PMHNP CERTIFICATION EXAM 2026 | ANCC Board
Certification Practice Test | Verified A+ Content |
Psychiatric Mental Health Nurse Practitioner | Pass
Guaranteed - A+ Graded
Section 1: Assessment, Diagnosis & Formulation (Q1-40)
Q1. A 24-year-old graduate student is brought to the emergency department by
campus police after classmates reported he has been speaking rapidly for 3 days,
sleeping only 2 hours nightly, and purchased $3,000 worth of electronics he cannot
afford. He believes he has discovered a new mathematical theorem. His speech is
pressured and he is easily distracted. Which rating scale is most appropriate to assess
the severity of his current manic symptoms?
A. PHQ-9
B. Young Mania Rating Scale (YMRS)
C. GAD-7
D. C-SSRS
Rationale: The YMRS is the validated instrument specifically designed to assess the
severity of manic symptoms in bipolar disorder. PHQ-9 screens depression severity;
GAD-7 screens anxiety; C-SSRS assesses suicidal ideation and behavior.
Correct Answer: B
Q2. A 19-year-old college freshman presents with 2 weeks of depressed mood,
anhedonia, hypersomnia, weight gain, and psychomotor retardation. She denies
suicidal ideation. Her mother has bipolar I disorder. Which is the most important next
step before initiating antidepressant monotherapy?
A. Order thyroid function tests
B. Screen for manic/hypomanic history with the Mood Disorder Questionnaire (MDQ)
C. Obtain an ECG
D. Check vitamin B12 level
,Rationale: Given the strong family history of bipolar I disorder and atypical
depressive features (hypersomnia, weight gain, psychomotor retardation), screening
for bipolarity with the MDQ is essential before initiating antidepressant
monotherapy, which could precipitate mania. While medical workup is important,
bipolar screening takes priority in this clinical context.
Correct Answer: B
Q3. A 45-year-old man with schizophrenia reports that the FBI has implanted a chip
in his brain to monitor his thoughts. He also states he hears a voice commenting on
his actions. Which type of hallucination is present?
A. Gustatory hallucination
B. Olfactory hallucination
C. Auditory hallucination
D. Tactile hallucination
Rationale: Hearing a voice commenting on one's actions is a classic first-rank
symptom of schizophrenia representing an auditory hallucination. The belief about
the FBI chip represents a delusion (specifically a persecutory delusion with a somatic
component), not a hallucination.
Correct Answer: C
Q4. During a mental status examination, a patient repeatedly uses rhyming words in
a nonsensical pattern: "I'm fine, dine, shine, line, pine." This speech pattern is best
described as:
A. Echolalia
B. Clang association
C. Neologism
D. Circumstantiality
Rationale: Clang associations are speech patterns where word choice is governed by
sound (rhyming or alliteration) rather than meaning, commonly seen in mania.
,Echolalia is repetition of others' words; neologisms are invented words;
circumstantiality involves delayed reaching of the point with unnecessary details.
Correct Answer: B
Q5. A 67-year-old retired accountant is referred by his primary care provider for
evaluation of memory complaints. His wife reports he has difficulty managing
finances, gets lost driving familiar routes, and repeatedly asks the same questions.
On MoCA testing, he scores 18/30, losing points on delayed recall,
visuospatial/executive function, and orientation. Which is the most likely diagnosis?
A. Major neurocognitive disorder due to Alzheimer's disease
B. Mild neurocognitive disorder
C. Pseudodementia
D. Delirium
Rationale: A MoCA score <26 with deficits in multiple cognitive domains (memory,
executive function, visuospatial skills) in the context of functional impairment
(difficulty with finances, driving) meets criteria for major neurocognitive disorder. The
insidious onset and progressive course suggest Alzheimer's pathology. Delirium
would show acute fluctuation; pseudodementia typically shows inconsistent effort.
Correct Answer: A
Q6. A 32-year-old woman presents after a motor vehicle accident 3 weeks ago. She
reports recurrent intrusive memories of the crash, nightmares, hypervigilance while
driving, and avoidance of the intersection where the accident occurred. She has
difficulty concentrating and reports exaggerated startle response. Which diagnosis
best fits?
A. Acute stress disorder
B. Posttraumatic stress disorder
C. Adjustment disorder
D. Panic disorder
, Rationale: Symptoms present for >1 month (3 weeks is borderline; however, with the
full symptom cluster of intrusion, avoidance, negative alterations in cognition/mood,
and marked alterations in arousal/reactivity following exposure to actual/threatened
death/serious injury, PTSD is the correct diagnosis). Acute stress disorder lasts 3 days
to 1 month; adjustment disorder lacks the specific intrusive/hyperarousal symptoms;
panic disorder lacks the trauma link.
Correct Answer: B
Q7. A 28-year-old man is evaluated for anxiety. He reports excessive worry about
multiple domains (work, finances, health, relationships) occurring more days than not
for the past 8 months, associated with muscle tension, fatigue, and irritability. He
denies panic attacks. Which rating scale should be used to monitor treatment
response?
A. MDQ
B. GAD-7
C. YMRS
D. C-SSRS
Rationale: The GAD-7 is a validated 7-item instrument for screening and monitoring
severity of generalized anxiety disorder. MDQ screens for bipolar disorder; YMRS
assesses mania; C-SSRS assesses suicidality.
Correct Answer: B
Q8. A 16-year-old is brought in by parents for refusing to eat, excessive exercise, and
weight loss from 130 to 98 lbs over 4 months. She is amenorrheic, bradycardic (HR
48), and has lanugo hair. Her BMI is 15.2. Which medical complication requires the
most immediate intervention?
A. Osteopenia
B. Electrolyte abnormalities
C. Lanugo hair growth
D. Amenorrhea
Certification Practice Test | Verified A+ Content |
Psychiatric Mental Health Nurse Practitioner | Pass
Guaranteed - A+ Graded
Section 1: Assessment, Diagnosis & Formulation (Q1-40)
Q1. A 24-year-old graduate student is brought to the emergency department by
campus police after classmates reported he has been speaking rapidly for 3 days,
sleeping only 2 hours nightly, and purchased $3,000 worth of electronics he cannot
afford. He believes he has discovered a new mathematical theorem. His speech is
pressured and he is easily distracted. Which rating scale is most appropriate to assess
the severity of his current manic symptoms?
A. PHQ-9
B. Young Mania Rating Scale (YMRS)
C. GAD-7
D. C-SSRS
Rationale: The YMRS is the validated instrument specifically designed to assess the
severity of manic symptoms in bipolar disorder. PHQ-9 screens depression severity;
GAD-7 screens anxiety; C-SSRS assesses suicidal ideation and behavior.
Correct Answer: B
Q2. A 19-year-old college freshman presents with 2 weeks of depressed mood,
anhedonia, hypersomnia, weight gain, and psychomotor retardation. She denies
suicidal ideation. Her mother has bipolar I disorder. Which is the most important next
step before initiating antidepressant monotherapy?
A. Order thyroid function tests
B. Screen for manic/hypomanic history with the Mood Disorder Questionnaire (MDQ)
C. Obtain an ECG
D. Check vitamin B12 level
,Rationale: Given the strong family history of bipolar I disorder and atypical
depressive features (hypersomnia, weight gain, psychomotor retardation), screening
for bipolarity with the MDQ is essential before initiating antidepressant
monotherapy, which could precipitate mania. While medical workup is important,
bipolar screening takes priority in this clinical context.
Correct Answer: B
Q3. A 45-year-old man with schizophrenia reports that the FBI has implanted a chip
in his brain to monitor his thoughts. He also states he hears a voice commenting on
his actions. Which type of hallucination is present?
A. Gustatory hallucination
B. Olfactory hallucination
C. Auditory hallucination
D. Tactile hallucination
Rationale: Hearing a voice commenting on one's actions is a classic first-rank
symptom of schizophrenia representing an auditory hallucination. The belief about
the FBI chip represents a delusion (specifically a persecutory delusion with a somatic
component), not a hallucination.
Correct Answer: C
Q4. During a mental status examination, a patient repeatedly uses rhyming words in
a nonsensical pattern: "I'm fine, dine, shine, line, pine." This speech pattern is best
described as:
A. Echolalia
B. Clang association
C. Neologism
D. Circumstantiality
Rationale: Clang associations are speech patterns where word choice is governed by
sound (rhyming or alliteration) rather than meaning, commonly seen in mania.
,Echolalia is repetition of others' words; neologisms are invented words;
circumstantiality involves delayed reaching of the point with unnecessary details.
Correct Answer: B
Q5. A 67-year-old retired accountant is referred by his primary care provider for
evaluation of memory complaints. His wife reports he has difficulty managing
finances, gets lost driving familiar routes, and repeatedly asks the same questions.
On MoCA testing, he scores 18/30, losing points on delayed recall,
visuospatial/executive function, and orientation. Which is the most likely diagnosis?
A. Major neurocognitive disorder due to Alzheimer's disease
B. Mild neurocognitive disorder
C. Pseudodementia
D. Delirium
Rationale: A MoCA score <26 with deficits in multiple cognitive domains (memory,
executive function, visuospatial skills) in the context of functional impairment
(difficulty with finances, driving) meets criteria for major neurocognitive disorder. The
insidious onset and progressive course suggest Alzheimer's pathology. Delirium
would show acute fluctuation; pseudodementia typically shows inconsistent effort.
Correct Answer: A
Q6. A 32-year-old woman presents after a motor vehicle accident 3 weeks ago. She
reports recurrent intrusive memories of the crash, nightmares, hypervigilance while
driving, and avoidance of the intersection where the accident occurred. She has
difficulty concentrating and reports exaggerated startle response. Which diagnosis
best fits?
A. Acute stress disorder
B. Posttraumatic stress disorder
C. Adjustment disorder
D. Panic disorder
, Rationale: Symptoms present for >1 month (3 weeks is borderline; however, with the
full symptom cluster of intrusion, avoidance, negative alterations in cognition/mood,
and marked alterations in arousal/reactivity following exposure to actual/threatened
death/serious injury, PTSD is the correct diagnosis). Acute stress disorder lasts 3 days
to 1 month; adjustment disorder lacks the specific intrusive/hyperarousal symptoms;
panic disorder lacks the trauma link.
Correct Answer: B
Q7. A 28-year-old man is evaluated for anxiety. He reports excessive worry about
multiple domains (work, finances, health, relationships) occurring more days than not
for the past 8 months, associated with muscle tension, fatigue, and irritability. He
denies panic attacks. Which rating scale should be used to monitor treatment
response?
A. MDQ
B. GAD-7
C. YMRS
D. C-SSRS
Rationale: The GAD-7 is a validated 7-item instrument for screening and monitoring
severity of generalized anxiety disorder. MDQ screens for bipolar disorder; YMRS
assesses mania; C-SSRS assesses suicidality.
Correct Answer: B
Q8. A 16-year-old is brought in by parents for refusing to eat, excessive exercise, and
weight loss from 130 to 98 lbs over 4 months. She is amenorrheic, bradycardic (HR
48), and has lanugo hair. Her BMI is 15.2. Which medical complication requires the
most immediate intervention?
A. Osteopenia
B. Electrolyte abnormalities
C. Lanugo hair growth
D. Amenorrhea
