ANCC PMHNP Practice Exam 2026 with
100 Questions with correct answers
and rationale graded A+ new!!
Section 1: Neurobiology & Psychopharmacology (Questions 1-25)
1. A patient with major depressive disorder is started on fluoxetine. The PMHNP knows that the
therapeutic effect is primarily due to:
A) Blockade of dopamine receptors
B) Inhibition of serotonin reuptake at the presynaptic neuron
C) Increased GABA activity
D) Norepinephrine reuptake inhibition
Rationale: Fluoxetine is an SSRI that selectively inhibits serotonin reuptake at the presynaptic
neuron, increasing serotonin availability in the synaptic cleft.
2. Which neurotransmitter is most associated with the positive symptoms of schizophrenia?
A) Serotonin
B) GABA
C) Dopamine
D) Acetylcholine
Rationale: The dopamine hypothesis states that excess dopamine in the mesolimbic pathway causes
positive symptoms (hallucinations, delusions).
3. A patient on lithium presents with coarse tremor, ataxia, and confusion. The lithium level is 2.1
mEq/L. The PMHNP should:
A) Continue lithium at current dose
B) Increase fluid intake only
C) Hold lithium and obtain emergency evaluation
,D) Add a beta-blocker
Rationale: A lithium level >1.5 mEq/L indicates toxicity. Levels >2.0 require emergency intervention
as it can be life-threatening.
4. Clozapine requires regular monitoring of:
A) Liver enzymes only
B) Absolute neutrophil count (ANC)
C) Thyroid function
D) Serum sodium
Rationale: Clozapine carries a black box warning for agranulocytosis; ANC monitoring is mandatory
per REMS protocol.
5. Which medication is FDA-approved for treatment-resistant depression?
A) Esketamine (Spravato)
B) Sertraline
C) Bupropion
D) Citalopram
Rationale: Esketamine nasal spray is FDA-approved specifically for treatment-resistant depression in
conjunction with an oral antidepressant.
6. The mechanism of action of buspirone is:
A) GABA receptor agonism
B) Partial agonist at 5-HT1A receptors
C) Dopamine antagonism
D) Norepinephrine reuptake inhibition
Rationale: Buspirone is a partial agonist at serotonin 5-HT1A receptors, used for generalized anxiety
disorder without dependency risk.
7. A patient taking an MAOI should avoid:
, A) Fresh fruit
B) Aged cheese and cured meats
C) Green vegetables
D) White rice
Rationale: Tyramine-rich foods can cause hypertensive crisis when combined with MAOIs.
8. Tardive dyskinesia is most commonly associated with:
A) Short-term SSRI use
B) Benzodiazepine withdrawal
C) Long-term typical antipsychotic use
D) Lithium therapy
Rationale: TD results from chronic dopamine receptor blockade, particularly with first-generation
antipsychotics.
9. Which antidepressant is most likely to cause sexual dysfunction?
A) Bupropion
B) Mirtazapine
C) Paroxetine
D) Vilazodone
Rationale: SSRIs, especially paroxetine, have the highest rates of sexual side effects.
10. Naltrexone is used in the treatment of:
A) Nicotine dependence
B) Alcohol and opioid use disorders
C) Cocaine dependence
D) Cannabis use disorder
Rationale: Naltrexone is an opioid antagonist FDA-approved for alcohol and opioid use disorders.
100 Questions with correct answers
and rationale graded A+ new!!
Section 1: Neurobiology & Psychopharmacology (Questions 1-25)
1. A patient with major depressive disorder is started on fluoxetine. The PMHNP knows that the
therapeutic effect is primarily due to:
A) Blockade of dopamine receptors
B) Inhibition of serotonin reuptake at the presynaptic neuron
C) Increased GABA activity
D) Norepinephrine reuptake inhibition
Rationale: Fluoxetine is an SSRI that selectively inhibits serotonin reuptake at the presynaptic
neuron, increasing serotonin availability in the synaptic cleft.
2. Which neurotransmitter is most associated with the positive symptoms of schizophrenia?
A) Serotonin
B) GABA
C) Dopamine
D) Acetylcholine
Rationale: The dopamine hypothesis states that excess dopamine in the mesolimbic pathway causes
positive symptoms (hallucinations, delusions).
3. A patient on lithium presents with coarse tremor, ataxia, and confusion. The lithium level is 2.1
mEq/L. The PMHNP should:
A) Continue lithium at current dose
B) Increase fluid intake only
C) Hold lithium and obtain emergency evaluation
,D) Add a beta-blocker
Rationale: A lithium level >1.5 mEq/L indicates toxicity. Levels >2.0 require emergency intervention
as it can be life-threatening.
4. Clozapine requires regular monitoring of:
A) Liver enzymes only
B) Absolute neutrophil count (ANC)
C) Thyroid function
D) Serum sodium
Rationale: Clozapine carries a black box warning for agranulocytosis; ANC monitoring is mandatory
per REMS protocol.
5. Which medication is FDA-approved for treatment-resistant depression?
A) Esketamine (Spravato)
B) Sertraline
C) Bupropion
D) Citalopram
Rationale: Esketamine nasal spray is FDA-approved specifically for treatment-resistant depression in
conjunction with an oral antidepressant.
6. The mechanism of action of buspirone is:
A) GABA receptor agonism
B) Partial agonist at 5-HT1A receptors
C) Dopamine antagonism
D) Norepinephrine reuptake inhibition
Rationale: Buspirone is a partial agonist at serotonin 5-HT1A receptors, used for generalized anxiety
disorder without dependency risk.
7. A patient taking an MAOI should avoid:
, A) Fresh fruit
B) Aged cheese and cured meats
C) Green vegetables
D) White rice
Rationale: Tyramine-rich foods can cause hypertensive crisis when combined with MAOIs.
8. Tardive dyskinesia is most commonly associated with:
A) Short-term SSRI use
B) Benzodiazepine withdrawal
C) Long-term typical antipsychotic use
D) Lithium therapy
Rationale: TD results from chronic dopamine receptor blockade, particularly with first-generation
antipsychotics.
9. Which antidepressant is most likely to cause sexual dysfunction?
A) Bupropion
B) Mirtazapine
C) Paroxetine
D) Vilazodone
Rationale: SSRIs, especially paroxetine, have the highest rates of sexual side effects.
10. Naltrexone is used in the treatment of:
A) Nicotine dependence
B) Alcohol and opioid use disorders
C) Cocaine dependence
D) Cannabis use disorder
Rationale: Naltrexone is an opioid antagonist FDA-approved for alcohol and opioid use disorders.
