PMHNP ANCC Review Exam Questions and
Correct Answers
Question 1
Tommy is an 8 year-old who presents to the PMHNP for evaluation of attention-
deficit hyperactivity disorder. His mother completed the Vanderbilt ADHD rating scale
and brought in the Vanderbilt teaching rating scale. Both your clinical interview and
the rating scales indicate Tommy has ADHD. What assessment indicator(s) need to be
completed prior to starting a stimulant mediation?
a. Get a copy of the rating scale completed by his grandparents.
b. Assess for family history of cardiovascular disease and, if positive for conduction
problems, order an electrocardiogram before prescribing medication.
c. Obtain blood pressure, and pulse, and begin the stimulant medication.
d. Assess for a family history of bipolar disorder.
Correct Answer
B. American Academy of Child and Adolescent Psychiatry practice parameters
require physical exam, pulse, weight, height, and blood pressure workup prior to the
start of stimulant medication. Because his grandfather had a cardiac conduction
problem, an electrocardiogram (ECG) should also be obtained prior to the start of
medication.
Question 2
Sarah presents for her initial intake appointment with complaints of depression. She is
being treated for hypertension and asthma by her primary care provider. Knowing
that certain medications can cause or exacerbate depression, you obtain a complete
medication history. Which of the following medications is known to exacerbate or
cause depression?
a. Omeprazole
b. Propranolol
c. Levothyroxine
d. Clarithromycin
Correct Answer
B. Beta blockers can cause or exacerbate depression.
Page 1 of 68
,Question 3
Which of the following best describes homeostasis in a family system?
a. Choices a family makes to keep the peace
b. Balance or stability that the family returns to despite its dysfunction
c. Need for change and balance in a family
d. Calm in a family that returns after a crisis
Correct Answer
B. Homeostasis is balance or stability that the family returns to despite its
dysfunction.
Question 4
You are treating a client with schizophrenia who takes clozapine. What laboratory
values will indicate the client needs to discontinue treatment?
a. White blood cell count of less than 1,800/mm3 and absolute neutrophil count of
less than 1,200/mm3
b. Absolute neutrophil count of less than 1,000/uL
c. White blood cell count of less than 1,200/mm3
d. Absolute neutrophil count of less than 2,000/uL
Correct Answer
B. The recent change in monitoring clozapine clients using the risk evaluation and
mitigation strategy (REMS) indicates persons treated on clozapine need to have
absolute neutrophil count monitored and, if it drops below 1,000/uL, treatment
must be interrupted and can be resumed once the absolute neutrophil count
normalizes above 1,000/uL.
Page 2 of 68
,Question 5
The trend in legal rulings on cases involving mental illness over the past 25 years has
been to
a. Encourage juries to find defendants not guilty by reason of insanity
b. Protect the person's freedoms or rights when he or she is committed to a mental
hospital
c. Place increasing trust in mental health professionals to make good and ethical
decisions
d. Decrease the "red tape" associated with commitments so that commitments are
faster and easier
Correct Answer
B. Identifies the trend of ensuring the protection of individual civil liberties for
psychiatric clients.
Question 6
A PMHNP who is working on the consult liaison service is referred to a patient in the
medical intensive care unit by the attending hospitalist. The consult note read
"Evaluate the patient for competency to make independent medical decisions and
consent for a surgical procedure." Based on the scope of practice of a PMHNP, which
response would be most appropriate?
a. Complete the patient assessment and write up the findings in the patient's medical
record.
b. Complete a patient assessment, including the mini mental status examination and
family collateral data to determine competency.
c. Call the hospitalist and provide education that competency is a legal concept and
explain that you can assess the patient for the capacity to make medical decisions.
d. Refuse the consult and inform the hospitalist that this is outside your scope of
practice.
Correct Answer
C. The legal system makes determination whether a person is competent;
practitioners can assess and make a determination about a person's capacity to
make medical decisions.
Page 3 of 68
, Question 7
What differentiates atypical antipsychotic medications from first-generation or typical
antipsychotic medications?
a. 5HT2a receptor antagonist properties
b. 5HT2a receptor agonist properties
c. Specific dopamine receptor 3 and 5HT2a blockade
d. Dopamine receptor 2 antagonist properties
Correct Answer
A. Typical antipsychotic medications block D2 receptors; atypical antipsychotic
medications block D2 receptors and have 5HT2a antagonist properties.
Question 8
Which of the following is the best rationale for using cognitive behavioral therapy?
a. Recognize and change his or her automatic thoughts
b. See reality as you see it
c. Change his or her reality by changing his or her environment
d. Recognize and accept that automatic thoughts suggest delusional thinking
Correct Answer
A. Cognitive behavioral therapy helps clients recognize and change their automatic
thoughts.
Question 9
As a PMHNP working on the consult liaison team, you know the importance of
preventing delirium due to which of the following?
a. Risk of 1-year mortality rate
b. Risk of harm to the client and staff
c. Risk of unremitting psychosis
d. Risk of aspiration
Correct Answer
A. Studies have identified high rates of mortality post hospitalization for delirium so
the best treatment is prevention.
Page 4 of 68
Correct Answers
Question 1
Tommy is an 8 year-old who presents to the PMHNP for evaluation of attention-
deficit hyperactivity disorder. His mother completed the Vanderbilt ADHD rating scale
and brought in the Vanderbilt teaching rating scale. Both your clinical interview and
the rating scales indicate Tommy has ADHD. What assessment indicator(s) need to be
completed prior to starting a stimulant mediation?
a. Get a copy of the rating scale completed by his grandparents.
b. Assess for family history of cardiovascular disease and, if positive for conduction
problems, order an electrocardiogram before prescribing medication.
c. Obtain blood pressure, and pulse, and begin the stimulant medication.
d. Assess for a family history of bipolar disorder.
Correct Answer
B. American Academy of Child and Adolescent Psychiatry practice parameters
require physical exam, pulse, weight, height, and blood pressure workup prior to the
start of stimulant medication. Because his grandfather had a cardiac conduction
problem, an electrocardiogram (ECG) should also be obtained prior to the start of
medication.
Question 2
Sarah presents for her initial intake appointment with complaints of depression. She is
being treated for hypertension and asthma by her primary care provider. Knowing
that certain medications can cause or exacerbate depression, you obtain a complete
medication history. Which of the following medications is known to exacerbate or
cause depression?
a. Omeprazole
b. Propranolol
c. Levothyroxine
d. Clarithromycin
Correct Answer
B. Beta blockers can cause or exacerbate depression.
Page 1 of 68
,Question 3
Which of the following best describes homeostasis in a family system?
a. Choices a family makes to keep the peace
b. Balance or stability that the family returns to despite its dysfunction
c. Need for change and balance in a family
d. Calm in a family that returns after a crisis
Correct Answer
B. Homeostasis is balance or stability that the family returns to despite its
dysfunction.
Question 4
You are treating a client with schizophrenia who takes clozapine. What laboratory
values will indicate the client needs to discontinue treatment?
a. White blood cell count of less than 1,800/mm3 and absolute neutrophil count of
less than 1,200/mm3
b. Absolute neutrophil count of less than 1,000/uL
c. White blood cell count of less than 1,200/mm3
d. Absolute neutrophil count of less than 2,000/uL
Correct Answer
B. The recent change in monitoring clozapine clients using the risk evaluation and
mitigation strategy (REMS) indicates persons treated on clozapine need to have
absolute neutrophil count monitored and, if it drops below 1,000/uL, treatment
must be interrupted and can be resumed once the absolute neutrophil count
normalizes above 1,000/uL.
Page 2 of 68
,Question 5
The trend in legal rulings on cases involving mental illness over the past 25 years has
been to
a. Encourage juries to find defendants not guilty by reason of insanity
b. Protect the person's freedoms or rights when he or she is committed to a mental
hospital
c. Place increasing trust in mental health professionals to make good and ethical
decisions
d. Decrease the "red tape" associated with commitments so that commitments are
faster and easier
Correct Answer
B. Identifies the trend of ensuring the protection of individual civil liberties for
psychiatric clients.
Question 6
A PMHNP who is working on the consult liaison service is referred to a patient in the
medical intensive care unit by the attending hospitalist. The consult note read
"Evaluate the patient for competency to make independent medical decisions and
consent for a surgical procedure." Based on the scope of practice of a PMHNP, which
response would be most appropriate?
a. Complete the patient assessment and write up the findings in the patient's medical
record.
b. Complete a patient assessment, including the mini mental status examination and
family collateral data to determine competency.
c. Call the hospitalist and provide education that competency is a legal concept and
explain that you can assess the patient for the capacity to make medical decisions.
d. Refuse the consult and inform the hospitalist that this is outside your scope of
practice.
Correct Answer
C. The legal system makes determination whether a person is competent;
practitioners can assess and make a determination about a person's capacity to
make medical decisions.
Page 3 of 68
, Question 7
What differentiates atypical antipsychotic medications from first-generation or typical
antipsychotic medications?
a. 5HT2a receptor antagonist properties
b. 5HT2a receptor agonist properties
c. Specific dopamine receptor 3 and 5HT2a blockade
d. Dopamine receptor 2 antagonist properties
Correct Answer
A. Typical antipsychotic medications block D2 receptors; atypical antipsychotic
medications block D2 receptors and have 5HT2a antagonist properties.
Question 8
Which of the following is the best rationale for using cognitive behavioral therapy?
a. Recognize and change his or her automatic thoughts
b. See reality as you see it
c. Change his or her reality by changing his or her environment
d. Recognize and accept that automatic thoughts suggest delusional thinking
Correct Answer
A. Cognitive behavioral therapy helps clients recognize and change their automatic
thoughts.
Question 9
As a PMHNP working on the consult liaison team, you know the importance of
preventing delirium due to which of the following?
a. Risk of 1-year mortality rate
b. Risk of harm to the client and staff
c. Risk of unremitting psychosis
d. Risk of aspiration
Correct Answer
A. Studies have identified high rates of mortality post hospitalization for delirium so
the best treatment is prevention.
Page 4 of 68
