ANCC PSYCHIATRIC-MENTAL HEALTH NURSING
(PMH-BC) CERTIFICATION EXAM — 150 ORIGINAL
PRACTICE QUESTIONS WITH ANSWERS &
RATIONALES | 2026/2027 EDITION
1. A patient tells the psychiatric nurse, “I feel completely hopeless, and nothing will ever get
better.” Which response is most therapeutic?
A. “You should try to think more positively.”
B. “Why do you think nothing will improve?”
C. “You sound as though you are feeling hopeless right now.”
D. “Things will probably get better soon.”
Answer: C. “You sound as though you are feeling hopeless right now.”
RATIONALE: Reflecting the patient's feelings demonstrates empathy and encourages further
exploration. Giving advice or false reassurance can interfere with therapeutic communication.
2. Which assessment finding is most important when evaluating a patient with major
depressive disorder?
A. Favorite recreational activity
B. Suicidal thoughts, intent, plan, and access to means
C. Preferred television programs
D. Childhood vaccination history
Answer: B. Suicidal thoughts, intent, plan, and access to means
RATIONALE: Suicide risk is a priority assessment in patients with depression. Assessment
should include ideation, intent, plan, access to lethal means, previous attempts, and protective
factors.
3. A patient with schizophrenia says, “The voices are telling me that I am worthless.”
Which response is most appropriate?
A. “The voices are not real, so ignore them.”
B. “I don't hear the voices, but I understand that you are experiencing them.”
C. “What did you do to make the voices angry?”
D. “You should listen to the voices carefully.”
, Answer: B. “I don't hear the voices, but I understand that you are experiencing them.”
RATIONALE: The nurse acknowledges the patient's experience without validating the
hallucination as reality.
4. A patient with mania has been pacing continuously and attempting to enter other
patients' rooms. What is the priority nursing intervention?
A. Encourage lengthy group therapy
B. Provide a low-stimulation environment with clear limits
C. Allow unrestricted activity
D. Ask the patient to remain alone without observation
Answer: B. Provide a low-stimulation environment with clear limits
RATIONALE: Patients experiencing mania benefit from decreased environmental
stimulation, structured activities, consistent limits, and protection from exhaustion or unsafe
behavior.
5. Which finding most strongly supports a diagnosis of delirium rather than dementia?
A. Gradual memory loss over several years
B. Progressive difficulty managing finances
C. Acute onset with fluctuating attention
D. Long-standing personality changes
Answer: C. Acute onset with fluctuating attention
RATIONALE: Delirium is characterized by an acute disturbance in attention and awareness
with a fluctuating course, often caused by an underlying medical condition, medication, or
substance.
6. A patient with generalized anxiety disorder reports excessive worry about finances,
family, health, and employment for 8 months. Which finding further supports the
diagnosis?
A. Worry is difficult to control
B. Anxiety occurs only during panic attacks
,C. Symptoms began immediately after intoxication
D. Worry occurs only before public speaking
Answer: A. Worry is difficult to control
RATIONALE: Generalized anxiety disorder involves excessive anxiety and worry about
multiple areas of life that are difficult to control and occur for at least 6 months.
7. A patient experiences recurrent unexpected panic attacks followed by persistent fear of
having another attack. Which diagnosis is most likely?
A. Specific phobia
B. Panic disorder
C. Social anxiety disorder
D. OCD
Answer: B. Panic disorder
RATIONALE: Recurrent unexpected panic attacks followed by persistent concern or
maladaptive behavioral changes are characteristic of panic disorder.
8. A patient repeatedly washes their hands for an hour because of intrusive fears of
contamination. Which diagnosis is most likely?
A. OCD
B. Delusional disorder
C. Somatic symptom disorder
D. Panic disorder
Answer: A. OCD
RATIONALE: Intrusive contamination fears are obsessions, while repetitive handwashing is
a compulsion.
9. A patient with bipolar disorder reports sleeping only 2 hours per night but states, “I feel
fantastic and don't need sleep.” Which symptom is this?
A. Insomnia
B. Hypersomnia
, C. Decreased need for sleep
D. Fatigue
Answer: C. Decreased need for sleep
RATIONALE: Decreased need for sleep is a manic or hypomanic symptom in which the
individual sleeps less without experiencing the expected fatigue.
10. Which feature differentiates mania from hypomania?
A. Elevated mood
B. Increased energy
C. Decreased need for sleep
D. Marked impairment or hospitalization
Answer: D. Marked impairment or hospitalization
RATIONALE: Mania causes marked functional impairment, may require hospitalization, or
may include psychotic features. Hypomania does not produce this level of impairment.
11. A patient has had hallucinations and delusions continuously for 8 months with
functional deterioration. Which diagnosis is most likely?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
D. Adjustment disorder
Answer: C. Schizophrenia
RATIONALE: Schizophrenia requires continuous disturbance for at least 6 months,
including characteristic active-phase symptoms.
12. Psychotic symptoms lasting 2 months with eventual recovery are most consistent with
which diagnosis?
A. Schizophreniform disorder
B. Schizophrenia
(PMH-BC) CERTIFICATION EXAM — 150 ORIGINAL
PRACTICE QUESTIONS WITH ANSWERS &
RATIONALES | 2026/2027 EDITION
1. A patient tells the psychiatric nurse, “I feel completely hopeless, and nothing will ever get
better.” Which response is most therapeutic?
A. “You should try to think more positively.”
B. “Why do you think nothing will improve?”
C. “You sound as though you are feeling hopeless right now.”
D. “Things will probably get better soon.”
Answer: C. “You sound as though you are feeling hopeless right now.”
RATIONALE: Reflecting the patient's feelings demonstrates empathy and encourages further
exploration. Giving advice or false reassurance can interfere with therapeutic communication.
2. Which assessment finding is most important when evaluating a patient with major
depressive disorder?
A. Favorite recreational activity
B. Suicidal thoughts, intent, plan, and access to means
C. Preferred television programs
D. Childhood vaccination history
Answer: B. Suicidal thoughts, intent, plan, and access to means
RATIONALE: Suicide risk is a priority assessment in patients with depression. Assessment
should include ideation, intent, plan, access to lethal means, previous attempts, and protective
factors.
3. A patient with schizophrenia says, “The voices are telling me that I am worthless.”
Which response is most appropriate?
A. “The voices are not real, so ignore them.”
B. “I don't hear the voices, but I understand that you are experiencing them.”
C. “What did you do to make the voices angry?”
D. “You should listen to the voices carefully.”
, Answer: B. “I don't hear the voices, but I understand that you are experiencing them.”
RATIONALE: The nurse acknowledges the patient's experience without validating the
hallucination as reality.
4. A patient with mania has been pacing continuously and attempting to enter other
patients' rooms. What is the priority nursing intervention?
A. Encourage lengthy group therapy
B. Provide a low-stimulation environment with clear limits
C. Allow unrestricted activity
D. Ask the patient to remain alone without observation
Answer: B. Provide a low-stimulation environment with clear limits
RATIONALE: Patients experiencing mania benefit from decreased environmental
stimulation, structured activities, consistent limits, and protection from exhaustion or unsafe
behavior.
5. Which finding most strongly supports a diagnosis of delirium rather than dementia?
A. Gradual memory loss over several years
B. Progressive difficulty managing finances
C. Acute onset with fluctuating attention
D. Long-standing personality changes
Answer: C. Acute onset with fluctuating attention
RATIONALE: Delirium is characterized by an acute disturbance in attention and awareness
with a fluctuating course, often caused by an underlying medical condition, medication, or
substance.
6. A patient with generalized anxiety disorder reports excessive worry about finances,
family, health, and employment for 8 months. Which finding further supports the
diagnosis?
A. Worry is difficult to control
B. Anxiety occurs only during panic attacks
,C. Symptoms began immediately after intoxication
D. Worry occurs only before public speaking
Answer: A. Worry is difficult to control
RATIONALE: Generalized anxiety disorder involves excessive anxiety and worry about
multiple areas of life that are difficult to control and occur for at least 6 months.
7. A patient experiences recurrent unexpected panic attacks followed by persistent fear of
having another attack. Which diagnosis is most likely?
A. Specific phobia
B. Panic disorder
C. Social anxiety disorder
D. OCD
Answer: B. Panic disorder
RATIONALE: Recurrent unexpected panic attacks followed by persistent concern or
maladaptive behavioral changes are characteristic of panic disorder.
8. A patient repeatedly washes their hands for an hour because of intrusive fears of
contamination. Which diagnosis is most likely?
A. OCD
B. Delusional disorder
C. Somatic symptom disorder
D. Panic disorder
Answer: A. OCD
RATIONALE: Intrusive contamination fears are obsessions, while repetitive handwashing is
a compulsion.
9. A patient with bipolar disorder reports sleeping only 2 hours per night but states, “I feel
fantastic and don't need sleep.” Which symptom is this?
A. Insomnia
B. Hypersomnia
, C. Decreased need for sleep
D. Fatigue
Answer: C. Decreased need for sleep
RATIONALE: Decreased need for sleep is a manic or hypomanic symptom in which the
individual sleeps less without experiencing the expected fatigue.
10. Which feature differentiates mania from hypomania?
A. Elevated mood
B. Increased energy
C. Decreased need for sleep
D. Marked impairment or hospitalization
Answer: D. Marked impairment or hospitalization
RATIONALE: Mania causes marked functional impairment, may require hospitalization, or
may include psychotic features. Hypomania does not produce this level of impairment.
11. A patient has had hallucinations and delusions continuously for 8 months with
functional deterioration. Which diagnosis is most likely?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
D. Adjustment disorder
Answer: C. Schizophrenia
RATIONALE: Schizophrenia requires continuous disturbance for at least 6 months,
including characteristic active-phase symptoms.
12. Psychotic symptoms lasting 2 months with eventual recovery are most consistent with
which diagnosis?
A. Schizophreniform disorder
B. Schizophrenia
