APEA Psychiatric-Mental Health Nurse
Practitioner PMHNP Certification
Practice Exam
This practice exam is designed to reflect the content and format of the
PMHNP board certification exams from the ANCC and AANP. The
questions test clinical knowledge across the lifespan and align with the
core domains of assessment, diagnosis, planning, and evaluation.
SECTION 1: ASSESSMENT & DIAGNOSIS
Question 1
A 45-year-old patient with no prior psychiatric history presents with a
3-week history of a persistently depressed mood, anhedonia, significant
weight loss, and insomnia. The patient also reports feeling hopeless and
having difficulty concentrating. What is the most appropriate initial action?
A) Prescribe a selective serotonin reuptake inhibitor (SSRI) immediately
B) Refer the patient for cognitive-behavioral therapy (CBT) only
C) Conduct a comprehensive psychiatric evaluation, including a medical
workup
D) Recommend an over-the-counter St. John's Wort supplement
Answer: C
Rationale: A comprehensive psychiatric evaluation is the essential first
step. This involves a detailed history, mental status exam, and assessment
for medical causes of depression. The patient's symptoms are new, and a
,medical workup is critical to rule out underlying conditions like
hypothyroidism or vitamin deficiencies before initiating treatment.
Treatment is based on findings from this thorough assessment.
Question 2
Which of the following is the most reliable indicator of treatment efficacy in
a patient with major depressive disorder?
A) The patient's subjective report of feeling "a little better"
B) A decrease in the patient's PHQ-9 score from 20 to 8
C) The patient's ability to return to work full-time
D) The patient reports having less fatigue
Answer: B
Rationale: Standardized screening tools like the PHQ-9 provide objective
and quantifiable data to measure treatment response. A significant
decrease in the PHQ-9 score (from 20, indicating severe depression, to 8,
indicating mild depression) is the strongest indicator of treatment efficacy.
While subjective reports and functional improvements are important, they
can be less reliable than validated scales.
Question 3
A patient with bipolar I disorder is prescribed lithium. The patient's serum
level is currently 1.2 mEq/L. What is the most appropriate nursing action?
A) Continue the current dose as prescribed
B) Decrease the dose and recheck serum levels
C) Increase the dose to achieve a higher therapeutic level
D) Educate the patient to take it with a high-sodium diet
Answer: A
, Rationale: The therapeutic range for lithium in the acute maintenance of
bipolar disorder is typically 0.6 to 1.2 mEq/L. A serum level of 1.2 mEq/L is
within the therapeutic range, so the current dose should be continued. The
patient should be monitored for signs of toxicity (e.g., GI upset, coarse
tremors, ataxia).
Question 4
Which of the following is a hallmark symptom of catatonia, a feature often
seen in schizophrenia spectrum disorders?
A) Waxy flexibility
B) Pressured speech
C) Flight of ideas
D) Grandiose delusions
Answer: A
Rationale: Catatonia is a psychomotor syndrome that can include waxy
flexibility, where a patient's limbs can be placed in unusual positions and
they will hold them there for an extended period. This is distinct from the
other options, which are more characteristic of mood disorders or other
psychotic features.
Question 5
Which of the following neurotransmitters is most implicated in the
pathophysiology of schizophrenia?
A) Dopamine
B) Serotonin
C) Norepinephrine
D) GABA
Answer: A
Practitioner PMHNP Certification
Practice Exam
This practice exam is designed to reflect the content and format of the
PMHNP board certification exams from the ANCC and AANP. The
questions test clinical knowledge across the lifespan and align with the
core domains of assessment, diagnosis, planning, and evaluation.
SECTION 1: ASSESSMENT & DIAGNOSIS
Question 1
A 45-year-old patient with no prior psychiatric history presents with a
3-week history of a persistently depressed mood, anhedonia, significant
weight loss, and insomnia. The patient also reports feeling hopeless and
having difficulty concentrating. What is the most appropriate initial action?
A) Prescribe a selective serotonin reuptake inhibitor (SSRI) immediately
B) Refer the patient for cognitive-behavioral therapy (CBT) only
C) Conduct a comprehensive psychiatric evaluation, including a medical
workup
D) Recommend an over-the-counter St. John's Wort supplement
Answer: C
Rationale: A comprehensive psychiatric evaluation is the essential first
step. This involves a detailed history, mental status exam, and assessment
for medical causes of depression. The patient's symptoms are new, and a
,medical workup is critical to rule out underlying conditions like
hypothyroidism or vitamin deficiencies before initiating treatment.
Treatment is based on findings from this thorough assessment.
Question 2
Which of the following is the most reliable indicator of treatment efficacy in
a patient with major depressive disorder?
A) The patient's subjective report of feeling "a little better"
B) A decrease in the patient's PHQ-9 score from 20 to 8
C) The patient's ability to return to work full-time
D) The patient reports having less fatigue
Answer: B
Rationale: Standardized screening tools like the PHQ-9 provide objective
and quantifiable data to measure treatment response. A significant
decrease in the PHQ-9 score (from 20, indicating severe depression, to 8,
indicating mild depression) is the strongest indicator of treatment efficacy.
While subjective reports and functional improvements are important, they
can be less reliable than validated scales.
Question 3
A patient with bipolar I disorder is prescribed lithium. The patient's serum
level is currently 1.2 mEq/L. What is the most appropriate nursing action?
A) Continue the current dose as prescribed
B) Decrease the dose and recheck serum levels
C) Increase the dose to achieve a higher therapeutic level
D) Educate the patient to take it with a high-sodium diet
Answer: A
, Rationale: The therapeutic range for lithium in the acute maintenance of
bipolar disorder is typically 0.6 to 1.2 mEq/L. A serum level of 1.2 mEq/L is
within the therapeutic range, so the current dose should be continued. The
patient should be monitored for signs of toxicity (e.g., GI upset, coarse
tremors, ataxia).
Question 4
Which of the following is a hallmark symptom of catatonia, a feature often
seen in schizophrenia spectrum disorders?
A) Waxy flexibility
B) Pressured speech
C) Flight of ideas
D) Grandiose delusions
Answer: A
Rationale: Catatonia is a psychomotor syndrome that can include waxy
flexibility, where a patient's limbs can be placed in unusual positions and
they will hold them there for an extended period. This is distinct from the
other options, which are more characteristic of mood disorders or other
psychotic features.
Question 5
Which of the following neurotransmitters is most implicated in the
pathophysiology of schizophrenia?
A) Dopamine
B) Serotonin
C) Norepinephrine
D) GABA
Answer: A
