PMHNP-BC Study Guide: All-In-One Guide + 4 Exam Practice Test (1400 Questions), Latest for Psychiatric Mental Health Nurse Practitioner(PMHNP-BC), OrganizationName AANPCB

A 32-year-old male with treatment-resistant schizophrenia stabilized on clozapine 400mg daily for 6 months presents to the outpatient clinic reporting severe constipation for the past 3 weeks. He describes hard stools, straining, and infrequent bowel movements (twice weekly). He denies abdominal pain, blood in stool, weight loss, or changes in diet/activity. His physical exam is unremarkable, and vital signs are normal. He states he has been compliant with clozapine and denies other medications or supplements. What is the PMHNP’s priority intervention?

When selecting an initial antidepressant for a 65-year-old patient with major depressive disorder and a history of osteoporosis, which pharmacodynamic property is the *highest priority* consideration to minimize fall risk?

A 45-year-old teacher seeks evaluation after a motor vehicle accident 4 weeks ago. She reports intrusive nightmares, avoidance of driving, hypervigilance, and difficulty concentrating since the event. Symptoms cause significant anxiety but no dissociation or functional impairment. She denies prior trauma history. The PMHNP-BC reviews DSM-5-TR criteria to determine the *priority* diagnosis.

A PMHNP is reviewing a patient’s GAD-7 score obtained during a routine primary care visit. The patient scored 12. According to established guidelines for GAD-7 interpretation, what is the *most appropriate* next step in clinical assessment for this patient?

A PMHNP is leading a team implementing a new electronic health record (EHR) system in a community mental health center. A seasoned nurse frequently states, “The old system worked fine,” and subtly discourages colleagues from attending training, though she complies minimally. The PMHNP aims to foster sustainable adoption using Lewin’s Change Theory. What is the *most* effective initial action by the PMHNP?

A 32-year-old female with a history of chronic migraines presents to the PMHNP clinic. She reports 8-10 debilitating migraines monthly, poorly controlled on propranolol. She desires pregnancy within the next year. The PMHNP considers preventive therapy. Which medication is the *most appropriate* initial choice considering her reproductive plans?

A 35-year-old female with ADHD and well-controlled hypertension (lisinopril 10 mg daily) is prescribed extended-release methylphenidate 36 mg daily. At her 1-month follow-up, her ADHD symptoms improved, but her BP is 148/92 mmHg (baseline 128/82 mmHg pre-stimulant). She denies caffeine excess or other medication changes. Which action by the PMHNP is *most* appropriate?

When evaluating emotional regulation development in a typically developing preschool-aged child (3-5 years), which capacity represents the primary developmental expectation according to established norms?

When releasing psychotherapy notes to a third-party payer for treatment purposes, which principle primarily governs the scope of information disclosed by the PMHNP?

A 9-year-old boy is brought by his parents to the PMHNP clinic. His teacher reports significant inattention and difficulty completing assignments, leading to declining grades over the past 6 months. Parents state he “focuses well” during video games but becomes easily distracted during homework. Physical exam and hearing/vision screening are normal. The parents are hesitant about medication. *As the PMHNP, what is the priority next step?*

A PMHNP is meeting a new client, a 22-year-old refugee who recently arrived from a conflict zone, presenting with symptoms consistent with PTSD. During the initial assessment, the client speaks softly, frequently diverts their gaze, and provides minimal responses to questions about their trauma history. The PMHNP has 30 minutes allocated for this intake segment. Recognizing the need to establish a foundational therapeutic alliance, what is the *most appropriate* initial approach by the PMHNP?

A PMHNP in a community clinic evaluates a transgender woman experiencing depression. She discloses avoiding past care due to providers misgendering her. The clinic’s EHR lacks dedicated gender identity fields, requiring staff to manually note pronouns. The patient now expresses hopelessness about “systems not seeing her.” What is the PMHNP’s most effective initial action to promote equitable care?

When implementing exposure therapy for a specific phobia, what is the primary mechanism by which the intervention achieves a reduction in the fear response according to behavioral principles?

A 72-year-old male with Major Depressive Disorder, recurrent, moderate, presents for follow-up 4 weeks after starting citalopram 20 mg daily. His PHQ-9 score decreased from 18 to 14. He reports improved mood but significant new fatigue and a 5-pound unintentional weight loss. Past medical history includes well-controlled hypertension (lisinopril 10 mg daily). Physical exam is unremarkable except for mild orthostatic hypotension. Vital signs: BP 128/82 mmHg (sitting), 112/70 mmHg (standing); HR 72 bpm. Which action by the PMHNP is *most* appropriate at this time?

A 58-year-old male with Major Depressive Disorder (MDD), previously unresponsive to two adequate trials of SSRIs, presents with persistent anhedonia, psychomotor retardation, and significant fatigue. The PMHNP is considering a medication with a primary mechanism targeting the mesolimbic dopamine pathway. Which medication choice is *most* aligned with this neurophysiological target?

When considering routine screening for hypothyroidism in an asymptomatic adult psychiatric patient, which factor represents the strongest evidence-based indication according to current major guidelines?

A 78-year-old female with major depressive disorder and osteoarthritis is admitted for a fall. Her medications include sertraline 100 mg daily, hydrocodone/acetaminophen 5/325 mg QID PRN pain, and temazepam 15 mg HS. She reports persistent low mood and sedation. Recent labs show normal hepatic/renal function. The PMHNP must optimize her regimen. *Which intervention is most evidence-based?*

In developing an inclusive organizational policy for transgender patient care, which approach *best* integrates the principle of cultural humility to mitigate implicit bias among nursing staff?

A 9-year-old child is brought to the PMHNP by his parents due to increasing difficulty focusing in school and frequent “daydreaming.” Teachers report he stares blankly for 5-10 seconds several times daily, during which he is unresponsive. He resumes activity immediately afterward with no recall. There is no overt motor activity during episodes. His parents note he occasionally drops objects just before an episode. Developmental history is otherwise normal. Based on this paroxysmal alteration in awareness, what is the most appropriate diagnostic consideration?

When evaluating a patient presenting with acute onset of auditory hallucinations and paranoid delusions occurring immediately after a 48-hour cocaine binge, which diagnostic principle takes precedence in the initial differential diagnosis according to standard psychiatric diagnostic systems?

When interpreting a CIWA-Ar score of 18 for a patient in alcohol withdrawal, what is the PRIMARY clinical implication guiding immediate intervention?

A PMHNP seeks an evidence-based, validated tool to monitor symptom change in adults with major depressive disorder during pharmacotherapy in an outpatient setting. Which tool is *most appropriate* based on its psychometric properties and alignment with clinical practice guidelines?

A 56-year-old male with Major Depressive Disorder (MDD) stabilized on fluoxetine 40mg daily for 6 months presents to the PMHNP with new-onset diffuse muscle aches and fatigue worsening over 3 weeks. He denies trauma, fever, or rash. Vital signs are normal. Physical exam reveals mild diffuse tenderness to palpation in major muscle groups but no weakness, swelling, or erythema. Recent basic metabolic panel and CBC are unremarkable. The patient expresses worry this is “a sign the depression is coming back.” Which action is the PMHNP’s priority?

A PMHNP is conducting an initial evaluation with a 25-year-old client who presents with tearfulness and reports a recent diagnosis of Generalized Anxiety Disorder from their PCP. The client states, “I just feel so overwhelmed all the time,” and looks down, wringing their hands. The PMHNP wants to encourage the client to elaborate on their experience and understand the specific nature of their overwhelm. Which question by the PMHNP is *most* appropriate at this point?

A PMHNP is preparing to obtain consent for electroconvulsive therapy (ECT) from a 68-year-old patient with severe treatment-resistant depression. The patient nods politely but has limited English proficiency. Her daughter, who is fluent in English, states, “I’ll translate everything for my mother.” The PMHNP notes the patient defers all questions to her daughter. How should the PMHNP proceed to ensure ethically valid informed consent?

A 58-year-old female with major depressive disorder (stable on sertraline 150 mg daily) and chronic low back pain presents for follow-up. She reports her pain significantly impacts her mood and function. She has a history of alcohol use disorder (sober 3 years) and reports ibuprofen provides minimal relief but causes stomach upset. Her exam reveals no neurological deficits. Considering her psychiatric history and comorbidities, which pharmacologic agent for pain management is the *most appropriate* initial choice for the PMHNP to prescribe?

A PMHNP is conducting an initial psychotherapy session with a 35-year-old client who experienced childhood sexual abuse. The client suddenly becomes quiet, stares blankly at the wall, and fidgets intensely while whispering, “I don’t deserve help.” The clinic policy limits session extensions, and the next appointment is in two weeks. Which action should the PMHNP prioritize *first* to maintain the therapeutic alliance using a trauma-informed approach?

A 58-year-old patient with Bipolar I Disorder, currently experiencing a moderate depressive episode despite 6 weeks of therapeutic serum lithium levels (0.8 mEq/L), is prescribed adjunctive therapy. The PMHNP understands the patient has a partial response to lithium but significant residual anhedonia and psychomotor retardation. Considering pharmacodynamic principles of receptor activity, which augmentation strategy is *most* appropriate to target the residual symptoms effectively?

When managing new-onset hyperglycemia attributed to a second-generation antipsychotic (SGA) in a patient with schizophrenia and no prior diabetes history, which pharmacologic intervention is consistently recommended as the first-line treatment according to major diabetes and psychiatric guidelines?

A 16-year-old high school student is brought to the school nurse’s office by a teacher after expressing passive suicidal thoughts (“I wish I wasn’t here anymore”) during class. The student appears withdrawn, has poor eye contact, and reports insomnia for 3 weeks following parental divorce. They deny active suicidal intent or plan but state, “I just can’t handle things.” The school’s policy mandates parental notification for safety concerns. The student pleads, “Please don’t tell my parents; they’ll get mad.” The nurse has 10 minutes before the next class.