ANCC IQ Domains 1-5, ANCC PMHNP
Exam Reported Questions, ANCC PMHNP
COMPREHENSIVE Q,ANCC Review
Questions and answers 2026
1. A 45-year-old patient with major depressive disorder has not responded to
two different SSRIs at adequate doses for 8 weeks each. The PMHNP decides
to initiate augmentation with an atypical antipsychotic. Which agent is FDA-
approved for this indication?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Risperidone
Answer: B
,rational,: Aripiprazole, brexpiprazole, and quetiapine XR are FDA-approved as
adjuncts to antidepressants for major depressive disorder. Ziprasidone, olanzapine,
and risperidone are not FDA-labeled for this indication, although olanzapine is
sometimes used off-label.
2. A patient presents with symptoms of restlessness, muscle rigidity, fever,
and altered mental status two days after starting haloperidol. Which of the
following is the most likely diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome (NMS)
C. Acute dystonia
D. Tardive dyskinesia
Answer: B
,rational,: NMS is characterized by fever, severe muscle rigidity, autonomic
,instability, and altered mental status, often occurring shortly after initiation of high-
potency typical antipsychotics like haloperidol. Serotonin syndrome usually follows
serotonergic agents and presents with clonus and hyperreflexia. Acute dystonia
involves muscle spasms without fever. Tardive dyskinesia is a late-onset
movement disorder.
3. A 7-year-old boy is being evaluated for ADHD. The PMHNP plans to start
methylphenidate. Which baseline assessment is essential before initiating this
medication?
A. Liver function tests
B. Electrocardiogram (ECG)
C. Cardiac history and family history of sudden cardiac death
D. Renal function panel
Answer: C
,rational,: Stimulant medications can increase heart rate and blood pressure; a
thorough cardiac history and family history of sudden cardiac death or arrhythmias
is essential before starting. ECG is not routinely required unless indicated.
4. A PMHNP is conducting a follow-up with a 72-year-old patient with
Alzheimer’s disease who is on donepezil. The patient’s caregiver reports new-
onset bradycardia and syncopal episodes. What is the most appropriate
action?
A. Increase the dose of donepezil
B. Discontinue donepezil and consider alternative treatment
C. Add memantine
D. Order an MRI brain
Answer: B
,rational,: Donepezil, a cholinesterase inhibitor, can cause bradycardia and
syncope due to increased vagal tone. The drug should be discontinued if
symptomatic bradycardia occurs. Memantine may be an alternative.
,5. A 32-year-old woman with bipolar I disorder, currently manic, is started on
lithium. Which laboratory test should be monitored regularly to ensure
therapeutic levels?
A. Serum lithium level every 6-12 months
B. Serum lithium level every 3-6 months after stabilization
C. Lithium level only when toxicity signs appear
D. Urine lithium level monthly
Answer: B
,rational,: After stabilization, serum lithium levels should be checked every 3–6
months, and more frequently if clinical status changes or interacting medications
are added.
6. A 55-year-old with generalized anxiety disorder is on paroxetine. The patient
reports anorgasmia and decreased libido. Which of the following medications
has the lowest risk of sexual side effects?
A. Sertraline
B. Fluoxetine
C. Bupropion
D. Venlafaxine
Answer: C
,rational,: Bupropion, an NDRI, has minimal sexual side effects compared to SSRIs
and SNRIs. Paroxetine has the highest incidence of sexual dysfunction among
SSRIs.
7. The PMHNP is using the PRIME-MD or PHQ-9 to screen for depression. This
is an example of which type of prevention?
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Quaternary prevention
Answer: B
, ,rational,: Screening for a disease in an asymptomatic population is secondary
prevention. Primary prevention prevents onset, tertiary reduces disability from
established disease.
8. According to Freudian theory, the stage during which the Oedipus complex
occurs is:
A. Oral
B. Anal
C. Phallic
D. Latency
Answer: C
,rational,: The phallic stage (ages 3–6 years) is when the Oedipus complex (boys)
and Electra complex (girls) occur according to Freud.
9. A PMHNP prescribes olanzapine for a patient with schizophrenia. Which
metabolic parameters should be monitored at baseline and periodically?
A. Liver enzymes
B. Fasting glucose, lipid profile, and weight
C. Serum creatinine
D. Complete blood count
Answer: B
,rational,: Olanzapine has a high metabolic risk; monitoring for hyperglycemia,
dyslipidemia, and weight gain is essential.
10. A patient on clozapine reports sore throat, fever, and malaise. The absolute
neutrophil count (ANC) is 900/µL. What is the appropriate action?
A. Continue clozapine, recheck CBC in 1 week
B. Discontinue clozapine immediately, do not rechallenge
C. Reduce clozapine dose by 50%
D. Add lithium to increase WBC
Answer: B
,rational,: ANC below 1000/µL indicates severe neutropenia; clozapine must be
Exam Reported Questions, ANCC PMHNP
COMPREHENSIVE Q,ANCC Review
Questions and answers 2026
1. A 45-year-old patient with major depressive disorder has not responded to
two different SSRIs at adequate doses for 8 weeks each. The PMHNP decides
to initiate augmentation with an atypical antipsychotic. Which agent is FDA-
approved for this indication?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Risperidone
Answer: B
,rational,: Aripiprazole, brexpiprazole, and quetiapine XR are FDA-approved as
adjuncts to antidepressants for major depressive disorder. Ziprasidone, olanzapine,
and risperidone are not FDA-labeled for this indication, although olanzapine is
sometimes used off-label.
2. A patient presents with symptoms of restlessness, muscle rigidity, fever,
and altered mental status two days after starting haloperidol. Which of the
following is the most likely diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome (NMS)
C. Acute dystonia
D. Tardive dyskinesia
Answer: B
,rational,: NMS is characterized by fever, severe muscle rigidity, autonomic
,instability, and altered mental status, often occurring shortly after initiation of high-
potency typical antipsychotics like haloperidol. Serotonin syndrome usually follows
serotonergic agents and presents with clonus and hyperreflexia. Acute dystonia
involves muscle spasms without fever. Tardive dyskinesia is a late-onset
movement disorder.
3. A 7-year-old boy is being evaluated for ADHD. The PMHNP plans to start
methylphenidate. Which baseline assessment is essential before initiating this
medication?
A. Liver function tests
B. Electrocardiogram (ECG)
C. Cardiac history and family history of sudden cardiac death
D. Renal function panel
Answer: C
,rational,: Stimulant medications can increase heart rate and blood pressure; a
thorough cardiac history and family history of sudden cardiac death or arrhythmias
is essential before starting. ECG is not routinely required unless indicated.
4. A PMHNP is conducting a follow-up with a 72-year-old patient with
Alzheimer’s disease who is on donepezil. The patient’s caregiver reports new-
onset bradycardia and syncopal episodes. What is the most appropriate
action?
A. Increase the dose of donepezil
B. Discontinue donepezil and consider alternative treatment
C. Add memantine
D. Order an MRI brain
Answer: B
,rational,: Donepezil, a cholinesterase inhibitor, can cause bradycardia and
syncope due to increased vagal tone. The drug should be discontinued if
symptomatic bradycardia occurs. Memantine may be an alternative.
,5. A 32-year-old woman with bipolar I disorder, currently manic, is started on
lithium. Which laboratory test should be monitored regularly to ensure
therapeutic levels?
A. Serum lithium level every 6-12 months
B. Serum lithium level every 3-6 months after stabilization
C. Lithium level only when toxicity signs appear
D. Urine lithium level monthly
Answer: B
,rational,: After stabilization, serum lithium levels should be checked every 3–6
months, and more frequently if clinical status changes or interacting medications
are added.
6. A 55-year-old with generalized anxiety disorder is on paroxetine. The patient
reports anorgasmia and decreased libido. Which of the following medications
has the lowest risk of sexual side effects?
A. Sertraline
B. Fluoxetine
C. Bupropion
D. Venlafaxine
Answer: C
,rational,: Bupropion, an NDRI, has minimal sexual side effects compared to SSRIs
and SNRIs. Paroxetine has the highest incidence of sexual dysfunction among
SSRIs.
7. The PMHNP is using the PRIME-MD or PHQ-9 to screen for depression. This
is an example of which type of prevention?
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Quaternary prevention
Answer: B
, ,rational,: Screening for a disease in an asymptomatic population is secondary
prevention. Primary prevention prevents onset, tertiary reduces disability from
established disease.
8. According to Freudian theory, the stage during which the Oedipus complex
occurs is:
A. Oral
B. Anal
C. Phallic
D. Latency
Answer: C
,rational,: The phallic stage (ages 3–6 years) is when the Oedipus complex (boys)
and Electra complex (girls) occur according to Freud.
9. A PMHNP prescribes olanzapine for a patient with schizophrenia. Which
metabolic parameters should be monitored at baseline and periodically?
A. Liver enzymes
B. Fasting glucose, lipid profile, and weight
C. Serum creatinine
D. Complete blood count
Answer: B
,rational,: Olanzapine has a high metabolic risk; monitoring for hyperglycemia,
dyslipidemia, and weight gain is essential.
10. A patient on clozapine reports sore throat, fever, and malaise. The absolute
neutrophil count (ANC) is 900/µL. What is the appropriate action?
A. Continue clozapine, recheck CBC in 1 week
B. Discontinue clozapine immediately, do not rechallenge
C. Reduce clozapine dose by 50%
D. Add lithium to increase WBC
Answer: B
,rational,: ANC below 1000/µL indicates severe neutropenia; clozapine must be
