THE ANCC PMHNP EXAM REVIEW: 200 COMPREHENSIVE BOARD-
STYLE QUESTIONS COVERING IQ DOMAINS 1–5 WITH VERIFIED
ANSWERS AND CLINICAL RATIONALES
1. A 35-year-old male with a history of alcohol use disorder is prescribed
disulfiram. He reports he has been abstinent for 5 days. The PMHNP's education
regarding this medication should include that consuming alcohol while on
disulfiram can cause which of the following?
A. Respiratory depression and coma
B. Hypertension and tachycardia followed by hypotension
C. Flushing, nausea, vomiting, and palpitations
D. Severe muscle rigidity and hyperthermia
Answer: C
Rationale: Disulfiram blocks acetaldehyde dehydrogenase, leading to
acetaldehyde accumulation when alcohol is consumed, causing the disulfiram-
ethanol reaction characterized by flushing, nausea, vomiting, and palpitations. It
does not primarily cause respiratory depression, coma, or severe muscle rigidity.
2. A 62-year-old patient with Parkinson's disease is started on pramipexole.
Three weeks later, the patient's family reports he has been gambling excessively
and making impulsive purchases. Which of the following is the most appropriate
action?
A. Increase the pramipexole dose to control parkinsonian symptoms
,B. Add an SSRI to control the impulse control disorder
C. Refer the patient for cognitive behavioral therapy
D. Consider reducing the dose or discontinuing the dopamine agonist
Answer: D
Rationale: Dopamine agonists like pramipexole are associated with impulse
control disorders. The appropriate action is to reduce the dose or discontinue the
medication. Increasing the dose would worsen symptoms, and adding an SSRI or
CBT alone is not the primary treatment without addressing the medication.
3. A 48-year-old female is prescribed lamotrigine for bipolar depression. She
asks about the most serious adverse effect. The PMHNP should warn her about
which of the following?
A. Weight gain and metabolic syndrome
B. Stevens-Johnson syndrome
C. Agranulocytosis
D. Nephrogenic diabetes insipidus
Answer: B
Rationale: Lamotrigine is associated with a risk of Stevens-Johnson syndrome, a
severe skin reaction. Weight gain is not typical; agranulocytosis is more associated
with clozapine; nephrogenic diabetes insipidus is associated with lithium.
4. According to Erikson's theory, a 25-year-old who is struggling to form intimate
relationships and instead isolates himself is most likely experiencing a crisis in
which stage?
A. Identity vs. Role Confusion
B. Intimacy vs. Isolation
,C. Generativity vs. Stagnation
D. Trust vs. Mistrust
Answer: B
Rationale: Intimacy vs. Isolation is the stage for young adults aged approximately
18-40, where forming close relationships is the primary task. Identity vs. Role
Confusion is for adolescents; Generativity vs. Stagnation is for middle adulthood.
5. A patient with PTSD reports frequent nightmares and hypervigilance. The
PMHNP considers a medication with FDA approval for this condition. Which of
the following is FDA-approved for PTSD?
A. Paroxetine and sertraline
B. Fluoxetine and venlafaxine
C. Duloxetine and escitalopram
D. Prazosin and propranolol
Answer: A
Rationale: Paroxetine and sertraline are FDA-approved for PTSD. Fluoxetine and
venlafaxine are used off-label, and prazosin is used off-label for nightmares.
Duloxetine is not FDA-approved for PTSD.
6. A 17-year-old female is brought in by her parents for significant weight loss
and refusal to maintain body weight above 85% of expected. She reports
amenorrhea for 4 months. Which of the following medical complications is most
concerning acutely?
A. Osteoporosis
B. Bradycardia and hypotension
C. Lanugo hair
, D. Electrolyte imbalance with hypokalemia
Answer: D
Rationale: In anorexia nervosa, refeeding or purging can lead to severe electrolyte
imbalances, especially hypokalemia, which can cause cardiac arrhythmias and is
acutely life-threatening. Osteoporosis and lanugo are chronic, and bradycardia is
serious but not as immediately life-threatening as severe electrolyte shifts.
7. A 55-year-old male with schizophrenia is being treated with clozapine. He has
a white blood cell count of 3,200/µL and an absolute neutrophil count (ANC) of
1,100/µL. According to REMS protocols, what is the appropriate action?
A. Continue clozapine and recheck in 1 week
B. Interrupt clozapine and monitor ANC weekly until it recovers above 1,500/µL
C. Discontinue clozapine permanently and never rechallenge
D. Reduce the dose by 50% and check ANC daily
Answer: B
Rationale: ANC between 1,000 and 1,500/µL is moderate neutropenia; clozapine
should be interrupted, and ANC should be monitored weekly until recovery above
1,500/µL. Permanent discontinuation is for ANC below 500/µL or severe
neutropenia with fever.
8. A 9-year-old boy with ADHD is currently on methylphenidate immediate-
release twice daily. He reports having trouble sleeping at night. Which of the
following is the most appropriate next step?
A. Add a sedative hypnotic at bedtime
B. Switch to methylphenidate extended-release formulation
C. Increase the afternoon dose to extend coverage
STYLE QUESTIONS COVERING IQ DOMAINS 1–5 WITH VERIFIED
ANSWERS AND CLINICAL RATIONALES
1. A 35-year-old male with a history of alcohol use disorder is prescribed
disulfiram. He reports he has been abstinent for 5 days. The PMHNP's education
regarding this medication should include that consuming alcohol while on
disulfiram can cause which of the following?
A. Respiratory depression and coma
B. Hypertension and tachycardia followed by hypotension
C. Flushing, nausea, vomiting, and palpitations
D. Severe muscle rigidity and hyperthermia
Answer: C
Rationale: Disulfiram blocks acetaldehyde dehydrogenase, leading to
acetaldehyde accumulation when alcohol is consumed, causing the disulfiram-
ethanol reaction characterized by flushing, nausea, vomiting, and palpitations. It
does not primarily cause respiratory depression, coma, or severe muscle rigidity.
2. A 62-year-old patient with Parkinson's disease is started on pramipexole.
Three weeks later, the patient's family reports he has been gambling excessively
and making impulsive purchases. Which of the following is the most appropriate
action?
A. Increase the pramipexole dose to control parkinsonian symptoms
,B. Add an SSRI to control the impulse control disorder
C. Refer the patient for cognitive behavioral therapy
D. Consider reducing the dose or discontinuing the dopamine agonist
Answer: D
Rationale: Dopamine agonists like pramipexole are associated with impulse
control disorders. The appropriate action is to reduce the dose or discontinue the
medication. Increasing the dose would worsen symptoms, and adding an SSRI or
CBT alone is not the primary treatment without addressing the medication.
3. A 48-year-old female is prescribed lamotrigine for bipolar depression. She
asks about the most serious adverse effect. The PMHNP should warn her about
which of the following?
A. Weight gain and metabolic syndrome
B. Stevens-Johnson syndrome
C. Agranulocytosis
D. Nephrogenic diabetes insipidus
Answer: B
Rationale: Lamotrigine is associated with a risk of Stevens-Johnson syndrome, a
severe skin reaction. Weight gain is not typical; agranulocytosis is more associated
with clozapine; nephrogenic diabetes insipidus is associated with lithium.
4. According to Erikson's theory, a 25-year-old who is struggling to form intimate
relationships and instead isolates himself is most likely experiencing a crisis in
which stage?
A. Identity vs. Role Confusion
B. Intimacy vs. Isolation
,C. Generativity vs. Stagnation
D. Trust vs. Mistrust
Answer: B
Rationale: Intimacy vs. Isolation is the stage for young adults aged approximately
18-40, where forming close relationships is the primary task. Identity vs. Role
Confusion is for adolescents; Generativity vs. Stagnation is for middle adulthood.
5. A patient with PTSD reports frequent nightmares and hypervigilance. The
PMHNP considers a medication with FDA approval for this condition. Which of
the following is FDA-approved for PTSD?
A. Paroxetine and sertraline
B. Fluoxetine and venlafaxine
C. Duloxetine and escitalopram
D. Prazosin and propranolol
Answer: A
Rationale: Paroxetine and sertraline are FDA-approved for PTSD. Fluoxetine and
venlafaxine are used off-label, and prazosin is used off-label for nightmares.
Duloxetine is not FDA-approved for PTSD.
6. A 17-year-old female is brought in by her parents for significant weight loss
and refusal to maintain body weight above 85% of expected. She reports
amenorrhea for 4 months. Which of the following medical complications is most
concerning acutely?
A. Osteoporosis
B. Bradycardia and hypotension
C. Lanugo hair
, D. Electrolyte imbalance with hypokalemia
Answer: D
Rationale: In anorexia nervosa, refeeding or purging can lead to severe electrolyte
imbalances, especially hypokalemia, which can cause cardiac arrhythmias and is
acutely life-threatening. Osteoporosis and lanugo are chronic, and bradycardia is
serious but not as immediately life-threatening as severe electrolyte shifts.
7. A 55-year-old male with schizophrenia is being treated with clozapine. He has
a white blood cell count of 3,200/µL and an absolute neutrophil count (ANC) of
1,100/µL. According to REMS protocols, what is the appropriate action?
A. Continue clozapine and recheck in 1 week
B. Interrupt clozapine and monitor ANC weekly until it recovers above 1,500/µL
C. Discontinue clozapine permanently and never rechallenge
D. Reduce the dose by 50% and check ANC daily
Answer: B
Rationale: ANC between 1,000 and 1,500/µL is moderate neutropenia; clozapine
should be interrupted, and ANC should be monitored weekly until recovery above
1,500/µL. Permanent discontinuation is for ANC below 500/µL or severe
neutropenia with fever.
8. A 9-year-old boy with ADHD is currently on methylphenidate immediate-
release twice daily. He reports having trouble sleeping at night. Which of the
following is the most appropriate next step?
A. Add a sedative hypnotic at bedtime
B. Switch to methylphenidate extended-release formulation
C. Increase the afternoon dose to extend coverage
