ANCC Psychiatric-260 Questions with Rationales |
Mental Health Nurse Practitioner (PMHNP-BC)
Certification Exam Updated for 2026 Test Content
Outline
Exam Blueprint
Domain 1: Assessment 23% 29 scored questions
Domain 2: Diagnosis 24% 30 scored questions
Domain 3: Planning and Implementation 29% 36 scored questions
Domain 4: Evaluation 24% 30 scored questions
Total 100% 125 scored questions
DOMAIN 1: ASSESSMENT QUESTIONS 1-60
Question 1
A 32-year-old female patient presents with complaints of persistent sadness, fatigue, and difficulty
sleeping for the past six months. She reports that she has lost interest in activities she once enjoyed
and has difficulty concentrating at work. Which of the following is the most appropriate initial
screening tool for depression in this patient?
A. PHQ-9
B. GAD-7
C. CAGE questionnaire
D. AUDIT
Correct Answer: A
Rationale: The PHQ-9 is a validated screening tool for depression that assesses the nine DSM-5
criteria for major depressive disorder. The GAD-7 is used for anxiety screening. The CAGE
questionnaire and AUDIT are used for alcohol use disorder screening.
,Question 2
A 45-year-old male patient presents with complaints of excessive worry, restlessness, and difficulty
sleeping. He reports that he has been worrying about his job, finances, and family for the past eight
months. He states that he cannot control his worry and it is affecting his ability to function at work.
Which of the following is the most likely diagnosis?
A. Generalized anxiety disorder
B. Panic disorder
C. Social anxiety disorder
D. Obsessive-compulsive disorder
Correct Answer: A
Rationale: Generalized anxiety disorder is characterized by excessive, uncontrollable worry about
multiple domains for at least six months, associated with restlessness, fatigue, difficulty
concentrating, irritability, muscle tension, and sleep disturbance. Panic disorder involves recurrent
panic attacks. Social anxiety disorder involves fear of social situations. OCD involves obsessions and
compulsions.
Question 3
A 28-year-old female patient presents with complaints of recurrent episodes of intense fear,
palpitations, sweating, and shortness of breath. These episodes occur suddenly and peak within
minutes. She reports that she is afraid of having another episode and has been avoiding leaving her
home. Which of the following is the most likely diagnosis?
A. Panic disorder
B. Generalized anxiety disorder
C. Social anxiety disorder
D. Agoraphobia
Correct Answer: A
Rationale: Panic disorder is characterized by recurrent, unexpected panic attacks followed by at least
one month of persistent concern about having additional attacks, worry about the consequences of the
,attacks, or significant maladaptive change in behavior related to the attacks. Agoraphobia is a
complication that may occur with panic disorder.
Question 4
A 55-year-old male patient presents with complaints of depressed mood and anhedonia for the past
three months. He reports that he has lost 20 pounds unintentionally, has difficulty sleeping, and has
been having thoughts of suicide. Which of the following is the most appropriate initial assessment
question?
A. Have you had thoughts of harming yourself?
B. Do you have a plan to harm yourself?
C. What medications are you currently taking?
D. What is your family history of mental illness?
Correct Answer: B
Rationale: The most urgent assessment question is to ask about the presence of a suicide plan. Asking
about suicidal ideation and intent is essential for determining immediate risk. While asking about self-
harm thoughts, current medications, and family history are all important, assessing the presence of a
plan is the highest priority for safety.
Question 5
A 22-year-old male patient presents with complaints of hearing voices that tell him he is worthless.
He reports that he has difficulty trusting others and believes that people are plotting against him.
Which of the following is the most likely diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Delusional disorder
D. Bipolar disorder with psychotic features
Correct Answer: A
, Rationale: Schizophrenia is characterized by delusions, hallucinations, disorganized speech, grossly
disorganized or catatonic behavior, and negative symptoms for at least six months. The presence of
auditory hallucinations and persecutory delusions is consistent with schizophrenia. Schizoaffective
disorder involves mood episodes. Delusional disorder involves non-bizarre delusions without other
psychotic symptoms.
Question 6
A 30-year-old female patient presents with complaints of irritability, elevated mood, and decreased
need for sleep for the past week. She reports that she has been engaging in reckless behavior,
including spending large amounts of money. She has a history of depressive episodes. Which of the
following is the most likely diagnosis?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder
Correct Answer: A
Rationale: Bipolar I disorder is characterized by at least one manic episode. Mania involves a distinct
period of abnormally and persistently elevated, expansive, or irritable mood and increased goal-
directed activity or energy lasting at least one week. Bipolar II disorder involves hypomanic episodes.
Cyclothymic disorder involves chronic fluctuating mood disturbances.
Question 7
A 40-year-old male patient presents with complaints of feeling sad, tired, and hopeless for the past
two months. He reports that he has been sleeping 12 hours per day but still feels tired. He has gained
15 pounds and has difficulty concentrating. Which of the following is the most likely diagnosis?
A. Major depressive disorder with atypical features
B. Major depressive disorder with melancholic features
C. Dysthymic disorder
D. Adjustment disorder with depressed mood
Mental Health Nurse Practitioner (PMHNP-BC)
Certification Exam Updated for 2026 Test Content
Outline
Exam Blueprint
Domain 1: Assessment 23% 29 scored questions
Domain 2: Diagnosis 24% 30 scored questions
Domain 3: Planning and Implementation 29% 36 scored questions
Domain 4: Evaluation 24% 30 scored questions
Total 100% 125 scored questions
DOMAIN 1: ASSESSMENT QUESTIONS 1-60
Question 1
A 32-year-old female patient presents with complaints of persistent sadness, fatigue, and difficulty
sleeping for the past six months. She reports that she has lost interest in activities she once enjoyed
and has difficulty concentrating at work. Which of the following is the most appropriate initial
screening tool for depression in this patient?
A. PHQ-9
B. GAD-7
C. CAGE questionnaire
D. AUDIT
Correct Answer: A
Rationale: The PHQ-9 is a validated screening tool for depression that assesses the nine DSM-5
criteria for major depressive disorder. The GAD-7 is used for anxiety screening. The CAGE
questionnaire and AUDIT are used for alcohol use disorder screening.
,Question 2
A 45-year-old male patient presents with complaints of excessive worry, restlessness, and difficulty
sleeping. He reports that he has been worrying about his job, finances, and family for the past eight
months. He states that he cannot control his worry and it is affecting his ability to function at work.
Which of the following is the most likely diagnosis?
A. Generalized anxiety disorder
B. Panic disorder
C. Social anxiety disorder
D. Obsessive-compulsive disorder
Correct Answer: A
Rationale: Generalized anxiety disorder is characterized by excessive, uncontrollable worry about
multiple domains for at least six months, associated with restlessness, fatigue, difficulty
concentrating, irritability, muscle tension, and sleep disturbance. Panic disorder involves recurrent
panic attacks. Social anxiety disorder involves fear of social situations. OCD involves obsessions and
compulsions.
Question 3
A 28-year-old female patient presents with complaints of recurrent episodes of intense fear,
palpitations, sweating, and shortness of breath. These episodes occur suddenly and peak within
minutes. She reports that she is afraid of having another episode and has been avoiding leaving her
home. Which of the following is the most likely diagnosis?
A. Panic disorder
B. Generalized anxiety disorder
C. Social anxiety disorder
D. Agoraphobia
Correct Answer: A
Rationale: Panic disorder is characterized by recurrent, unexpected panic attacks followed by at least
one month of persistent concern about having additional attacks, worry about the consequences of the
,attacks, or significant maladaptive change in behavior related to the attacks. Agoraphobia is a
complication that may occur with panic disorder.
Question 4
A 55-year-old male patient presents with complaints of depressed mood and anhedonia for the past
three months. He reports that he has lost 20 pounds unintentionally, has difficulty sleeping, and has
been having thoughts of suicide. Which of the following is the most appropriate initial assessment
question?
A. Have you had thoughts of harming yourself?
B. Do you have a plan to harm yourself?
C. What medications are you currently taking?
D. What is your family history of mental illness?
Correct Answer: B
Rationale: The most urgent assessment question is to ask about the presence of a suicide plan. Asking
about suicidal ideation and intent is essential for determining immediate risk. While asking about self-
harm thoughts, current medications, and family history are all important, assessing the presence of a
plan is the highest priority for safety.
Question 5
A 22-year-old male patient presents with complaints of hearing voices that tell him he is worthless.
He reports that he has difficulty trusting others and believes that people are plotting against him.
Which of the following is the most likely diagnosis?
A. Schizophrenia
B. Schizoaffective disorder
C. Delusional disorder
D. Bipolar disorder with psychotic features
Correct Answer: A
, Rationale: Schizophrenia is characterized by delusions, hallucinations, disorganized speech, grossly
disorganized or catatonic behavior, and negative symptoms for at least six months. The presence of
auditory hallucinations and persecutory delusions is consistent with schizophrenia. Schizoaffective
disorder involves mood episodes. Delusional disorder involves non-bizarre delusions without other
psychotic symptoms.
Question 6
A 30-year-old female patient presents with complaints of irritability, elevated mood, and decreased
need for sleep for the past week. She reports that she has been engaging in reckless behavior,
including spending large amounts of money. She has a history of depressive episodes. Which of the
following is the most likely diagnosis?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder
Correct Answer: A
Rationale: Bipolar I disorder is characterized by at least one manic episode. Mania involves a distinct
period of abnormally and persistently elevated, expansive, or irritable mood and increased goal-
directed activity or energy lasting at least one week. Bipolar II disorder involves hypomanic episodes.
Cyclothymic disorder involves chronic fluctuating mood disturbances.
Question 7
A 40-year-old male patient presents with complaints of feeling sad, tired, and hopeless for the past
two months. He reports that he has been sleeping 12 hours per day but still feels tired. He has gained
15 pounds and has difficulty concentrating. Which of the following is the most likely diagnosis?
A. Major depressive disorder with atypical features
B. Major depressive disorder with melancholic features
C. Dysthymic disorder
D. Adjustment disorder with depressed mood
