NRNP 6675 WEEK 9: PMHNP
CERTIFICATION PRE-TEST REFLECTION
ORIGINAL PRACTICE QUESTION BANK — QUESTIONS
1–100 WITH COMPLETE SOLUTIONS
2026 UPDATE
Important: These are original certification-style practice questions created for study
and reflection. They are not actual, leaked, or official NRNP 6675 or ANCC
examination questions.
QUESTION 1
A PMHNP reviews a certification-pretest result and discovers that pharmacology
questions were answered correctly 85% of the time, while diagnosis and differential-
diagnosis questions were answered correctly only 55% of the time. What is the BEST
interpretation?
A. Pharmacology should be completely removed from the study plan.
B. The candidate should focus exclusively on memorizing DSM diagnostic criteria.
C. Diagnosis and differential diagnosis represent a relative learning priority
based on the performance pattern.
D. The candidate has demonstrated mastery of all PMHNP certification domains.
Rationale: C is correct because reflection should identify relative strengths and
weaknesses and use that information to prioritize study activities. A is incorrect
because strong performance does not mean the topic should never be reviewed. B is
too narrow because diagnostic reasoning involves more than memorizing criteria. D
is incorrect because a single domain strength does not demonstrate overall mastery.
QUESTION 2
Which reflection statement demonstrates the MOST effective use of pretest results?
A. "I missed several questions, so I am not ready to become a PMHNP."
B. "The questions were difficult, so the results are not useful."
C. "I will analyze missed questions by content area and determine whether each
error resulted from knowledge gaps, misinterpretation, or test-taking strategy."
D. "I will repeat the same practice test until I obtain a passing score."
1
,Rationale: C is correct because meaningful reflection examines the cause of errors
rather than simply counting incorrect responses. A is an overgeneralization. B
discards potentially valuable diagnostic information. D may improve familiarity with
the questions without correcting underlying knowledge deficits.
QUESTION 3
A candidate consistently selects an incorrect answer because two options appear
clinically reasonable. Which skill should receive the greatest attention?
A. Memorization of medication brand names
B. Clinical prioritization and identification of the BEST answer
C. Increasing reading speed only
D. Memorizing laboratory reference ranges
Rationale: B is correct because certification questions frequently require
prioritization among plausible interventions. A and D may be useful knowledge but do
not directly address the stated problem. C alone does not improve clinical reasoning.
QUESTION 4
A patient taking lithium develops coarse tremor, vomiting, diarrhea, and increasing
confusion. What is the PMHNP's priority?
A. Increase the lithium dose because the symptoms indicate worsening mania.
B. Add an SSRI immediately.
C. Suspect lithium toxicity and arrange urgent evaluation, including an
appropriate lithium level and medical assessment.
D. Reassure the patient that gastrointestinal symptoms are expected and harmless.
Rationale: C is correct because gastrointestinal symptoms, worsening tremor, and
neurologic changes can indicate lithium toxicity and require prompt assessment. A
could worsen toxicity. B does not address the acute safety concern. D incorrectly
minimizes potentially serious toxicity.
QUESTION 5
Which finding most strongly suggests serotonin syndrome in a patient receiving
serotonergic medications?
A. Bradycardia and hypothermia
B. Isolated dry mouth
C. Agitation, hyperreflexia, clonus, autonomic instability, and hyperthermia
D. Increased appetite and weight gain
2
,Rationale: C is correct because serotonin syndrome commonly involves mental-status
changes, autonomic instability, and neuromuscular hyperactivity such as clonus and
hyperreflexia. A, B, and D are not characteristic of the syndrome.
QUESTION 6
A patient taking an antipsychotic develops fever, severe rigidity, altered
consciousness, and autonomic instability. Which condition should be suspected?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Acute dystonia
Rationale: B is correct because severe rigidity, hyperthermia, altered mental status,
and autonomic instability are classic features of neuroleptic malignant syndrome.
Serotonin syndrome more characteristically produces hyperreflexia and clonus. Panic
disorder does not cause severe rigidity or hyperthermia. Acute dystonia produces
muscle spasms but not this systemic presentation.
QUESTION 7
A patient with major depressive disorder reports decreased need for sleep, unusually
elevated energy, pressured speech, and grandiosity lasting several days. What should
the PMHNP consider most carefully?
A. Persistent depressive disorder
B. Generalized anxiety disorder
C. A bipolar-spectrum disorder
D. Adjustment disorder
Rationale: C is correct because episodic elevated or expansive mood, decreased need
for sleep, pressured speech, and grandiosity raise concern for mania or hypomania. A
and B do not adequately explain the elevated activation. D requires a different
relationship to an identifiable stressor and does not explain the manic syndrome.
QUESTION 8
A patient with depression reports suicidal thoughts but denies current intent or plan.
What is the BEST next step?
A. Automatically discharge the patient because there is no plan.
B. Avoid discussing suicide further because asking increases risk.
C. Conduct a comprehensive suicide-risk assessment and develop an appropriate
3
, safety plan based on the findings.
D. Immediately prescribe a sedative.
Rationale: C is correct because suicidal ideation requires structured assessment of
intent, plan, access to means, protective factors, history, and other risk variables. A
incorrectly assumes no plan means no risk. B contradicts evidence-based clinical
practice. D does not address the underlying safety assessment.
QUESTION 9
A patient reports hearing a voice saying, "You are worthless," but recognizes that the
voice is not coming from another person. Which phenomenon is being described?
A. Obsession
B. Delusion
C. Auditory hallucination with preserved insight
D. Confabulation
Rationale: C is correct because a hallucination is a perceptual experience without an
external stimulus; insight can vary. An obsession is an intrusive thought or urge. A
delusion is a fixed false belief. Confabulation involves production of fabricated
information, often without intentional deception.
QUESTION 10
Which finding is MOST characteristic of a negative symptom of schizophrenia?
A. Auditory hallucinations
B. Persecutory delusions
C. Avolition
D. Disorganized speech
Rationale: C is correct because avolition represents diminished motivation and is a
negative symptom. Hallucinations and delusions are positive symptoms. Disorganized
speech is generally categorized as a disorganization symptom.
QUESTION 11
A patient repeatedly checks the door lock for hours despite recognizing that the
behavior is excessive. Which diagnosis is MOST consistent with this presentation?
A. Delusional disorder
B. Obsessive-compulsive disorder
4
CERTIFICATION PRE-TEST REFLECTION
ORIGINAL PRACTICE QUESTION BANK — QUESTIONS
1–100 WITH COMPLETE SOLUTIONS
2026 UPDATE
Important: These are original certification-style practice questions created for study
and reflection. They are not actual, leaked, or official NRNP 6675 or ANCC
examination questions.
QUESTION 1
A PMHNP reviews a certification-pretest result and discovers that pharmacology
questions were answered correctly 85% of the time, while diagnosis and differential-
diagnosis questions were answered correctly only 55% of the time. What is the BEST
interpretation?
A. Pharmacology should be completely removed from the study plan.
B. The candidate should focus exclusively on memorizing DSM diagnostic criteria.
C. Diagnosis and differential diagnosis represent a relative learning priority
based on the performance pattern.
D. The candidate has demonstrated mastery of all PMHNP certification domains.
Rationale: C is correct because reflection should identify relative strengths and
weaknesses and use that information to prioritize study activities. A is incorrect
because strong performance does not mean the topic should never be reviewed. B is
too narrow because diagnostic reasoning involves more than memorizing criteria. D
is incorrect because a single domain strength does not demonstrate overall mastery.
QUESTION 2
Which reflection statement demonstrates the MOST effective use of pretest results?
A. "I missed several questions, so I am not ready to become a PMHNP."
B. "The questions were difficult, so the results are not useful."
C. "I will analyze missed questions by content area and determine whether each
error resulted from knowledge gaps, misinterpretation, or test-taking strategy."
D. "I will repeat the same practice test until I obtain a passing score."
1
,Rationale: C is correct because meaningful reflection examines the cause of errors
rather than simply counting incorrect responses. A is an overgeneralization. B
discards potentially valuable diagnostic information. D may improve familiarity with
the questions without correcting underlying knowledge deficits.
QUESTION 3
A candidate consistently selects an incorrect answer because two options appear
clinically reasonable. Which skill should receive the greatest attention?
A. Memorization of medication brand names
B. Clinical prioritization and identification of the BEST answer
C. Increasing reading speed only
D. Memorizing laboratory reference ranges
Rationale: B is correct because certification questions frequently require
prioritization among plausible interventions. A and D may be useful knowledge but do
not directly address the stated problem. C alone does not improve clinical reasoning.
QUESTION 4
A patient taking lithium develops coarse tremor, vomiting, diarrhea, and increasing
confusion. What is the PMHNP's priority?
A. Increase the lithium dose because the symptoms indicate worsening mania.
B. Add an SSRI immediately.
C. Suspect lithium toxicity and arrange urgent evaluation, including an
appropriate lithium level and medical assessment.
D. Reassure the patient that gastrointestinal symptoms are expected and harmless.
Rationale: C is correct because gastrointestinal symptoms, worsening tremor, and
neurologic changes can indicate lithium toxicity and require prompt assessment. A
could worsen toxicity. B does not address the acute safety concern. D incorrectly
minimizes potentially serious toxicity.
QUESTION 5
Which finding most strongly suggests serotonin syndrome in a patient receiving
serotonergic medications?
A. Bradycardia and hypothermia
B. Isolated dry mouth
C. Agitation, hyperreflexia, clonus, autonomic instability, and hyperthermia
D. Increased appetite and weight gain
2
,Rationale: C is correct because serotonin syndrome commonly involves mental-status
changes, autonomic instability, and neuromuscular hyperactivity such as clonus and
hyperreflexia. A, B, and D are not characteristic of the syndrome.
QUESTION 6
A patient taking an antipsychotic develops fever, severe rigidity, altered
consciousness, and autonomic instability. Which condition should be suspected?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Acute dystonia
Rationale: B is correct because severe rigidity, hyperthermia, altered mental status,
and autonomic instability are classic features of neuroleptic malignant syndrome.
Serotonin syndrome more characteristically produces hyperreflexia and clonus. Panic
disorder does not cause severe rigidity or hyperthermia. Acute dystonia produces
muscle spasms but not this systemic presentation.
QUESTION 7
A patient with major depressive disorder reports decreased need for sleep, unusually
elevated energy, pressured speech, and grandiosity lasting several days. What should
the PMHNP consider most carefully?
A. Persistent depressive disorder
B. Generalized anxiety disorder
C. A bipolar-spectrum disorder
D. Adjustment disorder
Rationale: C is correct because episodic elevated or expansive mood, decreased need
for sleep, pressured speech, and grandiosity raise concern for mania or hypomania. A
and B do not adequately explain the elevated activation. D requires a different
relationship to an identifiable stressor and does not explain the manic syndrome.
QUESTION 8
A patient with depression reports suicidal thoughts but denies current intent or plan.
What is the BEST next step?
A. Automatically discharge the patient because there is no plan.
B. Avoid discussing suicide further because asking increases risk.
C. Conduct a comprehensive suicide-risk assessment and develop an appropriate
3
, safety plan based on the findings.
D. Immediately prescribe a sedative.
Rationale: C is correct because suicidal ideation requires structured assessment of
intent, plan, access to means, protective factors, history, and other risk variables. A
incorrectly assumes no plan means no risk. B contradicts evidence-based clinical
practice. D does not address the underlying safety assessment.
QUESTION 9
A patient reports hearing a voice saying, "You are worthless," but recognizes that the
voice is not coming from another person. Which phenomenon is being described?
A. Obsession
B. Delusion
C. Auditory hallucination with preserved insight
D. Confabulation
Rationale: C is correct because a hallucination is a perceptual experience without an
external stimulus; insight can vary. An obsession is an intrusive thought or urge. A
delusion is a fixed false belief. Confabulation involves production of fabricated
information, often without intentional deception.
QUESTION 10
Which finding is MOST characteristic of a negative symptom of schizophrenia?
A. Auditory hallucinations
B. Persecutory delusions
C. Avolition
D. Disorganized speech
Rationale: C is correct because avolition represents diminished motivation and is a
negative symptom. Hallucinations and delusions are positive symptoms. Disorganized
speech is generally categorized as a disorganization symptom.
QUESTION 11
A patient repeatedly checks the door lock for hours despite recognizing that the
behavior is excessive. Which diagnosis is MOST consistent with this presentation?
A. Delusional disorder
B. Obsessive-compulsive disorder
4
