Free Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) (PMHNP-BC™) Board Certification Examination Practice Questions

Sample Practice Questions

Try these 10 sample questions from the Psychiatric-Mental Health Nurse Practitioner (Across the Lifespan) (PMHNP-BC™) Board Certification Examination practice bank. Each includes the answer and explanation. Continue with the interactive practice above to review the full question set.

1. 1A patient taking lithium begins a thiazide diuretic. What change in lithium exposure should the PMHNP anticipate?

   1. A. A lower serum lithium concentration due to increased urinary excretion
   2. B. A higher serum lithium concentration due to diuretic-related sodium loss
   3. C. A lower serum lithium concentration due to faster hepatic metabolism
   4. D. A higher serum lithium concentration due to reduced gastrointestinal absorption

   Answer: B

   Explanation: The FDA label states, "Diuretic-, ACE-, and ARB-induced sodium loss may increase serum lithium concentrations." A thiazide is a diuretic, so increased serum lithium exposure is the concern.

   Reference: FDA lithium carbonate extended release tablets prescribing information — Drug Interactions, page 4

2. 2A PMHNP suspects suicide risk in a seven-year-old child. According to the NIMH ASQ toolkit, which approach is recommended for this age?

   1. A. Use the four-item ASQ screening questionnaire
   2. B. Use the adult ASQ screening questionnaire
   3. C. Arrange a full mental health evaluation
   4. D. Use the PHQ-9 depression screening questionnaire

   Answer: C

   Explanation: NIMH states, "As there are no tools validated for use in kids under the age of 8 years, if suicide risk is suspected in younger children a full mental health evaluation is recommended instead of screening." This child is younger than eight.

   Reference: NIMH Ask Suicide-Screening Questions Toolkit — Using the Toolkit

3. 3A patient has a clinician-confirmed major depressive episode and a separate clinician-confirmed hypomanic episode meeting full episode criteria. No manic episode has occurred. Which bipolar diagnosis matches this course?

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

   Answer: B

   Explanation: APA states, "To diagnose bipolar II disorder in an individual, they must have at least one major depressive episode and at least one hypomanic episode (see above)." The documented episodes meet this requirement, and no manic episode is present.

   Reference: American Psychiatric Association: What Are Bipolar Disorders? — Bipolar II Disorder

4. 4A patient with depression repeatedly interprets small setbacks as proof of total failure. Which psychotherapy principle centers on identifying and changing such ineffective thought patterns while practicing more functional behavior?

   1. A. Cognitive behavioral therapy
   2. B. Interpersonal therapy
   3. C. Psychodynamic therapy
   4. D. Supportive therapy

   Answer: A

   Explanation: The APA explains, "Cognitive behavioral therapy (CBT) helps people identify and change thinking and behavior patterns that are unhealthy or ineffective, replacing them with more accurate thoughts and functional behaviors." The patient’s interpretation and behavior pattern are the targets of CBT.

   Reference: American Psychiatric Association: What Is Psychotherapy? — Types of Psychotherapy / Cognitive behavioral therapy

5. 5A PMHNP in a HIPAA-covered practice maintains several types of patient information. Which record qualifies as specially protected psychotherapy notes under the Privacy Rule?

   1. A. Separately maintained analysis of a private counseling conversation
   2. B. Medication prescriptions and monitoring in the medical record
   3. C. Counseling session start and stop times in the medical record
   4. D. Diagnosis and treatment plan summaries in the medical record

   Answer: A

   Explanation: HHS defines psychotherapy notes as notes "documenting or analyzing the contents of a conversation during a private counseling session" that are "separate from the rest of the patient’s medical record." Medication, session times, and summaries are expressly excluded.

   Reference: HHS: Does HIPAA Provide Extra Protections for Mental Health Information? — Definition of psychotherapy notes

6. 6During a medication review for a patient taking lithium, which newly added drug is specifically associated with a reduction in serum lithium concentration?

   1. A. Indomethacin
   2. B. Metronidazole
   3. C. Acetazolamide
   4. D. Piroxicam

   Answer: C

   Explanation: The label states, "The following drugs can lower serum lithium concentrations by increasing urinary lithium excretion: acetazolamide, urea, xanthine preparations, and alkalinizing agents such as sodium bicarbonate." Acetazolamide is the listed agent; the other options have different interaction concerns.

   Reference: FDA lithium carbonate extended release tablets prescribing information — Drug Interactions, page 4

7. 7In an outpatient visit, a patient says yes to one of the four ASQ screening questions. How should the PMHNP interpret that result?

   1. A. As a negative screen requiring no follow-up
   2. B. As a positive screen requiring safety assessment
   3. C. As an indeterminate screen requiring repetition
   4. D. As an acute positive screen requiring admission

   Answer: B

   Explanation: The NIMH information sheet specifies, "Positive screen: “yes” to any of the 4 items" and directs further acuity assessment after a positive response. One yes answer is therefore sufficient for a positive screen.

   Reference: NIMH ASQ Information Sheet — ASQ Information Sheet, Positive screen

8. 8A PMHNP evaluates a patient with delusions, hallucinations, and disorganized speech that have persisted for two months. Substance and medical causes have been excluded, and there has been no major mood episode. Which psychotic disorder best matches this duration?

   1. A. Brief psychotic disorder
   2. B. Schizophrenia
   3. C. Schizophreniform disorder
   4. D. Schizoaffective disorder

   Answer: C

   Explanation: The APA states, "The symptoms of schizophreniform disorder are similar to those of schizophrenia, but the symptoms only last a short time—at least one month but less than six months." Two months falls in this interval, while the other diagnoses require a different duration or mood-episode pattern.

   Reference: American Psychiatric Association: What Is Schizophrenia? — Related Conditions / Schizophreniform Disorder

9. 9A patient develops depression after a role transition and unresolved conflict with a close relative. Which psychotherapy model focuses specifically on these interpersonal problem areas?

   1. A. Interpersonal therapy
   2. B. Cognitive behavioral therapy
   3. C. Psychoanalysis
   4. D. Exposure therapy

   Answer: A

   Explanation: The APA states, "Interpersonal therapy (IPT) is a short-term form of treatment. It helps patients understand underlying interpersonal issues that are troublesome, like unresolved grief, changes in social or work roles, conflicts with significant others, and problems relating to others." The case fits those IPT targets.

   Reference: American Psychiatric Association: What Is Psychotherapy? — Types of Psychotherapy / Interpersonal therapy

10. 10A PMHNP working for a HIPAA-covered entity is asked to send separately maintained psychotherapy notes to another treating clinician. No exception applies. What permission does the Privacy Rule generally require?

    1. A. The patient's authorization for the notes disclosure
    2. B. Only the patient's informal agreement in the room
    3. C. Only a general treatment consent for the medical record
    4. D. Only the requesting clinician's treatment purpose

    Answer: A

    Explanation: HHS states that "with few exceptions, the Privacy Rule requires a covered entity to obtain a patient’s authorization prior to a disclosure of psychotherapy notes for any reason, including a disclosure for treatment purposes to a health care provider other than the originator of the notes." A routine treatment request alone does not remove this requirement.

    Reference: HHS: Does HIPAA Provide Extra Protections for Mental Health Information? — Disclosure of psychotherapy notes