AANC PMHNP Certification Exam Test Bank
New Latest Version with 500+ Questions from
Actual Past Exam, Correct Answers and
Rationales
Question 1
A 35-year-old male reports persistent sadness, anhedonia, and insomnia for 6 weeks. What is the most
likely diagnosis?
A) Adjustment disorder
B) Major depressive disorder
C) Persistent depressive disorder
D) Bipolar disorder
Correct Answer: B) Major depressive disorder
Rationale: Sadness, anhedonia, and insomnia for >2 weeks meet DSM-5 criteria for major depressive
disorder (MDD). Adjustment disorder requires a stressor with <6 months duration, persistent depressive
disorder lasts ≥2 years, and bipolar includes mania/hypomania.
Question 2
Which medication is first-line for generalized anxiety disorder (GAD) in a 40-year-old female?
A) Lorazepam
B) Sertraline
C) Buspirone
D) Propranolol
Correct Answer: B) Sertraline
Rationale: SSRIs like sertraline are first-line for GAD per APA guidelines due to efficacy and safety.
Lorazepam is short-term, buspirone is an alternative, and propranolol treats physical symptoms only.
Question 3
A 25-year-old reports auditory hallucinations and delusions of persecution. What is the most likely
diagnosis?
A) Schizophrenia
B) Brief psychotic disorder
C) Schizoaffective disorder
D) Delusional disorder
Correct Answer: A) Schizophrenia
Rationale: Auditory hallucinations and delusions for >1 month suggest schizophrenia (DSM-5). Brief
psychotic disorder lasts <1 month, schizoaffective includes mood episodes, and delusional disorder lacks
hallucinations.
Question 4
What is the primary goal of cognitive-behavioral therapy (CBT) for a patient with OCD?
A) Reduce medication dependence
B) Identify unconscious conflicts
C) Restructure maladaptive thoughts
D) Improve social skills
Correct Answer: C) Restructure maladaptive thoughts
,Rationale: CBT for OCD aims to challenge obsessive thoughts and reduce compulsive behaviors via
exposure and response prevention. Unconscious conflicts are psychoanalytic, and social skills are not the
focus.
Question 5
A 60-year-old male with a history of depression starts fluoxetine. What side effect should be monitored
closely?
A) Weight loss
B) Sexual dysfunction
C) Hyponatremia
D) Tremors
Correct Answer: C) Hyponatremia
Rationale: SSRIs like fluoxetine can cause SIADH and hyponatremia, especially in older adults. Sexual
dysfunction and weight changes occur, but hyponatremia is more urgent in this age group.
Question 6
Which screening tool is most appropriate for assessing alcohol use disorder in a 30-year-old?
A) PHQ-9
B) AUDIT
C) GAD-7
D) MMSE
Correct Answer: B) AUDIT
Rationale: The Alcohol Use Disorders Identification Test (AUDIT) is specific for alcohol use. PHQ-9
screens depression, GAD-7 anxiety, and MMSE cognition.
Question 7
A 15-year-old female reports binging and purging twice weekly for 3 months. What is the most likely
diagnosis?
A) Anorexia nervosa
B) Bulimia nervosa
C) Binge-eating disorder
D) Avoidant/restrictive food intake disorder
Correct Answer: B) Bulimia nervosa
Rationale: Binging and purging ≥1 time/week for 3 months meet DSM-5 criteria for bulimia nervosa.
Anorexia involves restriction, binge-eating lacks purging, and ARFID avoids food without body image
concerns.
Question 8
What is the mechanism of action of risperidone in treating schizophrenia?
A) Dopamine D2 receptor agonist
B) Serotonin reuptake inhibitor
C) Dopamine D2 receptor antagonist
D) GABA enhancer
Correct Answer: C) Dopamine D2 receptor antagonist
Rationale: Risperidone, an atypical antipsychotic, blocks D2 and 5-HT2 receptors to reduce positive
symptoms of schizophrenia. It’s not an agonist, SSRI, or GABA drug.
Question 9
A 50-year-old female with bipolar disorder is stable on lithium. What lab should be monitored regularly?
A) Liver function tests
B) Thyroid function tests
,C) Complete blood count
D) Blood glucose
Correct Answer: B) Thyroid function tests
Rationale: Lithium can cause hypothyroidism, requiring regular TSH monitoring (every 6–12 months).
Kidney function and lithium levels are also monitored, but thyroid is critical here.
Question 10
Which symptom distinguishes PTSD from acute stress disorder in a 28-year-old after a car accident?
A) Flashbacks
B) Hypervigilance
C) Symptoms lasting >1 month
D) Avoidance behavior
Correct Answer: C) Symptoms lasting >1 month
Rationale: PTSD requires symptoms (e.g., flashbacks, avoidance) for >1 month per DSM-5; acute stress
disorder lasts <1 month. Both share similar symptoms, but duration differentiates them.
Question 11
What is the first-line treatment for ADHD in a 7-year-old child?
A) Methylphenidate
B) Clonidine
C) Behavioral therapy
D) Fluoxetine
Correct Answer: C) Behavioral therapy
Rationale: AAP guidelines recommend behavioral therapy as first-line for ADHD in young children (<6–
12 years), with stimulants like methylphenidate added if needed. Clonidine and fluoxetine are not first-
line.
Question 12
A 45-year-old male reports excessive daytime sleepiness and snoring. What is the most likely diagnosis?
A) Narcolepsy
B) Obstructive sleep apnea
C) Restless legs syndrome
D) Insomnia
Correct Answer: B) Obstructive sleep apnea
Rationale: Snoring and daytime sleepiness suggest obstructive sleep apnea, common in middle-aged
adults. Narcolepsy involves sudden sleep attacks, restless legs affects sleep onset, and insomnia lacks
snoring.
Question 13
Which medication requires a black box warning for suicidal ideation in adolescents?
A) Sertraline
B) Bupropion
C) Venlafaxine
D) All of the above
Correct Answer: D) All of the above
Rationale: All antidepressants (SSRIs, SNRIs, others) carry an FDA black box warning for increased
suicidal ideation risk in patients <25 during initial treatment.
Question 14
A 70-year-old female reports memory loss and difficulty with daily tasks. What is the most appropriate
screening tool?
, A) GAD-7
B) Mini-Mental State Exam (MMSE)
C) PHQ-9
D) CAGE
Correct Answer: B) Mini-Mental State Exam (MMSE)
Rationale: The MMSE screens for cognitive impairment (e.g., dementia). GAD-7 assesses anxiety, PHQ-
9 depression, and CAGE alcohol use.
Question 15
What is the primary goal of motivational interviewing in a patient with substance use disorder?
A) Enforce abstinence
B) Enhance intrinsic motivation to change
C) Teach coping skills
D) Reduce withdrawal symptoms
Correct Answer: B) Enhance intrinsic motivation to change
Rationale: Motivational interviewing (MI) aims to elicit patient-driven change by exploring ambivalence.
It’s not about enforcement, skills, or withdrawal management.
Question 16
A 30-year-old female reports panic attacks with chest pain and shortness of breath. What is the most
appropriate acute treatment?
A) Alprazolam
B) Escitalopram
C) Propranolol
D) Cognitive therapy alone
Correct Answer: A) Alprazolam
Rationale: Benzodiazepines like alprazolam provide rapid relief for acute panic attacks. SSRIs
(escitalopram) are long-term, propranolol targets physical symptoms, and therapy isn’t immediate.
Question 17
Which finding suggests tardive dyskinesia in a patient on long-term antipsychotics?
A) Tremors at rest
B) Involuntary lip smacking
C) Muscle rigidity
D) Bradykinesia
Correct Answer: B) Involuntary lip smacking
Rationale: Tardive dyskinesia involves involuntary movements (e.g., lip smacking) after prolonged
antipsychotic use. Tremors, rigidity, and bradykinesia are parkinsonism, an earlier side effect.
Question 18
What is the most common cause of delirium in a hospitalized 80-year-old?
A) Medication side effects
B) Alcohol withdrawal
C) Stroke
D) Hypoglycemia
Correct Answer: A) Medication side effects
Rationale: Medications (e.g., anticholinergics, opioids) are the leading cause of delirium in older adults,
especially in hospitals. Other causes are possible but less common.
Question 19
A 22-year-old male reports grandiosity and decreased need for sleep for 5 days. What is the most likely
New Latest Version with 500+ Questions from
Actual Past Exam, Correct Answers and
Rationales
Question 1
A 35-year-old male reports persistent sadness, anhedonia, and insomnia for 6 weeks. What is the most
likely diagnosis?
A) Adjustment disorder
B) Major depressive disorder
C) Persistent depressive disorder
D) Bipolar disorder
Correct Answer: B) Major depressive disorder
Rationale: Sadness, anhedonia, and insomnia for >2 weeks meet DSM-5 criteria for major depressive
disorder (MDD). Adjustment disorder requires a stressor with <6 months duration, persistent depressive
disorder lasts ≥2 years, and bipolar includes mania/hypomania.
Question 2
Which medication is first-line for generalized anxiety disorder (GAD) in a 40-year-old female?
A) Lorazepam
B) Sertraline
C) Buspirone
D) Propranolol
Correct Answer: B) Sertraline
Rationale: SSRIs like sertraline are first-line for GAD per APA guidelines due to efficacy and safety.
Lorazepam is short-term, buspirone is an alternative, and propranolol treats physical symptoms only.
Question 3
A 25-year-old reports auditory hallucinations and delusions of persecution. What is the most likely
diagnosis?
A) Schizophrenia
B) Brief psychotic disorder
C) Schizoaffective disorder
D) Delusional disorder
Correct Answer: A) Schizophrenia
Rationale: Auditory hallucinations and delusions for >1 month suggest schizophrenia (DSM-5). Brief
psychotic disorder lasts <1 month, schizoaffective includes mood episodes, and delusional disorder lacks
hallucinations.
Question 4
What is the primary goal of cognitive-behavioral therapy (CBT) for a patient with OCD?
A) Reduce medication dependence
B) Identify unconscious conflicts
C) Restructure maladaptive thoughts
D) Improve social skills
Correct Answer: C) Restructure maladaptive thoughts
,Rationale: CBT for OCD aims to challenge obsessive thoughts and reduce compulsive behaviors via
exposure and response prevention. Unconscious conflicts are psychoanalytic, and social skills are not the
focus.
Question 5
A 60-year-old male with a history of depression starts fluoxetine. What side effect should be monitored
closely?
A) Weight loss
B) Sexual dysfunction
C) Hyponatremia
D) Tremors
Correct Answer: C) Hyponatremia
Rationale: SSRIs like fluoxetine can cause SIADH and hyponatremia, especially in older adults. Sexual
dysfunction and weight changes occur, but hyponatremia is more urgent in this age group.
Question 6
Which screening tool is most appropriate for assessing alcohol use disorder in a 30-year-old?
A) PHQ-9
B) AUDIT
C) GAD-7
D) MMSE
Correct Answer: B) AUDIT
Rationale: The Alcohol Use Disorders Identification Test (AUDIT) is specific for alcohol use. PHQ-9
screens depression, GAD-7 anxiety, and MMSE cognition.
Question 7
A 15-year-old female reports binging and purging twice weekly for 3 months. What is the most likely
diagnosis?
A) Anorexia nervosa
B) Bulimia nervosa
C) Binge-eating disorder
D) Avoidant/restrictive food intake disorder
Correct Answer: B) Bulimia nervosa
Rationale: Binging and purging ≥1 time/week for 3 months meet DSM-5 criteria for bulimia nervosa.
Anorexia involves restriction, binge-eating lacks purging, and ARFID avoids food without body image
concerns.
Question 8
What is the mechanism of action of risperidone in treating schizophrenia?
A) Dopamine D2 receptor agonist
B) Serotonin reuptake inhibitor
C) Dopamine D2 receptor antagonist
D) GABA enhancer
Correct Answer: C) Dopamine D2 receptor antagonist
Rationale: Risperidone, an atypical antipsychotic, blocks D2 and 5-HT2 receptors to reduce positive
symptoms of schizophrenia. It’s not an agonist, SSRI, or GABA drug.
Question 9
A 50-year-old female with bipolar disorder is stable on lithium. What lab should be monitored regularly?
A) Liver function tests
B) Thyroid function tests
,C) Complete blood count
D) Blood glucose
Correct Answer: B) Thyroid function tests
Rationale: Lithium can cause hypothyroidism, requiring regular TSH monitoring (every 6–12 months).
Kidney function and lithium levels are also monitored, but thyroid is critical here.
Question 10
Which symptom distinguishes PTSD from acute stress disorder in a 28-year-old after a car accident?
A) Flashbacks
B) Hypervigilance
C) Symptoms lasting >1 month
D) Avoidance behavior
Correct Answer: C) Symptoms lasting >1 month
Rationale: PTSD requires symptoms (e.g., flashbacks, avoidance) for >1 month per DSM-5; acute stress
disorder lasts <1 month. Both share similar symptoms, but duration differentiates them.
Question 11
What is the first-line treatment for ADHD in a 7-year-old child?
A) Methylphenidate
B) Clonidine
C) Behavioral therapy
D) Fluoxetine
Correct Answer: C) Behavioral therapy
Rationale: AAP guidelines recommend behavioral therapy as first-line for ADHD in young children (<6–
12 years), with stimulants like methylphenidate added if needed. Clonidine and fluoxetine are not first-
line.
Question 12
A 45-year-old male reports excessive daytime sleepiness and snoring. What is the most likely diagnosis?
A) Narcolepsy
B) Obstructive sleep apnea
C) Restless legs syndrome
D) Insomnia
Correct Answer: B) Obstructive sleep apnea
Rationale: Snoring and daytime sleepiness suggest obstructive sleep apnea, common in middle-aged
adults. Narcolepsy involves sudden sleep attacks, restless legs affects sleep onset, and insomnia lacks
snoring.
Question 13
Which medication requires a black box warning for suicidal ideation in adolescents?
A) Sertraline
B) Bupropion
C) Venlafaxine
D) All of the above
Correct Answer: D) All of the above
Rationale: All antidepressants (SSRIs, SNRIs, others) carry an FDA black box warning for increased
suicidal ideation risk in patients <25 during initial treatment.
Question 14
A 70-year-old female reports memory loss and difficulty with daily tasks. What is the most appropriate
screening tool?
, A) GAD-7
B) Mini-Mental State Exam (MMSE)
C) PHQ-9
D) CAGE
Correct Answer: B) Mini-Mental State Exam (MMSE)
Rationale: The MMSE screens for cognitive impairment (e.g., dementia). GAD-7 assesses anxiety, PHQ-
9 depression, and CAGE alcohol use.
Question 15
What is the primary goal of motivational interviewing in a patient with substance use disorder?
A) Enforce abstinence
B) Enhance intrinsic motivation to change
C) Teach coping skills
D) Reduce withdrawal symptoms
Correct Answer: B) Enhance intrinsic motivation to change
Rationale: Motivational interviewing (MI) aims to elicit patient-driven change by exploring ambivalence.
It’s not about enforcement, skills, or withdrawal management.
Question 16
A 30-year-old female reports panic attacks with chest pain and shortness of breath. What is the most
appropriate acute treatment?
A) Alprazolam
B) Escitalopram
C) Propranolol
D) Cognitive therapy alone
Correct Answer: A) Alprazolam
Rationale: Benzodiazepines like alprazolam provide rapid relief for acute panic attacks. SSRIs
(escitalopram) are long-term, propranolol targets physical symptoms, and therapy isn’t immediate.
Question 17
Which finding suggests tardive dyskinesia in a patient on long-term antipsychotics?
A) Tremors at rest
B) Involuntary lip smacking
C) Muscle rigidity
D) Bradykinesia
Correct Answer: B) Involuntary lip smacking
Rationale: Tardive dyskinesia involves involuntary movements (e.g., lip smacking) after prolonged
antipsychotic use. Tremors, rigidity, and bradykinesia are parkinsonism, an earlier side effect.
Question 18
What is the most common cause of delirium in a hospitalized 80-year-old?
A) Medication side effects
B) Alcohol withdrawal
C) Stroke
D) Hypoglycemia
Correct Answer: A) Medication side effects
Rationale: Medications (e.g., anticholinergics, opioids) are the leading cause of delirium in older adults,
especially in hospitals. Other causes are possible but less common.
Question 19
A 22-year-old male reports grandiosity and decreased need for sleep for 5 days. What is the most likely
