NEWEST 2026/2027 PMHNP-BC Certification Practice Exam verified with correct
answers A+ graded/instant pdf
1. A 32-year-old woman presents with excessive worry about finances, work
performance, and the health of her family. She reports difficulty controlling the
worry for the past 8 months and has insomnia, muscle tension, and fatigue.
Which diagnosis is most appropriate?
A. Panic Disorder
B. Generalized Anxiety Disorder
C. Adjustment Disorder with Anxiety
D. Obsessive-Compulsive Disorder
✅ Answer: B. Generalized Anxiety Disorder (GAD)
Rationale: GAD requires excessive anxiety and worry occurring more days than not for at least
6 months, associated with symptoms such as restlessness, fatigue, impaired concentration,
irritability, muscle tension, and sleep disturbance.
2. Which medication is considered first-line pharmacotherapy for generalized
anxiety disorder?
A. Alprazolam
B. Sertraline
C. Haloperidol
D. Benztropine
✅ Answer: B. Sertraline
Rationale: SSRIs and SNRIs are first-line treatments for GAD because of their efficacy and
lower risk of dependence compared with benzodiazepines.
3. A patient taking lithium presents with coarse tremor, vomiting, confusion, and
ataxia. What is the priority intervention?
A. Increase the lithium dose
B. Hold lithium and obtain a serum lithium level while assessing renal function and hydration
C. Prescribe propranolol only
D. Continue lithium
,✅ Answer: B
Rationale: These symptoms are consistent with lithium toxicity and require prompt evaluation.
4. Which antipsychotic requires routine monitoring of the absolute neutrophil
count (ANC)?
A. Risperidone
B. Quetiapine
C. Clozapine
D. Aripiprazole
✅ Answer: C. Clozapine
Rationale: Clozapine carries a risk of severe neutropenia and requires ANC monitoring.
5. Which neurotransmitter is most strongly associated with schizophrenia?
A. Dopamine
B. Acetylcholine
C. Histamine
D. Glycine
✅ Answer: A. Dopamine
Rationale: Excess dopamine activity in the mesolimbic pathway is associated with positive
symptoms of schizophrenia.
6. A patient taking fluoxetine develops fever, agitation, hyperreflexia, clonus, and
diaphoresis after starting linezolid. Which condition is most likely?
A. Neuroleptic Malignant Syndrome
B. Serotonin Syndrome
C. Acute Dystonia
D. Tardive Dyskinesia
✅ Answer: B. Serotonin Syndrome
,Rationale: The combination of serotonergic medications and MAOI activity can precipitate
serotonin syndrome.
7. Which defense mechanism involves attributing one's own unacceptable
thoughts or feelings to another person?
A. Sublimation
B. Projection
C. Regression
D. Reaction Formation
✅ Answer: B. Projection
Rationale: Projection is an unconscious defense mechanism in which internal thoughts or
feelings are attributed to someone else.
8. A patient reports recurrent unexpected panic attacks followed by persistent
concern about having additional attacks for 2 months. Which diagnosis is most
likely?
A. Social Anxiety Disorder
B. Generalized Anxiety Disorder
C. Panic Disorder
D. Specific Phobia
✅ Answer: C. Panic Disorder
Rationale: Panic disorder involves recurrent unexpected panic attacks and at least 1 month of
persistent concern or maladaptive behavioral changes.
9. Which medication has the greatest evidence for reducing suicide risk in
bipolar disorder?
A. Lamotrigine
B. Lithium
C. Valproate
D. Carbamazepine
✅ Answer: B. Lithium
, Rationale: Lithium has demonstrated anti-suicidal effects in patients with bipolar disorder.
10. A patient taking haloperidol develops sustained neck muscle contractions and
upward deviation of the eyes shortly after starting treatment. Which
extrapyramidal symptom is present?
A. Tardive dyskinesia
B. Akathisia
C. Acute dystonia
D. Parkinsonism
✅ Answer: C. Acute dystonia
Rationale: Acute dystonia presents with painful muscle spasms and is typically treated with
benztropine or diphenhydramine.
11. Which medication is FDA-approved for ADHD in adults and children?
A. Sertraline
B. Methylphenidate
C. Quetiapine
D. Buspirone
✅ Answer: B. Methylphenidate
Rationale: Stimulants are considered first-line treatment for ADHD.
12. 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 include flat affect, avolition, alogia, anhedonia, and asociality.
answers A+ graded/instant pdf
1. A 32-year-old woman presents with excessive worry about finances, work
performance, and the health of her family. She reports difficulty controlling the
worry for the past 8 months and has insomnia, muscle tension, and fatigue.
Which diagnosis is most appropriate?
A. Panic Disorder
B. Generalized Anxiety Disorder
C. Adjustment Disorder with Anxiety
D. Obsessive-Compulsive Disorder
✅ Answer: B. Generalized Anxiety Disorder (GAD)
Rationale: GAD requires excessive anxiety and worry occurring more days than not for at least
6 months, associated with symptoms such as restlessness, fatigue, impaired concentration,
irritability, muscle tension, and sleep disturbance.
2. Which medication is considered first-line pharmacotherapy for generalized
anxiety disorder?
A. Alprazolam
B. Sertraline
C. Haloperidol
D. Benztropine
✅ Answer: B. Sertraline
Rationale: SSRIs and SNRIs are first-line treatments for GAD because of their efficacy and
lower risk of dependence compared with benzodiazepines.
3. A patient taking lithium presents with coarse tremor, vomiting, confusion, and
ataxia. What is the priority intervention?
A. Increase the lithium dose
B. Hold lithium and obtain a serum lithium level while assessing renal function and hydration
C. Prescribe propranolol only
D. Continue lithium
,✅ Answer: B
Rationale: These symptoms are consistent with lithium toxicity and require prompt evaluation.
4. Which antipsychotic requires routine monitoring of the absolute neutrophil
count (ANC)?
A. Risperidone
B. Quetiapine
C. Clozapine
D. Aripiprazole
✅ Answer: C. Clozapine
Rationale: Clozapine carries a risk of severe neutropenia and requires ANC monitoring.
5. Which neurotransmitter is most strongly associated with schizophrenia?
A. Dopamine
B. Acetylcholine
C. Histamine
D. Glycine
✅ Answer: A. Dopamine
Rationale: Excess dopamine activity in the mesolimbic pathway is associated with positive
symptoms of schizophrenia.
6. A patient taking fluoxetine develops fever, agitation, hyperreflexia, clonus, and
diaphoresis after starting linezolid. Which condition is most likely?
A. Neuroleptic Malignant Syndrome
B. Serotonin Syndrome
C. Acute Dystonia
D. Tardive Dyskinesia
✅ Answer: B. Serotonin Syndrome
,Rationale: The combination of serotonergic medications and MAOI activity can precipitate
serotonin syndrome.
7. Which defense mechanism involves attributing one's own unacceptable
thoughts or feelings to another person?
A. Sublimation
B. Projection
C. Regression
D. Reaction Formation
✅ Answer: B. Projection
Rationale: Projection is an unconscious defense mechanism in which internal thoughts or
feelings are attributed to someone else.
8. A patient reports recurrent unexpected panic attacks followed by persistent
concern about having additional attacks for 2 months. Which diagnosis is most
likely?
A. Social Anxiety Disorder
B. Generalized Anxiety Disorder
C. Panic Disorder
D. Specific Phobia
✅ Answer: C. Panic Disorder
Rationale: Panic disorder involves recurrent unexpected panic attacks and at least 1 month of
persistent concern or maladaptive behavioral changes.
9. Which medication has the greatest evidence for reducing suicide risk in
bipolar disorder?
A. Lamotrigine
B. Lithium
C. Valproate
D. Carbamazepine
✅ Answer: B. Lithium
, Rationale: Lithium has demonstrated anti-suicidal effects in patients with bipolar disorder.
10. A patient taking haloperidol develops sustained neck muscle contractions and
upward deviation of the eyes shortly after starting treatment. Which
extrapyramidal symptom is present?
A. Tardive dyskinesia
B. Akathisia
C. Acute dystonia
D. Parkinsonism
✅ Answer: C. Acute dystonia
Rationale: Acute dystonia presents with painful muscle spasms and is typically treated with
benztropine or diphenhydramine.
11. Which medication is FDA-approved for ADHD in adults and children?
A. Sertraline
B. Methylphenidate
C. Quetiapine
D. Buspirone
✅ Answer: B. Methylphenidate
Rationale: Stimulants are considered first-line treatment for ADHD.
12. 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 include flat affect, avolition, alogia, anhedonia, and asociality.
