ANCC PSYCHIATRIC-MENTAL HEALTH
NURSING (PMH-BC) PRACTICE EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A 34-year-old client is admitted to an inpatient psychiatric unit
after expressing suicidal thoughts following the death of a spouse.
During the admission interview, the client states, “I have been
thinking about killing myself, and I know exactly how I would do
it. I already bought what I need, but I haven't decided when.” The
client denies previous suicide attempts. Which nursing action is the
priority?
A. Ask the client to sign a written no-suicide contract
B. Encourage the client to participate in a group therapy session
C. Initiate suicide precautions and ensure continuous observation
according to facility protocol
D. Allow the client private time to process the recent loss
Answer: C. Initiate suicide precautions and ensure continuous
observation according to facility protocol
Rationale: A specific suicide plan combined with access to means
represents a high-risk situation requiring immediate safety
interventions. The nurse should initiate appropriate suicide
precautions, remove access to potentially lethal means, and maintain
the level of observation required by institutional policy. A no-suicide
contract does not reliably prevent suicide and should never replace
1
,appropriate precautions. Therapy and grief processing are important
but are secondary to immediate safety.
2. A client with major depressive disorder has been taking sertraline
for 3 weeks. The client reports increased energy and says, “I
finally have enough energy to get things done,” but continues to
report hopelessness and recurrent thoughts of death. Which nursing
assessment is most important?
A. Determine whether the client has experienced increased appetite
B. Assess for the presence of a specific suicide plan and access to lethal
means
C. Determine whether the client has resumed previous social activities
D. Assess the client's level of interest in recreational activities
Answer: B. Assess for the presence of a specific suicide plan and
access to lethal means
Rationale: Early improvement in energy may occur before depressive
cognition and suicidal thinking resolve. This can temporarily increase
the client's ability to act on suicidal thoughts. A PMH-BC nurse
should directly assess suicidal ideation, intent, plan, means, and
protective factors. Changes in appetite, recreation, and socialization
may be clinically relevant but are not the immediate priority.
3. A client experiencing acute mania is pacing rapidly, speaking
loudly, interrupting other clients, and repeatedly demanding to
leave the unit. The client has slept only 2 hours during the previous
48 hours. Which intervention is most appropriate initially?
A. Encourage participation in a lengthy group discussion
B. Provide a quiet, low-stimulation environment with clear and concise
communication
C. Explain in detail the consequences of the client's disruptive behavior
D. Encourage the client to exercise vigorously to reduce excess energy
2
,Answer: B. Provide a quiet, low-stimulation environment with clear
and concise communication
Rationale: Acute mania is associated with increased activity, impaired
judgment, distractibility, and decreased need for sleep. Reducing
environmental stimulation can help decrease escalating behavior.
Communication should be brief, direct, calm, and consistent. Lengthy
explanations and stimulating activities can worsen agitation and
distractibility.
4. A client with schizophrenia tells the nurse, “The voices are telling
me that the staff are planning to poison my food.” Which response
by the nurse is most therapeutic?
A. “The voices are real, and you should avoid eating the food.”
B. “You should ignore the voices because they are not important.”
C. “I don't hear the voices, but I understand that they are frightening to
you. Let's talk about what you are experiencing.”
D. “Why do you believe the staff want to poison you?”
Answer: C. “I don't hear the voices, but I understand that they are
frightening to you. Let's talk about what you are experiencing.”
Rationale: The nurse should acknowledge the client's emotional
experience without reinforcing the hallucination or delusion. Stating
that the nurse does not hear the voices maintains reality orientation
while recognizing the client's distress. Agreeing with the hallucination
reinforces psychosis, while dismissing it can damage the therapeutic
relationship.
5. A client prescribed clozapine reports a fever, sore throat, and
generalized weakness. Which action should the psychiatric-mental
health nurse take first?
A. Encourage increased fluid intake
B. Administer the next scheduled dose and reassess later
3
, C. Notify the prescribing clinician promptly and arrange appropriate
blood count evaluation
D. Tell the client that mild flu-like symptoms are expected with
clozapine
Answer: C. Notify the prescribing clinician promptly and arrange
appropriate blood count evaluation
Rationale: Clozapine can cause severe neutropenia/agranulocytosis,
placing the client at risk for serious infection. Fever and sore throat
require prompt evaluation, including appropriate blood count
monitoring. The nurse should not assume these symptoms are benign
or simply administer the next dose without assessment.
6. A client taking lithium for bipolar disorder develops vomiting,
coarse hand tremors, slurred speech, severe diarrhea, and marked
unsteadiness. Which action is most appropriate?
A. Administer the next lithium dose with food
B. Hold lithium and notify the healthcare provider immediately
C. Encourage the client to exercise to eliminate excess lithium
D. Restrict sodium intake to reduce fluid retention
Answer: B. Hold lithium and notify the healthcare provider
immediately
Rationale: Severe gastrointestinal symptoms, coarse tremor,
dysarthria, and ataxia are concerning for lithium toxicity. The
medication should be withheld and the client promptly evaluated.
Lithium levels, renal function, electrolytes, and hydration status may
need assessment. Sodium restriction can increase lithium retention
and worsen toxicity risk.
7. A client receiving an SSRI develops agitation, diaphoresis,
hyperreflexia, diarrhea, fever, and muscle rigidity shortly after
4
NURSING (PMH-BC) PRACTICE EXAM WITH
ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A 34-year-old client is admitted to an inpatient psychiatric unit
after expressing suicidal thoughts following the death of a spouse.
During the admission interview, the client states, “I have been
thinking about killing myself, and I know exactly how I would do
it. I already bought what I need, but I haven't decided when.” The
client denies previous suicide attempts. Which nursing action is the
priority?
A. Ask the client to sign a written no-suicide contract
B. Encourage the client to participate in a group therapy session
C. Initiate suicide precautions and ensure continuous observation
according to facility protocol
D. Allow the client private time to process the recent loss
Answer: C. Initiate suicide precautions and ensure continuous
observation according to facility protocol
Rationale: A specific suicide plan combined with access to means
represents a high-risk situation requiring immediate safety
interventions. The nurse should initiate appropriate suicide
precautions, remove access to potentially lethal means, and maintain
the level of observation required by institutional policy. A no-suicide
contract does not reliably prevent suicide and should never replace
1
,appropriate precautions. Therapy and grief processing are important
but are secondary to immediate safety.
2. A client with major depressive disorder has been taking sertraline
for 3 weeks. The client reports increased energy and says, “I
finally have enough energy to get things done,” but continues to
report hopelessness and recurrent thoughts of death. Which nursing
assessment is most important?
A. Determine whether the client has experienced increased appetite
B. Assess for the presence of a specific suicide plan and access to lethal
means
C. Determine whether the client has resumed previous social activities
D. Assess the client's level of interest in recreational activities
Answer: B. Assess for the presence of a specific suicide plan and
access to lethal means
Rationale: Early improvement in energy may occur before depressive
cognition and suicidal thinking resolve. This can temporarily increase
the client's ability to act on suicidal thoughts. A PMH-BC nurse
should directly assess suicidal ideation, intent, plan, means, and
protective factors. Changes in appetite, recreation, and socialization
may be clinically relevant but are not the immediate priority.
3. A client experiencing acute mania is pacing rapidly, speaking
loudly, interrupting other clients, and repeatedly demanding to
leave the unit. The client has slept only 2 hours during the previous
48 hours. Which intervention is most appropriate initially?
A. Encourage participation in a lengthy group discussion
B. Provide a quiet, low-stimulation environment with clear and concise
communication
C. Explain in detail the consequences of the client's disruptive behavior
D. Encourage the client to exercise vigorously to reduce excess energy
2
,Answer: B. Provide a quiet, low-stimulation environment with clear
and concise communication
Rationale: Acute mania is associated with increased activity, impaired
judgment, distractibility, and decreased need for sleep. Reducing
environmental stimulation can help decrease escalating behavior.
Communication should be brief, direct, calm, and consistent. Lengthy
explanations and stimulating activities can worsen agitation and
distractibility.
4. A client with schizophrenia tells the nurse, “The voices are telling
me that the staff are planning to poison my food.” Which response
by the nurse is most therapeutic?
A. “The voices are real, and you should avoid eating the food.”
B. “You should ignore the voices because they are not important.”
C. “I don't hear the voices, but I understand that they are frightening to
you. Let's talk about what you are experiencing.”
D. “Why do you believe the staff want to poison you?”
Answer: C. “I don't hear the voices, but I understand that they are
frightening to you. Let's talk about what you are experiencing.”
Rationale: The nurse should acknowledge the client's emotional
experience without reinforcing the hallucination or delusion. Stating
that the nurse does not hear the voices maintains reality orientation
while recognizing the client's distress. Agreeing with the hallucination
reinforces psychosis, while dismissing it can damage the therapeutic
relationship.
5. A client prescribed clozapine reports a fever, sore throat, and
generalized weakness. Which action should the psychiatric-mental
health nurse take first?
A. Encourage increased fluid intake
B. Administer the next scheduled dose and reassess later
3
, C. Notify the prescribing clinician promptly and arrange appropriate
blood count evaluation
D. Tell the client that mild flu-like symptoms are expected with
clozapine
Answer: C. Notify the prescribing clinician promptly and arrange
appropriate blood count evaluation
Rationale: Clozapine can cause severe neutropenia/agranulocytosis,
placing the client at risk for serious infection. Fever and sore throat
require prompt evaluation, including appropriate blood count
monitoring. The nurse should not assume these symptoms are benign
or simply administer the next dose without assessment.
6. A client taking lithium for bipolar disorder develops vomiting,
coarse hand tremors, slurred speech, severe diarrhea, and marked
unsteadiness. Which action is most appropriate?
A. Administer the next lithium dose with food
B. Hold lithium and notify the healthcare provider immediately
C. Encourage the client to exercise to eliminate excess lithium
D. Restrict sodium intake to reduce fluid retention
Answer: B. Hold lithium and notify the healthcare provider
immediately
Rationale: Severe gastrointestinal symptoms, coarse tremor,
dysarthria, and ataxia are concerning for lithium toxicity. The
medication should be withheld and the client promptly evaluated.
Lithium levels, renal function, electrolytes, and hydration status may
need assessment. Sodium restriction can increase lithium retention
and worsen toxicity risk.
7. A client receiving an SSRI develops agitation, diaphoresis,
hyperreflexia, diarrhea, fever, and muscle rigidity shortly after
4
