AANP PMHNP -COMPREHENSIVE QUESTION BANK WITH CLINICAL
CASES EXAM 400+ QUESTIONS AND ANSWERS WITH RATIONALES
2026/2027 LATEST UPDATE
SECTION 1 — PSYCHIATRIC ASSESSMENT
1. A patient reports hearing a voice saying, “You are worthless.”
Which assessment question is the priority?
A. “How long have you heard the voice?”
B. “What does the voice sound like?”
C. “Does the voice tell you to hurt yourself or anyone else?”
D. “Have you experienced auditory hallucinations before?”
Answer: C
Rationale: The immediate priority with hallucinations is determining
whether they contain command content associated with danger.
Safety and suicide/homicide risk take precedence over phenomenologic
details.
2. Which finding most strongly indicates delirium rather than a
primary psychotic disorder?
A. Auditory hallucinations
B. Disorganized speech
C. Fluctuating attention and consciousness
D. Paranoid ideation
Answer: C
Rationale: Delirium is characterized by an acute disturbance in
attention and awareness with a fluctuating course. Psychotic symptoms
can occur but are not the defining feature.
,3. A patient says, “I don't want to live anymore.” What should the
PMHNP do first?
A. Ask about protective factors
B. Establish a safety plan
C. Perform a suicide risk assessment
D. Recommend psychotherapy
Answer: C
Rationale: A direct statement suggesting suicidality requires immediate
assessment of suicidal thoughts, intent, plan, access to means, previous
attempts, and other risk factors.
4. Which question is most appropriate for assessing suicidal intent?
A. “Do you feel depressed?”
B. “Have you thought about how you would kill yourself?”
C. “Do you have family support?”
D. “Are you sleeping well?”
Answer: B
Rationale: Asking directly about method and planning helps establish
the severity and immediacy of suicide risk. Direct questioning does not
cause suicide.
5. Which finding is most characteristic of mania?
A. Anhedonia
B. Psychomotor retardation
,C. Decreased need for sleep with increased energy
D. Social withdrawal
Answer: C
Rationale: Mania commonly involves elevated or irritable mood,
increased energy/activity, decreased need for sleep, pressured speech,
grandiosity, racing thoughts, distractibility, and risky behavior.
6. A patient sleeps only 3 hours nightly but reports feeling rested and
energetic. Which symptom is most concerning for mania?
A. Insomnia with fatigue
B. Decreased need for sleep
C. Early-morning awakening
D. Hypersomnia
Answer: B
Rationale: A decreased need for sleep differs from insomnia. In mania,
patients may sleep very little without experiencing daytime fatigue.
7. Which mental-status finding represents a thought-process
abnormality?
A. Delusion
B. Auditory hallucination
C. Flight of ideas
D. Depressed mood
Answer: C
Rationale: Flight of ideas describes rapid shifting between topics with
understandable associations and is a disturbance of thought process.
, 8. Which is a thought-content abnormality?
A. Loose associations
B. Tangentiality
C. Delusion
D. Neologism
Answer: C
Rationale: Delusions are disturbances of thought content. Loose
associations, tangentiality, and neologisms describe abnormalities in
thought organization or expression.
9. A patient believes the television news anchor is sending personal
messages specifically to them. This is best described as:
A. Thought broadcasting
B. Ideas of reference
C. Thought insertion
D. Grandiose delusion
Answer: B
Rationale: Ideas of reference occur when neutral external events are
interpreted as having a special personal meaning.
10. A patient believes that someone is inserting thoughts into their
mind. This is:
A. Thought withdrawal
B. Thought insertion
CASES EXAM 400+ QUESTIONS AND ANSWERS WITH RATIONALES
2026/2027 LATEST UPDATE
SECTION 1 — PSYCHIATRIC ASSESSMENT
1. A patient reports hearing a voice saying, “You are worthless.”
Which assessment question is the priority?
A. “How long have you heard the voice?”
B. “What does the voice sound like?”
C. “Does the voice tell you to hurt yourself or anyone else?”
D. “Have you experienced auditory hallucinations before?”
Answer: C
Rationale: The immediate priority with hallucinations is determining
whether they contain command content associated with danger.
Safety and suicide/homicide risk take precedence over phenomenologic
details.
2. Which finding most strongly indicates delirium rather than a
primary psychotic disorder?
A. Auditory hallucinations
B. Disorganized speech
C. Fluctuating attention and consciousness
D. Paranoid ideation
Answer: C
Rationale: Delirium is characterized by an acute disturbance in
attention and awareness with a fluctuating course. Psychotic symptoms
can occur but are not the defining feature.
,3. A patient says, “I don't want to live anymore.” What should the
PMHNP do first?
A. Ask about protective factors
B. Establish a safety plan
C. Perform a suicide risk assessment
D. Recommend psychotherapy
Answer: C
Rationale: A direct statement suggesting suicidality requires immediate
assessment of suicidal thoughts, intent, plan, access to means, previous
attempts, and other risk factors.
4. Which question is most appropriate for assessing suicidal intent?
A. “Do you feel depressed?”
B. “Have you thought about how you would kill yourself?”
C. “Do you have family support?”
D. “Are you sleeping well?”
Answer: B
Rationale: Asking directly about method and planning helps establish
the severity and immediacy of suicide risk. Direct questioning does not
cause suicide.
5. Which finding is most characteristic of mania?
A. Anhedonia
B. Psychomotor retardation
,C. Decreased need for sleep with increased energy
D. Social withdrawal
Answer: C
Rationale: Mania commonly involves elevated or irritable mood,
increased energy/activity, decreased need for sleep, pressured speech,
grandiosity, racing thoughts, distractibility, and risky behavior.
6. A patient sleeps only 3 hours nightly but reports feeling rested and
energetic. Which symptom is most concerning for mania?
A. Insomnia with fatigue
B. Decreased need for sleep
C. Early-morning awakening
D. Hypersomnia
Answer: B
Rationale: A decreased need for sleep differs from insomnia. In mania,
patients may sleep very little without experiencing daytime fatigue.
7. Which mental-status finding represents a thought-process
abnormality?
A. Delusion
B. Auditory hallucination
C. Flight of ideas
D. Depressed mood
Answer: C
Rationale: Flight of ideas describes rapid shifting between topics with
understandable associations and is a disturbance of thought process.
, 8. Which is a thought-content abnormality?
A. Loose associations
B. Tangentiality
C. Delusion
D. Neologism
Answer: C
Rationale: Delusions are disturbances of thought content. Loose
associations, tangentiality, and neologisms describe abnormalities in
thought organization or expression.
9. A patient believes the television news anchor is sending personal
messages specifically to them. This is best described as:
A. Thought broadcasting
B. Ideas of reference
C. Thought insertion
D. Grandiose delusion
Answer: B
Rationale: Ideas of reference occur when neutral external events are
interpreted as having a special personal meaning.
10. A patient believes that someone is inserting thoughts into their
mind. This is:
A. Thought withdrawal
B. Thought insertion
