiamine
D) Lorazepam
Answer: C
Rationale: Thiamine (vitamin B1) prevents Wernicke encephalopathy (ataxia,
oculomotor disturbances, confusion) and subsequent Korsakoff syndrome. It should be
administered before or concurrently with glucose. Benzodiazepines treat withdrawal
symptoms but do not prevent Wernicke .
11. A patient with major depressive disorder has failed two adequate trials of SSRIs.
According to the STAR-D trial findings, what is the most appropriate next step?
A) Switch to an MAOI
B) Augment with a second-generation antipsychotic
C) Refer for ECT
D) Add a stimulant
Answer: B
Rationale: The STAR-D trial found that augmentation with a second-generation
antipsychotic (e.g., aripiprazole, brexpiprazole) is an effective next step after inadequate
response to two antidepressants. Switching to another antidepressant is also reasonable,
but MAOIs and ECT are typically later options .
12. Which serum lab value should be monitored regularly for a patient taking long-
term valproate?
A) Thyroid-stimulating hormone (TSH)
B) Complete blood count (CBC) and liver function tests (LFTs)
C) Fasting blood glucose
D) Creatinine kinase (CK)
Recommended 200 Practice Questions & Answers
Psychiatric-Mental Health Nurse Practitioner Board
Review – 2025-2026 Edition |
1. A patient with schizophrenia has been stable on risperidone for 2 years. Which
assessment finding warrants immediate concern?
A) Mild weight gain of 5 pounds over 6 months
B) Occasional dry mouth managed with hard candy
C) New-onset repetitive lip smacking and tongue thrusting
D) Sedation that improves with morning coffee
Answer: C
Rationale: Repetitive lip smacking and tongue thrusting are signs of tardive dyskinesia
(TD), a potentially irreversible movement disorder associated with long-term antipsychotic
use. This requires immediate evaluation using the AIMS scale. Weight gain and dry mouth
are common but less urgent; sedation is typical but manageable .
2. The PMHNP is evaluating a patient with bipolar I disorder who presents with
pressured speech, decreased need for sleep, and grandiose delusions. Which
medication is most appropriate for acute management?
A) Lithium monotherapy
B) Valproate plus an atypical antipsychotic
C) Sertraline monotherapy
D) Bupropion extended-release
Answer: B
Rationale: Acute mania is best treated with a mood stabilizer (valproate or lithium)
combined with an atypical antipsychotic (quetiapine, risperidone, or olanzapine).
Antidepressants like sertraline or bupropion may worsen mania and are not first-line for
acute episodes .
3. A 16-year-old patient reports recurrent, uncontrollable worries about school
performance and family safety for the past 8 months. She has difficulty sleeping and
concentrating. Which diagnosis is most likely?
A) Panic disorder
,B) Social anxiety disorder
C) Generalized anxiety disorder
D) Adjustment disorder with anxiety
Answer: C
Rationale: GAD is characterized by excessive, uncontrollable worry occurring more
days than not for ≥6 months, along with sleep disturbance and concentration difficulties.
Panic disorder involves discrete panic attacks; social anxiety involves fear of scrutiny;
adjustment disorder occurs within 3 months of a stressor .
4. The PMHNP is considering switching a patient from fluoxetine to phenelzine. What
is the minimum washout period required to avoid serotonin syndrome?
A) 7 days
B) 14 days
C) 21 days
D) 28 days
Answer: D
*Rationale: Fluoxetine has a long half-life due to its active metabolite norfluoxetine (up
to 16 days). A minimum 5-week (35 days) washout is recommended before starting an
MAOI. Four weeks (28 days) is the absolute minimum to prevent serotonin syndrome .*
5. A patient with chronic insomnia reports improved sleep with zolpidem but now
requires higher doses to achieve the same effect. Which term best describes this
phenomenon?
A) Tolerance
B) Dependence
C) Withdrawal
D) Kindling
Answer: A
Rationale: Tolerance is the need for increasing doses to achieve the same therapeutic
effect. Dependence refers to physiologic adaptation; withdrawal occurs when the drug is
stopped; kindling refers to sensitization to withdrawal seizures with repeated detoxifications
.
6. The PMHNP is treating a patient with posttraumatic stress disorder (PTSD) related
to military combat. Which psychotherapy is most strongly recommended as first-line
treatment?
A) Interpersonal therapy (IPT)
B) Supportive therapy
,C) Prolonged exposure therapy
D) Psychoanalytic therapy
Answer: C
Rationale: Prolonged exposure therapy and cognitive processing therapy (CPT) are
trauma-focused CBTs with the strongest evidence base for PTSD. IPT is more effective for
mood disorders; supportive therapy is adjunctive .
7. A patient with bipolar II disorder reports persistent low mood, anhedonia, low
energy, and feeling "slowed down" for the past 6 weeks. She is currently taking
lamotrigine 200 mg daily. Which additional medication is most appropriate?
A) Escitalopram 10 mg daily
B) Quetiapine XR 150 mg at bedtime
C) Methylphenidate ER 18 mg daily
D) Buspirone 15 mg twice daily
Answer: B
Rationale: Bipolar depression often requires additional treatment beyond lamotrigine.
Quetiapine has FDA approval for bipolar depression as monotherapy or adjunct.
Antidepressants like escitalopram may increase the risk of mood destabilization and are not
first-line .
8. A 72-year-old patient with Alzheimer's disease is started on donepezil. Which side
effect is most common during dose titration?
A) Hepatotoxicity
B) Nephrotoxicity
C) Gastrointestinal distress (nausea, diarrhea)
D) Prolonged QT interval
Answer: C
Rationale: GI side effects (nausea, diarrhea, vomiting, anorexia) are most common with
cholinesterase inhibitors, especially during dose titration. Starting at low doses and titrating
slowly, and administering with food, can improve tolerability .
9. The PMHNP is assessing a patient who recently emigrated from Southeast Asia
and reports "thinking too much" with fatigue, poor concentration, and rumination.
How should the PMHNP approach this symptom?
A) Dismiss it as a cultural idiom not requiring treatment
B) Explore the symptom within the patient's cultural framework while assessing for
underlying depression or anxiety
C) Prescribe an antipsychotic for thought disorder
, D) Refer to a cultural healer only
Answer: B
*Rationale: "Thinking too much" is a cultural idiom of distress common in many Asian
cultures, often representing depression or anxiety. The PMHNP should validate the
symptom, explore its meaning, and assess for underlying DSM-5 disorders while remaining
culturally sensitive .*
10. A patient with alcohol use disorder is admitted for detoxification. Which
medication is most effective for preventing progression to Wernicke
encephalopathy?
A) Naltrexone
B) Disulfiram
C) Thiamine
D) Lorazepam
Answer: C
Rationale: Thiamine (vitamin B1) prevents Wernicke encephalopathy (ataxia,
oculomotor disturbances, confusion) and subsequent Korsakoff syndrome. It should be
administered before or concurrently with glucose. Benzodiazepines treat withdrawal
symptoms but do not prevent Wernicke .
11. A patient with major depressive disorder has failed two adequate trials of SSRIs.
According to the STAR-D trial findings, what is the most appropriate next step?
A) Switch to an MAOI
B) Augment with a second-generation antipsychotic
C) Refer for ECT
D) Add a stimulant
Answer: B
Rationale: The STAR-D trial found that augmentation with a second-generation
antipsychotic (e.g., aripiprazole, brexpiprazole) is an effective next step after inadequate
response to two antidepressants. Switching to another antidepressant is also reasonable,
but MAOIs and ECT are typically later options .
12. Which serum lab value should be monitored regularly for a patient taking long-
term valproate?
A) Thyroid-stimulating hormone (TSH)
B) Complete blood count (CBC) and liver function tests (LFTs)
C) Fasting blood glucose
D) Creatinine kinase (CK)
