ANCC PMHNP Exam
(PDF) Questions and Ansẉers with
rationales 2026\2027 update
This Exam contains:
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Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
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A 28-year-old patient presents with symptoms of major depressive
disorder (MDD). The PMHNP prescribes fluoxetine. What is the
primary mechanism of action of this medication?
A) Inhibiting monoamine oxidase (MAO)
B) Blocking serotonin and norepinephrine reuptake
C) Selectively blocking serotonin reuptake
D) Acting as a serotonin receptor antagonist
Correct Answer: C
Rationale: Fluoxetine is a selective serotonin reuptake inhibitor
(SSRI). It works by selectively blocking the reuptake of serotonin in
the synaptic cleft, increasing its availability. MAOIs inhibit the
enzyme monoamine oxidase (A). SNRIs block both serotonin and
norepinephrine (B). Serotonin receptor antagonists (like atypical
antipsychotics) block receptors, not reuptake (D).
A patient with schizophrenia is started on risperidone. At a 6-month
follow-up, the PMHNP notices involuntary, rhythmic movements of
the patient's mouth and tongue. What is the most likely diagnosis?
A) Acute dystonia
B) Tardive dyskinesia (TD)
C) Akathisia
D) Parkinsonism
Correct Answer: B
Rationale: Tardive dyskinesia is characterized by late-onset,
involuntary, choreoathetoid movements typically involving the face,
mouth, and tongue, associated with long-term dopamine D2
receptor antagonist use. Acute dystonia (A) presents as sustained
muscle contractions and occurs soon after starting medication.
Akathisia (C) is internal restlessness. Parkinsonism (D) includes
bradykinesia, rigidity, and tremor.
,A 45-year-old patient with bipolar I disorder is taking lithium. The
PMHNP notes a serum lithium level of 1.4 mEq/L. The patient
complains of nausea, vomiting, and coarse hand tremors. What is
the priority nursing intervention?
A) Administer a beta-blocker for the tremor
B) Hold the next dose of lithium and draw a repeat level
C) Switch the patient to valproic acid immediately
D) Encourage increased fluid intake with regular table salt
Correct Answer: B
Rationale: A lithium level of 1.4 mEq/L is in the toxic range
(therapeutic is 0.6–1.2 mEq/L). Symptoms of toxicity include
nausea, vomiting, coarse tremors, and ataxia. The priority is to hold
the medication to prevent further accumulation and recheck the
level. While fluids and salt are used to enhance excretion, holding
the drug is the immediate safety priority. Switching medications
abruptly (C) is dangerous during toxicity.
Which of the following medications is a CYP3A4 enzyme inducer,
which would decrease the serum levels of many psychotropic
medications?
A) Fluoxetine
B) Carbamazepine
C) Nefazodone
D) Fluvoxamine
Correct Answer: B
Rationale: Carbamazepine is a potent CYP3A4 inducer. It speeds up
the metabolism of drugs processed by this pathway, reducing their
efficacy. Fluoxetine (A), nefazodone (C), and fluvoxamine (D) are
CYP450 inhibitors.
, A PMHNP is treating a 22-year-old patient with Borderline Personality
Disorder who engages in self-harm. Which evidence-based
psychotherapy is the first-line treatment for this condition?
A) Cognitive Behavioral Therapy (CBT)
B) Dialectical Behavior Therapy (DBT)
C) Psychodynamic Psychotherapy
D) Supportive Psychotherapy
Correct Answer: B
Rationale: DBT was specifically developed by Marsha Linehan for
individuals with Borderline Personality Disorder and chronic self-
harm/suicidality. It focuses on distress tolerance, emotion
regulation, mindfulness, and interpersonal effectiveness. While
others can be used, DBT has the strongest evidence base as the
first-line standard of care.
A 16-year-old patient is prescribed methylphenidate for ADHD. The
parents report that the child has lost 5 pounds since starting the
medication 2 months ago and complains of stomach aches. What is
the best next step?
A) Switch to atomoxetine
B) Recommend taking the medication with meals
C) Add a mood stabilizer
D) Discontinue the medication immediately
Correct Answer: B
Rationale: Anorexia and abdominal pain are common side effects of
stimulants. Taking the medication with or immediately after meals
can help mitigate these effects. If this fails or weight loss is severe,
switching to a non-stimulant like atomoxetine (A) may be
considered, but trying a simple dietary adjustment is the best initial
step.
(PDF) Questions and Ansẉers with
rationales 2026\2027 update
This Exam contains:
Guarantee passing score
Questions and Ansẉers
format set of multiple-choice
Expert-Verified rationales
Verified ẉith trusted textbooks
,───────────────────────────────────────────────────────
─
A 28-year-old patient presents with symptoms of major depressive
disorder (MDD). The PMHNP prescribes fluoxetine. What is the
primary mechanism of action of this medication?
A) Inhibiting monoamine oxidase (MAO)
B) Blocking serotonin and norepinephrine reuptake
C) Selectively blocking serotonin reuptake
D) Acting as a serotonin receptor antagonist
Correct Answer: C
Rationale: Fluoxetine is a selective serotonin reuptake inhibitor
(SSRI). It works by selectively blocking the reuptake of serotonin in
the synaptic cleft, increasing its availability. MAOIs inhibit the
enzyme monoamine oxidase (A). SNRIs block both serotonin and
norepinephrine (B). Serotonin receptor antagonists (like atypical
antipsychotics) block receptors, not reuptake (D).
A patient with schizophrenia is started on risperidone. At a 6-month
follow-up, the PMHNP notices involuntary, rhythmic movements of
the patient's mouth and tongue. What is the most likely diagnosis?
A) Acute dystonia
B) Tardive dyskinesia (TD)
C) Akathisia
D) Parkinsonism
Correct Answer: B
Rationale: Tardive dyskinesia is characterized by late-onset,
involuntary, choreoathetoid movements typically involving the face,
mouth, and tongue, associated with long-term dopamine D2
receptor antagonist use. Acute dystonia (A) presents as sustained
muscle contractions and occurs soon after starting medication.
Akathisia (C) is internal restlessness. Parkinsonism (D) includes
bradykinesia, rigidity, and tremor.
,A 45-year-old patient with bipolar I disorder is taking lithium. The
PMHNP notes a serum lithium level of 1.4 mEq/L. The patient
complains of nausea, vomiting, and coarse hand tremors. What is
the priority nursing intervention?
A) Administer a beta-blocker for the tremor
B) Hold the next dose of lithium and draw a repeat level
C) Switch the patient to valproic acid immediately
D) Encourage increased fluid intake with regular table salt
Correct Answer: B
Rationale: A lithium level of 1.4 mEq/L is in the toxic range
(therapeutic is 0.6–1.2 mEq/L). Symptoms of toxicity include
nausea, vomiting, coarse tremors, and ataxia. The priority is to hold
the medication to prevent further accumulation and recheck the
level. While fluids and salt are used to enhance excretion, holding
the drug is the immediate safety priority. Switching medications
abruptly (C) is dangerous during toxicity.
Which of the following medications is a CYP3A4 enzyme inducer,
which would decrease the serum levels of many psychotropic
medications?
A) Fluoxetine
B) Carbamazepine
C) Nefazodone
D) Fluvoxamine
Correct Answer: B
Rationale: Carbamazepine is a potent CYP3A4 inducer. It speeds up
the metabolism of drugs processed by this pathway, reducing their
efficacy. Fluoxetine (A), nefazodone (C), and fluvoxamine (D) are
CYP450 inhibitors.
, A PMHNP is treating a 22-year-old patient with Borderline Personality
Disorder who engages in self-harm. Which evidence-based
psychotherapy is the first-line treatment for this condition?
A) Cognitive Behavioral Therapy (CBT)
B) Dialectical Behavior Therapy (DBT)
C) Psychodynamic Psychotherapy
D) Supportive Psychotherapy
Correct Answer: B
Rationale: DBT was specifically developed by Marsha Linehan for
individuals with Borderline Personality Disorder and chronic self-
harm/suicidality. It focuses on distress tolerance, emotion
regulation, mindfulness, and interpersonal effectiveness. While
others can be used, DBT has the strongest evidence base as the
first-line standard of care.
A 16-year-old patient is prescribed methylphenidate for ADHD. The
parents report that the child has lost 5 pounds since starting the
medication 2 months ago and complains of stomach aches. What is
the best next step?
A) Switch to atomoxetine
B) Recommend taking the medication with meals
C) Add a mood stabilizer
D) Discontinue the medication immediately
Correct Answer: B
Rationale: Anorexia and abdominal pain are common side effects of
stimulants. Taking the medication with or immediately after meals
can help mitigate these effects. If this fails or weight loss is severe,
switching to a non-stimulant like atomoxetine (A) may be
considered, but trying a simple dietary adjustment is the best initial
step.
