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PMH-BC Psychiatric Nursing Certification Exam
QUESTIONS AND VERIFIED ANSWERS WITH RATIONALES
JUST RELEASED
PMH-BC Psychiatric Nursing Certification Exam
Exam Coverage Areas (Mostly Tested)
1. Assessment and Diagnosis (22%) - Mental Status Examination (MSE) components, psychiatric
disorders across the lifespan (mood, thought, neurocognitive, personality, addiction), physiological
causes of psychiatric symptoms (e.g., UTI, thyroid dysfunction, delirium), developmental theories
(Erikson, Piaget, Peplau), coping and defense mechanisms, trauma history assessment, safety risk
assessment (suicide, violence), diagnostic studies and interpretation
2. Planning (21%) - Client-centered care planning with SMART goals, strengths-based approaches,
cultural competence and humility, health literacy considerations, interdisciplinary collaboration,
treatment modality selection, educational needs assessment, group dynamics and facilitation
3. Implementation (46%) - Therapeutic communication techniques (active listening, reflection,
motivational interviewing), treatment modalities (CBT, DBT, recovery model, trauma-informed care),
psychopharmacology (indications, contraindications, adverse effects, lab monitoring, medication
reconciliation), neurostimulation therapies (ECT, TMS, VNS, DBS), milieu management, crisis
intervention and de-escalation, psychoeducation, care coordination
4. Evaluation (10%) - Outcome measurement and symptom monitoring, legal and ethical
considerations (informed consent, self-determination, confidentiality, documentation), quality
improvement and serious reportable events, care plan revision based on assessment data, ongoing
reassessment
5. Psychopharmacology - Antipsychotics (FGAs, SGAs), antidepressants (SSRIs, SNRIs, MAOIs, TCAs,
atypical), mood stabilizers (lithium, anticonvulsants), anxiolytics/sedative-hypnotics, anticholinergics
for EPS, cognitive enhancers, stimulants, drug-drug interactions, Beers Criteria considerations in
older adults, lab value monitoring (lithium levels, CBC, LFTs, renal function, metabolic syndrome
screening for SGAs)
6. Psychiatric Disorders - Major Depressive Disorder, Bipolar Disorder, Schizophrenia Spectrum,
Anxiety Disorders, Neurocognitive Disorders (Alzheimer's, vascular, Lewy body, frontotemporal),
Substance Use Disorders, Personality Disorders (Cluster B particularly), Trauma- and Stressor-
Related Disorders (PTSD, acute stress), Obsessive-Compulsive and Related Disorders, Eating
Disorders, Somatic Symptom Disorders, Sleep-Wake Disorders
7. Therapeutic Modalities and Interventions - Individual therapy (CBT, DBT, interpersonal), group
therapy (psychoeducation, process, support), family therapy, milieu therapy, motivational
interviewing, crisis intervention, complementary and integrative therapies (mindfulness, relaxation,
aromatherapy), trauma-informed care principles, recovery-oriented care
8. Legal, Ethical, and Professional Issues - ANA Code of Ethics, Scope and Standards of Psychiatric-
Mental Health Nursing, informed consent, confidentiality and HIPAA, mandatory reporting (abuse,
Tarasoff duty), seclusion and restraint regulations, patient rights and advocacy, involuntary
commitment criteria, documentation standards, advance directives
9. Communication and Therapeutic Relationships - Phases of nurse-patient relationship (pre-
interaction, orientation, working, termination), therapeutic communication techniques vs. barriers,
transference/countertransference, culturally competent communication, de-escalation strategies
for agitated patients, establishing trust and therapeutic alliance
10. Suicide Assessment and Crisis Management - Risk factor identification, suicide screening tools,
direct questioning about suicidal ideation, plan, means, and intent, protective factors assessment,
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safety planning, crisis intervention models, emergency department protocols, post-crisis follow-up,
staff support after patient suicide
1. A 68-year-old patient with no prior psychiatric history is brought to the emergency department by
family members who report a sudden onset of confusion, hallucinations, and agitation that began
approximately 48 hours ago with symptoms worsening at night. The patient's vital signs reveal a
temperature of 101.2°F and a urinalysis shows positive leukocyte esterase and nitrites. What is the most
appropriate initial nursing action for this patient?
A) Administer haloperidol 5 mg IM for immediate agitation control
B) Obtain a urine culture and initiate prescribed antibiotic therapy while implementing safety precautions
C) Restrain the patient in four-point leathers to prevent falls during the acute confusion
D) Complete a full psychiatric assessment and schedule outpatient follow-up for probable dementia
Answer: B) Obtain a urine culture and initiate prescribed antibiotic therapy while implementing safety
precautions
Rationale: The acute onset of confusion, hallucinations, and agitation with fever and urinary findings
strongly suggests delirium secondary to urinary tract infection—a physiological cause of psychiatric
symptoms. Delirium is a medical emergency requiring identification and treatment of the underlying cause.
Safety precautions are essential as delirium causes fluctuating consciousness and increased fall risk.
Haloperidol may be needed but is not the initial priority; restraints would be inappropriate without first
attempting less restrictive measures; dementia has gradual onset, not acute with fever.
2. A nurse is establishing a therapeutic relationship with a newly admitted patient diagnosed with
borderline personality disorder. During the orientation phase, the patient repeatedly asks the nurse for
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personal information, including where the nurse lives and if the nurse is married. What is the most
appropriate therapeutic response by the nurse?
A) "I understand you want to know more about me, but the focus of our relationship is on helping you
achieve your treatment goals"
B) "I'm not comfortable sharing that information with you at this time"
C) "I live in the nearby town, and yes, I am married with two children"
D) "Why do you need to know that information from me?"
Answer: A) "I understand you want to know more about me, but the focus of our relationship is on
helping you achieve your treatment goals"
Rationale: This response maintains appropriate professional boundaries while validating the patient's
curiosity and redirecting the focus to therapeutic goals. Self-disclosure should be limited and purposeful in
psychiatric nursing. The patient's question represents a boundary test common in personality disorders.
Answering directly (C) is inappropriate self-disclosure; the response in B is dismissive and blocks
communication; D is confrontational and shifts focus to judgment.
3. A patient with schizophrenia who has been stable on a long-acting injectable antipsychotic for several
months now presents with new-onset muscle rigidity, tremors, shuffling gait, and difficulty speaking. The
patient's temperature is elevated at 100.8°F and the patient is diaphoretic. Which condition should the
nurse suspect based on these clinical findings?
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A) Tardive dyskinesia
B) Parkinsonism from extrapyramidal side effects
C) Neuroleptic malignant syndrome
D) Serotonin syndrome
Answer: C) Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse reaction to antipsychotic
medications characterized by muscle rigidity, hyperthermia, diaphoresis, autonomic instability, and altered
mental status. This constellation of symptoms—new rigidity, fever, and sweating—is classic for NMS and
requires immediate medical intervention. Tardive dyskinesia manifests as involuntary choreoathetoid
movements, typically after long-term use. Parkinsonism (muscle rigidity, tremor, shuffling gait) would not
typically cause fever or diaphoresis. Serotonin syndrome requires serotonergic agents and presents with
hyperthermia, muscle rigidity, and autonomic instability but typically with clonus and hyperreflexia.
4. A nurse is admitting a 22-year-old patient who reports experiencing a panic attack for the first time.
The patient states, "I thought I was dying because my heart was pounding so fast and I couldn't breathe."
Which response by the nurse best demonstrates therapeutic communication and validates the patient's
experience?
A) "You were not really dying. It was just a panic attack, and you are safe now."
B) "That must have been extremely frightening for you. Can you tell me what was happening right before
the symptoms started?"
PMH-BC Psychiatric Nursing Certification Exam
QUESTIONS AND VERIFIED ANSWERS WITH RATIONALES
JUST RELEASED
PMH-BC Psychiatric Nursing Certification Exam
Exam Coverage Areas (Mostly Tested)
1. Assessment and Diagnosis (22%) - Mental Status Examination (MSE) components, psychiatric
disorders across the lifespan (mood, thought, neurocognitive, personality, addiction), physiological
causes of psychiatric symptoms (e.g., UTI, thyroid dysfunction, delirium), developmental theories
(Erikson, Piaget, Peplau), coping and defense mechanisms, trauma history assessment, safety risk
assessment (suicide, violence), diagnostic studies and interpretation
2. Planning (21%) - Client-centered care planning with SMART goals, strengths-based approaches,
cultural competence and humility, health literacy considerations, interdisciplinary collaboration,
treatment modality selection, educational needs assessment, group dynamics and facilitation
3. Implementation (46%) - Therapeutic communication techniques (active listening, reflection,
motivational interviewing), treatment modalities (CBT, DBT, recovery model, trauma-informed care),
psychopharmacology (indications, contraindications, adverse effects, lab monitoring, medication
reconciliation), neurostimulation therapies (ECT, TMS, VNS, DBS), milieu management, crisis
intervention and de-escalation, psychoeducation, care coordination
4. Evaluation (10%) - Outcome measurement and symptom monitoring, legal and ethical
considerations (informed consent, self-determination, confidentiality, documentation), quality
improvement and serious reportable events, care plan revision based on assessment data, ongoing
reassessment
5. Psychopharmacology - Antipsychotics (FGAs, SGAs), antidepressants (SSRIs, SNRIs, MAOIs, TCAs,
atypical), mood stabilizers (lithium, anticonvulsants), anxiolytics/sedative-hypnotics, anticholinergics
for EPS, cognitive enhancers, stimulants, drug-drug interactions, Beers Criteria considerations in
older adults, lab value monitoring (lithium levels, CBC, LFTs, renal function, metabolic syndrome
screening for SGAs)
6. Psychiatric Disorders - Major Depressive Disorder, Bipolar Disorder, Schizophrenia Spectrum,
Anxiety Disorders, Neurocognitive Disorders (Alzheimer's, vascular, Lewy body, frontotemporal),
Substance Use Disorders, Personality Disorders (Cluster B particularly), Trauma- and Stressor-
Related Disorders (PTSD, acute stress), Obsessive-Compulsive and Related Disorders, Eating
Disorders, Somatic Symptom Disorders, Sleep-Wake Disorders
7. Therapeutic Modalities and Interventions - Individual therapy (CBT, DBT, interpersonal), group
therapy (psychoeducation, process, support), family therapy, milieu therapy, motivational
interviewing, crisis intervention, complementary and integrative therapies (mindfulness, relaxation,
aromatherapy), trauma-informed care principles, recovery-oriented care
8. Legal, Ethical, and Professional Issues - ANA Code of Ethics, Scope and Standards of Psychiatric-
Mental Health Nursing, informed consent, confidentiality and HIPAA, mandatory reporting (abuse,
Tarasoff duty), seclusion and restraint regulations, patient rights and advocacy, involuntary
commitment criteria, documentation standards, advance directives
9. Communication and Therapeutic Relationships - Phases of nurse-patient relationship (pre-
interaction, orientation, working, termination), therapeutic communication techniques vs. barriers,
transference/countertransference, culturally competent communication, de-escalation strategies
for agitated patients, establishing trust and therapeutic alliance
10. Suicide Assessment and Crisis Management - Risk factor identification, suicide screening tools,
direct questioning about suicidal ideation, plan, means, and intent, protective factors assessment,
, Page 2 of 146
safety planning, crisis intervention models, emergency department protocols, post-crisis follow-up,
staff support after patient suicide
1. A 68-year-old patient with no prior psychiatric history is brought to the emergency department by
family members who report a sudden onset of confusion, hallucinations, and agitation that began
approximately 48 hours ago with symptoms worsening at night. The patient's vital signs reveal a
temperature of 101.2°F and a urinalysis shows positive leukocyte esterase and nitrites. What is the most
appropriate initial nursing action for this patient?
A) Administer haloperidol 5 mg IM for immediate agitation control
B) Obtain a urine culture and initiate prescribed antibiotic therapy while implementing safety precautions
C) Restrain the patient in four-point leathers to prevent falls during the acute confusion
D) Complete a full psychiatric assessment and schedule outpatient follow-up for probable dementia
Answer: B) Obtain a urine culture and initiate prescribed antibiotic therapy while implementing safety
precautions
Rationale: The acute onset of confusion, hallucinations, and agitation with fever and urinary findings
strongly suggests delirium secondary to urinary tract infection—a physiological cause of psychiatric
symptoms. Delirium is a medical emergency requiring identification and treatment of the underlying cause.
Safety precautions are essential as delirium causes fluctuating consciousness and increased fall risk.
Haloperidol may be needed but is not the initial priority; restraints would be inappropriate without first
attempting less restrictive measures; dementia has gradual onset, not acute with fever.
2. A nurse is establishing a therapeutic relationship with a newly admitted patient diagnosed with
borderline personality disorder. During the orientation phase, the patient repeatedly asks the nurse for
, Page 3 of 146
personal information, including where the nurse lives and if the nurse is married. What is the most
appropriate therapeutic response by the nurse?
A) "I understand you want to know more about me, but the focus of our relationship is on helping you
achieve your treatment goals"
B) "I'm not comfortable sharing that information with you at this time"
C) "I live in the nearby town, and yes, I am married with two children"
D) "Why do you need to know that information from me?"
Answer: A) "I understand you want to know more about me, but the focus of our relationship is on
helping you achieve your treatment goals"
Rationale: This response maintains appropriate professional boundaries while validating the patient's
curiosity and redirecting the focus to therapeutic goals. Self-disclosure should be limited and purposeful in
psychiatric nursing. The patient's question represents a boundary test common in personality disorders.
Answering directly (C) is inappropriate self-disclosure; the response in B is dismissive and blocks
communication; D is confrontational and shifts focus to judgment.
3. A patient with schizophrenia who has been stable on a long-acting injectable antipsychotic for several
months now presents with new-onset muscle rigidity, tremors, shuffling gait, and difficulty speaking. The
patient's temperature is elevated at 100.8°F and the patient is diaphoretic. Which condition should the
nurse suspect based on these clinical findings?
, Page 4 of 146
A) Tardive dyskinesia
B) Parkinsonism from extrapyramidal side effects
C) Neuroleptic malignant syndrome
D) Serotonin syndrome
Answer: C) Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse reaction to antipsychotic
medications characterized by muscle rigidity, hyperthermia, diaphoresis, autonomic instability, and altered
mental status. This constellation of symptoms—new rigidity, fever, and sweating—is classic for NMS and
requires immediate medical intervention. Tardive dyskinesia manifests as involuntary choreoathetoid
movements, typically after long-term use. Parkinsonism (muscle rigidity, tremor, shuffling gait) would not
typically cause fever or diaphoresis. Serotonin syndrome requires serotonergic agents and presents with
hyperthermia, muscle rigidity, and autonomic instability but typically with clonus and hyperreflexia.
4. A nurse is admitting a 22-year-old patient who reports experiencing a panic attack for the first time.
The patient states, "I thought I was dying because my heart was pounding so fast and I couldn't breathe."
Which response by the nurse best demonstrates therapeutic communication and validates the patient's
experience?
A) "You were not really dying. It was just a panic attack, and you are safe now."
B) "That must have been extremely frightening for you. Can you tell me what was happening right before
the symptoms started?"
