PMHNP ANCC Exam LATEST 2026 UPDATE 100
QUESTIONS AND DETAILED VERIFIED ANSWERS
FROM ACTUAL EXAMS TEST GRADE A+
1. A psychiatric-mental health nurse practitioner (PMHNP) is assessing a patient with major
depressive disorder. Which neurotransmitter imbalance is most associated with
depression?
A. Dopamine excess
B. Acetylcholine excess
C. Serotonin deficiency
D. GABA excess
Answer: C. Serotonin deficiency
Rationale: Depression is strongly associated with decreased serotonin activity, along with
norepinephrine and dopamine dysregulation.
2. A patient taking lithium reports nausea, tremors, and diarrhea. What is the PMHNP’s
priority action?
A. Reassure the patient
B. Assess lithium level immediately
C. Encourage caffeine intake
D. Stop all fluids
Answer: B. Assess lithium level immediately
Rationale: These are early signs of lithium toxicity, and serum lithium levels must be checked
promptly.
3. Which defense mechanism involves refusing to accept reality?
A. Projection
B. Rationalization
C. Denial
D. Sublimation
,Answer: C. Denial
Rationale: Denial is an unconscious refusal to acknowledge painful or anxiety-provoking
realities.
4. A patient diagnosed with schizophrenia hears voices telling him to self-harm. What is the
nurse practitioner’s priority response?
A. Ask the patient to ignore the voices
B. Determine if the patient has a plan to act on commands
C. Tell the patient the voices are not real
D. Change the subject
Answer: B. Determine if the patient has a plan to act on commands
Rationale: Command hallucinations require immediate suicide and safety assessment.
5. Which medication requires dietary tyramine restrictions?
A. Fluoxetine
B. Sertraline
C. Phenelzine
D. Venlafaxine
Answer: C. Phenelzine
Rationale: Phenelzine is an MAOI; tyramine intake may trigger hypertensive crisis.
6. A manic patient has not slept for 3 days and is pacing continuously. Which nursing
intervention is priority?
A. Encourage group activities
B. Set firm limits and decrease stimulation
C. Teach meditation techniques
D. Offer detailed explanations
Answer: B. Set firm limits and decrease stimulation
Rationale: Manic patients require low-stimulation environments and structured limit-setting.
, 7. Which symptom is considered a negative symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Flat affect
D. Disorganized speech
Answer: C. Flat affect
Rationale: Negative symptoms reflect loss of normal function, including flat affect and avolition.
8. A patient with panic disorder suddenly develops chest pain and shortness of breath.
What should the PMHNP assess first?
A. Recent caffeine intake
B. Medical causes of symptoms
C. Childhood trauma
D. Sleep hygiene
Answer: B. Medical causes of symptoms
Rationale: Physical conditions such as myocardial infarction must be ruled out before psychiatric
causes are assumed.
9. Which statement best describes transference?
A. The clinician projects feelings onto the patient
B. The patient unconsciously redirects feelings to the clinician
C. The patient avoids emotional attachment
D. The clinician ignores professional boundaries
Answer: B. The patient unconsciously redirects feelings to the clinician
Rationale: Transference occurs when patients transfer emotions from past relationships onto
providers.
10. Which medication is FDA-approved for ADHD?
A. Clozapine
B. Methylphenidate
, C. Haloperidol
D. Buspirone
Answer: B. Methylphenidate
Rationale: Methylphenidate is a stimulant commonly prescribed for ADHD.
11. A patient taking clozapine develops fever and sore throat. What is the PMHNP’s priority
action?
A. Encourage fluids
B. Obtain white blood cell count
C. Prescribe acetaminophen
D. Reduce caffeine intake
Answer: B. Obtain white blood cell count
Rationale: Clozapine may cause agranulocytosis, a potentially fatal decrease in white blood cells.
12. Which disorder is characterized by recurrent binge eating followed by compensatory
behaviors?
A. Anorexia nervosa
B. Avoidant restrictive food intake disorder
C. Bulimia nervosa
D. Pica
Answer: C. Bulimia nervosa
Rationale: Bulimia involves binge eating and compensatory behaviors such as vomiting or
laxative abuse.
13. Which therapeutic communication technique is most appropriate?
A. Giving advice
B. Changing the topic
C. Reflecting feelings
D. Minimizing concerns
Answer: C. Reflecting feelings
QUESTIONS AND DETAILED VERIFIED ANSWERS
FROM ACTUAL EXAMS TEST GRADE A+
1. A psychiatric-mental health nurse practitioner (PMHNP) is assessing a patient with major
depressive disorder. Which neurotransmitter imbalance is most associated with
depression?
A. Dopamine excess
B. Acetylcholine excess
C. Serotonin deficiency
D. GABA excess
Answer: C. Serotonin deficiency
Rationale: Depression is strongly associated with decreased serotonin activity, along with
norepinephrine and dopamine dysregulation.
2. A patient taking lithium reports nausea, tremors, and diarrhea. What is the PMHNP’s
priority action?
A. Reassure the patient
B. Assess lithium level immediately
C. Encourage caffeine intake
D. Stop all fluids
Answer: B. Assess lithium level immediately
Rationale: These are early signs of lithium toxicity, and serum lithium levels must be checked
promptly.
3. Which defense mechanism involves refusing to accept reality?
A. Projection
B. Rationalization
C. Denial
D. Sublimation
,Answer: C. Denial
Rationale: Denial is an unconscious refusal to acknowledge painful or anxiety-provoking
realities.
4. A patient diagnosed with schizophrenia hears voices telling him to self-harm. What is the
nurse practitioner’s priority response?
A. Ask the patient to ignore the voices
B. Determine if the patient has a plan to act on commands
C. Tell the patient the voices are not real
D. Change the subject
Answer: B. Determine if the patient has a plan to act on commands
Rationale: Command hallucinations require immediate suicide and safety assessment.
5. Which medication requires dietary tyramine restrictions?
A. Fluoxetine
B. Sertraline
C. Phenelzine
D. Venlafaxine
Answer: C. Phenelzine
Rationale: Phenelzine is an MAOI; tyramine intake may trigger hypertensive crisis.
6. A manic patient has not slept for 3 days and is pacing continuously. Which nursing
intervention is priority?
A. Encourage group activities
B. Set firm limits and decrease stimulation
C. Teach meditation techniques
D. Offer detailed explanations
Answer: B. Set firm limits and decrease stimulation
Rationale: Manic patients require low-stimulation environments and structured limit-setting.
, 7. Which symptom is considered a negative symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Flat affect
D. Disorganized speech
Answer: C. Flat affect
Rationale: Negative symptoms reflect loss of normal function, including flat affect and avolition.
8. A patient with panic disorder suddenly develops chest pain and shortness of breath.
What should the PMHNP assess first?
A. Recent caffeine intake
B. Medical causes of symptoms
C. Childhood trauma
D. Sleep hygiene
Answer: B. Medical causes of symptoms
Rationale: Physical conditions such as myocardial infarction must be ruled out before psychiatric
causes are assumed.
9. Which statement best describes transference?
A. The clinician projects feelings onto the patient
B. The patient unconsciously redirects feelings to the clinician
C. The patient avoids emotional attachment
D. The clinician ignores professional boundaries
Answer: B. The patient unconsciously redirects feelings to the clinician
Rationale: Transference occurs when patients transfer emotions from past relationships onto
providers.
10. Which medication is FDA-approved for ADHD?
A. Clozapine
B. Methylphenidate
, C. Haloperidol
D. Buspirone
Answer: B. Methylphenidate
Rationale: Methylphenidate is a stimulant commonly prescribed for ADHD.
11. A patient taking clozapine develops fever and sore throat. What is the PMHNP’s priority
action?
A. Encourage fluids
B. Obtain white blood cell count
C. Prescribe acetaminophen
D. Reduce caffeine intake
Answer: B. Obtain white blood cell count
Rationale: Clozapine may cause agranulocytosis, a potentially fatal decrease in white blood cells.
12. Which disorder is characterized by recurrent binge eating followed by compensatory
behaviors?
A. Anorexia nervosa
B. Avoidant restrictive food intake disorder
C. Bulimia nervosa
D. Pica
Answer: C. Bulimia nervosa
Rationale: Bulimia involves binge eating and compensatory behaviors such as vomiting or
laxative abuse.
13. Which therapeutic communication technique is most appropriate?
A. Giving advice
B. Changing the topic
C. Reflecting feelings
D. Minimizing concerns
Answer: C. Reflecting feelings
