Psychiatric Mental Health Nurse (PMH Certification Exam)
New 2025 Version with All 150 Questions from Actual Past
Exam 100% Correct Answers and Rationale
Section 1: Pain Assessment (Questions 1–19)
1. A 55-year-old patient with chronic low back pain rates their pain as 7/10 on the Numeric
Rating Scale (NRS). What is the priority assessment?
A) Comprehensive history including onset, location, and aggravating factors.
B) Immediate opioid prescription.
C) Physical exam only.
D) No assessment needed. Correct Answer: A) Comprehensive history including onset,
location, and aggravating factors.
Rationale: Pain assessment begins with a thorough history to guide diagnosis and
management. ANCC Domain 1: Initial pain assessment using tools like NRS.
2. An elderly patient with dementia grimaces during movement. What pain assessment tool
is most appropriate?
A) PAINAD (Pain Assessment in Advanced Dementia) scale.
B) Visual Analog Scale (VAS).
C) No tool.
D) Verbal descriptor scale. Correct Answer: A) PAINAD (Pain Assessment in Advanced
Dementia) scale.
Rationale: PAINAD is validated for non-verbal patients. ANCC Domain 1: Assessment
in special populations like dementia.
3. A 40-year-old post-op patient reports sharp pain at the incision site. What physical
assessment finding indicates infection?
A) Erythema, warmth, and purulent drainage.
B) Mild tenderness only.
C) No drainage.
D) Cool skin. Correct Answer: A) Erythema, warmth, and purulent drainage.
Rationale: Signs of inflammation and infection. ANCC Domain 1: Physical assessment
for acute pain.
4. A patient with sickle cell disease has acute pain. What psychosocial assessment is key?
A) Screen for anxiety and coping mechanisms.
B) Ignore psychosocial.
C) Focus on physical only.
D) No screening. Correct Answer: A) Screen for anxiety and coping mechanisms.
Rationale: Chronic pain affects mental health. ANCC Domain 1: Psychosocial
assessment in chronic pain.
5. A 30-year-old with migraine reports photophobia. What cultural assessment?
A) Inquire about traditional remedies and beliefs.
B) No cultural inquiry.
C) Standard exam only.
D) Ignore culture. Correct Answer: A) Inquire about traditional remedies and beliefs.
Rationale: Ensures culturally competent care. ANCC Domain 1: Cultural factors in pain
, assessment.
6. A patient rates pain as 8/10 but appears comfortable. What next assessment?
A) Observe non-verbal cues and reassess with FLACC scale.
B) Accept self-report.
C) No reassessment.
D) Administer pain medication. Correct Answer: A) Observe non-verbal cues and
reassess with FLACC scale.
Rationale: Discrepancy requires further evaluation. ANCC Domain 1: Multi-dimensional
assessment.
7. An opioid-tolerant patient reports breakthrough pain. What assessment tool?
A) Brief Pain Inventory (BPI).
B) No tool.
C) NRS only.
D) VAS. Correct Answer: A) Brief Pain Inventory (BPI).
Rationale: Assesses pain interference in chronic cases. ANCC Domain 1: Assessment in
opioid-tolerant patients.
8. A pediatric patient with abdominal pain. What assessment?
A) Wong-Baker FACES scale.
B) Adult NRS.
C) No scale.
D) Verbal only. Correct Answer: A) Wong-Baker FACES scale.
Rationale: Age-appropriate for children. ANCC Domain 1: Pediatric pain assessment.
9. A patient with neuropathic pain describes burning. What assessment?
A) Neuropathy Symptom Score (NSS).
B) No specific tool.
C) General pain scale.
D) Ignore description. Correct Answer: A) Neuropathy Symptom Score (NSS).
Rationale: Evaluates neuropathic symptoms. ANCC Domain 1: Specialized pain
assessment.
10. A post-surgical patient has incisional pain. What assessment for opioid risk?
A) Opioid Risk Tool (ORT).
B) No risk assessment.
C) General history.
D) Labs only. Correct Answer: A) Opioid Risk Tool (ORT).
Rationale: Screens for abuse potential. ANCC Domain 1: Risk assessment in pain
management.
11. A patient with fibromyalgia has widespread pain. What assessment?
A) Widespread Pain Index (WPI).
B) No tool.
C) Local exam.
D) Ignore widespread. Correct Answer: A) Widespread Pain Index (WPI).
Rationale: Diagnostic for fibromyalgia. ANCC Domain 1: Chronic pain assessment.
12. An elderly patient with hip fracture pain. What tool?
A) PAINAD if non-verbal.
B) NRS.
C) No tool.
, D) Verbal descriptor. Correct Answer: A) PAINAD if non-verbal.
Rationale: For cognitively impaired elderly. ANCC Domain 1: Geriatric pain assessment.
13. A patient with cancer pain reports interference with sleep. What assessment?
A) MD Anderson Symptom Inventory (MDASI).
B) No assessment.
C) NRS only.
D) Physical exam. Correct Answer: A) MD Anderson Symptom Inventory (MDASI).
Rationale: Assesses symptom burden. ANCC Domain 1: Oncologic pain assessment.
14. A patient with sickle cell crisis has severe pain. What psychosocial?
A) Assess for depression and coping strategies.
B) Ignore psychosocial.
C) Physical only.
D) No coping assessment. Correct Answer: A) Assess for depression and coping
strategies.
Rationale: Chronic pain impacts mental health. ANCC Domain 1: Psychosocial
assessment.
15. A patient with post-herpetic neuralgia has burning pain. What assessment?
A) Neuropathic Pain Symptom Inventory (NPSI).
B) No tool.
C) General scale.
D) Ignore burning. Correct Answer: A) Neuropathic Pain Symptom Inventory (NPSI).
Rationale: Characterizes neuropathic pain. ANCC Domain 1: Neuropathic pain
assessment.
16. A pediatric patient with appendicitis has guarding. What pain assessment?
A) FLACC scale for behavioral cues.
B) Adult NRS.
C) No scale.
D) Verbal only. Correct Answer: A) FLACC scale for behavioral cues.
Rationale: Suitable for young children. ANCC Domain 1: Acute pediatric pain
assessment.
17. A patient with chronic pain has opioid tolerance. What assessment?
A) Current Opioid Misuse Measure (COMM).
B) No assessment.
C) General history.
D) Labs only. Correct Answer: A) Current Opioid Misuse Measure (COMM).
Rationale: Screens for misuse. ANCC Domain 1: Opioid tolerance assessment.
18. A patient with rheumatoid arthritis has morning stiffness. What assessment?
A) Disease Activity Score (DAS28).
B) No tool.
C) Local exam.
D) Ignore stiffness. Correct Answer: A) Disease Activity Score (DAS28).
Rationale: Evaluates RA activity. ANCC Domain 1: Inflammatory pain assessment.
19. A patient with terminal cancer has breakthrough pain. What assessment?
A) Edmonton Symptom Assessment System (ESAS).
B) No tool.
C) NRS only.
New 2025 Version with All 150 Questions from Actual Past
Exam 100% Correct Answers and Rationale
Section 1: Pain Assessment (Questions 1–19)
1. A 55-year-old patient with chronic low back pain rates their pain as 7/10 on the Numeric
Rating Scale (NRS). What is the priority assessment?
A) Comprehensive history including onset, location, and aggravating factors.
B) Immediate opioid prescription.
C) Physical exam only.
D) No assessment needed. Correct Answer: A) Comprehensive history including onset,
location, and aggravating factors.
Rationale: Pain assessment begins with a thorough history to guide diagnosis and
management. ANCC Domain 1: Initial pain assessment using tools like NRS.
2. An elderly patient with dementia grimaces during movement. What pain assessment tool
is most appropriate?
A) PAINAD (Pain Assessment in Advanced Dementia) scale.
B) Visual Analog Scale (VAS).
C) No tool.
D) Verbal descriptor scale. Correct Answer: A) PAINAD (Pain Assessment in Advanced
Dementia) scale.
Rationale: PAINAD is validated for non-verbal patients. ANCC Domain 1: Assessment
in special populations like dementia.
3. A 40-year-old post-op patient reports sharp pain at the incision site. What physical
assessment finding indicates infection?
A) Erythema, warmth, and purulent drainage.
B) Mild tenderness only.
C) No drainage.
D) Cool skin. Correct Answer: A) Erythema, warmth, and purulent drainage.
Rationale: Signs of inflammation and infection. ANCC Domain 1: Physical assessment
for acute pain.
4. A patient with sickle cell disease has acute pain. What psychosocial assessment is key?
A) Screen for anxiety and coping mechanisms.
B) Ignore psychosocial.
C) Focus on physical only.
D) No screening. Correct Answer: A) Screen for anxiety and coping mechanisms.
Rationale: Chronic pain affects mental health. ANCC Domain 1: Psychosocial
assessment in chronic pain.
5. A 30-year-old with migraine reports photophobia. What cultural assessment?
A) Inquire about traditional remedies and beliefs.
B) No cultural inquiry.
C) Standard exam only.
D) Ignore culture. Correct Answer: A) Inquire about traditional remedies and beliefs.
Rationale: Ensures culturally competent care. ANCC Domain 1: Cultural factors in pain
, assessment.
6. A patient rates pain as 8/10 but appears comfortable. What next assessment?
A) Observe non-verbal cues and reassess with FLACC scale.
B) Accept self-report.
C) No reassessment.
D) Administer pain medication. Correct Answer: A) Observe non-verbal cues and
reassess with FLACC scale.
Rationale: Discrepancy requires further evaluation. ANCC Domain 1: Multi-dimensional
assessment.
7. An opioid-tolerant patient reports breakthrough pain. What assessment tool?
A) Brief Pain Inventory (BPI).
B) No tool.
C) NRS only.
D) VAS. Correct Answer: A) Brief Pain Inventory (BPI).
Rationale: Assesses pain interference in chronic cases. ANCC Domain 1: Assessment in
opioid-tolerant patients.
8. A pediatric patient with abdominal pain. What assessment?
A) Wong-Baker FACES scale.
B) Adult NRS.
C) No scale.
D) Verbal only. Correct Answer: A) Wong-Baker FACES scale.
Rationale: Age-appropriate for children. ANCC Domain 1: Pediatric pain assessment.
9. A patient with neuropathic pain describes burning. What assessment?
A) Neuropathy Symptom Score (NSS).
B) No specific tool.
C) General pain scale.
D) Ignore description. Correct Answer: A) Neuropathy Symptom Score (NSS).
Rationale: Evaluates neuropathic symptoms. ANCC Domain 1: Specialized pain
assessment.
10. A post-surgical patient has incisional pain. What assessment for opioid risk?
A) Opioid Risk Tool (ORT).
B) No risk assessment.
C) General history.
D) Labs only. Correct Answer: A) Opioid Risk Tool (ORT).
Rationale: Screens for abuse potential. ANCC Domain 1: Risk assessment in pain
management.
11. A patient with fibromyalgia has widespread pain. What assessment?
A) Widespread Pain Index (WPI).
B) No tool.
C) Local exam.
D) Ignore widespread. Correct Answer: A) Widespread Pain Index (WPI).
Rationale: Diagnostic for fibromyalgia. ANCC Domain 1: Chronic pain assessment.
12. An elderly patient with hip fracture pain. What tool?
A) PAINAD if non-verbal.
B) NRS.
C) No tool.
, D) Verbal descriptor. Correct Answer: A) PAINAD if non-verbal.
Rationale: For cognitively impaired elderly. ANCC Domain 1: Geriatric pain assessment.
13. A patient with cancer pain reports interference with sleep. What assessment?
A) MD Anderson Symptom Inventory (MDASI).
B) No assessment.
C) NRS only.
D) Physical exam. Correct Answer: A) MD Anderson Symptom Inventory (MDASI).
Rationale: Assesses symptom burden. ANCC Domain 1: Oncologic pain assessment.
14. A patient with sickle cell crisis has severe pain. What psychosocial?
A) Assess for depression and coping strategies.
B) Ignore psychosocial.
C) Physical only.
D) No coping assessment. Correct Answer: A) Assess for depression and coping
strategies.
Rationale: Chronic pain impacts mental health. ANCC Domain 1: Psychosocial
assessment.
15. A patient with post-herpetic neuralgia has burning pain. What assessment?
A) Neuropathic Pain Symptom Inventory (NPSI).
B) No tool.
C) General scale.
D) Ignore burning. Correct Answer: A) Neuropathic Pain Symptom Inventory (NPSI).
Rationale: Characterizes neuropathic pain. ANCC Domain 1: Neuropathic pain
assessment.
16. A pediatric patient with appendicitis has guarding. What pain assessment?
A) FLACC scale for behavioral cues.
B) Adult NRS.
C) No scale.
D) Verbal only. Correct Answer: A) FLACC scale for behavioral cues.
Rationale: Suitable for young children. ANCC Domain 1: Acute pediatric pain
assessment.
17. A patient with chronic pain has opioid tolerance. What assessment?
A) Current Opioid Misuse Measure (COMM).
B) No assessment.
C) General history.
D) Labs only. Correct Answer: A) Current Opioid Misuse Measure (COMM).
Rationale: Screens for misuse. ANCC Domain 1: Opioid tolerance assessment.
18. A patient with rheumatoid arthritis has morning stiffness. What assessment?
A) Disease Activity Score (DAS28).
B) No tool.
C) Local exam.
D) Ignore stiffness. Correct Answer: A) Disease Activity Score (DAS28).
Rationale: Evaluates RA activity. ANCC Domain 1: Inflammatory pain assessment.
19. A patient with terminal cancer has breakthrough pain. What assessment?
A) Edmonton Symptom Assessment System (ESAS).
B) No tool.
C) NRS only.
