PMHNP ANCC EXAM AND PRACTICE EXAM
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MENTAL HEALTH NURSE PRACTITIONER)
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QUESTIONS AND 100% ACCURATE SOLUTIONS
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These questions are designed to reflect the style and content of the ANCC exam
blueprint, covering domains like Scientific Foundation, Diagnosis & Treatment, and
Psychotherapy & Related Therapies.
1. A 28-year-old patient with bipolar I disorder, currently prescribed lithium,
presents with a new onset of fine hand tremors, nausea, and muscle weakness.
Which of the following lab results would be the priority for the PMHNP to assess?
A. Serum calcium level
B. Complete blood count (CBC)
C. Serum lithium level
D. Thyroid-stimulating hormone (TSH) level
Correct Answer: C. Serum lithium level
Explanation: The triad of new-onset neurological symptoms (tremor), GI distress
(nausea), and general weakness in a patient on lithium therapy is highly suggestive
of lithium toxicity. The priority action is to assess the serum lithium level to confirm
toxicity and guide immediate treatment. While long-term lithium use can affect thyroid
and renal function, and can be associated with hypercalcemia, the acute presentation
described is most consistent with toxicity.
2. According to Bandura's Self-Efficacy Theory, a PMHNP working with a patient
who has severe social anxiety should primarily focus on:
A. Unconscious conflicts from childhood.
,B. The patient's perceived ability to successfully navigate a social situation.
C. The patient's hierarchy of unmet needs, starting with safety.
D. Maladaptive thought patterns that are automatic and distorted.
Correct Answer: B. The patient's perceived ability to successfully navigate a social
situation.
Explanation: Bandura's Social Learning/Self-Efficacy Theory posits that behavior is
influenced by cognitive and environmental factors, but the key predictor of change is an
individual's efficacy expectation—their belief in their own ability to execute a specific
behavior. A patient with low self-efficacy for social interactions will avoid them,
regardless of their actual skills. The PMHNP would focus on mastery experiences and
role-modeling to build this confidence.
3. A PMHNP is evaluating a 65-year-old patient for a depressive disorder. The
patient's medical history includes hypertension and hyperlipidemia. Which of the
following is the most critical initial assessment before prescribing an
antidepressant?
A. A baseline electrocardiogram (ECG)
B. A complete metabolic panel (CMP)
C. A family history of depression
D. A review of all over-the-counter and prescription medications
Correct Answer: D. A review of all over-the-counter and prescription medications
Explanation: While all options are important aspects of a comprehensive geriatric
assessment, the most critical initial step is a thorough medication review. Older adults
are at high risk for polypharmacy and significant drug-drug interactions. For example,
many antidepressants (especially SSRIs like fluoxetine) can inhibit cytochrome P450
enzymes, potentially increasing levels of commonly prescribed medications for
hypertension or hyperlipidemia, leading to adverse effects like bradycardia, falls, or
statin toxicity.
4. A patient prescribed clozapine for treatment-resistant schizophrenia reports
new-onset fever, malaise, and a sore throat. The PMHNP should prioritize which of
the following laboratory assessments?
A. Serum creatine kinase (CK)
B. Fasting blood glucose and lipid panel
C. Absolute neutrophil count (ANC)
D. Clozapine serum level
Correct Answer: C. Absolute neutrophil count (ANC)
,Explanation: Clozapine carries a black box warning for severe agranulocytosis (a
dramatic drop in neutrophils), which can lead to fatal infections. Fever and sore throat
are classic presenting signs of this potentially life-threatening adverse effect. The
PMHNP must immediately assess the ANC. If ANC levels are critically low (e.g.,
<500/mm³), clozapine must be discontinued immediately and never restarted.
5. During a mental status exam, a patient is asked to interpret the proverb,
"People who live in glass houses shouldn't throw stones." The patient responds,
"It means you shouldn't throw stones because you'll break the glass." This
response is most indicative of a deficit in:
A. Memory
B. Judgment
C. Abstract reasoning
D. Insight
Correct Answer: C. Abstract reasoning
Explanation: Proverb interpretation is a classic test of abstract reasoning and concrete
vs. abstract thinking. The ability to understand a metaphor or proverb (e.g., "Don't
criticize others for a flaw you also possess") is an abstract thought. The patient's
response is literal and concrete (focused only on the physical action of breaking glass),
suggesting a deficit in abstraction, which is often seen in cognitive disorders,
schizophrenia, or intellectual disabilities.
6. A patient with major depressive disorder has been taking fluoxetine 20 mg daily
for 6 weeks. The patient reports that their mood is "a little better, but not much."
What is the most appropriate next step for the PMHNP?
A. Discontinue fluoxetine and start a different SSRI.
B. Augment with low-dose aripiprazole.
C. Increase the dose of fluoxetine to 40 mg daily.
D. Add a low-dose tricyclic antidepressant (TCA).
Correct Answer: C. Increase the dose of fluoxetine to 40 mg daily.
Explanation: Fluoxetine is often prescribed at 20 mg as a starting dose. A partial
response at 6 weeks is expected, but the standard of care is to first optimize the
dose of the current medication before switching or augmenting. The therapeutic dose
range for fluoxetine is typically 20-80 mg/day. Increasing to 40 mg is a standard next
step. Augmentation is generally considered after an adequate trial of a first-line agent at
an optimized dose has failed to achieve remission.
, 7. Which of the following assessment tools is a 9-item, self-report questionnaire
specifically designed to screen for the severity of depression?
A. The Hamilton Rating Scale for Depression (HAM-D)
B. The Beck Anxiety Inventory (BAI)
C. The Patient Health Questionnaire-9 (PHQ-9)
D. The Abnormal Involuntary Movement Scale (AIMS)
Correct Answer: C. The Patient Health Questionnaire-9 (PHQ-9)
Explanation: The PHQ-9 is a widely used, validated, self-administered tool that screens
for and measures the severity of depression based on the 9 DSM-5 criteria. The HAM-D
(A) is a clinician-administered tool. The BAI (B) is for anxiety. The AIMS (D) is used to
monitor for tardive dyskinesia.
8. A patient with borderline personality disorder often says, "You're the only one
who understands me," in one session, and in the next session says, "You're a
horrible, uncaring person who has abandoned me." This pattern of alternating
idealization and devaluation is a classic example of:
A. Projective identification
B. Splitting
C. Magical thinking
D. A cognitive distortion
Correct Answer: B. Splitting
Explanation: Splitting is a primitive ego defense mechanism common in borderline
personality disorder. It is the failure to integrate the positive and negative aspects of self
or others, leading to thinking in extremes (all good or all bad). The patient's inability to
see the PMHNP as a whole person with both good and bad qualities, instead rapidly
alternating between "all good" and "all bad," is the hallmark of splitting.
9. According to the DSM-5-TR criteria for Major Depressive Disorder, which of the
following symptoms, if present for at least two weeks, would not count toward the
required five or more symptoms for diagnosis?
A. Hypersomnia nearly every day
B. A decrease in daily appetite without weight loss
C. Depressed mood most of the day, nearly every day
D. Irritability and anger outbursts, which are not characteristic of the patient
Correct Answer: B. A decrease in daily appetite without weight loss
NEWEST 2026 TEST BANK| ANCC (PSYCHIATRIC
MENTAL HEALTH NURSE PRACTITIONER)
CERTIFICATION EXAM PREP UP-TO-DATE EXAM
QUESTIONS AND 100% ACCURATE SOLUTIONS
| VERIFIED ANSWERS - INSTANT PDF
DOWNLOAD.
These questions are designed to reflect the style and content of the ANCC exam
blueprint, covering domains like Scientific Foundation, Diagnosis & Treatment, and
Psychotherapy & Related Therapies.
1. A 28-year-old patient with bipolar I disorder, currently prescribed lithium,
presents with a new onset of fine hand tremors, nausea, and muscle weakness.
Which of the following lab results would be the priority for the PMHNP to assess?
A. Serum calcium level
B. Complete blood count (CBC)
C. Serum lithium level
D. Thyroid-stimulating hormone (TSH) level
Correct Answer: C. Serum lithium level
Explanation: The triad of new-onset neurological symptoms (tremor), GI distress
(nausea), and general weakness in a patient on lithium therapy is highly suggestive
of lithium toxicity. The priority action is to assess the serum lithium level to confirm
toxicity and guide immediate treatment. While long-term lithium use can affect thyroid
and renal function, and can be associated with hypercalcemia, the acute presentation
described is most consistent with toxicity.
2. According to Bandura's Self-Efficacy Theory, a PMHNP working with a patient
who has severe social anxiety should primarily focus on:
A. Unconscious conflicts from childhood.
,B. The patient's perceived ability to successfully navigate a social situation.
C. The patient's hierarchy of unmet needs, starting with safety.
D. Maladaptive thought patterns that are automatic and distorted.
Correct Answer: B. The patient's perceived ability to successfully navigate a social
situation.
Explanation: Bandura's Social Learning/Self-Efficacy Theory posits that behavior is
influenced by cognitive and environmental factors, but the key predictor of change is an
individual's efficacy expectation—their belief in their own ability to execute a specific
behavior. A patient with low self-efficacy for social interactions will avoid them,
regardless of their actual skills. The PMHNP would focus on mastery experiences and
role-modeling to build this confidence.
3. A PMHNP is evaluating a 65-year-old patient for a depressive disorder. The
patient's medical history includes hypertension and hyperlipidemia. Which of the
following is the most critical initial assessment before prescribing an
antidepressant?
A. A baseline electrocardiogram (ECG)
B. A complete metabolic panel (CMP)
C. A family history of depression
D. A review of all over-the-counter and prescription medications
Correct Answer: D. A review of all over-the-counter and prescription medications
Explanation: While all options are important aspects of a comprehensive geriatric
assessment, the most critical initial step is a thorough medication review. Older adults
are at high risk for polypharmacy and significant drug-drug interactions. For example,
many antidepressants (especially SSRIs like fluoxetine) can inhibit cytochrome P450
enzymes, potentially increasing levels of commonly prescribed medications for
hypertension or hyperlipidemia, leading to adverse effects like bradycardia, falls, or
statin toxicity.
4. A patient prescribed clozapine for treatment-resistant schizophrenia reports
new-onset fever, malaise, and a sore throat. The PMHNP should prioritize which of
the following laboratory assessments?
A. Serum creatine kinase (CK)
B. Fasting blood glucose and lipid panel
C. Absolute neutrophil count (ANC)
D. Clozapine serum level
Correct Answer: C. Absolute neutrophil count (ANC)
,Explanation: Clozapine carries a black box warning for severe agranulocytosis (a
dramatic drop in neutrophils), which can lead to fatal infections. Fever and sore throat
are classic presenting signs of this potentially life-threatening adverse effect. The
PMHNP must immediately assess the ANC. If ANC levels are critically low (e.g.,
<500/mm³), clozapine must be discontinued immediately and never restarted.
5. During a mental status exam, a patient is asked to interpret the proverb,
"People who live in glass houses shouldn't throw stones." The patient responds,
"It means you shouldn't throw stones because you'll break the glass." This
response is most indicative of a deficit in:
A. Memory
B. Judgment
C. Abstract reasoning
D. Insight
Correct Answer: C. Abstract reasoning
Explanation: Proverb interpretation is a classic test of abstract reasoning and concrete
vs. abstract thinking. The ability to understand a metaphor or proverb (e.g., "Don't
criticize others for a flaw you also possess") is an abstract thought. The patient's
response is literal and concrete (focused only on the physical action of breaking glass),
suggesting a deficit in abstraction, which is often seen in cognitive disorders,
schizophrenia, or intellectual disabilities.
6. A patient with major depressive disorder has been taking fluoxetine 20 mg daily
for 6 weeks. The patient reports that their mood is "a little better, but not much."
What is the most appropriate next step for the PMHNP?
A. Discontinue fluoxetine and start a different SSRI.
B. Augment with low-dose aripiprazole.
C. Increase the dose of fluoxetine to 40 mg daily.
D. Add a low-dose tricyclic antidepressant (TCA).
Correct Answer: C. Increase the dose of fluoxetine to 40 mg daily.
Explanation: Fluoxetine is often prescribed at 20 mg as a starting dose. A partial
response at 6 weeks is expected, but the standard of care is to first optimize the
dose of the current medication before switching or augmenting. The therapeutic dose
range for fluoxetine is typically 20-80 mg/day. Increasing to 40 mg is a standard next
step. Augmentation is generally considered after an adequate trial of a first-line agent at
an optimized dose has failed to achieve remission.
, 7. Which of the following assessment tools is a 9-item, self-report questionnaire
specifically designed to screen for the severity of depression?
A. The Hamilton Rating Scale for Depression (HAM-D)
B. The Beck Anxiety Inventory (BAI)
C. The Patient Health Questionnaire-9 (PHQ-9)
D. The Abnormal Involuntary Movement Scale (AIMS)
Correct Answer: C. The Patient Health Questionnaire-9 (PHQ-9)
Explanation: The PHQ-9 is a widely used, validated, self-administered tool that screens
for and measures the severity of depression based on the 9 DSM-5 criteria. The HAM-D
(A) is a clinician-administered tool. The BAI (B) is for anxiety. The AIMS (D) is used to
monitor for tardive dyskinesia.
8. A patient with borderline personality disorder often says, "You're the only one
who understands me," in one session, and in the next session says, "You're a
horrible, uncaring person who has abandoned me." This pattern of alternating
idealization and devaluation is a classic example of:
A. Projective identification
B. Splitting
C. Magical thinking
D. A cognitive distortion
Correct Answer: B. Splitting
Explanation: Splitting is a primitive ego defense mechanism common in borderline
personality disorder. It is the failure to integrate the positive and negative aspects of self
or others, leading to thinking in extremes (all good or all bad). The patient's inability to
see the PMHNP as a whole person with both good and bad qualities, instead rapidly
alternating between "all good" and "all bad," is the hallmark of splitting.
9. According to the DSM-5-TR criteria for Major Depressive Disorder, which of the
following symptoms, if present for at least two weeks, would not count toward the
required five or more symptoms for diagnosis?
A. Hypersomnia nearly every day
B. A decrease in daily appetite without weight loss
C. Depressed mood most of the day, nearly every day
D. Irritability and anger outbursts, which are not characteristic of the patient
Correct Answer: B. A decrease in daily appetite without weight loss
