AANP PMHNP CERTIFICATION EXAM
QUESTIONS AND ANSWERS WITH
RATIONS 2026/2027
Question 1
A 28-year-old female presents with episodic palpitations,
sweating, trembling, and a sudden fear of "going crazy" that
began abruptly 6 months ago. She now actively avoids driving
on highways due to fear of experiencing an attack. What is the
most appropriate initial clinician-rated severity tool?
A. PHQ-9
B. GAD-7
C. Panic Disorder Severity Scale (PDSS)
D. Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
Answer: C
Rationale: The PDSS is a validated, clinician-rated scale
specifically designed to evaluate the frequency, distress, and
behavioral avoidance associated with panic disorder. The PHQ-
9, GAD-7, and Y-BOCS measure depression, generalized
anxiety, and OCD, respectively.
Question 2
,A patient with schizophrenia has been stable on risperidone for 5
years. He now presents with involuntary lip-smacking, tongue
protrusion, and purposeless facial grimacing. What is the most
likely diagnosis?
A. Acute dystonia
B. Tardive dyskinesia
C. Akathisia
D. Neuroleptic malignant syndrome
Answer: B
Rationale: Tardive dyskinesia is a late-onset, persistent
extrapyramidal movement disorder linked to long-term
dopamine antagonist exposure, classically featuring choreiform
movements of the face, tongue, and mouth.
Question 3
Which medication is considered first-line pharmacological
treatment for Generalized Anxiety Disorder (GAD)?
A. Lorazepam
B. Paroxetine
C. Imipramine
D. Risperidone
Answer: B
,Rationale: Selective serotonin reuptake inhibitors (SSRIs), such
as paroxetine or sertraline, or serotonin-norepinephrine reuptake
inhibitors (SNRIs) are first-line long-term treatments for GAD
due to favorable safety profiles and efficacy over
benzodiazepines.
Question 4
A patient taking fluoxetine develops severe confusion,
diaphoresis, tachycardia, and hyperreflexia. Which finding
would NOT be typical of this presentation?
A. Agitation
B. Hyperreflexia
C. Bradycardia
D. Diaphoresis
Answer: C
Rationale: Serotonin syndrome features autonomic instability,
mental status changes, and neuromuscular hyperactivity
(including hyperreflexia, agitation, and diaphoresis), whereas
bradycardia is atypical, as tachycardia and hypertension are
characteristically present.
Question 5
What is the primary clinical indication for long-term lithium
maintenance therapy?
A. Schizophrenia
, B. Bipolar disorder
C. Major depressive disorder
D. Panic disorder
Answer: B
Rationale:* Lithium is a gold-standard mood stabilizer indicated
for the acute treatment and long-term maintenance prophylaxis
of bipolar I and II disorders to reduce manic and depressive
relapse.
Question 6
A patient taking lithium presents with a coarse hand tremor,
persistent nausea, and polyuria. What is the immediate next
clinical action?
A. Increase the lithium dose to compensate
B. Order an immediate serum lithium level and basic
metabolic panel
C. Start a concurrent loop diuretic to clear the kidneys
D. Switch immediately to valproic acid
Answer: B
Rationale:* Coarse tremors, GI distress, and polyuria are
warning signs of lithium toxicity. Checking a stat serum lithium
level and renal panel is mandatory before altering dosing
schedules.
QUESTIONS AND ANSWERS WITH
RATIONS 2026/2027
Question 1
A 28-year-old female presents with episodic palpitations,
sweating, trembling, and a sudden fear of "going crazy" that
began abruptly 6 months ago. She now actively avoids driving
on highways due to fear of experiencing an attack. What is the
most appropriate initial clinician-rated severity tool?
A. PHQ-9
B. GAD-7
C. Panic Disorder Severity Scale (PDSS)
D. Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
Answer: C
Rationale: The PDSS is a validated, clinician-rated scale
specifically designed to evaluate the frequency, distress, and
behavioral avoidance associated with panic disorder. The PHQ-
9, GAD-7, and Y-BOCS measure depression, generalized
anxiety, and OCD, respectively.
Question 2
,A patient with schizophrenia has been stable on risperidone for 5
years. He now presents with involuntary lip-smacking, tongue
protrusion, and purposeless facial grimacing. What is the most
likely diagnosis?
A. Acute dystonia
B. Tardive dyskinesia
C. Akathisia
D. Neuroleptic malignant syndrome
Answer: B
Rationale: Tardive dyskinesia is a late-onset, persistent
extrapyramidal movement disorder linked to long-term
dopamine antagonist exposure, classically featuring choreiform
movements of the face, tongue, and mouth.
Question 3
Which medication is considered first-line pharmacological
treatment for Generalized Anxiety Disorder (GAD)?
A. Lorazepam
B. Paroxetine
C. Imipramine
D. Risperidone
Answer: B
,Rationale: Selective serotonin reuptake inhibitors (SSRIs), such
as paroxetine or sertraline, or serotonin-norepinephrine reuptake
inhibitors (SNRIs) are first-line long-term treatments for GAD
due to favorable safety profiles and efficacy over
benzodiazepines.
Question 4
A patient taking fluoxetine develops severe confusion,
diaphoresis, tachycardia, and hyperreflexia. Which finding
would NOT be typical of this presentation?
A. Agitation
B. Hyperreflexia
C. Bradycardia
D. Diaphoresis
Answer: C
Rationale: Serotonin syndrome features autonomic instability,
mental status changes, and neuromuscular hyperactivity
(including hyperreflexia, agitation, and diaphoresis), whereas
bradycardia is atypical, as tachycardia and hypertension are
characteristically present.
Question 5
What is the primary clinical indication for long-term lithium
maintenance therapy?
A. Schizophrenia
, B. Bipolar disorder
C. Major depressive disorder
D. Panic disorder
Answer: B
Rationale:* Lithium is a gold-standard mood stabilizer indicated
for the acute treatment and long-term maintenance prophylaxis
of bipolar I and II disorders to reduce manic and depressive
relapse.
Question 6
A patient taking lithium presents with a coarse hand tremor,
persistent nausea, and polyuria. What is the immediate next
clinical action?
A. Increase the lithium dose to compensate
B. Order an immediate serum lithium level and basic
metabolic panel
C. Start a concurrent loop diuretic to clear the kidneys
D. Switch immediately to valproic acid
Answer: B
Rationale:* Coarse tremors, GI distress, and polyuria are
warning signs of lithium toxicity. Checking a stat serum lithium
level and renal panel is mandatory before altering dosing
schedules.
