PMHNP-BC Certification
Examination V2.0 — 150
Advanced, Case-Based &
SATA-Integrated Practice
Questions Across the Five
ANCC Domains well
written by best
examiners in the world.
, Question % of
Section Domain
Range Exam
I Scientific Foundation Q1–Q33 22%
II Advanced Practice Skills Q34–Q74 27%
III Diagnosis and Treatment Q75–Q108 22%
Psychotherapy and Related
IV Q109–Q125 11%
Theories
Ethics, Legal Principles, and
V Q126–Q150 17%
Cultural Care
Exam Overview (2026 ANCC Blueprint): 175 total questions (150 scored, 25
pretest), 3.5 hours, passing scaled score ≥350 . Item formats include multiple-choice, select-all-
that-apply (SATA), and scenario-based items . First-time pass rate approximates 82% .
Topics: Neuroanatomy, neurophysiology, pathophysiology, psychopharmacology,
pharmacokinetics, pharmacodynamics, pharmacogenomics, genetics, epidemiology, research
methodology, and evidence-based practice.
Q1. A PMHNP is reviewing the neurobiology of major depressive disorder with a preceptor.
The discussion centers on monoamine hypotheses and neuroplasticity. Which statement best
reflects current understanding of the role of brain-derived neurotrophic factor (BDNF) in
depression pathophysiology?
, Correct Answer: C
A) BDNF is relevant only to anxiety disorders and has no role in mood regulation
B) Antidepressants act solely by increasing synaptic monoamines with no effect on neurotrophic
factors
C) Reduced BDNF signaling in the hippocampus and prefrontal cortex is associated with
impaired neuroplasticity and is a target of several antidepressant mechanisms
D) BDNF levels are consistently elevated in untreated major depression and must be suppressed
for recovery
Rationale: Contemporary models link stress-related reductions in BDNF to impaired
neuroplasticity in key mood-regulating circuits; many effective treatments restore BDNF
signaling. This reflects the neurotrophic hypothesis of depression .
Q2. A 32-year-old patient with schizophrenia exhibits predominantly negative symptoms
including avolition, alogia, and affective blunting. Which neurobiological mechanism is most
directly associated with these symptoms?
Correct Answer: B
A) Hyperactivity of the mesolimbic dopaminergic pathway
B) Hypoactivity of the mesocortical dopaminergic pathway
C) Increased glutamatergic transmission in the hippocampus
D) Hyperactivity of the nigrostriatal dopaminergic pathway
Rationale: Negative symptoms of schizophrenia (avolition, alogia, affective blunting,
anhedonia) are primarily associated with hypoactivity of the mesocortical dopaminergic
pathway, which projects to the prefrontal cortex. Mesolimbic hyperactivity is associated with
positive symptoms .
Q3. A patient with generalized anxiety disorder is prescribed pregabalin. The PMHNP
understands that this medication's mechanism of action involves:
Correct Answer: B
A) Positive allosteric modulation of GABA-A receptors
B) Binding to the alpha-2-delta subunit of voltage-gated calcium channels
, C) Serotonin and norepinephrine reuptake inhibition
D) Partial agonism at serotonin 5-HT1A receptors
Rationale: Pregabalin binds to the alpha-2-delta subunit of voltage-gated calcium channels,
reducing calcium influx and decreasing release of excitatory neurotransmitters (glutamate,
norepinephrine, substance P) .
Q4. A patient is started on lamotrigine for bipolar disorder maintenance. Which genetic
polymorphism is most relevant to the risk of lamotrigine-induced severe cutaneous adverse
reactions?
Correct Answer: B
A) CYP2D6
B) HLA-B*1502
C) CYP2C19
D) HLA-DQ2
Rationale: The HLA-B*1502 allele is strongly associated with risk of Stevens-Johnson
syndrome and toxic epidermal necrolysis with lamotrigine and carbamazepine, particularly in
Han Chinese populations .
Q5. A 28-year-old patient of Han Chinese descent is being initiated on carbamazepine for
bipolar disorder. Before prescribing, the PMHNP should:
Correct Answer: A
A) Order HLA-B*1502 genetic testing
B) Order CYP2D6 genotyping
C) Check serum carbamazepine level
D) Obtain an EEG
Rationale: The FDA recommends HLA-B*1502 screening before initiating carbamazepine in
patients of Asian ancestry due to increased risk of Stevens-Johnson syndrome. CYP2D6 is not
the relevant polymorphism for carbamazepine.
Examination V2.0 — 150
Advanced, Case-Based &
SATA-Integrated Practice
Questions Across the Five
ANCC Domains well
written by best
examiners in the world.
, Question % of
Section Domain
Range Exam
I Scientific Foundation Q1–Q33 22%
II Advanced Practice Skills Q34–Q74 27%
III Diagnosis and Treatment Q75–Q108 22%
Psychotherapy and Related
IV Q109–Q125 11%
Theories
Ethics, Legal Principles, and
V Q126–Q150 17%
Cultural Care
Exam Overview (2026 ANCC Blueprint): 175 total questions (150 scored, 25
pretest), 3.5 hours, passing scaled score ≥350 . Item formats include multiple-choice, select-all-
that-apply (SATA), and scenario-based items . First-time pass rate approximates 82% .
Topics: Neuroanatomy, neurophysiology, pathophysiology, psychopharmacology,
pharmacokinetics, pharmacodynamics, pharmacogenomics, genetics, epidemiology, research
methodology, and evidence-based practice.
Q1. A PMHNP is reviewing the neurobiology of major depressive disorder with a preceptor.
The discussion centers on monoamine hypotheses and neuroplasticity. Which statement best
reflects current understanding of the role of brain-derived neurotrophic factor (BDNF) in
depression pathophysiology?
, Correct Answer: C
A) BDNF is relevant only to anxiety disorders and has no role in mood regulation
B) Antidepressants act solely by increasing synaptic monoamines with no effect on neurotrophic
factors
C) Reduced BDNF signaling in the hippocampus and prefrontal cortex is associated with
impaired neuroplasticity and is a target of several antidepressant mechanisms
D) BDNF levels are consistently elevated in untreated major depression and must be suppressed
for recovery
Rationale: Contemporary models link stress-related reductions in BDNF to impaired
neuroplasticity in key mood-regulating circuits; many effective treatments restore BDNF
signaling. This reflects the neurotrophic hypothesis of depression .
Q2. A 32-year-old patient with schizophrenia exhibits predominantly negative symptoms
including avolition, alogia, and affective blunting. Which neurobiological mechanism is most
directly associated with these symptoms?
Correct Answer: B
A) Hyperactivity of the mesolimbic dopaminergic pathway
B) Hypoactivity of the mesocortical dopaminergic pathway
C) Increased glutamatergic transmission in the hippocampus
D) Hyperactivity of the nigrostriatal dopaminergic pathway
Rationale: Negative symptoms of schizophrenia (avolition, alogia, affective blunting,
anhedonia) are primarily associated with hypoactivity of the mesocortical dopaminergic
pathway, which projects to the prefrontal cortex. Mesolimbic hyperactivity is associated with
positive symptoms .
Q3. A patient with generalized anxiety disorder is prescribed pregabalin. The PMHNP
understands that this medication's mechanism of action involves:
Correct Answer: B
A) Positive allosteric modulation of GABA-A receptors
B) Binding to the alpha-2-delta subunit of voltage-gated calcium channels
, C) Serotonin and norepinephrine reuptake inhibition
D) Partial agonism at serotonin 5-HT1A receptors
Rationale: Pregabalin binds to the alpha-2-delta subunit of voltage-gated calcium channels,
reducing calcium influx and decreasing release of excitatory neurotransmitters (glutamate,
norepinephrine, substance P) .
Q4. A patient is started on lamotrigine for bipolar disorder maintenance. Which genetic
polymorphism is most relevant to the risk of lamotrigine-induced severe cutaneous adverse
reactions?
Correct Answer: B
A) CYP2D6
B) HLA-B*1502
C) CYP2C19
D) HLA-DQ2
Rationale: The HLA-B*1502 allele is strongly associated with risk of Stevens-Johnson
syndrome and toxic epidermal necrolysis with lamotrigine and carbamazepine, particularly in
Han Chinese populations .
Q5. A 28-year-old patient of Han Chinese descent is being initiated on carbamazepine for
bipolar disorder. Before prescribing, the PMHNP should:
Correct Answer: A
A) Order HLA-B*1502 genetic testing
B) Order CYP2D6 genotyping
C) Check serum carbamazepine level
D) Obtain an EEG
Rationale: The FDA recommends HLA-B*1502 screening before initiating carbamazepine in
patients of Asian ancestry due to increased risk of Stevens-Johnson syndrome. CYP2D6 is not
the relevant polymorphism for carbamazepine.
