PMHNP-BC Practice Questions (2026) — Free Sample Questions with Answers

Answer: D

Give cyproheptadine and continue the antipsychotic at a lower dose: Cyproheptadine treats serotonin syndrome, which features clonus and hyperreflexia. Continuing any dopamine blocker would worsen NMS.

Add benztropine and recheck the CK level in 1 week: Anticholinergics treat dystonia and parkinsonism, not NMS, and can impair heat loss. A week's delay ignores a life-threatening emergency.

Switch to an intramuscular second-generation antipsychotic: Second-generation antipsychotics also block D2 receptors and can cause or prolong NMS; all antipsychotics should be stopped.

Stop the haloperidol and begin cooling, IV fluids and close monitoring: Correct. Fever, rigidity, autonomic instability, altered mental status and a high CK after a D2 blocker indicate NMS. Stop the drug and give intensive supportive care; dantrolene or bromocriptine may be added.

NMS = dopamine blockade + hyperthermia + lead-pipe rigidity + autonomic instability + high CK, developing over days; stop the antipsychotic and support. Clonus and hyperreflexia point to serotonin syndrome instead.

Answer: B

Tangential thinking: In tangentiality the patient drifts away from the question and never returns to it. This patient does answer it.

Circumstantial thinking: Correct. Circumstantiality includes too much unnecessary detail but the patient eventually reaches the point ("I can't sleep").

Flight of ideas: Flight of ideas is rapid, pressured jumping between loosely linked topics, typical of mania; this speech is slow and detailed but linked.

Loosening of associations: Loose associations show no logical link between ideas. Here each detail connects plainly to the next.

Circumstantial = gets to the goal the long way; tangential = never gets there; loose associations = no logical links between ideas.

Answer: C

Moderate depression; repeat the PHQ-9 at the next routine visit: A score of 10–14 is moderate; 17 is higher. Any positive item 9 also needs same-day evaluation, not a delay.

Mild depression; offer watchful waiting and supportive counseling: Mild is 5–9. Watchful waiting is not appropriate at 17 with a positive suicide item.

Moderately severe depression; complete a suicide risk assessment now: Correct. Scores of 15–19 are moderately severe and usually call for active treatment. A positive item 9 requires a direct suicide risk assessment at this visit.

Severe depression; arrange involuntary hospitalization right away: Severe is 20–27. A positive item 9 is a screening result that calls for assessment, not automatic involuntary admission.

PHQ-9 bands: 0–4 minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe; any positive item 9 needs a same-visit suicide risk assessment.

Answer: A

Bipolar II disorder, current episode depressed: Correct. At least one hypomanic episode (4 or more consecutive days, observable change, no marked impairment or hospitalization) plus a major depressive episode, with no history of mania, is bipolar II.

Bipolar I disorder, current episode depressed: Bipolar I requires a manic episode: 7 days or more (or any duration if hospitalized) with marked impairment or psychosis. Her episodes did not reach that level.

Cyclothymic disorder with superimposed depression: Cyclothymia is excluded once full major depressive episode criteria have been met.

Major depressive disorder, recurrent, with mixed features: Her hypomanic periods happened separately from depression, so they are distinct hypomanic episodes, which rules out unipolar depression.

Hypomania (4 days or more, no marked impairment) + major depression = bipolar II; any full mania (7 days or more, or hospitalization, or psychosis) = bipolar I.

Answer: C

Precontemplation, with no intent to change in 6 months: This patient openly considers quitting, so is past precontemplation.

Preparation, with a plan to act within the next month: Preparation involves intending to act within about 30 days, often with concrete steps such as setting a quit date, which the patient declines.

Contemplation, intending change within about 6 months: Correct. Contemplation is awareness of the problem and intent to change in the foreseeable future (within about 6 months) without a commitment to act yet.

Action, having changed the behavior in the past 6 months: Action means the behavior has already been modified; this patient is still smoking.

TTM stages: precontemplation, contemplation, preparation, action, maintenance; match interventions to the stage (in contemplation, explore ambivalence and the pros and cons).

Answer: A

Breach confidentiality as state law allows to warn and protect the victim: Correct. Under Tarasoff-type duty-to-protect laws, a serious threat of violence against an identifiable victim requires reasonable protective steps, such as warning the victim and notifying police and considering hospitalization, following state law.

Keep the statement confidential because it was made in psychotherapy: Confidentiality is not absolute; a serious threat against an identifiable person triggers a duty to protect.

Document the threat and address it again at the next scheduled visit: Documentation alone, with a delay, does not protect someone facing an imminent, specific threat.

Notify the patient's employer so they can restrict his building access: This discloses information to a party who is not the target and does not protect the named victim.

Serious threat + identifiable victim means a duty to protect: take reasonable steps (warn, notify police, hospitalize) as your state's law defines.