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See where you stand before you buy. These sample questions match the ANCC
PMHNP-BC style — scenario-based, single best answer, with a rationale that explains the
reasoning. Work each one before reading the answer.
Unlock 2,600+ PMHNP-BC practice questions across 14 full-length simulators — $19.99 lifetime →
How close are these to the real PMHNP-BC exam?
The PMHNP-BC is 200 questions (175 scored) over 4 hours, weighted toward advanced practice skills,
diagnosis and treatment, and the scientific foundation — with psychopharmacology running
throughout. The samples below reflect that.
Sample PMHNP-BC questions
- A patient on lithium presents with coarse tremor, ataxia, vomiting, and confusion. The
priority action is to:- A. Increase the lithium dose
- B. Hold lithium and obtain a lithium level
- C. Add an SSRI
- D. Reassure and continue
Answer: B. Those are signs of lithium toxicity. Hold the drug and check a level
— lithium has a narrow therapeutic index (about 0.6–1.2 mEq/L), and toxicity can be
life-threatening. - Which monitoring is essential for a patient started on clozapine?
- A. Liver enzymes only
- B. Absolute neutrophil count (ANC)
- C. Thyroid panel
- D. No special monitoring
Answer: B. Clozapine can cause severe neutropenia/agranulocytosis, so ANC
monitoring is mandatory through a REMS program. It’s reserved for treatment-resistant cases for this reason. - A patient with bipolar disorder is in a depressive episode. Prescribing an antidepressant
alone risks:- A. Serotonin deficiency
- B. Inducing mania or rapid cycling
- C. Hypothyroidism
- D. No particular risk
Answer: B. Antidepressant monotherapy in bipolar disorder can trigger a manic
switch or rapid cycling; a mood stabilizer is the foundation of treatment. - A patient on an SSRI who is also taking a triptan and tramadol develops agitation,
hyperthermia, clonus, and diaphoresis. This suggests:- A. Neuroleptic malignant syndrome
- B. Serotonin syndrome
- C. Anticholinergic toxicity
- D. Lithium toxicity
Answer: B. Multiple serotonergic agents plus hyperthermia, clonus, and autonomic
signs point to serotonin syndrome. Stop the serotonergic drugs and provide supportive care. - Long-term use of a first-generation (typical) antipsychotic carries the highest risk of:
- A. Weight gain and diabetes
- B. Tardive dyskinesia and extrapyramidal symptoms
- C. Agranulocytosis
- D. QT shortening
Answer: B. Typical antipsychotics carry a higher risk of EPS and tardive
dyskinesia; atypicals are more associated with metabolic effects (A). Matching side-effect profiles
to agents is high-yield.
How did you do?
If the psychopharmacology felt shaky, that’s what practice is for. Our bank has 2,600+ PMHNP-BC
questions across 14 timed simulators with rationales like these, plus a free sample test.
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Sources & references
The exam facts on this page are drawn from official certifying-body materials, reviewed 2026-06-18 by the DrCertifications exam-prep team (10+ years in exam preparation and publishing).