, PMHNP-BC (ANCC) Exam Prep Question Bank
Psychiatric-Mental Health Nurse Practitioner Board
Certification
200 Practice Questions with Answers & Evidence-Based Rationales
Based on ANCC Test Content Outline – Updated 2025/2026 Edition
SECTION 1: SCIENTIFIC FOUNDATION (Questions 1-45)
Q1. A patient presents with symptoms of anhedonia, low energy, and
psychomotor retardation. Which neurotransmitter system is most directly
implicated in these symptoms?
• A) Norepinephrine
• B) Dopamine
• C) Serotonin
• D) GABA
Answer: B – Dopamine
Rationale: Dopamine pathways (mesolimbic and mesocortical) are critical for reward
processing, motivation, and psychomotor function. Deficits are strongly associated with
anhedonia and psychomotor retardation in depression.
Q2. The mechanism of action of selective serotonin reuptake inhibitors (SSRIs)
involves:
,• A) Blockade of serotonin autoreceptors
• B) Inhibition of serotonin reuptake at the presynaptic terminal
• C) Enhancement of serotonin release
• D) Antagonism of postsynaptic serotonin receptors
Answer: B – Inhibition of serotonin reuptake at the presynaptic terminal
Rationale: SSRIs work by blocking the serotonin transporter (SERT) on the presynaptic
neuron, preventing the reuptake of serotonin from the synaptic cleft and increasing its
availability at postsynaptic receptors.
Q3. A patient recently started on clozapine reports fever, sore throat, and lethargy.
What is the priority action?
• A) Increase the clozapine dose
• B) Order a complete blood count (CBC) with differential STAT
• C) Prescribe an antibiotic for possible infection
• D) Administer acetaminophen for fever
Answer: B – Order a complete blood count (CBC) with differential STAT
Rationale: Clozapine carries a black box warning for agranulocytosis, a potentially fatal
drop in neutrophils that increases infection risk. Fever and sore throat are early warning
signs requiring immediate CBC to assess absolute neutrophil count (ANC).
Q4. What is the most likely side effect when a patient abruptly withdraws from a
selective serotonin reuptake inhibitor (SSRI) after long-term use?
• A) Hypertensive crisis
• B) Serotonin syndrome
• C) Discontinuation syndrome
• D) Neuroleptic malignant syndrome
Answer: C – Discontinuation syndrome
Rationale: SSRI discontinuation syndrome typically presents with flu-like symptoms,
dizziness, sensory disturbances, anxiety, and insomnia. Gradual tapering prevents this. It
is not life-threatening but can be highly distressing.
, Q5. For a patient taking valproate (Depakote), which laboratory value requires the
most urgent monitoring?
• A) Complete blood count
• B) Liver function tests (LFTs)
• C) Thyroid function tests
• D) Serum creatinine
Answer: B – Liver function tests (LFTs)
Rationale: Valproate carries a black box warning for hepatotoxicity. LFTs must be
monitored regularly, especially during the first 6 months of therapy. Elevated liver
enzymes may indicate valproate-induced liver injury.
Q6. A 72-year-old patient with Alzheimer's disease is becoming increasingly
agitated and has started to hit staff when they attempt to assist with bathing.
Which intervention should be attempted FIRST?
• A) Haloperidol 0.5 mg IM
• B) Lorazepam 1 mg PO
• C) Identify and address potential triggers
• D) Increase the dose of donepezil
Answer: C – Identify and address potential triggers
Rationale: Behavioral and psychological symptoms of dementia (BPSD) should first be
managed with non-pharmacological interventions, including identifying and addressing
underlying triggers such as pain, hunger, fatigue, or environmental stressors.
Q7. A patient with schizophrenia has been on haloperidol for 3 years. The PMHNP
notices repetitive, involuntary movements of the tongue and facial muscles. What
is the most likely diagnosis?
• A) Acute dystonia
• B) Parkinsonism
Psychiatric-Mental Health Nurse Practitioner Board
Certification
200 Practice Questions with Answers & Evidence-Based Rationales
Based on ANCC Test Content Outline – Updated 2025/2026 Edition
SECTION 1: SCIENTIFIC FOUNDATION (Questions 1-45)
Q1. A patient presents with symptoms of anhedonia, low energy, and
psychomotor retardation. Which neurotransmitter system is most directly
implicated in these symptoms?
• A) Norepinephrine
• B) Dopamine
• C) Serotonin
• D) GABA
Answer: B – Dopamine
Rationale: Dopamine pathways (mesolimbic and mesocortical) are critical for reward
processing, motivation, and psychomotor function. Deficits are strongly associated with
anhedonia and psychomotor retardation in depression.
Q2. The mechanism of action of selective serotonin reuptake inhibitors (SSRIs)
involves:
,• A) Blockade of serotonin autoreceptors
• B) Inhibition of serotonin reuptake at the presynaptic terminal
• C) Enhancement of serotonin release
• D) Antagonism of postsynaptic serotonin receptors
Answer: B – Inhibition of serotonin reuptake at the presynaptic terminal
Rationale: SSRIs work by blocking the serotonin transporter (SERT) on the presynaptic
neuron, preventing the reuptake of serotonin from the synaptic cleft and increasing its
availability at postsynaptic receptors.
Q3. A patient recently started on clozapine reports fever, sore throat, and lethargy.
What is the priority action?
• A) Increase the clozapine dose
• B) Order a complete blood count (CBC) with differential STAT
• C) Prescribe an antibiotic for possible infection
• D) Administer acetaminophen for fever
Answer: B – Order a complete blood count (CBC) with differential STAT
Rationale: Clozapine carries a black box warning for agranulocytosis, a potentially fatal
drop in neutrophils that increases infection risk. Fever and sore throat are early warning
signs requiring immediate CBC to assess absolute neutrophil count (ANC).
Q4. What is the most likely side effect when a patient abruptly withdraws from a
selective serotonin reuptake inhibitor (SSRI) after long-term use?
• A) Hypertensive crisis
• B) Serotonin syndrome
• C) Discontinuation syndrome
• D) Neuroleptic malignant syndrome
Answer: C – Discontinuation syndrome
Rationale: SSRI discontinuation syndrome typically presents with flu-like symptoms,
dizziness, sensory disturbances, anxiety, and insomnia. Gradual tapering prevents this. It
is not life-threatening but can be highly distressing.
, Q5. For a patient taking valproate (Depakote), which laboratory value requires the
most urgent monitoring?
• A) Complete blood count
• B) Liver function tests (LFTs)
• C) Thyroid function tests
• D) Serum creatinine
Answer: B – Liver function tests (LFTs)
Rationale: Valproate carries a black box warning for hepatotoxicity. LFTs must be
monitored regularly, especially during the first 6 months of therapy. Elevated liver
enzymes may indicate valproate-induced liver injury.
Q6. A 72-year-old patient with Alzheimer's disease is becoming increasingly
agitated and has started to hit staff when they attempt to assist with bathing.
Which intervention should be attempted FIRST?
• A) Haloperidol 0.5 mg IM
• B) Lorazepam 1 mg PO
• C) Identify and address potential triggers
• D) Increase the dose of donepezil
Answer: C – Identify and address potential triggers
Rationale: Behavioral and psychological symptoms of dementia (BPSD) should first be
managed with non-pharmacological interventions, including identifying and addressing
underlying triggers such as pain, hunger, fatigue, or environmental stressors.
Q7. A patient with schizophrenia has been on haloperidol for 3 years. The PMHNP
notices repetitive, involuntary movements of the tongue and facial muscles. What
is the most likely diagnosis?
• A) Acute dystonia
• B) Parkinsonism
