ANCC PMHNP-BC Cheat Sheet

Scientific Foundation

22% of exam
Pathophysiology Pharmacology Neurobiology Psychogenomics Physical assessment

Advanced Practice Skills

27% of exam
Clinical interviewing Mental status exam Risk assessment Screening tools Recovery planning

Diagnosis and Treatment

22% of exam
DSM-5-TR diagnosis Differential diagnosis Psychopharmacology Complementary care Treatment planning

Psychotherapy and Related Theories

11% of exam
Therapy modalities Behavior change Developmental theory Family systems Therapeutic alliance

Ethics, Legal Principles, and Cultural Care

17% of exam
Patient rights Confidentiality Ethical principles Cultural humility Advocacy

Quick Facts

Credential PMHNP-BC
Total questions 175
Scored questions 150
Pretest questions 25 unscored
Exam time 3.5 hours
Passing score 350 scaled
Testing vendor Prometric
Testing window 120 days
Credential term 5 years
Clinical minimum 500 supervised hours
Current fees $220-$395 by membership

Serotonin Syndrome vs NMS SC

Serotonin syndrome

Clonus and hyperreflexia
Rapid onset
GI symptoms common

NMS

Lead-pipe rigidity
Slower onset
Elevated CK common
Neuromuscular pattern separates them

Adverse Effect Triage SC

Clonus and hyperreflexia → Suspect serotonin syndrome ( Stop serotonergic agents )
Fever and severe rigidity → Suspect malignant syndrome ( Urgent medical treatment )
Painful sustained contraction → Treat acute dystonia ( Protect airway )
Distressing inner restlessness → Assess for akathisia ( Do not mislabel agitation )
Delayed involuntary movements → Assess tardive dyskinesia ( Use structured scale )
Coarse tremor and ataxia → Assess lithium toxicity ( Check level and kidneys )
Rash with mucosal lesions → Stop culprit medication ( Urgent medical evaluation )
Fever with neutropenia → Escalate infection care ( Review clozapine management )

Neurotransmitters and Dopamine Pathways SC

Mesolimbic pathway Positive psychotic symptoms
Mesocortical pathway Negative and cognitive symptoms
Nigrostriatal pathway Movement and EPS effects
Tuberoinfundibular pathway Prolactin regulation
Serotonin Mood, anxiety, sleep, appetite
Norepinephrine Arousal, attention, energy
Dopamine Reward, motivation, movement
GABA Primary inhibitory signaling
Glutamate Primary excitatory signaling
Acetylcholine Attention, memory, learning
HPA axis Coordinates stress response

Positive vs Negative Symptoms SC

Positive

Hallucinations
Delusions
Disorganized speech

Negative

Avolition
Anhedonia
Diminished expression
Added versus diminished function

Psychotropic Mechanism Essentials SC

SSRIs Inhibit serotonin reuptake
SNRIs Inhibit serotonin and norepinephrine reuptake
Bupropion Inhibits norepinephrine and dopamine reuptake
Mirtazapine Blocks alpha-2, H1, serotonin receptors
Benzodiazepines Modulate GABA-A receptors
Typical antipsychotics Primarily block D2 receptors
Atypical antipsychotics Modulate dopamine and serotonin
Partial D2 agonists Stabilize dopamine signaling
Stimulants Increase catecholamine signaling
Cholinesterase inhibitors Reduce acetylcholine breakdown
CYP inhibitor May raise substrate levels
CYP inducer May lower substrate levels

High-Risk Adverse Syndromes SC

Serotonin syndrome Clonus, hyperreflexia, fever, diaphoresis
Neuroleptic malignant syndrome Rigidity, fever, elevated CK
Acute dystonia Sustained painful muscle contractions
Akathisia Distressing inner restlessness
Drug-induced parkinsonism Rigidity, tremor, bradykinesia
Tardive dyskinesia Delayed involuntary movements
Lithium toxicity GI upset, coarse tremor, ataxia
SJS or TEN Rash plus mucosal involvement
Severe neutropenia Infection risk; urgent evaluation
Anticholinergic toxicity Delirium, dryness, retention, hyperthermia
Valproate pregnancy risk Major fetal harm risk

CAGE Alcohol Screen AD

Cut down, Annoyed, Guilty, Eye-opener
Cut down Criticism annoyed Feel guilty Morning eye-opener

Mood vs Affect AD

Mood

Patient reports it
Sustained internal state
Quote patient when useful

Affect

Clinician observes it
Range and reactivity
Congruence matters
Mood reported; affect observed

Suicide Safety Triage AD

Current plan, intent, means → Emergency evaluation now ( Maintain immediate safety )
Recent attempt disclosed → Escalate level of care ( Assess medical needs )
Intoxication impairs assessment → Stabilize and reassess ( Risk remains dynamic )
Command hallucinations threaten harm → Protect and evaluate urgently ( Assess ability to resist )
Means remain accessible → Create lethal-means plan ( Use collaborative counseling )
No imminent danger → Build collaborative safety plan ( Document risk formulation )
Outpatient disposition chosen → Arrange timely follow-up ( Specify crisis resources )

Mental Status Examination AD

Appearance Grooming, dress, apparent age
Behavior Activity, cooperation, eye contact
Speech Rate, volume, fluency, latency
Mood Patient-reported emotional state
Affect Observed emotional expression
Thought process Organization and associations
Thought content Beliefs, preoccupations, safety themes
Perception Hallucinations and illusions
Cognition Orientation, attention, memory
Insight Understanding illness and needs
Judgment Anticipating choices and consequences

ASEPTIC Mental Status AD

Appearance, Speech, Emotion, Perception, Thought, Insight, Cognition
Appearance behavior Speech Mood affect Perception Thought Insight judgment Cognition

Screening and Assessment Tools AD

PHQ-9 Depression symptom severity
GAD-7 Generalized anxiety symptom severity
C-SSRS Suicidal ideation and behavior
SAFE-T Structures suicide evaluation
AIMS Tardive dyskinesia monitoring
CIWA-Ar Alcohol withdrawal severity
COWS Opioid withdrawal severity
AUDIT Hazardous alcohol use
DAST Drug-related problem screening
CAM Delirium detection
MoCA Brief cognitive screening
Vanderbilt scales Child ADHD symptom ratings

Suicide and Violence Formulation AD

Prior attempt Key historical suicide risk
Current ideation Ask frequency and intensity
Plan Assess specificity and lethality
Intent Assess expected action
Means access Assess firearms and medications
Dynamic factors Intoxication, agitation, acute loss
Protective factors Do not erase acute risk
Collateral information Clarifies baseline and access
Safety plan Steps through lethal-means safety
Level of care Match acuity and supports
Follow-up Specify timing and responsibility

Medication Monitoring Map AD

Lithium baseline Renal, thyroid, calcium, pregnancy
Lithium levels Use timed trough concentrations
Valproate CBC, liver tests, pregnancy
Carbamazepine CBC, liver tests, sodium
Antipsychotic metabolic Weight, pressure, glucose, lipids
Antipsychotic movement Structured movement assessment
Clozapine ANC per current labeling
Stimulants Pressure, pulse, growth, misuse
SSRIs and SNRIs Suicidality, sodium, bleeding, activation
Urine immunoassay Treat result as presumptive
Pharmacogenomics Adjunct, not diagnostic replacement

DIG FAST Mania DI

Distractibility, Indiscretion, Grandiosity, Flight, Activity, Sleep, Talk
Distractible Risky behavior Grandiose Flight of ideas Goal activity Sleep decreased Talkative

Mania vs Hypomania DI

Mania

Marked impairment
Hospitalization may occur
Psychosis may occur

Hypomania

Observable functional change
No marked impairment
No psychosis
Severity outranks duration alone

Diagnostic Duration Picker DI

Psychosis under one month → Consider brief psychosis ( Minimum one day )
Psychosis one to six months → Consider schizophreniform disorder ( Exclude mood and substances )
Disturbance at least six months → Consider schizophrenia ( Check active-phase criteria )
Trauma symptoms under one month → Consider acute stress ( Minimum three days )
Trauma symptoms exceed one month → Consider PTSD ( Confirm full clusters )
Elevation lasts four days → Consider hypomania ( No marked impairment )
Elevation lasts one week → Consider mania ( Hospitalization overrides duration )

Diagnostic Time Anchors DI

Major depression Two weeks; five symptoms
Mania One week or hospitalization
Hypomania Four consecutive days
Generalized anxiety Six months excessive anxiety
Acute stress disorder Three days through one month
PTSD Symptoms exceed one month
Brief psychotic disorder One day under one month
Schizophreniform disorder One through six months
Schizophrenia Continuous disturbance six months
Persistent depressive disorder Two years in adults
Cyclothymic disorder Two years in adults

SIGECAPS Depression DI

Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicide
Sleep change Interest loss Guilt Low energy Poor concentration Appetite change Psychomotor change Suicidality

Delirium vs Neurocognitive Disorder DI

Delirium

Acute and fluctuating
Attention impaired
Medical cause likely

Neurocognitive disorder

Usually gradual decline
Attention often preserved early
Independence may decline
Acute inattention signals delirium

High-Yield Diagnostic Discriminators DI

Delirium Acute fluctuating inattention
Major neurocognitive disorder Decline impairs independence
Bipolar I Mania defines diagnosis
Bipolar II Hypomania plus major depression
Schizoaffective disorder Psychosis persists without mood episode
OCD Usually ego-dystonic symptoms
OCPD Usually ego-syntonic traits
ADHD Childhood onset; multiple settings
Substance-induced disorder Symptoms track substance exposure
Normal grief Waves with preserved self-worth
Major depression Pervasive symptoms and impairment

Obsession vs Delusion DI

Obsession

Intrusive recurring thought
Usually unwanted
Often resisted

Delusion

Fixed false belief
Held despite evidence
Insight often absent
Assess conviction and insight

Evidence-Based Treatment Pairings DI

OCD ERP plus serotonergic medication
PTSD Trauma-focused psychotherapy
Borderline personality Dialectical behavior therapy
Chronic insomnia CBT-I first-line
Panic disorder CBT plus SSRI or SNRI
Acute mania Mood stabilizer or antipsychotic
Bipolar depression Use bipolar-specific treatment
Treatment-resistant schizophrenia Consider clozapine after adequate trials
Severe catatonia Benzodiazepine or ECT
ADHD Stimulant or approved nonstimulant
Major depression Match treatment to severity

Substance-Related Care DI

Alcohol withdrawal Benzodiazepines reduce seizure risk
Suspected Wernicke Give thiamine promptly
Hypoglycemia Never delay emergent glucose
Opioid overdose Ventilation plus naloxone
Opioid use disorder Buprenorphine, methadone, or naltrexone
Alcohol use disorder Match approved medication individually
Benzodiazepine dependence Avoid abrupt discontinuation
Stimulant intoxication Reduce stimulation; manage complications
Nicotine dependence Medication plus behavioral support
Positive immunoassay Confirm when clinically consequential

OARS Interviewing Skills PS

Open questions, Affirmations, Reflections, Summaries
Ask openly Affirm strengths Reflect meaning Summarize change talk

Transference vs Countertransference PS

Transference

Patient reactions
Past patterns enter therapy
Explore therapeutically

Countertransference

Clinician reactions
May distort judgment
Use reflection and supervision
Direction identifies the concept

Psychotherapy Modality Picker PS

Obsessions and compulsions → Choose ERP ( Prevent ritual response )
Chronic emotion dysregulation → Choose DBT ( Balance acceptance and change )
Insomnia maintains itself → Choose CBT-I ( Target sleep behaviors )
Ambivalence blocks change → Choose motivational interviewing ( Elicit change talk )
Interpersonal loss or transition → Choose interpersonal therapy ( Target current relationships )
Trauma drives symptoms → Choose trauma-focused therapy ( Assess readiness and safety )
Family interactions maintain symptoms → Choose family therapy ( Map relational patterns )

Psychotherapy Modality Map PS

CBT Links thoughts, feelings, behaviors
DBT Balances acceptance and change
ERP Exposure while preventing rituals
Motivational interviewing Elicits intrinsic change language
Interpersonal therapy Targets relationships and role transitions
Psychodynamic therapy Explores unconscious relational patterns
Supportive therapy Strengthens coping and functioning
Family systems Treats relational interaction patterns
Group therapy Uses shared therapeutic factors
CBT-I Restructures insomnia-maintaining behaviors
Trauma-focused therapy Processes trauma safely

CBT vs DBT PS

CBT

Restructures biased thoughts
Changes behavior patterns
Uses collaborative experiments

DBT

Balances acceptance and change
Builds four skill modules
Targets behavioral hierarchy
DBT adds dialectical skills

Therapeutic Process Concepts PS

Alliance Bond, goals, tasks
Transference Patient projects prior relationship patterns
Countertransference Clinician reactions require reflection
Boundary Protects therapeutic relationship
Validation Acknowledges understandable experience
Open question Invites elaboration
Reflection Returns meaning or feeling
Cognitive distortion Biased thinking pattern
Negative reinforcement Removal increases behavior
Universality Others share similar struggles
Exposure Approaches feared stimuli gradually

UARC Capacity Elements ET

Understand, Appreciate, Reason, Communicate
Understand information Appreciate consequences Reason about options Communicate a choice

Capacity vs Competency ET

Capacity

Clinical determination
Decision-specific
May fluctuate

Competency

Court determination
Legal status
Jurisdiction controls
Clinicians assess capacity

Confidentiality Disclosure Picker ET

Valid authorization covers request → Disclose authorized scope ( Verify identity and expiration )
Treatment disclosure is permitted → Share clinically necessary information ( Follow organizational policy )
Serious threat emerges → Apply state protection law ( Document consultation and action )
Reportable abuse suspected → Follow state mandate ( Report reasonable suspicion )
Substance-use records requested → Apply Part 2 ( Check current exceptions )
Psychotherapy notes requested → Apply special protections ( Separate from progress notes )
Legal demand arrives → Seek legal review ( Do not release reflexively )
Minor requests confidential care → Check state rules ( Explain privacy limits )

Ethics and Decision Capacity ET

Autonomy Respect informed patient choices
Beneficence Promote patient welfare
Nonmaleficence Avoid preventable harm
Justice Distribute care fairly
Veracity Communicate truthfully
Fidelity Keep professional commitments
Capacity Clinical and decision-specific
Competency Legal court determination
Informed consent Disclosure, understanding, voluntariness, authorization
Least restrictive care Preserve liberty when safe
Substituted judgment Apply patient's known preferences

Confidentiality and Legal Boundaries ET

HIPAA treatment use Disclosure may not need authorization
Minimum necessary Limit non-treatment disclosures
Psychotherapy notes Receive special HIPAA protection
Part 2 records Apply federal substance-use protections
Duty to protect Follow applicable state law
Mandatory reporting Requirements vary by jurisdiction
Minor consent Follow state-specific rules
Involuntary treatment Criteria vary by jurisdiction
Scope of practice State law controls authority
Telehealth practice Patient location governs licensure
Controlled substances Apply federal and state rules

Cultural and Recovery-Oriented Care ET

Cultural humility Practice lifelong self-reflection
Cultural formulation Elicit identity and explanatory model
Qualified interpreter Avoid family interpretation
Social determinants Assess structural barriers
Trauma-informed care Safety, choice, collaboration, empowerment
Recovery model Hope, agency, meaningful life
Shared decision-making Integrate evidence and preferences
Identity-affirming care Use respectful patient language
Spiritual assessment Explore meaning and supports
Structural competence Recognize systemic health effects
Advocacy Address access and inequity

Common Traps

Pretest Items Look Identical

Twenty-five items are unscored ≠ Answer every question

Scaled Score Is Not Percentage

Passing score is 350 ≠ Raw score gets converted

Screening Is Not Diagnosis

Tools estimate symptom burden ≠ Clinical assessment confirms diagnosis

Contracts Are Not Safety Plans

No-harm promises provide little protection ≠ Build actionable safety steps

Mood Is Not Affect

Mood comes from patient ≠ Affect comes from observation

Capacity Is Not Competency

Capacity is clinical ≠ Competency is legal

Law Is Jurisdiction-Specific

Check current state requirements ≠ Avoid universal legal deadlines

Avoid Antidepressant Monotherapy

Screen for bipolar disorder ≠ Use bipolar-specific treatment

Do Not Delay Glucose

Give thiamine promptly ≠ Treat hypoglycemia immediately

Clozapine REMS Was Removed

FDA ended REMS requirements ≠ Continue label-based safety monitoring

Genomics Remains Adjunctive

Results may inform prescribing ≠ They do not diagnose

Last Minute

1. Memorize five domain weights
2. Separate mood from affect
3. Know dopamine pathways
4. Differentiate serotonin syndrome and NMS
5. Review psychosis duration anchors
6. Compare mania and hypomania
7. Match screening tools correctly
8. Prioritize suicide safety
9. Recognize lithium toxicity
10. Review metabolic monitoring
11. Match disorders to therapies
12. Separate capacity from competency
13. Apply jurisdiction-specific law
14. Answer every exam item

ANCC Psychiatric-Mental Health Nurse Practitioner

Practice Questions 118 questions Study Guide 42 topics Cheat Sheet 177 facts Flashcards 50 cards Shorts 2 short s Videos 1 video Blogs 1 blog Free CE Podcast