PMHNP Exam Reported Questions
and Answers Latest 2026 Test
with complete solutions
Course
PMHNP Exam
1. A patient with major depressive disorder reports depressed mood, anhedonia, insomnia,
fatigue, and feelings of worthlessness for 3 weeks. Which diagnosis best fits this
presentation?
A. Generalized anxiety disorder
B. Major depressive disorder
C. Cyclothymic disorder
D. Adjustment disorder
Answer: B. Major depressive disorder
Rationale: The patient has a persistent depressed mood and anhedonia with multiple associated
symptoms lasting longer than 2 weeks and causing clinically significant impairment.
2. A patient with depression reports having thoughts of death but denies a specific plan or
intent. What is the PMHNP's priority assessment?
A. Childhood vaccination history
B. Suicide risk assessment
C. Dietary preference
D. Family occupation history
Answer: B. Suicide risk assessment
Rationale: Any report of thoughts of death or suicide requires direct assessment of suicidal
ideation, intent, plan, access to means, previous attempts, protective factors, and other risk
factors.
3. Which statement by a patient represents passive suicidal ideation?
A. “I have purchased a firearm and plan to use it tonight.”
B. “I wish I could go to sleep and never wake up.”
C. “I know exactly how I will kill myself.”
D. “I am going to overdose when I get home.”
Answer: B. “I wish I could go to sleep and never wake up.”
,Rationale: Passive suicidal ideation involves thoughts about death or wishing to be dead without
an active plan or intent. Active suicidal ideation requires further assessment of intent, plan, and
access to means.
4. A patient with bipolar I disorder presents with decreased need for sleep, pressured
speech, grandiosity, impulsive spending, and increased goal-directed activity for 10 days.
Which episode is most likely?
A. Major depressive episode
B. Manic episode
C. Panic attack
D. Dysthymic episode
Answer: B. Manic episode
Rationale: A distinct period of abnormally elevated, expansive, or irritable mood with increased
energy and associated symptoms lasting at least 1 week, or requiring hospitalization, is consistent
with mania.
5. A patient taking lithium reports severe diarrhea, vomiting, coarse tremor, and confusion.
What should the PMHNP suspect?
A. Therapeutic response
B. Lithium toxicity
C. Serotonin syndrome
D. Anticholinergic toxicity
Answer: B. Lithium toxicity
Rationale: Severe gastrointestinal symptoms, coarse tremor, confusion, and neurologic changes
can indicate lithium toxicity and require urgent evaluation, including serum lithium
concentration and renal function assessment.
6. Which laboratory parameters are particularly important for a patient receiving long-term
lithium therapy?
A. Renal and thyroid function
B. Amylase and lipase only
C. Hemoglobin A1c only
D. Troponin only
Answer: A. Renal and thyroid function
Rationale: Lithium is eliminated primarily through the kidneys and can affect thyroid function.
Periodic monitoring is therefore important.
, 7. A patient taking lithium asks why maintaining consistent fluid and sodium intake is
important. What is the best response?
A. “Changes can affect lithium levels in your body.”
B. “Sodium has no relationship to lithium.”
C. “You should eliminate sodium completely.”
D. “You should intentionally become dehydrated.”
Answer: A. “Changes can affect lithium levels in your body.”
Rationale: Sodium and fluid balance influence lithium handling by the kidneys. Significant
dehydration or major changes in sodium intake can increase the risk of lithium toxicity.
8. A patient taking an antipsychotic develops fever, severe muscle rigidity, altered mental
status, and autonomic instability. Which condition should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Panic disorder
C. Generalized anxiety disorder
D. Mild dystonia
Answer: A. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a potentially life-threatening reaction associated
with dopamine-blocking medications and can present with hyperthermia, severe rigidity, altered
mental status, and autonomic instability.
9. Which laboratory abnormality is particularly important when monitoring a patient
receiving clozapine?
A. Neutropenia
B. Hypercalcemia
C. Elevated amylase only
D. Increased sodium
Answer: A. Neutropenia
Rationale: Clozapine can cause severe neutropenia. Appropriate blood-count monitoring is
required according to current regulatory and clinical requirements.
10. A patient taking an antipsychotic develops repetitive lip smacking, tongue movements,
and chewing motions. Which adverse effect should the PMHNP suspect?
A. Tardive dyskinesia
B. Acute dystonia
C. Akathisia
D. Neuroleptic malignant syndrome
, Answer: A. Tardive dyskinesia
Rationale: Tardive dyskinesia is characterized by involuntary repetitive movements, particularly
involving the mouth, tongue, and face, and can occur after exposure to dopamine-receptor-
blocking medications.
11. A patient develops painful neck spasms and abnormal eye deviation shortly after starting
a high-potency antipsychotic. Which adverse effect is most likely?
A. Acute dystonia
B. Tardive dyskinesia
C. Akathisia
D. Metabolic syndrome
Answer: A. Acute dystonia
Rationale: Acute dystonia can involve sustained muscle contractions, including torticollis and
oculogyric crisis, and often occurs relatively soon after initiating or increasing an antipsychotic.
12. Which medication is commonly used to treat acute dystonia caused by an antipsychotic?
A. Benztropine
B. Fluoxetine
C. Lithium
D. Buspirone
Answer: A. Benztropine
Rationale: Anticholinergic medications such as benztropine are commonly used for acute
dystonic reactions.
13. A patient taking an antipsychotic reports an inability to sit still and constant pacing.
Which adverse effect is most consistent with this presentation?
A. Akathisia
B. Tardive dyskinesia
C. Acute dystonia
D. Neuroleptic malignant syndrome
Answer: A. Akathisia
Rationale: Akathisia is characterized by subjective inner restlessness accompanied by an inability
to remain still, often manifested as pacing or constant movement.
14. A patient taking an SSRI develops agitation, diaphoresis, diarrhea, hyperreflexia, clonus,
and fever after another serotonergic medication is added. Which condition should the
PMHNP suspect?
and Answers Latest 2026 Test
with complete solutions
Course
PMHNP Exam
1. A patient with major depressive disorder reports depressed mood, anhedonia, insomnia,
fatigue, and feelings of worthlessness for 3 weeks. Which diagnosis best fits this
presentation?
A. Generalized anxiety disorder
B. Major depressive disorder
C. Cyclothymic disorder
D. Adjustment disorder
Answer: B. Major depressive disorder
Rationale: The patient has a persistent depressed mood and anhedonia with multiple associated
symptoms lasting longer than 2 weeks and causing clinically significant impairment.
2. A patient with depression reports having thoughts of death but denies a specific plan or
intent. What is the PMHNP's priority assessment?
A. Childhood vaccination history
B. Suicide risk assessment
C. Dietary preference
D. Family occupation history
Answer: B. Suicide risk assessment
Rationale: Any report of thoughts of death or suicide requires direct assessment of suicidal
ideation, intent, plan, access to means, previous attempts, protective factors, and other risk
factors.
3. Which statement by a patient represents passive suicidal ideation?
A. “I have purchased a firearm and plan to use it tonight.”
B. “I wish I could go to sleep and never wake up.”
C. “I know exactly how I will kill myself.”
D. “I am going to overdose when I get home.”
Answer: B. “I wish I could go to sleep and never wake up.”
,Rationale: Passive suicidal ideation involves thoughts about death or wishing to be dead without
an active plan or intent. Active suicidal ideation requires further assessment of intent, plan, and
access to means.
4. A patient with bipolar I disorder presents with decreased need for sleep, pressured
speech, grandiosity, impulsive spending, and increased goal-directed activity for 10 days.
Which episode is most likely?
A. Major depressive episode
B. Manic episode
C. Panic attack
D. Dysthymic episode
Answer: B. Manic episode
Rationale: A distinct period of abnormally elevated, expansive, or irritable mood with increased
energy and associated symptoms lasting at least 1 week, or requiring hospitalization, is consistent
with mania.
5. A patient taking lithium reports severe diarrhea, vomiting, coarse tremor, and confusion.
What should the PMHNP suspect?
A. Therapeutic response
B. Lithium toxicity
C. Serotonin syndrome
D. Anticholinergic toxicity
Answer: B. Lithium toxicity
Rationale: Severe gastrointestinal symptoms, coarse tremor, confusion, and neurologic changes
can indicate lithium toxicity and require urgent evaluation, including serum lithium
concentration and renal function assessment.
6. Which laboratory parameters are particularly important for a patient receiving long-term
lithium therapy?
A. Renal and thyroid function
B. Amylase and lipase only
C. Hemoglobin A1c only
D. Troponin only
Answer: A. Renal and thyroid function
Rationale: Lithium is eliminated primarily through the kidneys and can affect thyroid function.
Periodic monitoring is therefore important.
, 7. A patient taking lithium asks why maintaining consistent fluid and sodium intake is
important. What is the best response?
A. “Changes can affect lithium levels in your body.”
B. “Sodium has no relationship to lithium.”
C. “You should eliminate sodium completely.”
D. “You should intentionally become dehydrated.”
Answer: A. “Changes can affect lithium levels in your body.”
Rationale: Sodium and fluid balance influence lithium handling by the kidneys. Significant
dehydration or major changes in sodium intake can increase the risk of lithium toxicity.
8. A patient taking an antipsychotic develops fever, severe muscle rigidity, altered mental
status, and autonomic instability. Which condition should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Panic disorder
C. Generalized anxiety disorder
D. Mild dystonia
Answer: A. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a potentially life-threatening reaction associated
with dopamine-blocking medications and can present with hyperthermia, severe rigidity, altered
mental status, and autonomic instability.
9. Which laboratory abnormality is particularly important when monitoring a patient
receiving clozapine?
A. Neutropenia
B. Hypercalcemia
C. Elevated amylase only
D. Increased sodium
Answer: A. Neutropenia
Rationale: Clozapine can cause severe neutropenia. Appropriate blood-count monitoring is
required according to current regulatory and clinical requirements.
10. A patient taking an antipsychotic develops repetitive lip smacking, tongue movements,
and chewing motions. Which adverse effect should the PMHNP suspect?
A. Tardive dyskinesia
B. Acute dystonia
C. Akathisia
D. Neuroleptic malignant syndrome
, Answer: A. Tardive dyskinesia
Rationale: Tardive dyskinesia is characterized by involuntary repetitive movements, particularly
involving the mouth, tongue, and face, and can occur after exposure to dopamine-receptor-
blocking medications.
11. A patient develops painful neck spasms and abnormal eye deviation shortly after starting
a high-potency antipsychotic. Which adverse effect is most likely?
A. Acute dystonia
B. Tardive dyskinesia
C. Akathisia
D. Metabolic syndrome
Answer: A. Acute dystonia
Rationale: Acute dystonia can involve sustained muscle contractions, including torticollis and
oculogyric crisis, and often occurs relatively soon after initiating or increasing an antipsychotic.
12. Which medication is commonly used to treat acute dystonia caused by an antipsychotic?
A. Benztropine
B. Fluoxetine
C. Lithium
D. Buspirone
Answer: A. Benztropine
Rationale: Anticholinergic medications such as benztropine are commonly used for acute
dystonic reactions.
13. A patient taking an antipsychotic reports an inability to sit still and constant pacing.
Which adverse effect is most consistent with this presentation?
A. Akathisia
B. Tardive dyskinesia
C. Acute dystonia
D. Neuroleptic malignant syndrome
Answer: A. Akathisia
Rationale: Akathisia is characterized by subjective inner restlessness accompanied by an inability
to remain still, often manifested as pacing or constant movement.
14. A patient taking an SSRI develops agitation, diaphoresis, diarrhea, hyperreflexia, clonus,
and fever after another serotonergic medication is added. Which condition should the
PMHNP suspect?
