Free Psychiatric Mental Health Nurse Practitioner (PMHNP) certification examination Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Psychiatric Mental Health Nurse Practitioner (PMHNP) certification examination practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A 29-year-old psychiatric outpatient answers yes to an Ask Suicide-Screening Questions (ASQ) item. The PMHNP has no further risk information yet. According to the NIMH clinical pathway, which assessment should come next?

   1. A. Repeat the four-item ASQ to establish whether the first response persists.
   2. B. Complete a brief suicide safety assessment to determine the need for further evaluation.
   3. C. Arrange a comprehensive mental health evaluation before clarifying the screen.
   4. D. Select outpatient follow-up based on the screening response alone.

   Answer: B

   Explanation: NIMH states, "Patients who screen positive for suicide risk on the ASQ should receive a brief suicide safety assessment (BSSA) conducted by a trained clinician" to determine whether a more comprehensive evaluation is needed. A positive screen calls for this intermediate assessment before choosing a disposition.

   Reference: NIMH Ask Suicide-Screening Questions (ASQ) Toolkit — What happens if patients screen positive?

2. 2A 24-year-old has a depressive episode and a documented seven-day manic episode with markedly elevated mood, increased activity, reduced need for sleep, grandiosity, and severe occupational impairment. No substance or medical cause is found. Which bipolar classification does this history support?

   1. A. Bipolar I disorder
   2. B. Bipolar II disorder
   3. C. Cyclothymic disorder
   4. D. Major depressive disorder

   Answer: A

   Explanation: NIMH states, "Bipolar I disorder is defined by manic episodes that last at least 7 days (most of the day, nearly every day) or when manic symptoms are so severe that hospital care is needed." The documented seven-day manic episode supports bipolar I classification.

   Reference: NIMH Bipolar Disorder — Types of bipolar disorder

3. 3A PMHNP reviews lamotrigine's labeled role in a bipolar I care plan. Which treatment phase matches the prescribing information?

   1. A. Maintenance to delay future mood episodes
   2. B. Acute treatment to end a manic episode
   3. C. Acute treatment to end a mixed episode
   4. D. Acute treatment to end a depressive episode

   Answer: A

   Explanation: The label states, "Lamotrigine tablets are indicated for the maintenance treatment of bipolar I disorder to delay the time to occurrence of mood episodes". Its acute mood episode treatment effectiveness has not been established.

   Reference: DailyMed Lamotrigine Tablets Prescribing Information — Section 1.2 Bipolar Disorder; Limitations of Use

4. 4A patient is taking clozapine for treatment-resistant psychosis. Although the federal REMS program has ended, which laboratory measure should the PMHNP continue to monitor for the serious blood-cell risk?

   1. A. Absolute neutrophil count
   2. B. Serum lithium concentration
   3. C. Thyroid-stimulating hormone
   4. D. Fasting serum triglycerides

   Answer: A

   Explanation: FDA says, "Prescribers should continue to monitor their patients’ ANC before starting clozapine and during treatment according to the prescribing information" because severe neutropenia remains a risk. Removal of REMS reporting did not remove clinical ANC monitoring.

   Reference: FDA Removes Clozapine REMS Program — What Should Health Care Professionals Do?

5. 5During an outpatient suicide risk interview, an adult says they have no detailed suicide plan. Which follow-up best assesses whether a potential plan could be carried out?

   1. A. Ask how often suicidal thoughts occur during a typical week.
   2. B. Ask whether a trusted person is available for support.
   3. C. Ask about a possible method and access to the means.
   4. D. Ask when any earlier self-injury last occurred.

   Answer: C

   Explanation: The NIMH worksheet instructs clinicians to "Assess if the patient has a suicide plan, regardless of how they responded to any other questions (ask about method and access to means)." Method and access test feasibility even when the patient has not described a detailed plan.

   Reference: NIMH Adult Outpatient Brief Suicide Safety Assessment Worksheet — Suicide Plan

6. 6An adult reports difficult-to-control worry on most days with restlessness, fatigue, and muscle tension. When considering generalized anxiety disorder, what is the minimum duration of this worry specified by NIMH?

   1. A. At least 2 weeks
   2. B. At least 1 month
   3. C. At least 6 months
   4. D. At least 12 months

   Answer: C

   Explanation: NIMH specifies, "To be diagnosed with GAD, a person must find it difficult to control worry on most days for at least 6 months." The listed symptoms meet the symptom-count context; the question asks only for the minimum worry duration.

   Reference: NIMH Generalized Anxiety Disorder: What You Need to Know — How is generalized anxiety disorder diagnosed?

7. 7A patient with bipolar depression asks why an antidepressant will not be prescribed without a mood stabilizer or atypical antipsychotic. Which treatment-emergent syndrome does NIMH specifically warn about with antidepressant monotherapy?

   1. A. A manic episode
   2. B. Serotonin syndrome
   3. C. Tardive dyskinesia
   4. D. Neuroleptic malignant syndrome

   Answer: A

   Explanation: NIMH states, "antidepressants are not used alone because they can trigger a manic episode or rapid cycling in a person with bipolar disorder." The specific bipolar-course risk is mania, while the other choices are distinct adverse syndromes associated with different drug effects.

   Reference: NIMH Bipolar Disorder — How is bipolar disorder treated? / Medications

8. 8At a follow-up visit for a patient taking lithium for bipolar disorder, which monitoring set is most directly supported by NIMH?

   1. A. Lithium level, kidney function, and thyroid function.
   2. B. Neutrophil count, hemoglobin, and platelet count.
   3. C. Weight, fasting glucose, and serum lipid levels.
   4. D. Liver enzymes, pancreatic enzymes, and platelets.

   Answer: A

   Explanation: NIMH states that clinicians generally ask people taking lithium to undergo "regular monitoring to check lithium levels and kidney and thyroid function." The other panels are used for different medication concerns.

   Reference: NIMH Mental Health Medications — What are mood stabilizers?

9. 9A patient reports an episode of self-injury two years ago. The PMHNP needs to clarify whether the patient intended to die during that episode. Which interview question targets that judgment most directly?

   1. A. What method did you use during that episode?
   2. B. When did the episode occur?
   3. C. Did you receive medical care afterward?
   4. D. Did you want to die when you injured yourself?

   Answer: D

   Explanation: For past behavior, the NIMH worksheet directs the clinician to assess intent by asking "Did you want to die?" Method, timing, and treatment are also history elements, but they do not directly elicit the patient's intent at that time.

   Reference: NIMH Adult Outpatient Brief Suicide Safety Assessment Worksheet — Past Behavior

10. 10An adult has trauma-related re-experiencing, avoidance, arousal, and mood symptoms with functional impairment; medication, substance use, and other illness do not explain them. What minimum duration must these symptoms exceed before PTSD criteria can be met?

    1. A. Longer than 2 weeks
    2. B. Longer than 1 month
    3. C. Longer than 6 months
    4. D. Longer than 12 months

    Answer: B

    Explanation: NIMH says, "To meet the criteria for PTSD, a person must have symptoms for longer than 1 month," with interference in daily life and exclusion of medication, substance use, or another illness. The stem supplies those other conditions, and the duration threshold is longer than one month.

    Reference: NIMH Post-Traumatic Stress Disorder — What are the symptoms of PTSD?