1
ANCC PMHNP Exam (NEW 2025/2026
Update) Questions with Answers and
Rationales Grade A | 100% Correct
(Verified Solutions)
Question 1
A patient presents with a history of at least four mood episodes in the past
year. What additional specifier will the practitioner add to the diagnosis of
bipolar disorder?
• A) With psychotic features
• B) With mixed features
• C) Rapid cycling
• D) With seasonal pattern
Correct Answer: C) Rapid cycling
Rationale: Rapid cycling is a specifier for bipolar disorder defined as four or
more mood episodes (mania, hypomania, or depression) in a 12-month
period. It is important to identify because it may indicate a more severe
course and different treatment approach.
Question 2
Which of the following is a key feature distinguishing delirium from
dementia?
• A) Gradual onset
• B) Chronic course
• C) Acute onset with fluctuating course
• D) Irreversible cognitive decline
pg. 1
,2
Correct Answer: C) Acute onset with fluctuating course
Rationale: Delirium is characterized by acute onset (hours to days) with a
fluctuating course and is typically reversible. Dementia has a gradual onset,
chronic course, and progressive decline. Identifying delirium is critical as it
often indicates an underlying medical condition.
Question 3
A 72-year-old patient presents with memory impairment, personality changes
over the past year, asterixis, palmar erythema, peripheral edema, and a large
ecchymotic area on the left elbow. What is the most likely underlying cause?
• A) Alzheimer's disease
• B) Hepatic encephalopathy
• C) Vascular dementia
• D) Lewy body dementia
Correct Answer: B) Hepatic encephalopathy
Rationale: Hepatic encephalopathy is the loss of brain function when a
damaged liver does not remove toxins from the blood. Clinical features
include cognitive impairment, personality changes, asterixis (liver flap),
palmar erythema, peripheral edema, and easy bruising (ecchymosis). The
presence of liver disease signs points to this diagnosis.
Question 4
A patient presents with depressive symptoms, hypersomnia, increased
appetite, and weight gain. Which specifier is most appropriate?
• A) Melancholic features
• B) Atypical features
• C) Psychotic features
• D) Catatonic features
pg. 2
, 3
Correct Answer: B) Atypical features
Rationale: Atypical features of depression include mood reactivity (mood
brightens in response to positive events), hypersomnia, increased appetite or
weight gain, leaden paralysis (heavy feeling in limbs), and rejection
sensitivity. Melancholic features include anhedonia and profound sadness.
Question 5
Which of the following is a symptom of serotonin syndrome?
• A) Bradycardia
• B) Hypothermia
• C) Hyperreflexia and clonus
• D) Sedation
Correct Answer: C) Hyperreflexia and clonus
Rationale: Serotonin syndrome is characterized by the triad of altered mental
status, autonomic instability, and neuromuscular abnormalities
(hyperreflexia, clonus, tremor, rigidity). It is caused by excessive serotonergic
activity, often from combining serotonergic medications. Symptoms can range
from mild to life-threatening.
Question 6
A patient with bipolar disorder presents with a euphoric mood, grandiosity,
decreased need for sleep, and rapid speech. This is most consistent with:
• A) Hypomanic episode
• B) Manic episode
• C) Mixed episode
• D) Major depressive episode
Correct Answer: B) Manic episode
pg. 3
ANCC PMHNP Exam (NEW 2025/2026
Update) Questions with Answers and
Rationales Grade A | 100% Correct
(Verified Solutions)
Question 1
A patient presents with a history of at least four mood episodes in the past
year. What additional specifier will the practitioner add to the diagnosis of
bipolar disorder?
• A) With psychotic features
• B) With mixed features
• C) Rapid cycling
• D) With seasonal pattern
Correct Answer: C) Rapid cycling
Rationale: Rapid cycling is a specifier for bipolar disorder defined as four or
more mood episodes (mania, hypomania, or depression) in a 12-month
period. It is important to identify because it may indicate a more severe
course and different treatment approach.
Question 2
Which of the following is a key feature distinguishing delirium from
dementia?
• A) Gradual onset
• B) Chronic course
• C) Acute onset with fluctuating course
• D) Irreversible cognitive decline
pg. 1
,2
Correct Answer: C) Acute onset with fluctuating course
Rationale: Delirium is characterized by acute onset (hours to days) with a
fluctuating course and is typically reversible. Dementia has a gradual onset,
chronic course, and progressive decline. Identifying delirium is critical as it
often indicates an underlying medical condition.
Question 3
A 72-year-old patient presents with memory impairment, personality changes
over the past year, asterixis, palmar erythema, peripheral edema, and a large
ecchymotic area on the left elbow. What is the most likely underlying cause?
• A) Alzheimer's disease
• B) Hepatic encephalopathy
• C) Vascular dementia
• D) Lewy body dementia
Correct Answer: B) Hepatic encephalopathy
Rationale: Hepatic encephalopathy is the loss of brain function when a
damaged liver does not remove toxins from the blood. Clinical features
include cognitive impairment, personality changes, asterixis (liver flap),
palmar erythema, peripheral edema, and easy bruising (ecchymosis). The
presence of liver disease signs points to this diagnosis.
Question 4
A patient presents with depressive symptoms, hypersomnia, increased
appetite, and weight gain. Which specifier is most appropriate?
• A) Melancholic features
• B) Atypical features
• C) Psychotic features
• D) Catatonic features
pg. 2
, 3
Correct Answer: B) Atypical features
Rationale: Atypical features of depression include mood reactivity (mood
brightens in response to positive events), hypersomnia, increased appetite or
weight gain, leaden paralysis (heavy feeling in limbs), and rejection
sensitivity. Melancholic features include anhedonia and profound sadness.
Question 5
Which of the following is a symptom of serotonin syndrome?
• A) Bradycardia
• B) Hypothermia
• C) Hyperreflexia and clonus
• D) Sedation
Correct Answer: C) Hyperreflexia and clonus
Rationale: Serotonin syndrome is characterized by the triad of altered mental
status, autonomic instability, and neuromuscular abnormalities
(hyperreflexia, clonus, tremor, rigidity). It is caused by excessive serotonergic
activity, often from combining serotonergic medications. Symptoms can range
from mild to life-threatening.
Question 6
A patient with bipolar disorder presents with a euphoric mood, grandiosity,
decreased need for sleep, and rapid speech. This is most consistent with:
• A) Hypomanic episode
• B) Manic episode
• C) Mixed episode
• D) Major depressive episode
Correct Answer: B) Manic episode
pg. 3
