ANCC Psychiatric-Mental Health Nurse Practitioner (PMHNP) Exam
Questions and Answers with Rationales 2026/2027 Update
1. A patient with major depressive disorder reports depressed mood,
anhedonia, insomnia, fatigue, and feelings of worthlessness for 3
weeks. Which additional symptom most strongly supports the
diagnosis?
A. Elevated self-esteem
B. Increased goal-directed activity
C. Recurrent thoughts of death
D. Decreased need for sleep
Answer: C
Rationale: Recurrent thoughts of death are a core depressive symptom.
Elevated self-esteem, increased goal-directed activity, and decreased
need for sleep are associated with mania/hypomania.
2. Which neurotransmitter is most strongly associated with the
regulation of mood and is the primary target of SSRIs?
A. Acetylcholine
B. Serotonin
C. GABA
D. Glutamate
Answer: B
Rationale: SSRIs increase serotonergic signaling by inhibiting serotonin
reuptake.
3. A patient taking sertraline develops agitation, diaphoresis, diarrhea,
tremor, hyperreflexia, and clonus. What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Tardive dyskinesia
,Answer: B
Rationale: Serotonin syndrome commonly presents with autonomic
instability, gastrointestinal symptoms, neuromuscular hyperactivity,
and mental-status changes.
4. Which finding is most characteristic of neuroleptic malignant
syndrome?
A. Lead-pipe rigidity and hyperthermia
B. Diarrhea and clonus
C. Pinpoint pupils
D. Excessive salivation without rigidity
Answer: A
Rationale: NMS is characterized by severe rigidity, hyperthermia,
altered mental status, and autonomic instability, often accompanied by
elevated CK.
5. A patient with bipolar I disorder is experiencing acute mania with
psychosis. Which treatment approach is most appropriate?
A. Antidepressant monotherapy
B. Antipsychotic medication
C. Psychotherapy alone
D. Stimulant medication
Answer: B
Rationale: Antipsychotics are commonly used for acute mania,
particularly when psychotic symptoms are present.
6. Which feature distinguishes bipolar I disorder from bipolar II
disorder?
A. Presence of depression
B. Presence of anxiety
C. At least one manic episode
D. Family history of mood disorders
,Answer: C
Rationale: Bipolar I requires a manic episode. Bipolar II requires
hypomania plus a major depressive episode and no history of mania.
7. A patient has had excessive anxiety and worry occurring more days
than not for more than 6 months and finds it difficult to control the
worry. Which diagnosis is most likely?
A. Panic disorder
B. Generalized anxiety disorder
C. Adjustment disorder
D. Specific phobia
Answer: B
Rationale: Persistent, difficult-to-control excessive worry across
multiple domains for at least 6 months is characteristic of GAD.
8. Which medication class is generally considered first-line
pharmacotherapy for generalized anxiety disorder?
A. SSRIs
B. Barbiturates
C. Stimulants
D. Anticholinergics
Answer: A
Rationale: SSRIs and SNRIs are commonly first-line pharmacologic
treatments for GAD.
9. A patient experiences recurrent unexpected panic attacks followed
by persistent concern about having another attack. Which diagnosis is
most likely?
A. Social anxiety disorder
B. Panic disorder
C. OCD
D. PTSD
, Answer: B
Rationale: Panic disorder involves recurrent unexpected panic attacks
accompanied by persistent concern or behavioral changes related to
future attacks.
10. Which symptom is characteristic of a panic attack?
A. Gradual cognitive decline
B. Palpitations and fear of dying
C. Persistent elevated mood for weeks
D. Compulsive counting
Answer: B
Rationale: Panic attacks can include palpitations, chest discomfort,
shortness of breath, dizziness, derealization, and intense fear of dying
or losing control.
11. Which psychotherapy has strong evidence for obsessive-compulsive
disorder?
A. Exposure and response prevention
B. Supportive therapy only
C. Dream analysis alone
D. Aversion therapy
Answer: A
Rationale: ERP is a specialized form of CBT that systematically exposes
patients to feared stimuli while preventing compulsive responses.
12. A patient repeatedly checks that the stove is off despite knowing it
is already off. The checking behavior is best described as a:
A. Delusion
B. Compulsion
C. Hallucination
D. Flashback
Answer: B
Questions and Answers with Rationales 2026/2027 Update
1. A patient with major depressive disorder reports depressed mood,
anhedonia, insomnia, fatigue, and feelings of worthlessness for 3
weeks. Which additional symptom most strongly supports the
diagnosis?
A. Elevated self-esteem
B. Increased goal-directed activity
C. Recurrent thoughts of death
D. Decreased need for sleep
Answer: C
Rationale: Recurrent thoughts of death are a core depressive symptom.
Elevated self-esteem, increased goal-directed activity, and decreased
need for sleep are associated with mania/hypomania.
2. Which neurotransmitter is most strongly associated with the
regulation of mood and is the primary target of SSRIs?
A. Acetylcholine
B. Serotonin
C. GABA
D. Glutamate
Answer: B
Rationale: SSRIs increase serotonergic signaling by inhibiting serotonin
reuptake.
3. A patient taking sertraline develops agitation, diaphoresis, diarrhea,
tremor, hyperreflexia, and clonus. What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Tardive dyskinesia
,Answer: B
Rationale: Serotonin syndrome commonly presents with autonomic
instability, gastrointestinal symptoms, neuromuscular hyperactivity,
and mental-status changes.
4. Which finding is most characteristic of neuroleptic malignant
syndrome?
A. Lead-pipe rigidity and hyperthermia
B. Diarrhea and clonus
C. Pinpoint pupils
D. Excessive salivation without rigidity
Answer: A
Rationale: NMS is characterized by severe rigidity, hyperthermia,
altered mental status, and autonomic instability, often accompanied by
elevated CK.
5. A patient with bipolar I disorder is experiencing acute mania with
psychosis. Which treatment approach is most appropriate?
A. Antidepressant monotherapy
B. Antipsychotic medication
C. Psychotherapy alone
D. Stimulant medication
Answer: B
Rationale: Antipsychotics are commonly used for acute mania,
particularly when psychotic symptoms are present.
6. Which feature distinguishes bipolar I disorder from bipolar II
disorder?
A. Presence of depression
B. Presence of anxiety
C. At least one manic episode
D. Family history of mood disorders
,Answer: C
Rationale: Bipolar I requires a manic episode. Bipolar II requires
hypomania plus a major depressive episode and no history of mania.
7. A patient has had excessive anxiety and worry occurring more days
than not for more than 6 months and finds it difficult to control the
worry. Which diagnosis is most likely?
A. Panic disorder
B. Generalized anxiety disorder
C. Adjustment disorder
D. Specific phobia
Answer: B
Rationale: Persistent, difficult-to-control excessive worry across
multiple domains for at least 6 months is characteristic of GAD.
8. Which medication class is generally considered first-line
pharmacotherapy for generalized anxiety disorder?
A. SSRIs
B. Barbiturates
C. Stimulants
D. Anticholinergics
Answer: A
Rationale: SSRIs and SNRIs are commonly first-line pharmacologic
treatments for GAD.
9. A patient experiences recurrent unexpected panic attacks followed
by persistent concern about having another attack. Which diagnosis is
most likely?
A. Social anxiety disorder
B. Panic disorder
C. OCD
D. PTSD
, Answer: B
Rationale: Panic disorder involves recurrent unexpected panic attacks
accompanied by persistent concern or behavioral changes related to
future attacks.
10. Which symptom is characteristic of a panic attack?
A. Gradual cognitive decline
B. Palpitations and fear of dying
C. Persistent elevated mood for weeks
D. Compulsive counting
Answer: B
Rationale: Panic attacks can include palpitations, chest discomfort,
shortness of breath, dizziness, derealization, and intense fear of dying
or losing control.
11. Which psychotherapy has strong evidence for obsessive-compulsive
disorder?
A. Exposure and response prevention
B. Supportive therapy only
C. Dream analysis alone
D. Aversion therapy
Answer: A
Rationale: ERP is a specialized form of CBT that systematically exposes
patients to feared stimuli while preventing compulsive responses.
12. A patient repeatedly checks that the stove is off despite knowing it
is already off. The checking behavior is best described as a:
A. Delusion
B. Compulsion
C. Hallucination
D. Flashback
Answer: B
