ANCC PMHNP 2026 EXAM With
400 FULL QUESTIONS AND
CORRECT ANSWERS
1. A patient with borderline personality disorder becomes intensely
anxious when the PMHNP is on vacation. What explains this
behavior?
A. Has failed to develop clear ego boundaries
B. Has failed to master object constancy
C. Is employing primitive idealization
D. Is employing projective identification
Answer: B. Patients with borderline personality disorder often lack
object constancy and cannot maintain an emotional connection to
others when they are physically absent, leading to intense anxiety and
fear of abandonment.
2. A patient on escitalopram shows improvements in sleep and
energy after four weeks. Which statement is correct regarding
suicide risk?
A. Discontinue the medication
B. Increase the medication
C. Risk for suicide is not a concern
D. Suicide potential is increased
Answer: D. As energy and motivation improve with antidepressant
treatment before mood fully stabilizes, patients may have an increased
capacity to act on suicidal thoughts, requiring close monitoring.
3. What is the purpose of the ANA Psychiatric-Mental Health
Nursing: Scope and Standards of Practice?
A. Define the role and actions of the NP
B. Establish legal prescribing authority
C. Define legal statutes of the PMHNP role
D. Distinguish NP role from physician role
,Answer: A. The Scope & Standards clarify competencies expected in
practice and define the role of the psychiatric-mental health nurse
practitioner.
4. Which is the best example of primary prevention in community
behavioral health?
A. Aftercare program for chronically ill clients
B. Court-ordered counseling for abusive parents
C. 24-hour crisis hotlines
D. Parenting skills classes for pregnant adolescents
Answer: D. Primary prevention targets individuals before illness onset;
parenting classes for at-risk adolescents aim to prevent future mental
health issues.
5. A patient with schizophrenia has been on clozapine for 3 months.
Which laboratory monitoring is required at this time per REMS
guidelines?
A. WBC and ANC every 2 weeks
B. WBC and ANC every 4 weeks
C. WBC and ANC every 6 months
D. No further monitoring after initial period
Answer: A. Clozapine REMS monitoring schedule requires weekly WBC
and ANC for the first 6 months.
6. A patient on haloperidol develops involuntary, repetitive
movements of the mouth and tongue after 3 years of treatment.
What is the most likely diagnosis?
A. Acute dystonia
B. Parkinsonism
C. Tardive dyskinesia
D. Akathisia
Answer: C. Tardive dyskinesia is a late-onset, involuntary movement
disorder caused by long-term antipsychotic use, characterized by
orofacial movements.
,7. A patient taking valproate for bipolar disorder has a drug level of
45 mcg/mL. What is the appropriate interpretation?
A. Subtherapeutic (therapeutic range 50-125 mcg/mL)
B. Therapeutic
C. Toxic
D. Requires immediate dose reduction
Answer: A. The therapeutic range for valproate in bipolar disorder is 50-
125 mcg/mL; 45 mcg/mL is subtherapeutic.
8. Which cytochrome P450 enzyme is most commonly responsible
for drug-drug interactions in psychiatric practice?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Answer: B. CYP3A4 metabolizes approximately 50% of all medications
and is responsible for many significant drug interactions in psychiatric
practice.
9. A patient with schizophrenia has failed trials of two
antipsychotics. Which medication is most likely to reduce risk of
suicide?
A. Aripiprazole
B. Lurasidone
C. Iloperidone
D. Clozapine
Answer: D. Clozapine is the only antipsychotic shown to reduce the risk
of suicide in patients diagnosed with schizophrenia.
10. Which lab test should be ordered to rule out a medical cause of
dementia symptoms?
A. Albumin
B. Thiamine
C. Vitamin D3
D. Vitamin B12
, Answer: D. Low vitamin B12 levels have been associated with dementia-
like symptoms; B12 testing is essential in dementia workup.
11. A patient on lithium presents with nausea, vomiting, ataxia, and
coarse tremor. What is the next step?
A. Add antipsychotic
B. Check lithium blood level
C. Switch to SSRI
D. Increase fluid restriction
Answer: B. Symptoms suggest possible lithium toxicity; checking serum
level is essential before adjusting therapy.
12. A patient with bipolar I on lamotrigine needs counseling about
which serious risk?
A. Weight gain
B. Stevens-Johnson syndrome risk
C. Hyperlipidemia
D. Tardive dyskinesia
Answer: B. Lamotrigine carries a small but serious risk of rash
progressing to Stevens-Johnson syndrome; patient education is
essential.
13. Which scale is used to screen for depression?
A. AUDIT
B. MMSE
C. PHQ-9
D. CAGE
Answer: C. The PHQ-9 is a validated tool for screening and monitoring
depression severity.
14. What is the best initial pharmacotherapy for ADHD in adults?
A. Fluoxetine
B. Atomoxetine
C. Methylphenidate
D. Clozapine
400 FULL QUESTIONS AND
CORRECT ANSWERS
1. A patient with borderline personality disorder becomes intensely
anxious when the PMHNP is on vacation. What explains this
behavior?
A. Has failed to develop clear ego boundaries
B. Has failed to master object constancy
C. Is employing primitive idealization
D. Is employing projective identification
Answer: B. Patients with borderline personality disorder often lack
object constancy and cannot maintain an emotional connection to
others when they are physically absent, leading to intense anxiety and
fear of abandonment.
2. A patient on escitalopram shows improvements in sleep and
energy after four weeks. Which statement is correct regarding
suicide risk?
A. Discontinue the medication
B. Increase the medication
C. Risk for suicide is not a concern
D. Suicide potential is increased
Answer: D. As energy and motivation improve with antidepressant
treatment before mood fully stabilizes, patients may have an increased
capacity to act on suicidal thoughts, requiring close monitoring.
3. What is the purpose of the ANA Psychiatric-Mental Health
Nursing: Scope and Standards of Practice?
A. Define the role and actions of the NP
B. Establish legal prescribing authority
C. Define legal statutes of the PMHNP role
D. Distinguish NP role from physician role
,Answer: A. The Scope & Standards clarify competencies expected in
practice and define the role of the psychiatric-mental health nurse
practitioner.
4. Which is the best example of primary prevention in community
behavioral health?
A. Aftercare program for chronically ill clients
B. Court-ordered counseling for abusive parents
C. 24-hour crisis hotlines
D. Parenting skills classes for pregnant adolescents
Answer: D. Primary prevention targets individuals before illness onset;
parenting classes for at-risk adolescents aim to prevent future mental
health issues.
5. A patient with schizophrenia has been on clozapine for 3 months.
Which laboratory monitoring is required at this time per REMS
guidelines?
A. WBC and ANC every 2 weeks
B. WBC and ANC every 4 weeks
C. WBC and ANC every 6 months
D. No further monitoring after initial period
Answer: A. Clozapine REMS monitoring schedule requires weekly WBC
and ANC for the first 6 months.
6. A patient on haloperidol develops involuntary, repetitive
movements of the mouth and tongue after 3 years of treatment.
What is the most likely diagnosis?
A. Acute dystonia
B. Parkinsonism
C. Tardive dyskinesia
D. Akathisia
Answer: C. Tardive dyskinesia is a late-onset, involuntary movement
disorder caused by long-term antipsychotic use, characterized by
orofacial movements.
,7. A patient taking valproate for bipolar disorder has a drug level of
45 mcg/mL. What is the appropriate interpretation?
A. Subtherapeutic (therapeutic range 50-125 mcg/mL)
B. Therapeutic
C. Toxic
D. Requires immediate dose reduction
Answer: A. The therapeutic range for valproate in bipolar disorder is 50-
125 mcg/mL; 45 mcg/mL is subtherapeutic.
8. Which cytochrome P450 enzyme is most commonly responsible
for drug-drug interactions in psychiatric practice?
A. CYP1A2
B. CYP3A4
C. CYP2D6
D. CYP2C19
Answer: B. CYP3A4 metabolizes approximately 50% of all medications
and is responsible for many significant drug interactions in psychiatric
practice.
9. A patient with schizophrenia has failed trials of two
antipsychotics. Which medication is most likely to reduce risk of
suicide?
A. Aripiprazole
B. Lurasidone
C. Iloperidone
D. Clozapine
Answer: D. Clozapine is the only antipsychotic shown to reduce the risk
of suicide in patients diagnosed with schizophrenia.
10. Which lab test should be ordered to rule out a medical cause of
dementia symptoms?
A. Albumin
B. Thiamine
C. Vitamin D3
D. Vitamin B12
, Answer: D. Low vitamin B12 levels have been associated with dementia-
like symptoms; B12 testing is essential in dementia workup.
11. A patient on lithium presents with nausea, vomiting, ataxia, and
coarse tremor. What is the next step?
A. Add antipsychotic
B. Check lithium blood level
C. Switch to SSRI
D. Increase fluid restriction
Answer: B. Symptoms suggest possible lithium toxicity; checking serum
level is essential before adjusting therapy.
12. A patient with bipolar I on lamotrigine needs counseling about
which serious risk?
A. Weight gain
B. Stevens-Johnson syndrome risk
C. Hyperlipidemia
D. Tardive dyskinesia
Answer: B. Lamotrigine carries a small but serious risk of rash
progressing to Stevens-Johnson syndrome; patient education is
essential.
13. Which scale is used to screen for depression?
A. AUDIT
B. MMSE
C. PHQ-9
D. CAGE
Answer: C. The PHQ-9 is a validated tool for screening and monitoring
depression severity.
14. What is the best initial pharmacotherapy for ADHD in adults?
A. Fluoxetine
B. Atomoxetine
C. Methylphenidate
D. Clozapine
