ANCC Psychiatric Mental Health Nursing (PMH-BC)
Certification Exam New 2026 Version with All Questions,
Answers and Rationale
QUESTIONS 1–25 (MOST TESTED & MOST MISSED)
1. A patient states, “I hear voices telling me to hurt myself.” What is the PRIORITY action?
A. Ask the patient to ignore the voices
B. Assess command hallucinations and intent
C. Reorient the patient to reality
D. Administer PRN antipsychotic
✅ Correct Answer: B
Explanation:
Command hallucinations + self-harm = IMMEDIATE suicide risk assessment.
2. Which statement best demonstrates therapeutic communication?
A. “You shouldn’t feel that way.”
B. “Everything will be fine.”
C. “Tell me more about what you’re experiencing.”
D. “Why did you do that?”
✅ Correct Answer: C
3. A patient with bipolar I disorder presents with pressured speech, grandiosity, and decreased need
for sleep. This is best described as:
A. Hypomania
B. Mania
C. Cyclothymia
D. Mixed episode
,✅ Correct Answer: B
4. Which medication requires regular monitoring of serum levels?
A. Fluoxetine
B. Olanzapine
C. Lithium
D. Buspirone
✅ Correct Answer: C
5. Which lab finding is MOST concerning in a patient taking lithium?
A. Sodium 140 mEq/L
B. Creatinine 2.1 mg/dL
C. Glucose 110 mg/dL
D. Hemoglobin 13 g/dL
✅ Correct Answer: B
Explanation:
Lithium is renally excreted → kidney impairment = toxicity risk.
6. A patient abruptly stops taking benzodiazepines. What is the greatest risk?
A. Weight loss
B. Hypertension
C. Seizures
D. Depression
✅ Correct Answer: C
7. Which symptom differentiates schizophrenia from major depressive disorder with psychotic
features?
A. Hallucinations
B. Delusions
C. Negative symptoms
D. Disorganized speech
✅ Correct Answer: C
, 8. Which medication is FIRST-LINE for PTSD?
A. Haloperidol
B. Sertraline
C. Lithium
D. Clonazepam
✅ Correct Answer: B
9. A patient says, “I want to kill myself,” but has no plan. What is the nurse’s BEST response?
A. Document and monitor
B. Ask about access to means
C. Provide reassurance
D. Encourage journaling
✅ Correct Answer: B
10. Which defense mechanism involves attributing one’s feelings to others?
A. Denial
B. Projection
C. Rationalization
D. Regression
✅ Correct Answer: B
11. Which disorder is MOST associated with dissociation?
A. Panic disorder
B. PTSD
C. OCD
D. Social anxiety disorder
✅ Correct Answer: B
12. A patient with OCD reports repetitive hand washing. The behavior is best described as a:
A. Delusion
B. Compulsion
C. Obsession
D. Hallucination
✅ Correct Answer: B
Certification Exam New 2026 Version with All Questions,
Answers and Rationale
QUESTIONS 1–25 (MOST TESTED & MOST MISSED)
1. A patient states, “I hear voices telling me to hurt myself.” What is the PRIORITY action?
A. Ask the patient to ignore the voices
B. Assess command hallucinations and intent
C. Reorient the patient to reality
D. Administer PRN antipsychotic
✅ Correct Answer: B
Explanation:
Command hallucinations + self-harm = IMMEDIATE suicide risk assessment.
2. Which statement best demonstrates therapeutic communication?
A. “You shouldn’t feel that way.”
B. “Everything will be fine.”
C. “Tell me more about what you’re experiencing.”
D. “Why did you do that?”
✅ Correct Answer: C
3. A patient with bipolar I disorder presents with pressured speech, grandiosity, and decreased need
for sleep. This is best described as:
A. Hypomania
B. Mania
C. Cyclothymia
D. Mixed episode
,✅ Correct Answer: B
4. Which medication requires regular monitoring of serum levels?
A. Fluoxetine
B. Olanzapine
C. Lithium
D. Buspirone
✅ Correct Answer: C
5. Which lab finding is MOST concerning in a patient taking lithium?
A. Sodium 140 mEq/L
B. Creatinine 2.1 mg/dL
C. Glucose 110 mg/dL
D. Hemoglobin 13 g/dL
✅ Correct Answer: B
Explanation:
Lithium is renally excreted → kidney impairment = toxicity risk.
6. A patient abruptly stops taking benzodiazepines. What is the greatest risk?
A. Weight loss
B. Hypertension
C. Seizures
D. Depression
✅ Correct Answer: C
7. Which symptom differentiates schizophrenia from major depressive disorder with psychotic
features?
A. Hallucinations
B. Delusions
C. Negative symptoms
D. Disorganized speech
✅ Correct Answer: C
, 8. Which medication is FIRST-LINE for PTSD?
A. Haloperidol
B. Sertraline
C. Lithium
D. Clonazepam
✅ Correct Answer: B
9. A patient says, “I want to kill myself,” but has no plan. What is the nurse’s BEST response?
A. Document and monitor
B. Ask about access to means
C. Provide reassurance
D. Encourage journaling
✅ Correct Answer: B
10. Which defense mechanism involves attributing one’s feelings to others?
A. Denial
B. Projection
C. Rationalization
D. Regression
✅ Correct Answer: B
11. Which disorder is MOST associated with dissociation?
A. Panic disorder
B. PTSD
C. OCD
D. Social anxiety disorder
✅ Correct Answer: B
12. A patient with OCD reports repetitive hand washing. The behavior is best described as a:
A. Delusion
B. Compulsion
C. Obsession
D. Hallucination
✅ Correct Answer: B
