2026 PMHNP Exam Study Guide
PMHNP Role, Scope of Practice, and Regulatory Process
• NP Core Competencies
o Scientific foundations
o Leadership
o Quality
o Practice inquiry
o Technology and information literacy
o Policy
o Health delivery system
o Ethics
o Independent practice
• Ethical Principles
o Justice: Doing what is fair; fairness in all aspects of care
o Beneficence: Promoting wellbeing and doing good
o Nonmaleficence: Doing no harm
o Fidelity: Being true and loyal
o Autonomy: Doing for self
o Veracity: Telling the truth
o Respect: Treating everyone with equal respect
• Theoretical Approaches to Ethical Decision Making:
o Deontological theory: An action is judged as good or bad based on the act itself regardless of
the consequences
o Teleological theory: An action is judged as good or bad based on the consequences or outcome
o Virtue ethics: Actions are chosen based on the moral virtues (honesty, courage, compassion,
wisdom, gratitude, self-respect) or the character of the person making the decision
• Four Elements of Negligence Needed to Prove Malpractice
o Duty: The NP had a duty to exercise reasonable care when undertaking and providing treatment
o Breach of Duty: The NP violated the applicable standard of care in treating a client’s condition
o Proximate Cause: There is a causal relationship between the breach in standard of care and the
client’s injuries
o Damages: The client experiences permanent and substantial damages as a result of the breach
in standard of care
• Health Policy
o Involvement: Testify at a public meeting, lobby, or work with the media to bring awareness to
an issue
o Phases of Policymaking:
▪ Formulation
▪ Implementation
▪ Evaluation
, Theoretical Basis of Care
• Biopsychosocial Framework of Care
o Recovery is the single most important goal in mental health care
o Four major dimensions of recovery:
▪ Health
▪ Home
▪ Purpose
▪ Community
• Therapeutic Relationship
o Transference: Displacement of feelings for significant people in the pt’s past onto the PMHNP in
the present relationship
o Countertransference: The nurse’s emotional reaction to the client based on their past
experiences
Phases of a Therapeutic Nurse-Client Relationship
Phase Nursing Action Common Pt Behavior
Introduction (orientation) • Create a trusting • Initial hesitancy to participate fully
environment in assessment and treatment
• Establish professional planning (approach avoidance)
boundaries
• Establish the length of
anticipated interaction
• Provide diagnostic
evaluation
• Set mutually agreed-upon
treatment objectives
Working (identification and exploitation) • Clarify pt expectations • Transference and
and mutually set goals countertransference
• Implement treatment • Pt resistance to care and change
plan
• Monitor health
• Undertaking preventative
health care
• Measuring outcomes of
care
• Evaluating outcomes of
care
• Reprioritizing plan and
objectives as indicated
, Termination (resolution) • Review pt’s progress • Pt resistance to termination
toward objectives • Regression
• Establish long-term plan • Reemergence of
of care symptoms/problems
• Focus on self-
management strategies
• Disengaging from
relationship
PMHNP Role, Scope of Practice, and Regulatory Process
• NP Core Competencies
o Scientific foundations
o Leadership
o Quality
o Practice inquiry
o Technology and information literacy
o Policy
o Health delivery system
o Ethics
o Independent practice
• Ethical Principles
o Justice: Doing what is fair; fairness in all aspects of care
o Beneficence: Promoting wellbeing and doing good
o Nonmaleficence: Doing no harm
o Fidelity: Being true and loyal
o Autonomy: Doing for self
o Veracity: Telling the truth
o Respect: Treating everyone with equal respect
• Theoretical Approaches to Ethical Decision Making:
o Deontological theory: An action is judged as good or bad based on the act itself regardless of
the consequences
o Teleological theory: An action is judged as good or bad based on the consequences or outcome
o Virtue ethics: Actions are chosen based on the moral virtues (honesty, courage, compassion,
wisdom, gratitude, self-respect) or the character of the person making the decision
• Four Elements of Negligence Needed to Prove Malpractice
o Duty: The NP had a duty to exercise reasonable care when undertaking and providing treatment
o Breach of Duty: The NP violated the applicable standard of care in treating a client’s condition
o Proximate Cause: There is a causal relationship between the breach in standard of care and the
client’s injuries
o Damages: The client experiences permanent and substantial damages as a result of the breach
in standard of care
• Health Policy
o Involvement: Testify at a public meeting, lobby, or work with the media to bring awareness to
an issue
o Phases of Policymaking:
▪ Formulation
▪ Implementation
▪ Evaluation
, Theoretical Basis of Care
• Biopsychosocial Framework of Care
o Recovery is the single most important goal in mental health care
o Four major dimensions of recovery:
▪ Health
▪ Home
▪ Purpose
▪ Community
• Therapeutic Relationship
o Transference: Displacement of feelings for significant people in the pt’s past onto the PMHNP in
the present relationship
o Countertransference: The nurse’s emotional reaction to the client based on their past
experiences
Phases of a Therapeutic Nurse-Client Relationship
Phase Nursing Action Common Pt Behavior
Introduction (orientation) • Create a trusting • Initial hesitancy to participate fully
environment in assessment and treatment
• Establish professional planning (approach avoidance)
boundaries
• Establish the length of
anticipated interaction
• Provide diagnostic
evaluation
• Set mutually agreed-upon
treatment objectives
Working (identification and exploitation) • Clarify pt expectations • Transference and
and mutually set goals countertransference
• Implement treatment • Pt resistance to care and change
plan
• Monitor health
• Undertaking preventative
health care
• Measuring outcomes of
care
• Evaluating outcomes of
care
• Reprioritizing plan and
objectives as indicated
, Termination (resolution) • Review pt’s progress • Pt resistance to termination
toward objectives • Regression
• Establish long-term plan • Reemergence of
of care symptoms/problems
• Focus on self-
management strategies
• Disengaging from
relationship
