ANCC PMHNP Cert Exam
Review Questions and
Verified answers 2025/2026
1. A patient with schizophrenia believes the government is monitoring their thoughts.
This is best described as which type of delusion?
A. Grandiose
B. Somatic
C. Persecutory
D. Referential
✅ Answer: C. Persecutory
Rationale: Persecutory delusions involve beliefs of being targeted, harassed, or persecuted. In
this case, the belief in government surveillance is classic.
2. Which neurotransmitter is most implicated in the pathophysiology of anxiety
disorders?
A. Dopamine
B. GABA
C. Acetylcholine
D. Glutamate
✅ Answer: B. GABA
Rationale: GABA (gamma-aminobutyric acid) is the main inhibitory neurotransmitter in the CNS
and is involved in the calming effect; low levels are linked to anxiety.
3. A PMHNP prescribes lithium for a patient with bipolar I disorder. What is the most
important lab test to monitor for lithium toxicity?
A. Liver enzymes
,B. CBC with differential
C. Serum creatinine
D. TSH
✅ Answer: C. Serum creatinine
Rationale: Lithium is renally excreted. Monitoring kidney function is crucial to prevent toxicity.
4. Which of the following is a hallmark feature of borderline personality disorder?
A. Excessive need for admiration
B. Recurrent legal issues
C. Instability in interpersonal relationships
D. Preoccupation with orderliness
✅ Answer: C. Instability in interpersonal relationships
Rationale: Borderline personality disorder is characterized by unstable relationships, affective
instability, impulsivity, and fear of abandonment.
5. The PMHNP knows that an EPS (extrapyramidal symptom) like acute dystonia can be
managed by which of the following?
A. Lorazepam
B. Diphenhydramine
C. Haloperidol
D. Risperidone
✅ Answer: B. Diphenhydramine
Rationale: Diphenhydramine (Benadryl) and benztropine are commonly used to treat dystonic
reactions due to their anticholinergic effects.
6. Which of the following screening tools is most appropriate for assessing generalized
anxiety disorder in adults?
A. PHQ-9
B. GAD-7
C. CAGE
D. CIWA-Ar
✅ Answer: B. GAD-7
Rationale: GAD-7 is a 7-item screening tool specifically designed for generalized anxiety
disorder.
,7. A patient on clozapine presents with fever and sore throat. What is the immediate next
step?
A. Prescribe antipyretics
B. Obtain a CBC
C. Reassure the patient
D. Increase the dose
✅ Answer: B. Obtain a CBC
Rationale: Clozapine carries a risk of agranulocytosis; fever and sore throat may signal
neutropenia. CBC with ANC is urgent.
8. Which psychotropic medication has the highest risk of metabolic syndrome?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Lurasidone
✅ Answer: C. Olanzapine
Rationale: Olanzapine is known for causing significant weight gain, hyperlipidemia, and insulin
resistance.
9. A 17-year-old reports irritability, poor sleep, and racing thoughts for the past week.
What is the most likely diagnosis?
A. ADHD
B. Schizophrenia
C. Bipolar I disorder
D. Major depressive disorder
✅ Answer: C. Bipolar I disorder
Rationale: Symptoms suggest a manic episode, which is a key diagnostic feature of bipolar I
disorder.
10. What is the black box warning for all antidepressants in children and adolescents?
A. Risk of seizures
B. Risk of mania
C. Risk of suicidal ideation
D. Risk of tardive dyskinesia
✅ Answer: C. Risk of suicidal ideation
Rationale: All antidepressants carry an FDA black box warning for increased risk of suicidal
thinking in youth.
, 11. What is the first-line pharmacologic treatment for PTSD?
A. Benzodiazepines
B. Beta-blockers
C. SSRIs
D. Antipsychotics
✅ Answer: C. SSRIs
Rationale: SSRIs (e.g., sertraline, paroxetine) are first-line pharmacologic agents approved for
PTSD.
12. Which medication requires monitoring of white blood cell count every week during
the first 6 months of therapy?
A. Clozapine
B. Risperidone
C. Olanzapine
D. Quetiapine
✅ Answer: A. Clozapine
Rationale: Clozapine requires regular WBC/ANC monitoring due to the risk of agranulocytosis.
13. A patient with a history of opioid use disorder wants treatment. What is the PMHNP's
most appropriate pharmacologic option?
A. Clonidine
B. Methadone
C. Disulfiram
D. Diazepam
✅ Answer: B. Methadone
Rationale: Methadone is a full opioid agonist used in opioid maintenance therapy, especially for
OUD.
14. What lab must be monitored before and during valproic acid (Depakote) therapy?
A. Renal function
B. Liver function
C. Thyroid function
D. Electrolytes
✅ Answer: B. Liver function
Rationale: Valproic acid can cause hepatotoxicity; baseline and periodic LFTs are essential.
Review Questions and
Verified answers 2025/2026
1. A patient with schizophrenia believes the government is monitoring their thoughts.
This is best described as which type of delusion?
A. Grandiose
B. Somatic
C. Persecutory
D. Referential
✅ Answer: C. Persecutory
Rationale: Persecutory delusions involve beliefs of being targeted, harassed, or persecuted. In
this case, the belief in government surveillance is classic.
2. Which neurotransmitter is most implicated in the pathophysiology of anxiety
disorders?
A. Dopamine
B. GABA
C. Acetylcholine
D. Glutamate
✅ Answer: B. GABA
Rationale: GABA (gamma-aminobutyric acid) is the main inhibitory neurotransmitter in the CNS
and is involved in the calming effect; low levels are linked to anxiety.
3. A PMHNP prescribes lithium for a patient with bipolar I disorder. What is the most
important lab test to monitor for lithium toxicity?
A. Liver enzymes
,B. CBC with differential
C. Serum creatinine
D. TSH
✅ Answer: C. Serum creatinine
Rationale: Lithium is renally excreted. Monitoring kidney function is crucial to prevent toxicity.
4. Which of the following is a hallmark feature of borderline personality disorder?
A. Excessive need for admiration
B. Recurrent legal issues
C. Instability in interpersonal relationships
D. Preoccupation with orderliness
✅ Answer: C. Instability in interpersonal relationships
Rationale: Borderline personality disorder is characterized by unstable relationships, affective
instability, impulsivity, and fear of abandonment.
5. The PMHNP knows that an EPS (extrapyramidal symptom) like acute dystonia can be
managed by which of the following?
A. Lorazepam
B. Diphenhydramine
C. Haloperidol
D. Risperidone
✅ Answer: B. Diphenhydramine
Rationale: Diphenhydramine (Benadryl) and benztropine are commonly used to treat dystonic
reactions due to their anticholinergic effects.
6. Which of the following screening tools is most appropriate for assessing generalized
anxiety disorder in adults?
A. PHQ-9
B. GAD-7
C. CAGE
D. CIWA-Ar
✅ Answer: B. GAD-7
Rationale: GAD-7 is a 7-item screening tool specifically designed for generalized anxiety
disorder.
,7. A patient on clozapine presents with fever and sore throat. What is the immediate next
step?
A. Prescribe antipyretics
B. Obtain a CBC
C. Reassure the patient
D. Increase the dose
✅ Answer: B. Obtain a CBC
Rationale: Clozapine carries a risk of agranulocytosis; fever and sore throat may signal
neutropenia. CBC with ANC is urgent.
8. Which psychotropic medication has the highest risk of metabolic syndrome?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Lurasidone
✅ Answer: C. Olanzapine
Rationale: Olanzapine is known for causing significant weight gain, hyperlipidemia, and insulin
resistance.
9. A 17-year-old reports irritability, poor sleep, and racing thoughts for the past week.
What is the most likely diagnosis?
A. ADHD
B. Schizophrenia
C. Bipolar I disorder
D. Major depressive disorder
✅ Answer: C. Bipolar I disorder
Rationale: Symptoms suggest a manic episode, which is a key diagnostic feature of bipolar I
disorder.
10. What is the black box warning for all antidepressants in children and adolescents?
A. Risk of seizures
B. Risk of mania
C. Risk of suicidal ideation
D. Risk of tardive dyskinesia
✅ Answer: C. Risk of suicidal ideation
Rationale: All antidepressants carry an FDA black box warning for increased risk of suicidal
thinking in youth.
, 11. What is the first-line pharmacologic treatment for PTSD?
A. Benzodiazepines
B. Beta-blockers
C. SSRIs
D. Antipsychotics
✅ Answer: C. SSRIs
Rationale: SSRIs (e.g., sertraline, paroxetine) are first-line pharmacologic agents approved for
PTSD.
12. Which medication requires monitoring of white blood cell count every week during
the first 6 months of therapy?
A. Clozapine
B. Risperidone
C. Olanzapine
D. Quetiapine
✅ Answer: A. Clozapine
Rationale: Clozapine requires regular WBC/ANC monitoring due to the risk of agranulocytosis.
13. A patient with a history of opioid use disorder wants treatment. What is the PMHNP's
most appropriate pharmacologic option?
A. Clonidine
B. Methadone
C. Disulfiram
D. Diazepam
✅ Answer: B. Methadone
Rationale: Methadone is a full opioid agonist used in opioid maintenance therapy, especially for
OUD.
14. What lab must be monitored before and during valproic acid (Depakote) therapy?
A. Renal function
B. Liver function
C. Thyroid function
D. Electrolytes
✅ Answer: B. Liver function
Rationale: Valproic acid can cause hepatotoxicity; baseline and periodic LFTs are essential.
