These 30 PMH-BC practice questions are free, untimed and need no account. Each has 4 options, as in ANCC's own sample items, and the split between domains copies the outline, so Implementation supplies the most. After you answer, the explanations show why the keyed answer holds and where each of the other options goes wrong.
The set mirrors the exam's proportions on a smaller scale. Implementation provides the largest share, as it does on test day with 58 of 125 scored items; here that means milieu rules, therapeutic replies, care after ECT and medication monitoring. Assessment and Diagnosis and Planning come next, and Evaluation brings up the rear. Every item sits at RN scope; none asks you to choose a drug or a dose.
Domain labels on each question show where your misses cluster. If they bunch in one domain, its section in the study guide is the next stop.
Documents behind these figures: ANCC outline 2024[1] ANCC role study[2]
Answer, then read the explanation
Answered 0 of 30Matched the key: 0
IIIIIIIV
I. Assessment & Diagnosis 22%
II. Planning 21%
III. Implementation 46%
IV. Evaluation 10%
Assessment & Diagnosis · 22%Question 1 of 30
A client changes the subject every time the nurse mentions the client's mother. According to Sullivan's interpersonal theory, this behavior is best understood as:
Each of the 4 choices opens onto the reasoning behind it.
AA syntaxic exchange
Why A is wrong. A syntaxic exchange rests on shared, consensually validated meaning; abruptly changing the subject avoids that shared conversation rather than achieving it.
BA malevolent transformation
Why B is wrong. Malevolent transformation is Sullivan's term for the belief, rooted in early rejection, that others are hostile; nothing here shows the client sees the nurse as an enemy.
CA parataxic distortion
Why C is wrong. A parataxic distortion is seeing the nurse through the lens of earlier relationships; this client is reacting to a topic, not to a distorted view of the nurse.
DA security operation
Why D is right. Sullivan called the maneuvers people use to escape anxiety in a relationship security operations; steering away from one painful topic every time is a classic example.
Assessment & Diagnosis · 22%Question 2 of 30
Twenty hours after his last drink, a client hears voices accusing him of crimes. He is oriented to person, place, and time, and his vital signs are only mildly elevated. These findings are most consistent with:
AWernicke encephalopathy
Why A is wrong. Wernicke encephalopathy presents with confusion, eye-movement problems, and an unsteady gait rather than voices with a clear sensorium.
BAlcohol-induced hallucinosis
Why B is right. Voices that start within about 12 to 48 hours of the last drink while orientation and vital signs stay near normal fit alcohol-induced hallucinosis.
CFirst-episode schizophrenia
Why C is wrong. Hallucinations that appear within a day of stopping alcohol point to withdrawal; schizophrenia also needs a longer course and other symptoms.
DDelirium tremens
Why D is wrong. Delirium tremens usually begins about 48 to 72 hours after the last drink and brings disorientation and marked autonomic instability, which are absent here.
Assessment & Diagnosis · 22%Question 3 of 30
A client with paranoid personality disorder reads hidden insults into the nurse's neutral remarks. Which approach is most appropriate during the assessment interview?
AUse light teasing and humor to build rapport
Why A is wrong. Teasing is easily read as mockery by someone who already hears insults in neutral remarks.
BHold the interview in the busy dayroom
Why B is wrong. A busy dayroom adds people the client may believe are watching or judging, and it removes privacy.
CBe direct and explain what will be recorded
Why C is right. Being direct about what will be recorded leaves less room for hidden meanings and lowers suspicion.
DShare personal stories to gain the client's trust
Why D is wrong. Personal disclosure shifts the focus to the nurse and may be seen as a manipulation.
Assessment & Diagnosis · 22%Question 4 of 30
Since moving into a long-term care facility 1 week ago, an 82-year-old has become withdrawn and anxious, sleeps poorly, and asks repeatedly when she can go home. Which nursing diagnosis best fits?
AChronic confusion
Why A is wrong. A change that began a week ago is not chronic, and the client is not described as confused.
BRisk for maladaptive grieving
Why B is wrong. This label applies to a risk of grief after a death or similar loss; here the symptoms are already present and tied directly to the move.
CRelocation stress syndrome
Why C is right. Anxiety, withdrawal, poor sleep, and asking to go home that begin right after a move fit relocation stress syndrome.
DImpaired memory
Why D is wrong. Asking repeatedly to go home expresses distress about the move; the stem gives no evidence of memory loss.
Assessment & Diagnosis · 22%Question 5 of 30
A client describes a recent assault in full detail in a flat, calm voice, while her heart rate rises and she begins to sweat. Which defense mechanism is most likely operating?
AIsolation of affect
Why A is right. The memory is fully available but its emotion has been split off; the calm, flat telling paired with a racing heart and sweating is isolation of affect.
BDissociation
Why B is wrong. Dissociation disrupts awareness or memory, whereas this client stays present and recalls every detail in order.
CRepression
Why C is wrong. Repression keeps a memory out of awareness altogether, yet this client recounts the assault in full.
DRationalization
Why D is wrong. Rationalization offers reasonable-sounding excuses for behavior; this client is not justifying anything.
Assessment & Diagnosis · 22%Question 6 of 30
A 70-year-old client with severe depression says calmly, "The world has ended, and I no longer exist. You are talking to no one." The nurse documents this as a:
ADelusion of reference
Why A is wrong. Delusions of reference assign personal meaning to outside events, which this statement does not do.
BNihilistic delusion
Why B is right. A fixed belief that the world or the self no longer exists is a nihilistic delusion, often seen in severe psychotic depression in older adults.
CGrandiose delusion
Why C is wrong. Grandiose delusions inflate worth or power, the opposite of a belief that the self is gone.
DSomatic delusion
Why D is wrong. Somatic delusions concern a body part or function, such as organs rotting; this client denies existing at all.
Assessment & Diagnosis · 22%Question 7 of 30
A 14-year-old refuses to go to school because of a pimple on her chin and says, "Everyone will be staring at it all day." She socializes normally otherwise. The nurse recognizes this belief as:
AThe imaginary audience
Why A is right. Believing that everyone is watching and judging a minor flaw is Elkind's imaginary audience, a normal feature of early adolescent thinking.
BThe personal fable
Why B is wrong. The personal fable is the belief that one is unique or invulnerable, not the belief that others are watching.
CSocial anxiety disorder
Why C is wrong. Social anxiety disorder is a persistent fear across many social situations; she socializes normally apart from this day.
DBody dysmorphic disorder
Why D is wrong. Body dysmorphic disorder involves lasting preoccupation with perceived defects and repetitive checking; a single pimple with normal social life does not fit.
Planning · 21%Question 8 of 30
A client with schizophrenia who is preparing for discharge says he has "nothing to do all day" at home. Which team member should the nurse plan to involve to help him build leisure skills and community activities?
ADietitian
Why A is wrong. A dietitian addresses nutrition, which the client has not raised.
BRecreational therapist
Why B is right. A recreational therapist assesses interests and builds leisure skills and links to community activities, which is the gap this client describes.
CPsychiatrist
Why C is wrong. The psychiatrist manages diagnosis and medications but is not the team member who develops leisure skills.
DClinical pharmacist
Why D is wrong. A pharmacist reviews the medication regimen; this need concerns how he spends his days.
Planning · 21%Question 9 of 30
During planning for a client with depression whose progress has stalled, the nurse reviews the client's support system. Which factor is most important to reassess?
AHow many relatives and friends the client can list
Why A is wrong. A long list of names says nothing about whether any of them actually helps.
BHow close the support people live to the treatment facility
Why B is wrong. Distance can affect visits, but a nearby relative who will not participate offers no support.
CHow willing and able the support people are to take part
Why C is right. Supports only help if they are willing to engage and able to do so, so their willingness and capacity matter most when progress stalls.
DThe educational background of the support people
Why D is wrong. Education level has little bearing on whether family and friends can support recovery.
Planning · 21%Question 10 of 30
A Filipino American client with depression has delayed care because of hiya, fear of bringing shame on her family. The nurse's most appropriate response is:
A"Shame shouldn't stop you from getting help."
Why A is wrong. Telling her what she should feel dismisses a cultural value instead of working with it.
B"Your family will understand once you tell them."
Why B is wrong. This promises a family reaction the nurse cannot know and pressures her to disclose.
C"Who would you want to know about your treatment?"
Why C is right. Asking who she wants to know about her treatment respects hiya, her fear of shaming the family, and removes a barrier to care.
D"Depression is common; there's no shame in it."
Why D is wrong. Reassurance that there is no shame argues with her experience; to her, the shame is real for the family.
Planning · 21%Question 11 of 30
A Cambodian client with depression reports headaches, fatigue, and a "weak heart" but denies feeling sad. Medical workup is normal. The nurse's most appropriate response is:
A"Your tests are normal, so you are healthy."
Why A is wrong. Normal tests do not mean she is well; her suffering is real and fits depression.
B"These aches are really just your depression."
Why B is wrong. Telling her the aches are 'just' depression imposes a label and implies the symptoms are not real.
C"Let's focus on feelings rather than your body."
Why C is wrong. Redirecting away from the body dismisses the way she experiences and describes distress.
D"Tell me how these symptoms affect your life."
Why D is right. Many people express depression through body complaints; asking how the symptoms affect her life accepts her idiom of distress and opens the door to discuss mood.
Planning · 21%Question 12 of 30
An older adult who recently moved from Japan to live with her son has depression and few contacts outside the home. Which discharge plan element best strengthens her support network?
AReferral to a senior program for Japanese-speaking elders
Why A is right. A program in her own language offers peers and lasting contacts outside the home, which builds a wider network.
BDaily phone check-ins from her son during his work breaks
Why B is wrong. Calls from her son keep her dependent on one person and do not add new relationships.
CWeekly individual therapy in English through an interpreter
Why C is wrong. Therapy treats the depression but does not by itself create a support network.
DA subscription to Japanese-language television
Why D is wrong. Television is passive and offers no real social contact.
Planning · 21%Question 13 of 30
An 80-year-old client with depression who lives alone is being discharged on mirtazapine. She had a fall at home last month. Which plan element is most appropriate?
ATaking the mirtazapine dose each morning
Why A is wrong. Mirtazapine is usually taken at bedtime because it causes drowsiness; a morning dose would add daytime sedation and more chances to fall.
BBed rest for the first week back at home
Why B is wrong. Bed rest weakens muscles and worsens balance, which raises the risk of falling once she gets up.
CA home safety visit by a nurse or therapist
Why C is right. Mirtazapine is sedating, and she lives alone after a recent fall, so a home safety visit to check the home for hazards and needed aids lowers her fall risk without limiting her independence.
DRestraints at night while she sleeps
Why D is wrong. Restraints do not prevent falls, can cause injury when a person tries to get up, and are not a home safety measure.
Implementation · 46%Question 14 of 30
A client with schizophrenia has a history of drinking excessive water and developing low sodium. Which monitoring plan should the nurse implement?
AOffer unlimited water on request
Why A is wrong. Unlimited access feeds the polydipsia that put him at risk of hyponatremia.
BMeasure intake only at mealtimes
Why B is wrong. Most excess drinking happens between meals, so measuring intake only at mealtimes would miss the problem.
CCheck his sodium once a month
Why C is wrong. Low sodium from water intoxication can develop within hours, so a monthly level would come too late.
DWeigh him at the same time each day
Why D is right. Body weight rises quickly with water retained from heavy drinking, so a consistent daily weight is a practical early warning of dangerous dilution.
Implementation · 46%Question 15 of 30
On an adult inpatient unit, the nurse finds two clients kissing in one client's bedroom. Both are calm. The nurse's most appropriate action is to:
Aseparate them calmly and restate the rule
Why A is right. Sexual contact between inpatients is usually not allowed because vulnerability and consent are hard to judge; separating them calmly and restating the rule protects both without shaming.
Bleave them alone together in the room
Why B is wrong. Leaving them alone together ignores that consent is hard to judge for inpatients whose judgment may be impaired, and the unit rule still applies.
Cwarn that they will lose privileges next time
Why C is wrong. Warning about lost privileges does not stop the behavior now and sounds punitive rather than therapeutic.
Dcall each client's family to report what happened
Why D is wrong. Telling families breaches confidentiality and does nothing to manage the situation on the unit.
Implementation · 46%Question 16 of 30
A client with a trauma history refuses to attend group and shouts at staff. Which question by the nurse reflects a trauma-informed approach?
A"What happened that made group feel unsafe for you today?"
Why A is right. A trauma-informed question asks what happened to the person instead of what is wrong with them, and it treats the outburst as a possible reaction to feeling unsafe.
B"Why are you refusing to follow the unit schedule?"
Why B is wrong. Asking why the client is refusing sounds accusing and invites defensiveness.
C"Do you understand that refusing group affects your privileges?"
Why C is wrong. Threatening privileges uses control and consequences, which can retraumatize.
D"Can you calm down so we can talk about your behavior?"
Why D is wrong. Asking for calm first puts the focus on behavior and makes no attempt to understand the trigger.
Implementation · 46%Question 17 of 30
A client stopped taking their antipsychotic three weeks ago and now has returning hallucinations. Which nursing conclusion is most accurate?
AThe client has developed a new, more severe psychiatric disorder
Why A is wrong. The returning symptoms are the same ones the medication was controlling, not a new illness.
BThe symptoms point to nonadherence and call for re-engagement
Why B is right. Psychotic symptoms often return within weeks of stopping an antipsychotic, so the nurse explores why the client stopped and works with them to resume treatment.
CThe hallucinations are probably unrelated to stopping the drug
Why C is wrong. The timing, symptoms coming back three weeks after stopping, links the relapse directly to the stopped medication.
DThe medication has failed and should be replaced
Why D is wrong. A drug that is not being taken has not been tested; relapse after stopping is not treatment failure.
Implementation · 46%Question 18 of 30
An adolescent with anorexia nervosa is found doing sit-ups in her room after meals. Which intervention is most appropriate?
ASupervise activity as the team's plan directs
Why A is right. Compulsive exercise burns calories that refeeding is meant to restore, so activity is limited and monitored according to the team plan.
BLet her exercise to reduce her anxiety
Why B is wrong. Exercise here is a purging behavior that relieves anxiety by undoing the meal, so allowing it reinforces the disorder.
CIgnore the exercise for now
Why C is wrong. Ignoring exercise right after meals lets a symptom of anorexia continue unchecked.
DAdd more calories to make up for the exercise
Why D is wrong. Adjusting calories is a team and dietitian decision; on its own it accepts the behavior instead of addressing it.
Implementation · 46%Question 19 of 30
Forty minutes after ECT, a client in the recovery area is awake, has stable vital signs, and is mildly confused. The client gets up and says, "I need the bathroom." The nurse should:
Akeep the client in bed until the confusion clears
Why A is wrong. Keeping the client in bed denies a basic need when a supervised trip is safe.
Bask for a PRN sedative so the client rests longer
Why B is wrong. Sedating a client who is waking up after anesthesia adds to the confusion and fall risk and ignores the need.
Clet the client go alone, as vital signs are stable
Why C is wrong. Stable vital signs do not make a confused client safe to walk alone.
Dassist the client there and stay close by the door
Why D is right. Mild confusion after ECT raises the risk of falls, so the nurse assists the client to the toilet and stays close by.
Implementation · 46%Question 20 of 30
A client with catatonia who has been mute and rigid for a day receives the ordered lorazepam. Twenty minutes later he speaks and moves more freely. How should the nurse interpret this?
AA sign of benzodiazepine intoxication
Why A is wrong. Intoxication causes more sedation and slurred speech, not new speech and freer movement.
BAn expected response supporting catatonia
Why B is right. A quick improvement after a benzodiazepine is typical of catatonia and helps confirm it; the nurse documents the change and keeps monitoring.
CAn early sign of neuroleptic malignant syndrome
Why C is wrong. Neuroleptic malignant syndrome brings fever, rigidity, and unstable vital signs, which is the opposite of the improvement described.
DProof that the catatonia was being faked
Why D is wrong. A real response to lorazepam supports catatonia; it does not show the client was faking.
Implementation · 46%Question 21 of 30
A client with panic disorder is breathing rapidly and reports lightheadedness and tingling around the lips and fingers. Cardiac causes have been ruled out. Which action should the nurse take?
AHave the client breathe into a paper bag
Why A is wrong. Paper-bag rebreathing is no longer recommended because it can cause hypoxia and is unsafe if the cause is not panic.
BEncourage deep, rapid breaths for more oxygen
Why B is wrong. Fast, deep breathing is the cause of the symptoms and would worsen them.
CCoach the client to slow the breathing rate
Why C is right. Slow breathing reverses the CO2 loss that causes tingling and lightheadedness, and the nurse's calm coaching also reduces the panic.
DApply oxygen by nasal cannula at 2 L/min
Why D is wrong. Oxygen levels are normal in hyperventilation, and oxygen does not correct the low CO2.
Implementation · 46%Question 22 of 30
The nurse says to a client, "I notice you've been pacing since your visitor left." This therapeutic technique is:
Areflecting feelings
Why A is wrong. Reflecting names a feeling the client has expressed; this remark names only a behavior.
Bfocusing
Why B is wrong. Focusing narrows talk to one topic the client has already raised.
Cmaking an observation
Why C is right. Making an observation states what the nurse sees, pacing since the visit, without adding meaning, which invites the client to talk about it.
Dinterpreting
Why D is wrong. Interpreting would add a meaning to the behavior, such as saying the visit upset the client.
Implementation · 46%Question 23 of 30
A client is admitted involuntarily and anxiously asks the nurse what will happen on the unit. Which nursing action best supports his adjustment to the milieu?
ATell him not to worry, as staff will handle the details
Why A is wrong. Telling him not to worry is false reassurance that dismisses his concern and leaves him uninformed.
BOrient him calmly to the routine, rules, and his rights
Why B is right. Clear, calm orientation lowers anxiety, sets expectations, and tells him which rights he keeps during an involuntary stay.
CGive him the policy manual to read on his own later
Why C is wrong. A manual handed over without discussion is hard to absorb when he is anxious, and it gives no personal contact.
DExplain that the usual unit rules do not apply to him
Why D is wrong. Unit rules apply to everyone; telling him otherwise is inaccurate and confusing.
Implementation · 46%Question 24 of 30
A young client keeps asking the nurse to decide what she should eat and wear and says, "You're like the mom I never had." According to Peplau, the client is casting the nurse in which role?
ACounselor
Why A is wrong. The counselor role helps the client understand present experiences; it is not the role this client is projecting.
BSurrogate
Why B is right. Peplau's surrogate role is one the client places on the nurse, here a mother figure, which the nurse helps the client recognize while promoting independence.
CResource person
Why C is wrong. A resource person gives specific information about care or resources, which this request is not.
DTeacher
Why D is wrong. The teacher role shares knowledge the client asks for or needs; this client is seeking a parent, not information.
Implementation · 46%Question 25 of 30
A nurse who has worked closely with a woman who has borderline personality disorder will be on vacation for 2 weeks. What is the best approach?
APromise to call her daily while away
Why A is wrong. Daily calls while on leave breach boundaries and cannot be sustained.
BLeave without mentioning it to avoid upset
Why B is wrong. Leaving without mentioning the absence is likely to feel like abandonment and can trigger a crisis.
CLet her call the nurse at home if needed
Why C is wrong. Inviting calls at home crosses a professional boundary and ties the client to one person instead of the treatment team.
DTell her early and name who will cover
Why D is right. Early notice and a named substitute reduce feelings of abandonment, which are central to borderline personality disorder.
Implementation · 46%Question 26 of 30
A client is released from restraints after regaining control and is now calm. Which nursing action is most important next?
AReview the events with the client and plan alternatives
Why A is right. Debriefing after restraint helps the client understand what led to it and plan other ways to cope next time.
BAvoid discussing the event to prevent re-escalation
Why B is wrong. Avoiding the topic misses the chance to learn from the event once the client is calm.
CHave the client apologize to the staff who were involved
Why C is wrong. Demanding an apology is punitive and does not build coping skills.
DTell the client restraints will be used again if needed
Why D is wrong. Telling the client restraints will be used again reads as a threat rather than a plan to prevent recurrence.
Implementation · 46%Question 27 of 30
A client with schizophrenia who is hearing voices asks the nurse, "You can hear them too, can't you?" Which response by the nurse is most therapeutic?
A"Yes, I hear them, but they can't hurt you while you're here."
Why A is wrong. Pretending to hear the voices reinforces the hallucination and damages trust.
B"Those voices aren't real, so you need to try to ignore them."
Why B is wrong. Arguing that the voices are not real and telling the client to ignore them feels invalidating and rarely works.
C"Let's not talk about the voices; let's talk about your day."
Why C is wrong. Refusing to talk about the voices dismisses the client's experience and leaves the distress unexplored.
D"No, I don't hear them, but I can see they're upsetting you."
Why D is right. Answering 'no' states reality honestly without arguing about the voices, and naming that they are upsetting responds to the client's distress.
Evaluation · 10%Question 28 of 30
Six months after clients with schizophrenia complete a relapse-prevention group, which finding best shows the group was effective?
AMembers can name each of their medications
Why A is wrong. Knowing medication names is knowledge, not proof of fewer relapses.
BMost members attended at least 8 of the 10 sessions
Why B is wrong. Attendance shows people came; it does not show they stayed well.
CMembers rated the group highly on the exit survey
Why C is wrong. Satisfaction ratings reflect how members felt about the group, not whether relapse fell.
DMembers were readmitted less often than before
Why D is right. Fewer readmissions show the group changed the outcome it was meant to prevent, relapse.
Evaluation · 10%Question 29 of 30
A client in an anger management group has the goal of handling frustration without aggression. Which statement best shows the goal is being met?
A"I walked away to cool off when my roommate took my chair."
Why A is right. Walking away to cool off during a real, frustrating event shows frustration handled without aggression, so the goal is being met.
B"I still get angry, but now I feel bad about it afterward."
Why B is wrong. Still getting angry and feeling bad afterward describes regret, not frustration handled without aggression.
C"I yelled at my roommate, but at least I didn't hit him."
Why C is wrong. Yelling at the roommate is still aggression, so the goal is not yet met.
D"I understand now that my anger comes from how my father treated me."
Why D is wrong. Insight into where anger comes from does not prove the behavior has changed.
Evaluation · 10%Question 30 of 30
A client with schizophrenia has received a long-acting injectable antipsychotic for 3 months. Which finding most strongly indicates the need to revise the treatment plan?
AOne missed appointment, rescheduled within the same week
Why A is wrong. A single missed visit that was quickly rescheduled shows engagement rather than failure.
BPersistent voices and growing fear of the injections
Why B is right. Symptoms that persist after 3 months together with fear that threatens future doses show the plan is not working and needs revision.
CWeight gain in month one that has since leveled off
Why C is wrong. Early weight gain that has stabilized is a known effect to monitor, not a reason to change the plan now.
DMild drowsiness for a day or so after each injection
Why D is wrong. Brief drowsiness after a dose is a common, tolerable effect.
When two replies both sound kind
Several questions here ask for the most therapeutic response, and two of the options often sound warm. A few checks separate them:
Does it hand out advice? Telling the client what to do, or offering the nurse's own opinion, takes the lead away from the client.
Does it close the door? A reply that changes the subject or answers for the client ends the exchange before the client has said what matters.
Is safety in the stem? A hint of risk outranks rapport. When the stem mentions a plan, a means or a threat, the right answer deals with that first, even if a softer option is available.
Is it within RN scope? A reply that promises a medication change or a discharge date the nurse cannot give is the wrong one, however gentle it sounds.
When both options still survive, look again at the qualifier in the question: first, best or most therapeutic.
Your tally here versus ANCC's scale
This page tallies right answers, nothing more. ANCC scores its exam on a scale, needs 350 to pass and publishes no percent-correct equivalent, so a percentage from this set cannot predict your result. Treat it as a way to rank domains against each other.
The real sitting is longer and timed, with 150 questions inside 3 hours and 25 unscored trial items you cannot spot among them. Scoring, the pass line and retests are explained on exam facts.
Origin of these items
They are study items written for the current outline, not retired exam questions. ANCC's own practice material is covered in the FAQ of the study guide.
Are these psychiatric nursing questions written at RN or NP level?
RN level. They follow the PMH-BC outline, where the nurse assesses, plans, intervenes and evaluates, and they leave out prescribing and making a psychiatric (DSM) diagnosis, which belong to the nurse practitioner role.
Can I download this psychiatric nursing quiz as a PDF with answers?
No. The set runs in the browser, and the explanation for each item appears once you choose an option.
How high should I score here before booking the exam?
No score here can tell you that. The set is short, untimed and scored as a raw percentage, while the exam is scaled. Note the domains where misses gather and work on those first.