AANP PMHNP Certification Board Exam
– Ultimate Study Bank 2026
Instructions
• Correct Answers are in Bold Italics
• Rationales are in Italic based on the AANPCB and ANCC PMHNP
exam blueprints
• Questions cover the core domains: Scientific Foundation (22%),
Advanced Practice Skills (27%), Diagnosis & Treatment (22%),
Psychotherapy & Related Theories (11%), and Ethics, Legal & Cultural
Care (17%)
• Based on the 2025/2026 updated exam content
1. A patient with schizophrenia has been stable on risperidone 4 mg
daily for 3 years but now presents with galactorrhea and amenorrhea.
What is the most appropriate next step?
A. Increase the risperidone dose
B. Switch to aripiprazole
C. Add bromocriptine
D. Order a prolactin level and consider switching to a prolactin-sparing
antipsychotic
Correct Answer: D. Order a prolactin level and consider switching to a
prolactin-sparing antipsychotic.
,Rationale: Risperidone is a potent dopamine antagonist that can elevate
prolactin levels, causing galactorrhea and amenorrhea. Aripiprazole is a
partial dopamine agonist and does not elevate prolactin levels. The first step
is to confirm hyperprolactinemia with a serum prolactin level, then consider
switching to a prolactin-sparing antipsychotic like aripiprazole .
2. A 24-year-old patient with bipolar I disorder is in a manic episode.
Which medication is first-line for acute mania?
A. Lamotrigine
B. Lithium
C. Fluoxetine
D. Quetiapine
Correct Answer: B. Lithium.
Rationale: Lithium is a first-line treatment for acute mania in bipolar I
disorder. Lamotrigine is more effective for bipolar depression; antidepressants
like fluoxetine can precipitate mania; quetiapine is also used but lithium
remains a primary choice .
3. A patient with generalized anxiety disorder has been on sertraline
for 6 weeks with partial response. Which augmentation strategy is
most appropriate?
A. Adding alprazolam as needed
B. Adding buspirone
C. Increasing sertraline to maximum dose immediately
D. Switching to fluoxetine
Correct Answer: B. Adding buspirone.
,Rationale: Buspirone is a 5-HT1A partial agonist that can be used as an
augmentation agent for SSRI partial responders. It has minimal abuse
potential and does not cause dependence, unlike benzodiazepines .
4. A 32-year-old patient with depression and insomnia is started on
mirtazapine. Which side effect requires close monitoring?
A. Insomnia
B. Weight gain
C. Dry mouth
D. Hypertension
Correct Answer: B. Weight gain.
Rationale: Mirtazapine is associated with significant weight gain due to its
strong antihistamine (H1) receptor antagonism. This can be a significant
concern for patients, especially those with metabolic risk factors .
5. A patient with ADHD is prescribed methylphenidate. Which adverse
effect should the PMHNP monitor for?
A. Bradycardia
B. Weight gain
C. Insomnia
D. Hypertension
Correct Answer: C. Insomnia.
Rationale: Methylphenidate is a stimulant that can cause insomnia and
appetite suppression. It is best to take it in the morning or early afternoon to
minimize sleep disruption .
, 6. Which of the following is a negative symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Avolition
D. Disorganized speech
Correct Answer: C. Avolition.
Rationale: Negative symptoms include avolition (lack of motivation), flat
affect, alogia (poverty of speech), and anhedonia. Hallucinations, delusions,
and disorganized speech are positive symptoms .
7. A patient with panic disorder is started on paroxetine. When does
paroxetine achieve full therapeutic effect?
A. 24-48 hours
B. 1-2 weeks
C. 4-6 weeks
D. 8-12 weeks
Correct Answer: C. 4-6 weeks.
Rationale: SSRIs like paroxetine typically take 4-6 weeks to achieve full
therapeutic effect. Patients should be educated not to discontinue
prematurely .
8. A 65-year-old patient with Alzheimer's disease is started on
donepezil. Which common side effect requires monitoring?
– Ultimate Study Bank 2026
Instructions
• Correct Answers are in Bold Italics
• Rationales are in Italic based on the AANPCB and ANCC PMHNP
exam blueprints
• Questions cover the core domains: Scientific Foundation (22%),
Advanced Practice Skills (27%), Diagnosis & Treatment (22%),
Psychotherapy & Related Theories (11%), and Ethics, Legal & Cultural
Care (17%)
• Based on the 2025/2026 updated exam content
1. A patient with schizophrenia has been stable on risperidone 4 mg
daily for 3 years but now presents with galactorrhea and amenorrhea.
What is the most appropriate next step?
A. Increase the risperidone dose
B. Switch to aripiprazole
C. Add bromocriptine
D. Order a prolactin level and consider switching to a prolactin-sparing
antipsychotic
Correct Answer: D. Order a prolactin level and consider switching to a
prolactin-sparing antipsychotic.
,Rationale: Risperidone is a potent dopamine antagonist that can elevate
prolactin levels, causing galactorrhea and amenorrhea. Aripiprazole is a
partial dopamine agonist and does not elevate prolactin levels. The first step
is to confirm hyperprolactinemia with a serum prolactin level, then consider
switching to a prolactin-sparing antipsychotic like aripiprazole .
2. A 24-year-old patient with bipolar I disorder is in a manic episode.
Which medication is first-line for acute mania?
A. Lamotrigine
B. Lithium
C. Fluoxetine
D. Quetiapine
Correct Answer: B. Lithium.
Rationale: Lithium is a first-line treatment for acute mania in bipolar I
disorder. Lamotrigine is more effective for bipolar depression; antidepressants
like fluoxetine can precipitate mania; quetiapine is also used but lithium
remains a primary choice .
3. A patient with generalized anxiety disorder has been on sertraline
for 6 weeks with partial response. Which augmentation strategy is
most appropriate?
A. Adding alprazolam as needed
B. Adding buspirone
C. Increasing sertraline to maximum dose immediately
D. Switching to fluoxetine
Correct Answer: B. Adding buspirone.
,Rationale: Buspirone is a 5-HT1A partial agonist that can be used as an
augmentation agent for SSRI partial responders. It has minimal abuse
potential and does not cause dependence, unlike benzodiazepines .
4. A 32-year-old patient with depression and insomnia is started on
mirtazapine. Which side effect requires close monitoring?
A. Insomnia
B. Weight gain
C. Dry mouth
D. Hypertension
Correct Answer: B. Weight gain.
Rationale: Mirtazapine is associated with significant weight gain due to its
strong antihistamine (H1) receptor antagonism. This can be a significant
concern for patients, especially those with metabolic risk factors .
5. A patient with ADHD is prescribed methylphenidate. Which adverse
effect should the PMHNP monitor for?
A. Bradycardia
B. Weight gain
C. Insomnia
D. Hypertension
Correct Answer: C. Insomnia.
Rationale: Methylphenidate is a stimulant that can cause insomnia and
appetite suppression. It is best to take it in the morning or early afternoon to
minimize sleep disruption .
, 6. Which of the following is a negative symptom of schizophrenia?
A. Hallucinations
B. Delusions
C. Avolition
D. Disorganized speech
Correct Answer: C. Avolition.
Rationale: Negative symptoms include avolition (lack of motivation), flat
affect, alogia (poverty of speech), and anhedonia. Hallucinations, delusions,
and disorganized speech are positive symptoms .
7. A patient with panic disorder is started on paroxetine. When does
paroxetine achieve full therapeutic effect?
A. 24-48 hours
B. 1-2 weeks
C. 4-6 weeks
D. 8-12 weeks
Correct Answer: C. 4-6 weeks.
Rationale: SSRIs like paroxetine typically take 4-6 weeks to achieve full
therapeutic effect. Patients should be educated not to discontinue
prematurely .
8. A 65-year-old patient with Alzheimer's disease is started on
donepezil. Which common side effect requires monitoring?
