ANCC PSYCHIATRIC-MENTAL HEALTH NURSING
BOARD CERTIFICATION EXAMINATION
COMPREHENSIVE 200-QUESTION PRACTICE TEST
WITH ANSWERS AND RATIONALES BY DOMAIN
2026/2027 ACADEMIC YEAR
DOMAIN I: ASSESSMENT AND DIAGNOSIS (Questions 1-
28)
Question 1
A 72-year-old patient is brought to the emergency department by family
members who report a sudden onset of confusion, hallucinations, and agitation
that began 48 hours ago. The patient has a history of hypertension and type 2
diabetes. Which assessment finding is MOST indicative of delirium rather than
dementia?
A) Gradual memory loss over several years
B) Impaired judgment and reasoning
C) Acute onset with fluctuating level of consciousness
D) Personality changes with social withdrawal
Correct answer: C) Acute onset with fluctuating level of consciousness
Rationale: Delirium is characterized by acute onset (hours to days) and fluctuating
course with disturbances in attention and consciousness. Dementia typically has
,gradual onset with progressive cognitive decline. The acute onset with fluctuation is
the key distinguishing feature of delirium.
Reference: Domain I – Assessment and Diagnosis; Physiological Causes of Psychiatric
Symptoms
Question 2
A 45-year-old patient with major depressive disorder presents with
psychomotor retardation, hypersomnia, weight gain, and carbohydrate craving.
Which specifier BEST describes this presentation?
A) Melancholic features
B) Psychotic features
C) Atypical features
D) Catatonic features
Correct answer: C) Atypical features
Rationale: Atypical features of major depressive disorder include mood reactivity,
significant weight gain or increased appetite, hypersomnia, leaden paralysis
(heaviness in limbs), and long-standing pattern of interpersonal rejection sensitivity.
Melancholic features include anhedonia, early morning awakening, and psychomotor
agitation or retardation with distinct quality of mood.
Reference: Domain I – Assessment and Diagnosis; Psychiatric Disorders – Mood
Disorders
,Question 3
A patient diagnosed with schizophrenia has been taking antipsychotic
medication for 6 months. The nurse observes repetitive, involuntary chewing
movements and tongue protrusion. The AIMS (Abnormal Involuntary
Movement Scale) is scored. This assessment tool is used to evaluate which
condition?
A) Parkinsonism
B) Akathisia
C) Tardive dyskinesia
D) Dystonia
Correct answer: C) Tardive dyskinesia
Rationale: The Abnormal Involuntary Movement Scale (AIMS) is specifically designed
to assess for tardive dyskinesia, a late-onset movement disorder characterized by
involuntary, repetitive movements of the face, mouth, tongue, and extremities.
Tardive dyskinesia is associated with long-term antipsychotic use.
Reference: Domain I – Assessment and Diagnosis; Assessment Tools and Techniques
Question 4
During a Mental Status Examination (MSE), the patient speaks rapidly, jumps
from topic to topic, and is difficult to interrupt. The nurse documents this
speech pattern as:
A) Circumstantiality
B) Tangentiality
, C) Flight of ideas
D) Pressured speech
Correct answer: C) Flight of ideas
Rationale: Flight of ideas is characterized by rapid, continuous speech with abrupt
shifts from one topic to another, often seen in manic episodes. Pressured speech is
rapid speech that is difficult to interrupt but may not have the topic-jumping quality.
Circumstantiality involves excessive detail before reaching the point.
Reference: Domain I – Assessment and Diagnosis; Mental Status Examination
Question 5
A patient with a history of alcohol use disorder presents with tachycardia,
diaphoresis, tremors, and visual hallucinations. Vital signs: HR 120, BP 160/95,
temperature 99.8°F. These symptoms began 72 hours after last alcohol
consumption. Which condition is the patient MOST likely experiencing?
A) Alcohol intoxication
B) Wernicke-Korsakoff syndrome
C) Alcohol withdrawal delirium (Delirium Tremens)
D) Alcohol-induced liver failure
Correct answer: C) Alcohol withdrawal delirium (Delirium Tremens)
Rationale: Delirium tremens is a severe form of alcohol withdrawal that typically
occurs 48-96 hours after last alcohol use. Symptoms include severe autonomic
BOARD CERTIFICATION EXAMINATION
COMPREHENSIVE 200-QUESTION PRACTICE TEST
WITH ANSWERS AND RATIONALES BY DOMAIN
2026/2027 ACADEMIC YEAR
DOMAIN I: ASSESSMENT AND DIAGNOSIS (Questions 1-
28)
Question 1
A 72-year-old patient is brought to the emergency department by family
members who report a sudden onset of confusion, hallucinations, and agitation
that began 48 hours ago. The patient has a history of hypertension and type 2
diabetes. Which assessment finding is MOST indicative of delirium rather than
dementia?
A) Gradual memory loss over several years
B) Impaired judgment and reasoning
C) Acute onset with fluctuating level of consciousness
D) Personality changes with social withdrawal
Correct answer: C) Acute onset with fluctuating level of consciousness
Rationale: Delirium is characterized by acute onset (hours to days) and fluctuating
course with disturbances in attention and consciousness. Dementia typically has
,gradual onset with progressive cognitive decline. The acute onset with fluctuation is
the key distinguishing feature of delirium.
Reference: Domain I – Assessment and Diagnosis; Physiological Causes of Psychiatric
Symptoms
Question 2
A 45-year-old patient with major depressive disorder presents with
psychomotor retardation, hypersomnia, weight gain, and carbohydrate craving.
Which specifier BEST describes this presentation?
A) Melancholic features
B) Psychotic features
C) Atypical features
D) Catatonic features
Correct answer: C) Atypical features
Rationale: Atypical features of major depressive disorder include mood reactivity,
significant weight gain or increased appetite, hypersomnia, leaden paralysis
(heaviness in limbs), and long-standing pattern of interpersonal rejection sensitivity.
Melancholic features include anhedonia, early morning awakening, and psychomotor
agitation or retardation with distinct quality of mood.
Reference: Domain I – Assessment and Diagnosis; Psychiatric Disorders – Mood
Disorders
,Question 3
A patient diagnosed with schizophrenia has been taking antipsychotic
medication for 6 months. The nurse observes repetitive, involuntary chewing
movements and tongue protrusion. The AIMS (Abnormal Involuntary
Movement Scale) is scored. This assessment tool is used to evaluate which
condition?
A) Parkinsonism
B) Akathisia
C) Tardive dyskinesia
D) Dystonia
Correct answer: C) Tardive dyskinesia
Rationale: The Abnormal Involuntary Movement Scale (AIMS) is specifically designed
to assess for tardive dyskinesia, a late-onset movement disorder characterized by
involuntary, repetitive movements of the face, mouth, tongue, and extremities.
Tardive dyskinesia is associated with long-term antipsychotic use.
Reference: Domain I – Assessment and Diagnosis; Assessment Tools and Techniques
Question 4
During a Mental Status Examination (MSE), the patient speaks rapidly, jumps
from topic to topic, and is difficult to interrupt. The nurse documents this
speech pattern as:
A) Circumstantiality
B) Tangentiality
, C) Flight of ideas
D) Pressured speech
Correct answer: C) Flight of ideas
Rationale: Flight of ideas is characterized by rapid, continuous speech with abrupt
shifts from one topic to another, often seen in manic episodes. Pressured speech is
rapid speech that is difficult to interrupt but may not have the topic-jumping quality.
Circumstantiality involves excessive detail before reaching the point.
Reference: Domain I – Assessment and Diagnosis; Mental Status Examination
Question 5
A patient with a history of alcohol use disorder presents with tachycardia,
diaphoresis, tremors, and visual hallucinations. Vital signs: HR 120, BP 160/95,
temperature 99.8°F. These symptoms began 72 hours after last alcohol
consumption. Which condition is the patient MOST likely experiencing?
A) Alcohol intoxication
B) Wernicke-Korsakoff syndrome
C) Alcohol withdrawal delirium (Delirium Tremens)
D) Alcohol-induced liver failure
Correct answer: C) Alcohol withdrawal delirium (Delirium Tremens)
Rationale: Delirium tremens is a severe form of alcohol withdrawal that typically
occurs 48-96 hours after last alcohol use. Symptoms include severe autonomic
