Page 1 of 85
nursing foundations , Physiology Midterm C Purple Book PMHNP
COMBINED EXAMINATION 2026 UPDATED 2026 – 2027 WITH
QUESTIONS WITH CORRECT ANSWERS VERIFIED 100%
GRADED A+
Purple Book PMHNP 100 multiple choice questions w/answers ANCC
1. The purpose of the American Nurses Association's Psychiatric-Mental
Health Nursing: Scope and Standards of Practice is to
A. Define the role and actions for the NP
Establish the legal authority for the prescription of psychotropic
B. medications
C. Define the legal statutes of the role of the PMHNP
D. Define the differences between the physician role and the NP role
Correct Answer: A. The ANA's Psychiatric-Mental Health Nursing: Scope and
Standards of Practice defines the role and actions of the nurse practitioner.
2) Primary prevention care practices are an essential aspect of the PMHNP
role. Which of the following is the best example of a primary prevention care
strategy for community behavioral health?
a) Aftercare program for chronically mentally ill clients recently discharged
from the hospital
b) Court-ordered counseling for abusive parents
c) 24-hour crisis hotlines
d) Parenting skills classes for pregnant adolescents
Correct Answer: D. Information reduces incidence of disease.
3
The trend in legal rulings on cases involving mental illness over the past 25
years has been to
a) Encourage juries to find defendants not guilty by reason of insanity
b) Protect the person's freedoms or rights when he or she is committed to a
mental hospital
c) Place increasing trust in mental health professionals to make good and
ethical decisions
d) Decrease the "red tape" associated with commitments so that commitments
are faster and easier
B. Identifies the trend of ensuring the protection of individual civil liberties for
psychiatric clients.
4
Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic
symptoms, refuses to take any of his ordered medication because he believes
"Jesus Christ told me I am the prophet and must fast for a year." Your actions
should be based on your knowledge of which of the following?
a) Psychiatric clients cannot refuse treatment
b) Psychiatric clients do not always know what is good for them
c) Psychiatric clients can refuse treatment
, Page 2 of 85
d) Psychiatric clients cannot be trusted to make good healthcare decisions
and, therefore, the nurse's best clinical judgment should guide actions
C. As with any client, psychiatric clients can refuse treatment un- less a legal
process resulting in involuntary commitment or mandatory court order for treatment
has been obtained.
5. Which of the following statements best reflects the difference between the
nurse-client (N-C) relationship and a social relationship?
a) In the N-C relationship, the primary focus is on the client and the client's
needs.
b) Goals in the N-C relationship are deliberately left vague and unspoken so
that the client can work on any issue.
c) In the N-C relationship, the nurse is solely responsible for making the
relationship work.
d) In the N-C relationship, there is no place for social interaction.
A. Social relationships are mutual interpersonal relationships in which the needs of
both parties are addressed. The N-C relationship is most con- cerned with meeting
the needs of the client.
6. A community has an unusually high incidence of depression and drug use
among the teen- age population. The public health nurses decide to address
this problem, in part, by modifying the environment and strengthening the
capacities of families to prevent the development of new cases of depression
and drug use. What is this is an example of?
a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Protective factorial prevention
A. This action focuses on interventions designed to reduce the incidence of new
cases of disease.
7
Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours, she states
she wishes to leave because "this place can't help me." The best nursing
action that reflects the legal right of this client is
a) Discharge the client
b) Explain that the client cannot leave until you can complete further
assessment
c) Allow the client to leave but have her sign forms stating she is leaving
against medical advice
d) Immediately start the paperwork to commit the client and to allow you to
treat her against her wishes
Correct Answer: B. Almost every state allows for a brief period of detainment to as-
sess a client for dangerousness to self or others before allowing the client to leave a
hospital setting, even if the admission was voluntary.
8
In many characteristics that are known to be helpful in relationship-building.
Which of the fol- lowing is an essential part of building a therapeutic
relationship? forming a therapeutic relationship with clients, the PMHNP must
consider developing
a) Collecting a family history
b) Like-mindedness
, Page 3 of 85
c) Authenticity
d) Accuracy in assessment
C. Authenticity. Being genuine, honest, and respectful are essential elements in
establishing a working relationship with any client. Like-mindednessis not a part of
the therapeutic relationship. Although an important aspect of the PMHNP role,
collecting a family history and accuracy in assessment does not in and of itself
facilitate relationship-building.
9
According to the DSM-5, which of the following is true? (Ch. 3)
a) A mental disorder is equivalent to the need for treatment.
b) Diagnostic criteria are used to inform clinical judgment.
c) Socially deviant behavior is considered a mental disorder.
d) A culturally expected response to a stressor is not a mental disorder.
Correct Answer: D. All DSM-5 disorders need to be made taking a person's culture
into account. A cultural expression of a response to grief, loss, or stress is not con-
sidered a DSM-5 diagnosis.
10
Mrs. French has been in individual therapy for 3 months. She has shown much
growth and improvement in her functioning and insight and is to discontinue
services within the next few weeks. In the next session, after you discuss
service termination, she suddenly begins to demonstrate the original
symptoms that had brought her to treatment initially. She is now hesitant to
discharge, wants to continue services, and is displaying an increase in
regressive defense mechanisms. What is the best explanation for Ms. French's
behavior?
a) An exacerbation of her symptoms related to stress
b) The normal cyclic nature of chronic mental health symptoms
c) A sign of normal resistance to termination seen in the termination phase of
therapy
d) A sign of pathological attachment to the therapist that must be addressed
C. Clients frequently display resistance and regression at the termination of a
meaningful therapeutic process. The PMHNP is responsible for planning an effective
termination and monitoring clients during the termination period.
11
A client is displaying low self-esteem, poor self-control, self-doubt, and a high
level of de- pendency. These behaviors indicate developmental failure of which
of the following stages of development:
a) Infancy
b) Early childhood
c) Late childhood
d) School age
Correct Answer: B. These signs indicate developmental failure of early childhood.
12
Mr. Thompson has been forgetful lately, for example, forgetting where he has
placed his keys or what time appointments are scheduled, and he has stated
that he thinks these are just random behaviors that have no particular
meaning. Which Freudian-based psychodynamic principle assumes that all
behavior and actions are purposeful?
a) Pleasure principle
b) Psychic determinism principle
, Page 4 of 85
c) Reality principle
d) Unconsciousness principle
B. The psychic determinism principle states that all behavior has purpose and
meaning, often unconscious in nature, and that no behaviors occur randomly or by
coincidence.
13
1) An example of a mature, healthy defense mechanism is
a) Denial
b) b. Rationalization
c) Repression
d) Suppression
Correct Answer: D. Suppression is the only defense mechanism listed in which the
client channels conflicting energies into growth-promoting activities.
14
Mr. Johnson is a 54-year-old client you have been seeing for several weeks in
therapy. While discussing his current concerns of marital stress, he lies on the
floor and assumes the fetal position. This is most likely an example of
a) Immature regressive defense mechanism
b) Denial of reality
c) Immature fantasy defense mechanism
d) Repressive behavior
Correct Answer: A. Immature regressive defense mechanism is a return to a behav-
ior common to an earlier stage of development.
15
Defense mechanisms are best viewed as a function of the ego
a) To alert us to harm and danger
b) To alert us to problems
c) Used to resolve a conflict
d) Used to protect the id
Correct Answer: C. Defense mechanisms are a function of the ego used to resolve a
conflict.
16
One of the health care changes that has occurred as a result of the affordable
care act (ACA) is that doctors/hospitals/clinic groups or health systems are
coming together and assum- ing the responsibility for quality care to large
groups of individuals insured by Medicare. The health care clinics/systems
doctors or hospitals that join together are called which of the following?
a) Health Maintenance Organization (HMO)
b) Preferred Provider Network (PPO)
c) Accountable Care Organization (ACO)
d) Individual Health Plan (IHP)
Correct Answer: C. ACO's are groups of doctors or other health care providers who
voluntarily come together and assume the care provided to Medicare patients.
17
Health care economics is concerned with making decisions so the benefits
outweigh the cost of resource utilization. What are two concepts that
healthcare economics is concerned with in regard to fair distribution of
resources and allocation?
a) Equity and efficiency
b) Cost and benefits
nursing foundations , Physiology Midterm C Purple Book PMHNP
COMBINED EXAMINATION 2026 UPDATED 2026 – 2027 WITH
QUESTIONS WITH CORRECT ANSWERS VERIFIED 100%
GRADED A+
Purple Book PMHNP 100 multiple choice questions w/answers ANCC
1. The purpose of the American Nurses Association's Psychiatric-Mental
Health Nursing: Scope and Standards of Practice is to
A. Define the role and actions for the NP
Establish the legal authority for the prescription of psychotropic
B. medications
C. Define the legal statutes of the role of the PMHNP
D. Define the differences between the physician role and the NP role
Correct Answer: A. The ANA's Psychiatric-Mental Health Nursing: Scope and
Standards of Practice defines the role and actions of the nurse practitioner.
2) Primary prevention care practices are an essential aspect of the PMHNP
role. Which of the following is the best example of a primary prevention care
strategy for community behavioral health?
a) Aftercare program for chronically mentally ill clients recently discharged
from the hospital
b) Court-ordered counseling for abusive parents
c) 24-hour crisis hotlines
d) Parenting skills classes for pregnant adolescents
Correct Answer: D. Information reduces incidence of disease.
3
The trend in legal rulings on cases involving mental illness over the past 25
years has been to
a) Encourage juries to find defendants not guilty by reason of insanity
b) Protect the person's freedoms or rights when he or she is committed to a
mental hospital
c) Place increasing trust in mental health professionals to make good and
ethical decisions
d) Decrease the "red tape" associated with commitments so that commitments
are faster and easier
B. Identifies the trend of ensuring the protection of individual civil liberties for
psychiatric clients.
4
Mr. Smithers, an involuntarily hospitalized patient experiencing psychotic
symptoms, refuses to take any of his ordered medication because he believes
"Jesus Christ told me I am the prophet and must fast for a year." Your actions
should be based on your knowledge of which of the following?
a) Psychiatric clients cannot refuse treatment
b) Psychiatric clients do not always know what is good for them
c) Psychiatric clients can refuse treatment
, Page 2 of 85
d) Psychiatric clients cannot be trusted to make good healthcare decisions
and, therefore, the nurse's best clinical judgment should guide actions
C. As with any client, psychiatric clients can refuse treatment un- less a legal
process resulting in involuntary commitment or mandatory court order for treatment
has been obtained.
5. Which of the following statements best reflects the difference between the
nurse-client (N-C) relationship and a social relationship?
a) In the N-C relationship, the primary focus is on the client and the client's
needs.
b) Goals in the N-C relationship are deliberately left vague and unspoken so
that the client can work on any issue.
c) In the N-C relationship, the nurse is solely responsible for making the
relationship work.
d) In the N-C relationship, there is no place for social interaction.
A. Social relationships are mutual interpersonal relationships in which the needs of
both parties are addressed. The N-C relationship is most con- cerned with meeting
the needs of the client.
6. A community has an unusually high incidence of depression and drug use
among the teen- age population. The public health nurses decide to address
this problem, in part, by modifying the environment and strengthening the
capacities of families to prevent the development of new cases of depression
and drug use. What is this is an example of?
a) Primary prevention
b) Secondary prevention
c) Tertiary prevention
d) Protective factorial prevention
A. This action focuses on interventions designed to reduce the incidence of new
cases of disease.
7
Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours, she states
she wishes to leave because "this place can't help me." The best nursing
action that reflects the legal right of this client is
a) Discharge the client
b) Explain that the client cannot leave until you can complete further
assessment
c) Allow the client to leave but have her sign forms stating she is leaving
against medical advice
d) Immediately start the paperwork to commit the client and to allow you to
treat her against her wishes
Correct Answer: B. Almost every state allows for a brief period of detainment to as-
sess a client for dangerousness to self or others before allowing the client to leave a
hospital setting, even if the admission was voluntary.
8
In many characteristics that are known to be helpful in relationship-building.
Which of the fol- lowing is an essential part of building a therapeutic
relationship? forming a therapeutic relationship with clients, the PMHNP must
consider developing
a) Collecting a family history
b) Like-mindedness
, Page 3 of 85
c) Authenticity
d) Accuracy in assessment
C. Authenticity. Being genuine, honest, and respectful are essential elements in
establishing a working relationship with any client. Like-mindednessis not a part of
the therapeutic relationship. Although an important aspect of the PMHNP role,
collecting a family history and accuracy in assessment does not in and of itself
facilitate relationship-building.
9
According to the DSM-5, which of the following is true? (Ch. 3)
a) A mental disorder is equivalent to the need for treatment.
b) Diagnostic criteria are used to inform clinical judgment.
c) Socially deviant behavior is considered a mental disorder.
d) A culturally expected response to a stressor is not a mental disorder.
Correct Answer: D. All DSM-5 disorders need to be made taking a person's culture
into account. A cultural expression of a response to grief, loss, or stress is not con-
sidered a DSM-5 diagnosis.
10
Mrs. French has been in individual therapy for 3 months. She has shown much
growth and improvement in her functioning and insight and is to discontinue
services within the next few weeks. In the next session, after you discuss
service termination, she suddenly begins to demonstrate the original
symptoms that had brought her to treatment initially. She is now hesitant to
discharge, wants to continue services, and is displaying an increase in
regressive defense mechanisms. What is the best explanation for Ms. French's
behavior?
a) An exacerbation of her symptoms related to stress
b) The normal cyclic nature of chronic mental health symptoms
c) A sign of normal resistance to termination seen in the termination phase of
therapy
d) A sign of pathological attachment to the therapist that must be addressed
C. Clients frequently display resistance and regression at the termination of a
meaningful therapeutic process. The PMHNP is responsible for planning an effective
termination and monitoring clients during the termination period.
11
A client is displaying low self-esteem, poor self-control, self-doubt, and a high
level of de- pendency. These behaviors indicate developmental failure of which
of the following stages of development:
a) Infancy
b) Early childhood
c) Late childhood
d) School age
Correct Answer: B. These signs indicate developmental failure of early childhood.
12
Mr. Thompson has been forgetful lately, for example, forgetting where he has
placed his keys or what time appointments are scheduled, and he has stated
that he thinks these are just random behaviors that have no particular
meaning. Which Freudian-based psychodynamic principle assumes that all
behavior and actions are purposeful?
a) Pleasure principle
b) Psychic determinism principle
, Page 4 of 85
c) Reality principle
d) Unconsciousness principle
B. The psychic determinism principle states that all behavior has purpose and
meaning, often unconscious in nature, and that no behaviors occur randomly or by
coincidence.
13
1) An example of a mature, healthy defense mechanism is
a) Denial
b) b. Rationalization
c) Repression
d) Suppression
Correct Answer: D. Suppression is the only defense mechanism listed in which the
client channels conflicting energies into growth-promoting activities.
14
Mr. Johnson is a 54-year-old client you have been seeing for several weeks in
therapy. While discussing his current concerns of marital stress, he lies on the
floor and assumes the fetal position. This is most likely an example of
a) Immature regressive defense mechanism
b) Denial of reality
c) Immature fantasy defense mechanism
d) Repressive behavior
Correct Answer: A. Immature regressive defense mechanism is a return to a behav-
ior common to an earlier stage of development.
15
Defense mechanisms are best viewed as a function of the ego
a) To alert us to harm and danger
b) To alert us to problems
c) Used to resolve a conflict
d) Used to protect the id
Correct Answer: C. Defense mechanisms are a function of the ego used to resolve a
conflict.
16
One of the health care changes that has occurred as a result of the affordable
care act (ACA) is that doctors/hospitals/clinic groups or health systems are
coming together and assum- ing the responsibility for quality care to large
groups of individuals insured by Medicare. The health care clinics/systems
doctors or hospitals that join together are called which of the following?
a) Health Maintenance Organization (HMO)
b) Preferred Provider Network (PPO)
c) Accountable Care Organization (ACO)
d) Individual Health Plan (IHP)
Correct Answer: C. ACO's are groups of doctors or other health care providers who
voluntarily come together and assume the care provided to Medicare patients.
17
Health care economics is concerned with making decisions so the benefits
outweigh the cost of resource utilization. What are two concepts that
healthcare economics is concerned with in regard to fair distribution of
resources and allocation?
a) Equity and efficiency
b) Cost and benefits
