ANCC PMHNP Cert Exam
Review Questions and
answers
1. A client presents with symptoms of anhedonia, low mood, insomnia, and weight
loss. Which is the most appropriate first-line pharmacologic treatment?
A. Bupropion
B. Sertraline
C. Mirtazapine
D. Amitriptyline
Answer: B. Sertraline
Rationale: SSRIs like sertraline are considered first-line treatment for major
depressive disorder due to their favorable side effect profile and safety in overdose.
2. A 32-year-old female with bipolar I disorder presents with acute mania. What is
the most appropriate initial pharmacologic treatment?
A. Fluoxetine
B. Lithium
C. Buspirone
D. Donepezil
Answer: B. Lithium
Rationale: Lithium is a first-line mood stabilizer for acute mania and long-term
maintenance in bipolar I disorder.
,3. What is the most appropriate intervention when a client expresses passive suicidal
ideation without intent or plan?
A. Immediate hospitalization
B. Initiate a no-suicide contract
C. Conduct further risk assessment and create a safety plan
D. Prescribe a benzodiazepine
Answer: C. Conduct further risk assessment and create a safety plan
Rationale: Passive ideation without intent or plan warrants comprehensive risk
assessment and safety planning rather than hospitalization.
4. Which of the following neurotransmitters is most implicated in the
pathophysiology of schizophrenia?
A. Norepinephrine
B. GABA
C. Dopamine
D. Serotonin
Answer: C. Dopamine
Rationale: The dopamine hypothesis suggests that excess dopamine activity,
particularly in the mesolimbic pathway, contributes to positive symptoms of
schizophrenia.
5. What is the most appropriate initial response to a client exhibiting command
auditory hallucinations to harm others?
A. Explore the content further
B. Immediately assess risk and notify appropriate staff
C. Ignore the hallucination
D. Increase their antipsychotic dosage
Answer: B. Immediately assess risk and notify appropriate staff
,Rationale: Command hallucinations can pose safety risks. Immediate risk assessment
and safety measures are critical.
6. Which lab value should be monitored regularly in a patient taking clozapine?
A. AST/ALT
B. WBC and ANC
C. TSH
D. BUN and Creatinine
Answer: B. WBC and ANC
Rationale: Clozapine carries a risk of agranulocytosis, so regular monitoring of white
blood cells and absolute neutrophil count is essential.
7. A PMHNP is using cognitive behavioral therapy (CBT). What is a primary goal of
CBT?
A. Uncover unconscious thoughts
B. Strengthen emotional insight
C. Modify distorted thinking patterns
D. Establish a strong transference relationship
Answer: C. Modify distorted thinking patterns
Rationale: CBT aims to identify and change maladaptive thoughts and behaviors.
8. A patient on lithium therapy presents with tremor, confusion, and diarrhea. What
is the most likely diagnosis?
A. Lithium toxicity
B. Dehydration
C. Bipolar depression
D. Hyponatremia
Answer: A. Lithium toxicity
, Rationale: These are classic signs of lithium toxicity, which requires immediate
intervention.
9. A child presents with hyperactivity, impulsivity, and difficulty concentrating. What
is the most likely diagnosis?
A. Autism spectrum disorder
B. Oppositional defiant disorder
C. ADHD
D. Conduct disorder
Answer: C. ADHD
Rationale: These are hallmark symptoms of ADHD, particularly the combined
presentation.
10. Which of the following medications has the highest risk for metabolic syndrome?
A. Aripiprazole
B. Ziprasidone
C. Olanzapine
D. Haloperidol
Answer: C. Olanzapine
Rationale: Olanzapine is associated with a significant risk for weight gain,
hyperlipidemia, and insulin resistance.
11. A patient taking an SSRI reports sexual dysfunction. What is the best next step in
management?
A. Discontinue the SSRI immediately
B. Switch to a TCA
C. Augment with bupropion
D. Increase the SSRI dosage
Answer: C. Augment with bupropion
Review Questions and
answers
1. A client presents with symptoms of anhedonia, low mood, insomnia, and weight
loss. Which is the most appropriate first-line pharmacologic treatment?
A. Bupropion
B. Sertraline
C. Mirtazapine
D. Amitriptyline
Answer: B. Sertraline
Rationale: SSRIs like sertraline are considered first-line treatment for major
depressive disorder due to their favorable side effect profile and safety in overdose.
2. A 32-year-old female with bipolar I disorder presents with acute mania. What is
the most appropriate initial pharmacologic treatment?
A. Fluoxetine
B. Lithium
C. Buspirone
D. Donepezil
Answer: B. Lithium
Rationale: Lithium is a first-line mood stabilizer for acute mania and long-term
maintenance in bipolar I disorder.
,3. What is the most appropriate intervention when a client expresses passive suicidal
ideation without intent or plan?
A. Immediate hospitalization
B. Initiate a no-suicide contract
C. Conduct further risk assessment and create a safety plan
D. Prescribe a benzodiazepine
Answer: C. Conduct further risk assessment and create a safety plan
Rationale: Passive ideation without intent or plan warrants comprehensive risk
assessment and safety planning rather than hospitalization.
4. Which of the following neurotransmitters is most implicated in the
pathophysiology of schizophrenia?
A. Norepinephrine
B. GABA
C. Dopamine
D. Serotonin
Answer: C. Dopamine
Rationale: The dopamine hypothesis suggests that excess dopamine activity,
particularly in the mesolimbic pathway, contributes to positive symptoms of
schizophrenia.
5. What is the most appropriate initial response to a client exhibiting command
auditory hallucinations to harm others?
A. Explore the content further
B. Immediately assess risk and notify appropriate staff
C. Ignore the hallucination
D. Increase their antipsychotic dosage
Answer: B. Immediately assess risk and notify appropriate staff
,Rationale: Command hallucinations can pose safety risks. Immediate risk assessment
and safety measures are critical.
6. Which lab value should be monitored regularly in a patient taking clozapine?
A. AST/ALT
B. WBC and ANC
C. TSH
D. BUN and Creatinine
Answer: B. WBC and ANC
Rationale: Clozapine carries a risk of agranulocytosis, so regular monitoring of white
blood cells and absolute neutrophil count is essential.
7. A PMHNP is using cognitive behavioral therapy (CBT). What is a primary goal of
CBT?
A. Uncover unconscious thoughts
B. Strengthen emotional insight
C. Modify distorted thinking patterns
D. Establish a strong transference relationship
Answer: C. Modify distorted thinking patterns
Rationale: CBT aims to identify and change maladaptive thoughts and behaviors.
8. A patient on lithium therapy presents with tremor, confusion, and diarrhea. What
is the most likely diagnosis?
A. Lithium toxicity
B. Dehydration
C. Bipolar depression
D. Hyponatremia
Answer: A. Lithium toxicity
, Rationale: These are classic signs of lithium toxicity, which requires immediate
intervention.
9. A child presents with hyperactivity, impulsivity, and difficulty concentrating. What
is the most likely diagnosis?
A. Autism spectrum disorder
B. Oppositional defiant disorder
C. ADHD
D. Conduct disorder
Answer: C. ADHD
Rationale: These are hallmark symptoms of ADHD, particularly the combined
presentation.
10. Which of the following medications has the highest risk for metabolic syndrome?
A. Aripiprazole
B. Ziprasidone
C. Olanzapine
D. Haloperidol
Answer: C. Olanzapine
Rationale: Olanzapine is associated with a significant risk for weight gain,
hyperlipidemia, and insulin resistance.
11. A patient taking an SSRI reports sexual dysfunction. What is the best next step in
management?
A. Discontinue the SSRI immediately
B. Switch to a TCA
C. Augment with bupropion
D. Increase the SSRI dosage
Answer: C. Augment with bupropion
