PMHNP ANCC Board Review Practice Exam (200 Questions and
Verified Answers ) Psychiatric-Mental Health Nurse Practitioner
Certification Simulation (ANCC-Style)
Introduction
This 200-question PMHNP practice exam is designed to simulate the structure, difficulty level, and
content domains of the American Nurses Credentialing Center (ANCC) Psychiatric-Mental Health
Nurse Practitioner (PMHNP-BC) certification exam.
The questions are written in a board-style clinical format, emphasizing real-world psychiatric decision-
making, including:
Psychiatric assessment and diagnosis (DSM-5-TR concepts)
Psychopharmacology and medication management
Therapeutic communication and psychotherapy principles
Crisis intervention and risk assessment
Neurobiology and psychopathology
Differential diagnosis across psychiatric disorders
Evidence-based treatment guidelines
1.
A 29-year-old patient presents with persistently elevated mood, decreased need
for sleep, pressured speech, and excessive involvement in risky pleasurable
activities lasting 8 days. What is the most likely diagnosis?
Answer: Bipolar I Disorder, manic episode
Explanation: A manic episode lasting at least 7 days with impaired judgment
and risky behavior is diagnostic of Bipolar I disorder.
2.
Which medication is considered the gold-standard first-line mood stabilizer for
acute mania and long-term relapse prevention in bipolar disorder?
,Answer: Lithium
Explanation: Lithium remains the first-line treatment for acute mania and
maintenance therapy due to strong evidence of efficacy.
3.
A patient taking lithium reports severe hand tremors, vomiting, diarrhea, and
worsening confusion. What condition should the PMHNP suspect immediately?
Answer: Lithium toxicity
Explanation: These symptoms indicate lithium toxicity, which requires urgent
serum level assessment and discontinuation of the drug.
4.
A patient treated with clozapine requires routine monitoring to prevent a life-
threatening adverse effect. Which laboratory test is most essential?
Answer: Absolute neutrophil count (ANC)
Explanation: Clozapine can cause agranulocytosis, so regular ANC
monitoring is required to detect dangerous leukopenia early.
5.
A patient experiences recurrent unexpected panic attacks with palpitations,
shortness of breath, and fear of dying. What is the most appropriate first-line
treatment plan?
Answer: Cognitive behavioral therapy combined with an SSRI
Explanation: CBT plus SSRIs is first-line for panic disorder, providing both
symptom control and relapse prevention.
,6.
A patient on multiple serotonergic medications presents with hyperthermia,
clonus, agitation, and hyperreflexia. What is the most likely diagnosis?
Answer: Serotonin syndrome
Explanation: Serotonin syndrome is caused by excess serotonin activity and
presents with neuromuscular, autonomic, and mental status changes.
7.
Which combination is recommended as first-line treatment for post-traumatic
stress disorder?
Answer: SSRIs and trauma-focused psychotherapy
Explanation: Evidence-based guidelines recommend SSRIs such as
sertraline combined with trauma-focused therapy for PTSD.
8.
A patient reports hearing a voice commenting on their actions throughout the
day. What type of psychotic symptom is this?
Answer: Auditory hallucination
Explanation: Auditory hallucinations are perceptions of sound or voices
without external stimuli, commonly seen in psychotic disorders.
9.
A patient demonstrates unstable relationships, impulsivity, chronic feelings of
emptiness, and fear of abandonment. What is the most likely diagnosis?
, Answer: Borderline personality disorder
Explanation: Borderline personality disorder is characterized by emotional
instability, impulsivity, and fear of abandonment.
10.
Which antidepressant is generally considered safest and most commonly used
when pharmacologic treatment is required during pregnancy?
Answer: Fluoxetine
Explanation: Fluoxetine has the most reproductive safety data among SSRIs
and is commonly used when antidepressants are needed in pregnancy.
11.
A hospitalized patient receiving haloperidol develops high fever, severe muscle
rigidity, altered mental status, and autonomic instability. What is the most likely
diagnosis?
Answer: Neuroleptic malignant syndrome (NMS)
Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by fever, rigidity, autonomic instability, and altered mental status.
12.
A patient taking multiple serotonergic agents develops confusion, diarrhea,
tremor, hyperreflexia, and clonus. What is the most appropriate diagnosis?
Answer: Serotonin syndrome
Explanation: Serotonin syndrome is caused by excess serotonin activity,
typically from drug interactions or overdose.
Verified Answers ) Psychiatric-Mental Health Nurse Practitioner
Certification Simulation (ANCC-Style)
Introduction
This 200-question PMHNP practice exam is designed to simulate the structure, difficulty level, and
content domains of the American Nurses Credentialing Center (ANCC) Psychiatric-Mental Health
Nurse Practitioner (PMHNP-BC) certification exam.
The questions are written in a board-style clinical format, emphasizing real-world psychiatric decision-
making, including:
Psychiatric assessment and diagnosis (DSM-5-TR concepts)
Psychopharmacology and medication management
Therapeutic communication and psychotherapy principles
Crisis intervention and risk assessment
Neurobiology and psychopathology
Differential diagnosis across psychiatric disorders
Evidence-based treatment guidelines
1.
A 29-year-old patient presents with persistently elevated mood, decreased need
for sleep, pressured speech, and excessive involvement in risky pleasurable
activities lasting 8 days. What is the most likely diagnosis?
Answer: Bipolar I Disorder, manic episode
Explanation: A manic episode lasting at least 7 days with impaired judgment
and risky behavior is diagnostic of Bipolar I disorder.
2.
Which medication is considered the gold-standard first-line mood stabilizer for
acute mania and long-term relapse prevention in bipolar disorder?
,Answer: Lithium
Explanation: Lithium remains the first-line treatment for acute mania and
maintenance therapy due to strong evidence of efficacy.
3.
A patient taking lithium reports severe hand tremors, vomiting, diarrhea, and
worsening confusion. What condition should the PMHNP suspect immediately?
Answer: Lithium toxicity
Explanation: These symptoms indicate lithium toxicity, which requires urgent
serum level assessment and discontinuation of the drug.
4.
A patient treated with clozapine requires routine monitoring to prevent a life-
threatening adverse effect. Which laboratory test is most essential?
Answer: Absolute neutrophil count (ANC)
Explanation: Clozapine can cause agranulocytosis, so regular ANC
monitoring is required to detect dangerous leukopenia early.
5.
A patient experiences recurrent unexpected panic attacks with palpitations,
shortness of breath, and fear of dying. What is the most appropriate first-line
treatment plan?
Answer: Cognitive behavioral therapy combined with an SSRI
Explanation: CBT plus SSRIs is first-line for panic disorder, providing both
symptom control and relapse prevention.
,6.
A patient on multiple serotonergic medications presents with hyperthermia,
clonus, agitation, and hyperreflexia. What is the most likely diagnosis?
Answer: Serotonin syndrome
Explanation: Serotonin syndrome is caused by excess serotonin activity and
presents with neuromuscular, autonomic, and mental status changes.
7.
Which combination is recommended as first-line treatment for post-traumatic
stress disorder?
Answer: SSRIs and trauma-focused psychotherapy
Explanation: Evidence-based guidelines recommend SSRIs such as
sertraline combined with trauma-focused therapy for PTSD.
8.
A patient reports hearing a voice commenting on their actions throughout the
day. What type of psychotic symptom is this?
Answer: Auditory hallucination
Explanation: Auditory hallucinations are perceptions of sound or voices
without external stimuli, commonly seen in psychotic disorders.
9.
A patient demonstrates unstable relationships, impulsivity, chronic feelings of
emptiness, and fear of abandonment. What is the most likely diagnosis?
, Answer: Borderline personality disorder
Explanation: Borderline personality disorder is characterized by emotional
instability, impulsivity, and fear of abandonment.
10.
Which antidepressant is generally considered safest and most commonly used
when pharmacologic treatment is required during pregnancy?
Answer: Fluoxetine
Explanation: Fluoxetine has the most reproductive safety data among SSRIs
and is commonly used when antidepressants are needed in pregnancy.
11.
A hospitalized patient receiving haloperidol develops high fever, severe muscle
rigidity, altered mental status, and autonomic instability. What is the most likely
diagnosis?
Answer: Neuroleptic malignant syndrome (NMS)
Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by fever, rigidity, autonomic instability, and altered mental status.
12.
A patient taking multiple serotonergic agents develops confusion, diarrhea,
tremor, hyperreflexia, and clonus. What is the most appropriate diagnosis?
Answer: Serotonin syndrome
Explanation: Serotonin syndrome is caused by excess serotonin activity,
typically from drug interactions or overdose.
