PMHNP Board Exam Practice 2026 Complete Questions and Answers Solved 100%

A pt is scoring 16 on the Hamilton-D scale and you place them on Lexapro 10mg. The pt comes to the office 10 weeks later and their score is now 18. What adjustment would you make with the Lexapro?

Increase dose

A pt is scoring a 19 on the Beck Depression scale. Pt is started on Lexapro 10mg then comes back 8 weeks later and now scores a 29. What adjustment would you make to the Lexapro?

Increase the dose

A pt is scoring a 2 on the GAD scale. They have been taking Lexapro for 5 months. What adjustment would you make?

None

A 72yo female is brought in by her husband with increasing forgetfulness, insomnia, decreased activity, and decreased appetite x2mo. She has a hx of HTN and is being treated with Lisinopril. The exam is normal and the MMSE provides a score of 24 but she declines to answer some questions and needs to be urged to participate in the assessment. What is the most likely diagnosis?

Depression

A new female patient has been recently diagnosed with bipolar disorder. The PMHNP and the patient agree to start Lithium. The PMHNP reviews the benefits and risks of taking Lithium with the patient then the PMHNP sends the order to the pharmacy. Which pt right was violated in this case?

Confidentiality

You are treating a 47yo male pt with a hx of asthma who presents with sudden onset sxs of tachycardia, elevated BP, sweating, shaking, agitation, and anxiety. What should the PMHNP prescribe?

Hydroxyzine (avoid Propranolol, can cause bronchospasm and pt has asthma; avoid benzos)

A parent brings in their adolescent child who has a very low BMI of 12. BP is low. Pt is losing weight and severely dehydrated. What should the PMHNP do?

Refer for hospitalization

An 80yo female pt comes in with forgetfulness and confusion. What should you do?

UA with culture and sensitivity (infections can cause delirium in the elderly)

You are doing group therapy but a person is not comfortable sharing in front of others. You are trying to promote interpersonal learning, so the person still needs to be involved in group therapy. What do you do as the PMHNP?

Encourage them to keep attending groups and provide individual sessions

You believe your coworker is lazy because she came to work late. What is this called?

Mislabeling

A pt's husband did not call her, so the pt believes he might have died in a car accident. What is this called?

Catastrophizing

Marital conflict could benefit from what type of therapy?

Interpersonal Therapy

You are conducting a conjoined therapy appointment. Only 1 person shows up out of the couple and the other person does not. What should you do?

Reschedule the appointment

A mom calls and reports that her 5yo child was sodomized by the 16yo sibling. What do you do?

Tell the mom to keep the children apart, notify CPS, arrange for crisis therapy for the family

If a pt is unable to remember what happened in a specific time frame, what technique can you use?

Ask questions that can anchor their memory or link memorable events

You start a pt on an antidepressant. How will you see if the medication is effective?

Use a standardized rating scale

A pt taking an antipsychotic has started to experience TD. What is the resulting TD called in relation to this antipsychotic?

Iatrogenic

How would you get NPs across the nation involved in a discussion about a new policy that will affect them?

Survey

If your coworkers are against a policy you are trying to implement, what should you do?

Discuss how the policy will improve the quality of patient care

How can you ensure continuous quality improvement in an outpatient clinic?

Develop an instrument to monitor clinical outcomes

How can you ensure continuous quality improvement when treating patients with mental illnesses like depression and anxiety?

Use a rating scale at baseline and regular intervals

A pt started a medication and then found out the FDA released a BBW about the medication. What should the PMHNP do?

Research risks and benefits of continuing medication

A pt was taking the same medication for years and now it is no longer effective. The pt requires a higher dose. What is this called?

Tolerance

How do you know if someone is ready to transition to a less intensive outpatient program?

They take responsibility for their actions and can identify coping skills

How do you know if someone is NOT ready to transition to a less intensive outpatient program?

They still blame others for the cause of their substance use

Your clinic wants you to develop a new policy to help address medication errors. What should your first step be?

Assess the common types of med errors

You have a pregnant patient who is using alcohol. What is your first intervention?

Refer to a residential treatment center

If a pt has a hx of multiple SAs, what should you mention during your first visit?

Confidentiality, mandated reporting

How do you know if a pt with dementia is giving consent?

They can repeat the benefits and risks

A pt with psychosis is unable to provide informed consent. What should you do?

Assess for involuntary treatment

You decide to stop a medication that is causing harmful side effects. This is an example of what?

Nonmaleficence

You diagnosis a pt with MDD and prescribe them a SSRI. This is an example of what?

Beneficence

A 3yo gets sick on a bright sunny day then might think that the sun caused them to get sick. This is an example of what?

Magical thinking

You are meeting with a victim of rape. What is the PMHNP's initial action?

Provide a safe environment

You walk into the inpatient unit and need to discharge your pt. What must be done before you discharge them?

Ensure the pt can stay safe and cope effectively

When does behavioral management and support start in the inpatient setting?

After the patient is admitted

Where should you conduct a patient interview?

Private office with door open

A child comes in with their parents and they report abuse. What should you do?

Interview child and parents separately, report to CPS

A child comes in for a follow-up appointment without their parents. The child is playing with a toy in a sexual way and you suspect some form of sexual abuse. What should you do based on this suspicion?

Report to CPS

An adolescent tells you they are attracted to the same gender. It is a consensual relationship with another adolescent of the same age. What do you do?

Keep info confidential

You have noticed that a lot of women who commit suicide in the postpartum period leave without an OB doctor performing an assessment on them. There is a gap in care. What should you do?

Collaborate with the OB

You walk into the inpatient facility and are about to discharge the patient to a rehab facility. The facility wants a copy of the patient's lab results. What do you do?

Obtain informed consent then fax labs over

A patient is complaining of losing their job or house. What should you do?

Offer brief supportive therapy

A patient has somatic complaints of pain but the PCP could not find any cause for their pain. What do you do?

Validate the symptom of pain based on cultural context

You diagnose someone from a specific culture with schizophrenia. What should you do?

Provide education based on cultural context

You need to do health promotion in the community. You notice people who live there are rom different ethnicities. What should you do?

Use ethnospecific assessment parameters

Some Native Americans believe that a healing stick has powers relating to mental health. The person wants to have the healing stick with them on an inpatient unit. What is your action?

Educate the staff on cultural sensitivity, let pt keep the healing stick

TSH=0.4. Does the patient have hypo or hyperthyroidism?

Hyperthyroidism

TSH=7.0. Does the patient have hypo or hyperthyroidism?

Hypothyroidism

A patient c/o R upper quadrant abdominal pain, yellowing of the skin, and dark colored urine which could indicate hepatotoxicity. What is your intervention?

D/C med, do liver function test

A 38yo female pt has a mood disorder and does not want to gain weight or develop metabolic syndrome. Which medication is the best option for her?

Lamictal

A pt is started on Seroquel which is known for causing weight. The pt has been taking the medication and developed metabolic syndrome. What is your next action?

Encourage exercise, provide nutritional counseling

A pt with bipolar disorder has thoughts of self-harm and needs a mood stabilizer that can decrease these thoughts. Which medication do you choose?

Lithium

A pt on Lithium plans to go on a hike. What statement shows they have good insight?

They plan to bring extra gallons of water

You are starting a 14yo female on Prozac. What do you need to make sure you assess for?

Frequency and severity of self-harm thoughts

A pt on Prozac c/o insomnia. What is your intervention?

Encourage them to take it in the morning

A MRI or PET scan is done to examine the brain of someone with schizophrenia. What would you expect to find?

Everything is decreased in size except the ventricles

What is a hallmark sign of schizophrenia?

Impaired proverb interpretation

A pt on Haldol 5mg PO BID is at a high risk for relapse. Convert this med to IM formulation for the first month dosage. What would the dose be?

200mg (give max of 100mg at a time)

A pt believes their classmates have joined a cult. What is this an example of?

Delusion

A pt on Zyprexa recently started smoking. What should you do to the dose?

Increase

A pt on Zyprexa recently stopped smoking. What should you do to the dose?

Decrease

A pt is taking both Tegretol and Erythromycin. What dose adjustment should be made?

Decrease Tegretol (inhibitor takes over inducer)

A pt is on flonase and a mood stabilizer. What should you do if they think the mood stabilizer is not working?

Increase dose of mood stabilizer

A pt with depression is prescribed Lexapro which will take 4-6 weeks to be effective. They then get started on Interferon. What adjustment should you make?

Increase dose of Lexapro

A pt with psychosis is on Abilify as well as Prednisone. Pt /o continued psychosis. What should you do?

Increase dose of Abilify

Which NTs are involved in addiction?

Dopamine, GABA

A pt with anorexia c/o pain or bloating after eating. What could this be caused by?

Delayed gastric emptying (Omeprazole, Famotidine)

A pt is very anxious and agitated, so you give them a benzo to help with symptoms. Instead of them helping, it causes the pt to have worsening symptoms. What is the patient experiencing?

Paradoxical effect

A pt is pregnant and has bipolar disorder. She is concerned that her child will also develop bipolar. How will you help her determine this risk?

Family history

A nurse went to work where they had previously been assaulted by a patient. Now the person is starting to have anxiety and insomnia. The symptoms have lasted for 3 weeks. What would your diagnosis be?

Acute stress disorder