PMHNP Certification Exam 2026/2027 |
Practice Questions & Answers, ANCC Exam
Prep
• This comprehensive question practice exam mirrors the ANCC PMHNP
certification assessment, featuring evidence-based questions across all major
psychiatric nursing domains to prepare you for board certification.
• Use this material by completing timed sections, reviewing detailed rationales for
every question, and targeting weak areas for focused study before your exam date.
1. A 35-year-old female presents with persistent low mood, loss of interest in
previously enjoyed activities, significant appetite changes, and sleep
disturbances lasting 3 weeks. What is the most appropriate initial diagnostic
consideration?
A) Persistent Depressive Disorder (Dysthymia)
B) Major Depressive Disorder
C) Adjustment Disorder with Depressed Mood
D) Bipolar II Disorder
E) Substance-Induced Depressive Disorder
CORRECT ANSWER: B) Major Depressive Disorder
RATIONALE: Major Depressive Disorder is characterized by a depressed mood
and/or loss of interest/pleasure lasting at least 2 weeks, with at least 5 symptoms
total including appetite changes, sleep disturbance, and others. The 3-week
duration meets the minimum 2-week criterion. Persistent Depressive Disorder
requires symptoms for at least 2 years (not 3 weeks), Adjustment Disorder typically
resolves within 6 months of stressor removal, Bipolar II requires hypomanic
episodes which are not described, and substance-induced disorder requires
confirmed substance use.
,2. A 28-year-old male with a new diagnosis of schizophrenia is prescribed
risperidone. Which laboratory value should be monitored as a priority given
this medication?
A) Liver function tests
B) Fasting glucose and lipid panel
C) Renal function
D) Complete blood count
E) Thyroid-stimulating hormone
CORRECT ANSWER: B) Fasting glucose and lipid panel
RATIONALE: Atypical antipsychotics like risperidone carry significant metabolic
risks including hyperglycemia, dyslipidemia, and weight gain. Fasting glucose and
lipid panels should be obtained at baseline and monitored regularly (3 months,
then annually) to detect metabolic syndrome development. While CBC and liver
function tests are important, metabolic monitoring is the priority concern with
atypical antipsychotics.
3. A 42-year-old patient with Generalized Anxiety Disorder reports chronic
worry about multiple life domains, muscle tension, and sleep difficulties.
First-line pharmacological treatment should be?
A) Benzodiazepine monotherapy
B) Buspiron
C) SSRI or SNRI
D) Tricyclic antidepressant
E) Antipsychotic augmentation
CORRECT ANSWER: C) SSRI or SNRI
RATIONALE: SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-
norepinephrine reuptake inhibitors) are first-line pharmacological treatments for
,GAD per major clinical guidelines. They provide sustained anxiolytic effects without
the dependence risk of benzodiazepines. Benzodiazepines may be used short-term
adjunctively but not as monotherapy long-term. Buspirone has limited efficacy,
tricyclics are second-line, and antipsychotics are not indicated for GAD alone.
4. A 19-year-old college student presents with decreased need for sleep,
increased goal-directed activity, racing thoughts, and impulsive spending over
4 days. No previous depressive episodes documented. What is the most likely
diagnosis?
A) Bipolar I Disorder
B) Bipolar II Disorder
C) Cyclothymia
D) Major Depressive Disorder with mixed features
E) Substance-Induced Bipolar and Related Disorder
CORRECT ANSWER: A) Bipolar I Disorder
RATIONALE: Bipolar I Disorder requires at least one manic episode (lasting
minimum 7 days with decreased need for sleep, increased goal-directed activity,
racing thoughts, and impulsive behaviors). The 4-day presentation suggests a
hypomanic episode, but without prior depressive episodes documented, Bipolar I is
most appropriate. Bipolar II requires hypomanic episodes (3+ days) and depressive
episodes. Cyclothymia requires multiple hypomanic and depressive periods over 2
years. A thorough substance/medication history is essential but the presentation is
consistent with Bipolar I.
5. A 67-year-old male with cognitive decline, memory loss, confusion, and
disorientation is brought to the clinic by his family. Initial cognitive screening
shows MMSE score of 18. Which neuropsychiatric condition is most likely?
A) Delirium
, B) Mild Cognitive Impairment
C) Major Neurocognitive Disorder due to Alzheimer's Disease
D) Normal pressure hydrocephalus
E) Vitamin B12 deficiency
CORRECT ANSWER: C) Major Neurocognitive Disorder due to Alzheimer's
Disease
RATIONALE: An MMSE score of 18 (normal >23) indicates moderate cognitive
impairment consistent with Major Neurocognitive Disorder. Alzheimer's Disease is
the most common cause of neurocognitive decline in elderly patients, presenting
with memory loss, disorientation, and confusion. Delirium develops acutely (hours
to days) with fluctuating consciousness; this patient has insidious onset. Mild
Cognitive Impairment shows less severe decline. While B12 deficiency and normal
pressure hydrocephalus must be ruled out, the presentation is most consistent
with Alzheimer's dementia.
6. A 32-year-old female presents with recurrent, intrusive thoughts about
harm coming to her 6-year-old son, accompanied by severe anxiety. She
performs repeated checking and reassurance-seeking behaviors. What is the
primary diagnosis?
A) Generalized Anxiety Disorder
B) Obsessive-Compulsive Disorder
C) Posttraumatic Stress Disorder
D) Specific Phobia
E) Illness Anxiety Disorder
CORRECT ANSWER: B) Obsessive-Compulsive Disorder
RATIONALE: OCD is characterized by obsessions (intrusive, unwanted thoughts
causing anxiety) and compulsions (repetitive behaviors aimed at reducing anxiety).
The patient's intrusive thoughts about harm and checking/reassurance-seeking
Practice Questions & Answers, ANCC Exam
Prep
• This comprehensive question practice exam mirrors the ANCC PMHNP
certification assessment, featuring evidence-based questions across all major
psychiatric nursing domains to prepare you for board certification.
• Use this material by completing timed sections, reviewing detailed rationales for
every question, and targeting weak areas for focused study before your exam date.
1. A 35-year-old female presents with persistent low mood, loss of interest in
previously enjoyed activities, significant appetite changes, and sleep
disturbances lasting 3 weeks. What is the most appropriate initial diagnostic
consideration?
A) Persistent Depressive Disorder (Dysthymia)
B) Major Depressive Disorder
C) Adjustment Disorder with Depressed Mood
D) Bipolar II Disorder
E) Substance-Induced Depressive Disorder
CORRECT ANSWER: B) Major Depressive Disorder
RATIONALE: Major Depressive Disorder is characterized by a depressed mood
and/or loss of interest/pleasure lasting at least 2 weeks, with at least 5 symptoms
total including appetite changes, sleep disturbance, and others. The 3-week
duration meets the minimum 2-week criterion. Persistent Depressive Disorder
requires symptoms for at least 2 years (not 3 weeks), Adjustment Disorder typically
resolves within 6 months of stressor removal, Bipolar II requires hypomanic
episodes which are not described, and substance-induced disorder requires
confirmed substance use.
,2. A 28-year-old male with a new diagnosis of schizophrenia is prescribed
risperidone. Which laboratory value should be monitored as a priority given
this medication?
A) Liver function tests
B) Fasting glucose and lipid panel
C) Renal function
D) Complete blood count
E) Thyroid-stimulating hormone
CORRECT ANSWER: B) Fasting glucose and lipid panel
RATIONALE: Atypical antipsychotics like risperidone carry significant metabolic
risks including hyperglycemia, dyslipidemia, and weight gain. Fasting glucose and
lipid panels should be obtained at baseline and monitored regularly (3 months,
then annually) to detect metabolic syndrome development. While CBC and liver
function tests are important, metabolic monitoring is the priority concern with
atypical antipsychotics.
3. A 42-year-old patient with Generalized Anxiety Disorder reports chronic
worry about multiple life domains, muscle tension, and sleep difficulties.
First-line pharmacological treatment should be?
A) Benzodiazepine monotherapy
B) Buspiron
C) SSRI or SNRI
D) Tricyclic antidepressant
E) Antipsychotic augmentation
CORRECT ANSWER: C) SSRI or SNRI
RATIONALE: SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-
norepinephrine reuptake inhibitors) are first-line pharmacological treatments for
,GAD per major clinical guidelines. They provide sustained anxiolytic effects without
the dependence risk of benzodiazepines. Benzodiazepines may be used short-term
adjunctively but not as monotherapy long-term. Buspirone has limited efficacy,
tricyclics are second-line, and antipsychotics are not indicated for GAD alone.
4. A 19-year-old college student presents with decreased need for sleep,
increased goal-directed activity, racing thoughts, and impulsive spending over
4 days. No previous depressive episodes documented. What is the most likely
diagnosis?
A) Bipolar I Disorder
B) Bipolar II Disorder
C) Cyclothymia
D) Major Depressive Disorder with mixed features
E) Substance-Induced Bipolar and Related Disorder
CORRECT ANSWER: A) Bipolar I Disorder
RATIONALE: Bipolar I Disorder requires at least one manic episode (lasting
minimum 7 days with decreased need for sleep, increased goal-directed activity,
racing thoughts, and impulsive behaviors). The 4-day presentation suggests a
hypomanic episode, but without prior depressive episodes documented, Bipolar I is
most appropriate. Bipolar II requires hypomanic episodes (3+ days) and depressive
episodes. Cyclothymia requires multiple hypomanic and depressive periods over 2
years. A thorough substance/medication history is essential but the presentation is
consistent with Bipolar I.
5. A 67-year-old male with cognitive decline, memory loss, confusion, and
disorientation is brought to the clinic by his family. Initial cognitive screening
shows MMSE score of 18. Which neuropsychiatric condition is most likely?
A) Delirium
, B) Mild Cognitive Impairment
C) Major Neurocognitive Disorder due to Alzheimer's Disease
D) Normal pressure hydrocephalus
E) Vitamin B12 deficiency
CORRECT ANSWER: C) Major Neurocognitive Disorder due to Alzheimer's
Disease
RATIONALE: An MMSE score of 18 (normal >23) indicates moderate cognitive
impairment consistent with Major Neurocognitive Disorder. Alzheimer's Disease is
the most common cause of neurocognitive decline in elderly patients, presenting
with memory loss, disorientation, and confusion. Delirium develops acutely (hours
to days) with fluctuating consciousness; this patient has insidious onset. Mild
Cognitive Impairment shows less severe decline. While B12 deficiency and normal
pressure hydrocephalus must be ruled out, the presentation is most consistent
with Alzheimer's dementia.
6. A 32-year-old female presents with recurrent, intrusive thoughts about
harm coming to her 6-year-old son, accompanied by severe anxiety. She
performs repeated checking and reassurance-seeking behaviors. What is the
primary diagnosis?
A) Generalized Anxiety Disorder
B) Obsessive-Compulsive Disorder
C) Posttraumatic Stress Disorder
D) Specific Phobia
E) Illness Anxiety Disorder
CORRECT ANSWER: B) Obsessive-Compulsive Disorder
RATIONALE: OCD is characterized by obsessions (intrusive, unwanted thoughts
causing anxiety) and compulsions (repetitive behaviors aimed at reducing anxiety).
The patient's intrusive thoughts about harm and checking/reassurance-seeking
