ANCC PMHNP ACTUAL EXAM REVIEW AND PERFECT STUDY GUIDE
2026 LATAEST EDITION 150 QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES
1. A patient with borderline personality disorder experiences intense anxiety when an adult
psychiatric and mental health nurse practitioner goes on vacation. The best explanation for this
reaction is that the patient:
A. has failed to develop clear ego boundaries.
B. has failed to master object constancy.
C. is employing primitive idealization.
D. is employing projective identification.
Rationale: Patients with borderline personality disorder lack object constancy, meaning they cannot
maintain an emotional connection to others when physically absent, leading to intense anxiety and fear
of abandonment.
2. A patient has been taking escitalopram (Lexapro) 10 mg daily for four weeks. Initially, the patient
reported depression and suicidal thoughts. Sleep, appetite, energy, and appearance have improved.
Which statement applies?
A. The medication should be discontinued.
B. The medication should be increased.
C. The patient's risk for suicide is not a concern.
D. The patient's suicide potential is increased.
Rationale: As energy improves before mood fully stabilizes, patients may have increased capacity to act
on suicidal thoughts, increasing suicide risk early in treatment.
3. Which behavior reflects existentially oriented therapy?
A. Attempting to understand a patient's subjective world
B. Challenging a patient's irrational beliefs
C. Developing specific plans for change
D. Establishing general group goals
Rationale: Existential therapy emphasizes understanding the patient’s subjective experience, meaning,
and personal responsibility.
4. Forty-eight hours after surviving a plane crash, patients report flashbacks, startle reactions, and
sleep disruption. The nurse practitioner should respond by:
,A. advising hypnotic medication
B. educating survivors about prodromal symptoms of PTSD
C. encouraging daytime rest
D. suggesting a posttrauma support group
Rationale: Education and normalization of acute stress reactions shortly after trauma help prevent
progression to PTSD.
5. Using interpersonal therapy, the nurse practitioner recognizes readiness for termination when the
patient demonstrates:
A. understanding that leaving a significant other may be painful but offers growth
B. use of breathing exercises
C. free association and dream analysis
D. completion of homework assignments
Rationale: Interpersonal therapy focuses on relationship transitions and growth, signaling readiness for
termination.
6. An Hispanic patient reports using hot chili juice for a “nervous condition” with no adverse effects.
The nurse practitioner should:
A. discourage the practice
B. prescribe medication
C. suggest an alternative food
D. view this as a self-care ritual that should be preserved
Rationale: Cultural practices that are not harmful should be respected and preserved.
7. Before initiating a renally cleared medication in an older adult, the nurse practitioner assesses:
A. blood urea nitrogen
B. creatinine clearance
C. urine specific gravity
D. urinary sediment
Rationale: Creatinine clearance best reflects kidney function and medication clearance in older adults.
8. Using a cognitive-behavioral approach, after identifying a stressor, the next intervention is to
identify:
A. alternative positive responses
B. negative consequences
,C. possible outcomes
D. rational and irrational beliefs about the stressor
Rationale: CBT focuses on identifying and restructuring irrational beliefs driving maladaptive behavior.
9. Which characteristic of fluoxetine (Prozac) provides the greatest safety for severely depressed
patients?
A. greater efficacy than TCAs
B. fewer drug interactions
C. less potential for injury with intentional overdose
D. reduced suicidal thinking
Rationale: SSRIs have a much safer overdose profile than tricyclic antidepressants.
10. When lobbying for nurse practitioner reimbursement, the nurse practitioner emphasizes:
A. the ability of nurse practitioners to provide needed health care
B. caring attitudes
C. expanding nursing scope
D. equal urban and rural services
Rationale: Advocacy focuses on patient access and healthcare delivery effectiveness.
11. A patient on lithium develops toxicity after starting hydrochlorothiazide. This interaction causes:
A. hypokalemia
B. hyponatremia
C. increased renal clearance of lithium
D. reduced renal clearance of lithium
Rationale: Thiazide diuretics reduce lithium clearance, increasing serum lithium levels.
12. Which statement from a patient with PTSD and chronic suicidal ideation indicates need for
hospital assessment?
A. “I wish I were dead.”
B. “My wife removed all my guns.”
C. “My wife left with the children. I have no future.”
D. “I stopped taking my meds.”
Rationale: Acute loss and hopelessness significantly increase suicide risk.
, 13. A patient has not slept in three days, has poor concentration, and denies fatigue. The diagnosis is:
A. ADHD
B. Bipolar disorder
C. Panic disorder
D. Primary insomnia
Rationale: Decreased need for sleep without fatigue is characteristic of mania.
14. Patient education about sertraline (Zoloft) should emphasize which side effect?
A. agranulocytosis
B. hypernatremia
C. sexual dysfunction
D. weight loss
Rationale: Sexual dysfunction is a common SSRI adverse effect.
15. Tourette disorder involves:
A. decreased GABA and increased glutamate
B. prefrontal cortex deficits
C. imbalances in dopaminergic, serotonergic, and noradrenergic systems
D. excessive locus coeruleus activity
Rationale: Tourette disorder is linked to neurotransmitter dysregulation, especially dopamine.
16. Before implementing evidence-based practice changes, the nurse practitioner first:
A. brainstorms with stakeholders
B. compares benchmarks
C. synthesizes evidence
D. identifies barriers and facilitators reflecting patient values
Rationale: Understanding barriers and facilitators ensures effective implementation.
17. Anxiety and panic symptoms are associated with low levels of:
A. cortisol
B. dopamine
C. gamma-aminobutyric acid (GABA)
D. glutamate
Rationale: GABA is inhibitory; low levels result in increased anxiety.
2026 LATAEST EDITION 150 QUESTIONS AND CORRECT ANSWERS
WITH RATIONALES
1. A patient with borderline personality disorder experiences intense anxiety when an adult
psychiatric and mental health nurse practitioner goes on vacation. The best explanation for this
reaction is that the patient:
A. has failed to develop clear ego boundaries.
B. has failed to master object constancy.
C. is employing primitive idealization.
D. is employing projective identification.
Rationale: Patients with borderline personality disorder lack object constancy, meaning they cannot
maintain an emotional connection to others when physically absent, leading to intense anxiety and fear
of abandonment.
2. A patient has been taking escitalopram (Lexapro) 10 mg daily for four weeks. Initially, the patient
reported depression and suicidal thoughts. Sleep, appetite, energy, and appearance have improved.
Which statement applies?
A. The medication should be discontinued.
B. The medication should be increased.
C. The patient's risk for suicide is not a concern.
D. The patient's suicide potential is increased.
Rationale: As energy improves before mood fully stabilizes, patients may have increased capacity to act
on suicidal thoughts, increasing suicide risk early in treatment.
3. Which behavior reflects existentially oriented therapy?
A. Attempting to understand a patient's subjective world
B. Challenging a patient's irrational beliefs
C. Developing specific plans for change
D. Establishing general group goals
Rationale: Existential therapy emphasizes understanding the patient’s subjective experience, meaning,
and personal responsibility.
4. Forty-eight hours after surviving a plane crash, patients report flashbacks, startle reactions, and
sleep disruption. The nurse practitioner should respond by:
,A. advising hypnotic medication
B. educating survivors about prodromal symptoms of PTSD
C. encouraging daytime rest
D. suggesting a posttrauma support group
Rationale: Education and normalization of acute stress reactions shortly after trauma help prevent
progression to PTSD.
5. Using interpersonal therapy, the nurse practitioner recognizes readiness for termination when the
patient demonstrates:
A. understanding that leaving a significant other may be painful but offers growth
B. use of breathing exercises
C. free association and dream analysis
D. completion of homework assignments
Rationale: Interpersonal therapy focuses on relationship transitions and growth, signaling readiness for
termination.
6. An Hispanic patient reports using hot chili juice for a “nervous condition” with no adverse effects.
The nurse practitioner should:
A. discourage the practice
B. prescribe medication
C. suggest an alternative food
D. view this as a self-care ritual that should be preserved
Rationale: Cultural practices that are not harmful should be respected and preserved.
7. Before initiating a renally cleared medication in an older adult, the nurse practitioner assesses:
A. blood urea nitrogen
B. creatinine clearance
C. urine specific gravity
D. urinary sediment
Rationale: Creatinine clearance best reflects kidney function and medication clearance in older adults.
8. Using a cognitive-behavioral approach, after identifying a stressor, the next intervention is to
identify:
A. alternative positive responses
B. negative consequences
,C. possible outcomes
D. rational and irrational beliefs about the stressor
Rationale: CBT focuses on identifying and restructuring irrational beliefs driving maladaptive behavior.
9. Which characteristic of fluoxetine (Prozac) provides the greatest safety for severely depressed
patients?
A. greater efficacy than TCAs
B. fewer drug interactions
C. less potential for injury with intentional overdose
D. reduced suicidal thinking
Rationale: SSRIs have a much safer overdose profile than tricyclic antidepressants.
10. When lobbying for nurse practitioner reimbursement, the nurse practitioner emphasizes:
A. the ability of nurse practitioners to provide needed health care
B. caring attitudes
C. expanding nursing scope
D. equal urban and rural services
Rationale: Advocacy focuses on patient access and healthcare delivery effectiveness.
11. A patient on lithium develops toxicity after starting hydrochlorothiazide. This interaction causes:
A. hypokalemia
B. hyponatremia
C. increased renal clearance of lithium
D. reduced renal clearance of lithium
Rationale: Thiazide diuretics reduce lithium clearance, increasing serum lithium levels.
12. Which statement from a patient with PTSD and chronic suicidal ideation indicates need for
hospital assessment?
A. “I wish I were dead.”
B. “My wife removed all my guns.”
C. “My wife left with the children. I have no future.”
D. “I stopped taking my meds.”
Rationale: Acute loss and hopelessness significantly increase suicide risk.
, 13. A patient has not slept in three days, has poor concentration, and denies fatigue. The diagnosis is:
A. ADHD
B. Bipolar disorder
C. Panic disorder
D. Primary insomnia
Rationale: Decreased need for sleep without fatigue is characteristic of mania.
14. Patient education about sertraline (Zoloft) should emphasize which side effect?
A. agranulocytosis
B. hypernatremia
C. sexual dysfunction
D. weight loss
Rationale: Sexual dysfunction is a common SSRI adverse effect.
15. Tourette disorder involves:
A. decreased GABA and increased glutamate
B. prefrontal cortex deficits
C. imbalances in dopaminergic, serotonergic, and noradrenergic systems
D. excessive locus coeruleus activity
Rationale: Tourette disorder is linked to neurotransmitter dysregulation, especially dopamine.
16. Before implementing evidence-based practice changes, the nurse practitioner first:
A. brainstorms with stakeholders
B. compares benchmarks
C. synthesizes evidence
D. identifies barriers and facilitators reflecting patient values
Rationale: Understanding barriers and facilitators ensures effective implementation.
17. Anxiety and panic symptoms are associated with low levels of:
A. cortisol
B. dopamine
C. gamma-aminobutyric acid (GABA)
D. glutamate
Rationale: GABA is inhibitory; low levels result in increased anxiety.
