AANP PMHNP Certification Board Exam
– Ultimate Study Bank
Instructions
• Correct Answers are in Bold Italics
• Rationales are in Italic based on the AANPCB and ANCC PMHNP
exam blueprints
• Questions cover the core domains: Scientific Foundation (22%),
Advanced Practice Skills (27%), Diagnosis & Treatment (22%),
Psychotherapy & Related Theories (11%), and Ethics, Legal & Cultural
Care (17%)
• Based on the 2025/2026 updated exam content
1. A patient with schizophrenia has been stable on risperidone 4 mg
daily for 3 years but now presents with galactorrhea and amenorrhea.
Which of the following is the most appropriate next step?
A. Increase the risperidone dose
B. Switch to aripiprazole
C. Add bromocriptine
D. Order a prolactin level and consider switching to aripiprazole or
aripiprazole augmentation
Correct Answer: D. Order a prolactin level and consider switching to
aripiprazole or aripiprazole augmentation.
Rationale: Risperidone is a potent dopamine antagonist that can elevate
prolactin levels, causing galactorrhea and amenorrhea. Aripiprazole is a
,partial dopamine agonist and does not elevate prolactin levels. The first step
is to confirm hyperprolactinemia with a serum prolactin level, then consider
switching to a prolactin-sparing antipsychotic like aripiprazole .
2. A 24-year-old patient with bipolar I disorder is in a manic episode.
Which of the following is the first-line treatment for acute mania?
A. Lamotrigine
B. Lithium
C. Fluoxetine
D. Quetiapine
Correct Answer: B. Lithium.
Rationale: Lithium is a first-line treatment for acute mania in bipolar I
disorder. Lamotrigine is more effective for bipolar depression; antidepressants
like fluoxetine can precipitate mania; quetiapine is also used but lithium
remains a primary choice .
3. A patient with generalized anxiety disorder has been on sertraline
for 6 weeks with partial response. The PMHNP plans to augment the
SSRI. Which of the following would be the most appropriate
augmentation strategy?
A. Adding alprazolam as needed
B. Adding buspirone
C. Increasing sertraline to maximum dose immediately
D. Switching to fluoxetine
Correct Answer: B. Adding buspirone.
,Rationale: Buspirone is a 5-HT1A partial agonist that can be used as an
augmentation agent for SSRI partial responders. It has minimal abuse
potential and does not cause dependence, unlike benzodiazepines .
4. A 32-year-old patient with depression and insomnia is started on
mirtazapine. Which side effect should the PMHNP monitor most
closely?
A. Insomnia
B. Weight gain
C. Dry mouth
D. Hypertension
Correct Answer: B. Weight gain.
Rationale: Mirtazapine is associated with significant weight gain due to its
strong antihistamine (H1) receptor antagonism. This can be a significant
concern for patients, especially those with metabolic risk factors .
5. A patient with ADHD is prescribed methylphenidate. The PMHNP
should monitor for which of the following potential adverse effects?
A. Bradycardia
B. Weight gain
C. Insomnia
D. Hypertension
Correct Answer: C. Insomnia.
Rationale: Methylphenidate is a stimulant that can cause insomnia and
appetite suppression. It is best to take it in the morning or early afternoon to
minimize sleep disruption .
, 6. Which of the following is a negative symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Avolition
D. Disorganized speech
Correct Answer: C. Avolition.
Rationale: Negative symptoms include avolition (lack of motivation), flat
affect, alogia (poverty of speech), and anhedonia. Hallucinations, delusions,
and disorganized speech are positive symptoms .
7. A patient with panic disorder is started on paroxetine. The PMHNP
should inform the patient that the medication may take how long to
achieve full therapeutic effect?
A. 24-48 hours
B. 1-2 weeks
C. 4-6 weeks
D. 8-12 weeks
Correct Answer: C. 4-6 weeks.
Rationale: SSRIs like paroxetine typically take 4-6 weeks to achieve full
therapeutic effect. Patients should be educated not to discontinue
prematurely .
– Ultimate Study Bank
Instructions
• Correct Answers are in Bold Italics
• Rationales are in Italic based on the AANPCB and ANCC PMHNP
exam blueprints
• Questions cover the core domains: Scientific Foundation (22%),
Advanced Practice Skills (27%), Diagnosis & Treatment (22%),
Psychotherapy & Related Theories (11%), and Ethics, Legal & Cultural
Care (17%)
• Based on the 2025/2026 updated exam content
1. A patient with schizophrenia has been stable on risperidone 4 mg
daily for 3 years but now presents with galactorrhea and amenorrhea.
Which of the following is the most appropriate next step?
A. Increase the risperidone dose
B. Switch to aripiprazole
C. Add bromocriptine
D. Order a prolactin level and consider switching to aripiprazole or
aripiprazole augmentation
Correct Answer: D. Order a prolactin level and consider switching to
aripiprazole or aripiprazole augmentation.
Rationale: Risperidone is a potent dopamine antagonist that can elevate
prolactin levels, causing galactorrhea and amenorrhea. Aripiprazole is a
,partial dopamine agonist and does not elevate prolactin levels. The first step
is to confirm hyperprolactinemia with a serum prolactin level, then consider
switching to a prolactin-sparing antipsychotic like aripiprazole .
2. A 24-year-old patient with bipolar I disorder is in a manic episode.
Which of the following is the first-line treatment for acute mania?
A. Lamotrigine
B. Lithium
C. Fluoxetine
D. Quetiapine
Correct Answer: B. Lithium.
Rationale: Lithium is a first-line treatment for acute mania in bipolar I
disorder. Lamotrigine is more effective for bipolar depression; antidepressants
like fluoxetine can precipitate mania; quetiapine is also used but lithium
remains a primary choice .
3. A patient with generalized anxiety disorder has been on sertraline
for 6 weeks with partial response. The PMHNP plans to augment the
SSRI. Which of the following would be the most appropriate
augmentation strategy?
A. Adding alprazolam as needed
B. Adding buspirone
C. Increasing sertraline to maximum dose immediately
D. Switching to fluoxetine
Correct Answer: B. Adding buspirone.
,Rationale: Buspirone is a 5-HT1A partial agonist that can be used as an
augmentation agent for SSRI partial responders. It has minimal abuse
potential and does not cause dependence, unlike benzodiazepines .
4. A 32-year-old patient with depression and insomnia is started on
mirtazapine. Which side effect should the PMHNP monitor most
closely?
A. Insomnia
B. Weight gain
C. Dry mouth
D. Hypertension
Correct Answer: B. Weight gain.
Rationale: Mirtazapine is associated with significant weight gain due to its
strong antihistamine (H1) receptor antagonism. This can be a significant
concern for patients, especially those with metabolic risk factors .
5. A patient with ADHD is prescribed methylphenidate. The PMHNP
should monitor for which of the following potential adverse effects?
A. Bradycardia
B. Weight gain
C. Insomnia
D. Hypertension
Correct Answer: C. Insomnia.
Rationale: Methylphenidate is a stimulant that can cause insomnia and
appetite suppression. It is best to take it in the morning or early afternoon to
minimize sleep disruption .
, 6. Which of the following is a negative symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Avolition
D. Disorganized speech
Correct Answer: C. Avolition.
Rationale: Negative symptoms include avolition (lack of motivation), flat
affect, alogia (poverty of speech), and anhedonia. Hallucinations, delusions,
and disorganized speech are positive symptoms .
7. A patient with panic disorder is started on paroxetine. The PMHNP
should inform the patient that the medication may take how long to
achieve full therapeutic effect?
A. 24-48 hours
B. 1-2 weeks
C. 4-6 weeks
D. 8-12 weeks
Correct Answer: C. 4-6 weeks.
Rationale: SSRIs like paroxetine typically take 4-6 weeks to achieve full
therapeutic effect. Patients should be educated not to discontinue
prematurely .
