Are flashcards effective for the PMHNP-BC exam?

Yes. Flashcards use active recall — retrieving an answer from memory — which research shows is one of the most effective ways to make information stick, especially for the high-volume psychopharmacology facts (drug levels, black-box warnings, screening cutoffs) the PMHNP exam tests.

What topics do the PMHNP flashcards cover?

All five ANCC domains: Scientific Foundation (neurotransmitters, pharmacokinetics, EPS, NMS), Advanced Practice Skills (screening tools, the mental status exam, risk assessment), Diagnosis and Treatment (DSM-5-TR criteria and psychopharmacology), Psychotherapy and Related Theories, and Ethics, Legal Principles and Cultural Care.

Are the psychopharmacology cards up to date?

Yes. The drug cards reflect current FDA labeling — including that lithium's therapeutic range is 0.8–1.2 mEq/L acute and 0.8–1.0 maintenance (toxicity ≥1.5), that the FDA removed the Clozapine REMS in 2025 (label-schedule ANC monitoring still recommended), and that oral naltrexone no longer carries a boxed warning.

How should I study with these flashcards?

Mix the modes: flip to learn, type to test recall, match for speed, and quiz to check yourself. Spend the most time on the largest and highest-stakes content — Advanced Practice Skills and the diagnosis-and-treatment psychopharmacology — and drill drug levels and black-box warnings until they're automatic.

Are the PMHNP flashcards free?

Yes — 100% free, all four study modes, no paywall.

Lithium therapeutic range

0.8–1.2 mEq/L acute, 0.8–1.0 maintenance (FDA); toxicity $\ge 1.5$ mEq/L; draw a 12-hour trough.

Mesolimbic dopamine pathway

VTA → nucleus accumbens; overactivity = positive psychotic symptoms (hallucinations, delusions); target of antipsychotic D2 blockade.

Mesocortical dopamine pathway

VTA → prefrontal cortex; underactivity = negative/cognitive symptoms of schizophrenia.

Nigrostriatal dopamine pathway

Substantia nigra → striatum; D2 blockade here causes EPS (parkinsonism, dystonia, akathisia, tardive dyskinesia).

Tuberoinfundibular dopamine pathway

Hypothalamus → pituitary; dopamine inhibits prolactin; D2 blockade → hyperprolactinemia (galactorrhea, amenorrhea, gynecomastia).

Fear processing and threat detection; hyperactive in anxiety and PTSD.

Memory consolidation; atrophies with chronic stress/cortisol and in depression/PTSD.

Executive function and impulse control; matures into the mid-20s (relevant to adolescent risk-taking).

Hypothalamus → pituitary → adrenal; chronic activation raises cortisol; dysregulated in depression.

Principal inhibitory neurotransmitter; target of benzodiazepines, barbiturates, alcohol, and Z-drugs.

Principal excitatory neurotransmitter; NMDA-receptor target of ketamine/esketamine and memantine.

Regulates mood, sleep, appetite, and anxiety; raised by SSRIs, SNRIs, and MAOIs.

Arousal, attention, and stress response; raised by SNRIs, TCAs, MAOIs, and atomoxetine.

Memory and cognition; blockade causes anticholinergic effects; deficient in Alzheimer disease (treated with cholinesterase inhibitors).

Absorption, Distribution, Metabolism, Excretion — the four pharmacokinetic processes.

Half-life (t$_{1/2}$)

Time for plasma concentration to fall by 50%; about 5 half-lives to reach steady state or clear a drug.

CYP2D6 inhibitors (psych)

Fluoxetine, paroxetine, and bupropion raise levels of 2D6 substrates.

CYP1A2 induction by smoking

Tobacco smoke induces 1A2, lowering clozapine/olanzapine levels; quitting raises levels (toxicity risk).

Fluvoxamine raises clozapine, olanzapine, and caffeine levels.

Metabolizes many psychotropics; inhibited by grapefruit and ketoconazole; induced by carbamazepine.

Carbamazepine autoinduction

Induces its own metabolism (and 3A4), lowering its own and other drug levels over 2–4 weeks.

CYP2D6 poor metabolizer

Higher drug levels and toxicity at standard doses of 2D6 substrates (many antidepressants).

CYP2D6 ultrarapid metabolizer

Subtherapeutic levels and treatment failure at standard doses.

Sustained muscle contraction (torticollis, oculogyric crisis) hours–days after an antipsychotic; treat with IM/IV benztropine or diphenhydramine.

Subjective inner restlessness/inability to sit still; treat by lowering dose, propranolol, benztropine, or a benzodiazepine.

Drug-induced parkinsonism

Bradykinesia, rigidity, and tremor from D2 blockade; treat with an anticholinergic or dose reduction.

Tardive dyskinesia (TD)

Late-onset involuntary choreoathetoid movements (lip-smacking, tongue) from chronic D2 blockade; treat with VMAT2 inhibitors (valbenazine, deutetrabenazine); often irreversible.

Abnormal Involuntary Movement Scale — screens for tardive dyskinesia.

Neuroleptic malignant syndrome (NMS)

Fever, 'lead-pipe' rigidity, autonomic instability, altered mental status, elevated CK from D2 blockade; stop the drug, give dantrolene/bromocriptine, support.

Triad of mental-status change, autonomic instability, and neuromuscular hyperactivity (clonus, hyperreflexia); rapid onset; stop serotonergic agents, give cyproheptadine, support.

NMS vs serotonin syndrome

NMS = rigidity + bradyreflexia, slow onset (days); serotonin syndrome = hyperreflexia/clonus, fast onset (hours).

Allele (common in some Asian populations) predicting carbamazepine/oxcarbazepine Stevens-Johnson syndrome; screen before starting.

Heritability of schizophrenia

About 80%; bipolar disorder about 60–85% — among the most heritable psychiatric disorders.

Pharmacogenomic testing

CYP2D6/2C19 genotyping can guide antidepressant selection and dosing (CPIC guidelines).

Advanced physical assessment (PMHNP)

Systematic exam to identify medical causes/comorbidities of psychiatric presentations (e.g., thyroid, neurologic).

9-item depression screen/severity, 0–27; $\ge 10$ = moderate (treatment threshold); item 9 screens suicidality.

5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe.

7-item generalized-anxiety screen, 0–21; $\ge 10$ = moderate anxiety (clinically significant).

5 mild, 10 moderate, 15 severe.

Vanderbilt ADHD scale

Parent/teacher rating used for childhood ADHD diagnosis and monitoring.

MDQ (Mood Disorder Questionnaire)

Screens for bipolar-spectrum disorder.

Columbia-Suicide Severity Rating Scale; assesses suicidal-ideation severity and behavior.

Geriatric Depression Scale; depression screen designed for older adults.

Edinburgh Postnatal Depression Scale; perinatal/postpartum depression screen.

Cognitive screens; MoCA is more sensitive for mild cognitive impairment; MMSE $\le 23$–24 suggests impairment.

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PMHNP Flashcards

Lithium therapeutic range: 0.8–1.2 mEq/L acute, 0.8–1.0 maintenance (FDA); toxicity $\ge 1.5$ mEq/L; draw a 12-hour trough.
Mesolimbic dopamine pathway: VTA → nucleus accumbens; overactivity = positive psychotic symptoms (hallucinations, delusions); target of antipsychotic D2 blockade.
Mesocortical dopamine pathway: VTA → prefrontal cortex; underactivity = negative/cognitive symptoms of schizophrenia.
Nigrostriatal dopamine pathway: Substantia nigra → striatum; D2 blockade here causes EPS (parkinsonism, dystonia, akathisia, tardive dyskinesia).
Tuberoinfundibular dopamine pathway: Hypothalamus → pituitary; dopamine inhibits prolactin; D2 blockade → hyperprolactinemia (galactorrhea, amenorrhea, gynecomastia).
Amygdala: Fear processing and threat detection; hyperactive in anxiety and PTSD.
Hippocampus: Memory consolidation; atrophies with chronic stress/cortisol and in depression/PTSD.
Prefrontal cortex: Executive function and impulse control; matures into the mid-20s (relevant to adolescent risk-taking).
HPA axis: Hypothalamus → pituitary → adrenal; chronic activation raises cortisol; dysregulated in depression.
GABA: Principal inhibitory neurotransmitter; target of benzodiazepines, barbiturates, alcohol, and Z-drugs.
Glutamate: Principal excitatory neurotransmitter; NMDA-receptor target of ketamine/esketamine and memantine.
Serotonin (5-HT): Regulates mood, sleep, appetite, and anxiety; raised by SSRIs, SNRIs, and MAOIs.
Norepinephrine (NE): Arousal, attention, and stress response; raised by SNRIs, TCAs, MAOIs, and atomoxetine.
Acetylcholine (ACh): Memory and cognition; blockade causes anticholinergic effects; deficient in Alzheimer disease (treated with cholinesterase inhibitors).
ADME: Absorption, Distribution, Metabolism, Excretion — the four pharmacokinetic processes.
Half-life (t $_{1/2}$ ): Time for plasma concentration to fall by 50%; about 5 half-lives to reach steady state or clear a drug.
CYP2D6 inhibitors (psych): Fluoxetine, paroxetine, and bupropion raise levels of 2D6 substrates.
CYP1A2 induction by smoking: Tobacco smoke induces 1A2, lowering clozapine/olanzapine levels; quitting raises levels (toxicity risk).
CYP1A2 inhibitor: Fluvoxamine raises clozapine, olanzapine, and caffeine levels.
CYP3A4: Metabolizes many psychotropics; inhibited by grapefruit and ketoconazole; induced by carbamazepine.
Carbamazepine autoinduction: Induces its own metabolism (and 3A4), lowering its own and other drug levels over 2–4 weeks.
CYP2D6 poor metabolizer: Higher drug levels and toxicity at standard doses of 2D6 substrates (many antidepressants).
CYP2D6 ultrarapid metabolizer: Subtherapeutic levels and treatment failure at standard doses.
Acute dystonia: Sustained muscle contraction (torticollis, oculogyric crisis) hours–days after an antipsychotic; treat with IM/IV benztropine or diphenhydramine.
Akathisia: Subjective inner restlessness/inability to sit still; treat by lowering dose, propranolol, benztropine, or a benzodiazepine.
Drug-induced parkinsonism: Bradykinesia, rigidity, and tremor from D2 blockade; treat with an anticholinergic or dose reduction.
Tardive dyskinesia (TD): Late-onset involuntary choreoathetoid movements (lip-smacking, tongue) from chronic D2 blockade; treat with VMAT2 inhibitors (valbenazine, deutetrabenazine); often irreversible.
AIMS: Abnormal Involuntary Movement Scale — screens for tardive dyskinesia.
Neuroleptic malignant syndrome (NMS): Fever, 'lead-pipe' rigidity, autonomic instability, altered mental status, elevated CK from D2 blockade; stop the drug, give dantrolene/bromocriptine, support.
Serotonin syndrome: Triad of mental-status change, autonomic instability, and neuromuscular hyperactivity (clonus, hyperreflexia); rapid onset; stop serotonergic agents, give cyproheptadine, support.
NMS vs serotonin syndrome: NMS = rigidity + bradyreflexia, slow onset (days); serotonin syndrome = hyperreflexia/clonus, fast onset (hours).
HLA-B*1502: Allele (common in some Asian populations) predicting carbamazepine/oxcarbazepine Stevens-Johnson syndrome; screen before starting.
Heritability of schizophrenia: About 80%; bipolar disorder about 60–85% — among the most heritable psychiatric disorders.
Pharmacogenomic testing: CYP2D6/2C19 genotyping can guide antidepressant selection and dosing (CPIC guidelines).
Advanced physical assessment (PMHNP): Systematic exam to identify medical causes/comorbidities of psychiatric presentations (e.g., thyroid, neurologic).
PHQ-9: 9-item depression screen/severity, 0–27; $\ge 10$ = moderate (treatment threshold); item 9 screens suicidality.
PHQ-9 severity bands: 5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe.
GAD-7: 7-item generalized-anxiety screen, 0–21; $\ge 10$ = moderate anxiety (clinically significant).
GAD-7 bands: 5 mild, 10 moderate, 15 severe.
Vanderbilt ADHD scale: Parent/teacher rating used for childhood ADHD diagnosis and monitoring.
MDQ (Mood Disorder Questionnaire): Screens for bipolar-spectrum disorder.
C-SSRS: Columbia-Suicide Severity Rating Scale; assesses suicidal-ideation severity and behavior.
GDS: Geriatric Depression Scale; depression screen designed for older adults.
EPDS: Edinburgh Postnatal Depression Scale; perinatal/postpartum depression screen.
MoCA vs MMSE: Cognitive screens; MoCA is more sensitive for mild cognitive impairment; MMSE $\le 23$ –24 suggests impairment.
PCL-5: PTSD Checklist for DSM-5; self-report PTSD symptom screen.
Y-BOCS: Yale-Brown Obsessive Compulsive Scale; measures OCD severity.
AUDIT: 10-item alcohol-use screen (WHO); $\ge 8$ indicates hazardous drinking.
DAST: Drug Abuse Screening Test; screens non-alcohol drug use.
CAGE: 4-item alcohol screen (Cut down, Annoyed, Guilty, Eye-opener); $\ge 2$ is positive.
CRAFFT: Adolescent substance-use screen.
CIWA-Ar: Rates alcohol-withdrawal severity; $\ge 8$ –10 = medicate (benzodiazepines); $\ge 15$ = high risk of seizures/DTs.
COWS: Clinical Opiate Withdrawal Scale; 5–12 mild, 13–24 moderate, 25–36 moderately severe, >36 severe.
MSE components: Appearance, Behavior, Speech, Mood, Affect, Thought process, Thought content, Perception, Cognition, Insight, Judgment.
Mood vs affect: Mood = the patient's stated, sustained emotion (subjective); affect = the observed emotional expression (objective).
Thought process: Form of thinking: linear, tangential, circumstantial, loose associations, flight of ideas, word salad.
Thought content: What the patient thinks: delusions, obsessions, suicidal/homicidal ideation, paranoia.
Motivational interviewing (MI): Collaborative, patient-centered method to strengthen change motivation; uses OARS (Open questions, Affirmations, Reflective listening, Summaries); rolls with resistance.
Open-ended questions: Encourage elaboration; preferred over yes/no questions in clinical interviewing.
Strongest predictor of future suicide: A previous suicide attempt.
Acute suicide risk factors: Prior attempt (strongest), a plan with means/access, hopelessness, recent loss, substance use, command hallucinations.
Means restriction: Limiting access to lethal means (firearms, medications) is an evidence-based suicide-prevention intervention.
Safety planning: Collaborative written plan: warning signs, coping strategies, supports, means restriction, crisis contacts.
Psychiatric-emergency priorities: Ensure safety first (patient/staff/others); de-escalate before chemical or physical restraint; use the least restrictive option.
Levels of prevention: Primary = prevent onset (education, vaccination); secondary = early detection/screening; tertiary = reduce complications of established disease.
SAMHSA recovery model: Recovery is person-driven, holistic, and hope-based; emphasizes resilience and protective factors.
Psychoeducation: Teaching patients/families about illness and treatment to improve adherence and outcomes; tailor method and topic to the learner.
MDD (DSM-5-TR): $\ge 5$ symptoms for $\ge 2$ weeks including depressed mood OR anhedonia; mnemonic SIGECAPS.
SIGECAPS: MDD symptom mnemonic: Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidality.
Persistent depressive disorder (dysthymia): Depressed mood most days for $\ge 2$ years (1 year in children/adolescents).
Bipolar I: At least one manic episode ( $\ge 1$ week or hospitalization); a depressive episode is not required.
Bipolar II: At least one hypomanic episode ( $\ge 4$ days) plus at least one major depressive episode; no full mania.
Manic episode (DIGFAST): Distractibility, Impulsivity/Indiscretion, Grandiosity, Flight of ideas, Activity increase, Sleep decreased, Talkativeness.
GAD (DSM-5-TR): Excessive worry more days than not for $\ge 6$ months plus $\ge 3$ physical symptoms (restlessness, fatigue, concentration, irritability, muscle tension, sleep).
Panic disorder: Recurrent unexpected panic attacks plus $\ge 1$ month of worry about attacks or behavior change.
Social anxiety disorder: Marked fear of social/performance situations with scrutiny, lasting $\ge 6$ months.
OCD: Obsessions and/or compulsions that are time-consuming (>1 hr/day) or cause distress/impairment.
PTSD: Trauma exposure plus intrusion, avoidance, negative cognitions/mood, and arousal/reactivity for >1 month.
Acute stress disorder: Trauma-related symptoms lasting 3 days–1 month (vs PTSD >1 month).
Schizophrenia (DSM-5-TR): $\ge 2$ of delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms for $\ge 1$ month, with $\ge 6$ months of disturbance.
Schizophreniform vs schizophrenia: Schizophreniform = 1–6 months of symptoms; schizophrenia $\ge 6$ months.
Schizoaffective disorder: A mood episode concurrent with schizophrenia symptoms plus $\ge 2$ weeks of psychosis WITHOUT mood symptoms.
Brief psychotic disorder: Psychotic symptoms 1 day–1 month with full return to baseline.
ADHD (DSM-5-TR): Inattentive and/or hyperactive-impulsive symptoms, several before age 12, in $\ge 2$ settings.
Autism spectrum disorder: Persistent deficits in social communication plus restricted/repetitive behaviors; early developmental onset.
Anorexia nervosa: Restriction → low body weight, intense fear of weight gain, body-image disturbance.
Bulimia nervosa: Binge eating plus compensatory behaviors $\ge 1$ /week for 3 months; usually normal weight.
Borderline personality disorder: Instability of relationships, self-image, and affect plus impulsivity; fear of abandonment, splitting, self-harm.
Antisocial personality disorder: Disregard for/violation of others' rights since age 15; requires age $\ge 18$ and conduct disorder before 15.
Delirium: Acute, fluctuating disturbance of attention/awareness from a medical cause; reversible.
Delirium vs dementia: Delirium = acute, fluctuating, altered consciousness, reversible; dementia = gradual, progressive, clear consciousness.
SSRIs: First-line for depression/anxiety; block serotonin reuptake (sertraline, escitalopram, fluoxetine).
SSRI side effects: GI upset, sexual dysfunction, insomnia/sedation, initial anxiety, hyponatremia (SIADH), serotonin-syndrome risk.
Antidepressant boxed warning: Increased suicidal ideation/behavior in patients under 25; monitor closely early in treatment.
SNRIs: Venlafaxine, duloxetine, desvenlafaxine; raise serotonin and norepinephrine; can raise blood pressure.
SNRI vs SSRI: SNRIs add norepinephrine reuptake inhibition (useful for pain/low energy); more discontinuation symptoms (venlafaxine).
TCAs: Amitriptyline, nortriptyline; effective but anticholinergic and cardiotoxic (QRS widening); lethal in overdose.
MAOIs: Phenelzine, tranylcypromine, selegiline; require a tyramine-free diet (avoid aged cheese, cured meats, fermented foods) to prevent hypertensive crisis.
MAOI washout: $\ge 2$ weeks between an MAOI and other serotonergic agents (5 weeks after fluoxetine) to avoid serotonin syndrome.
Bupropion: NDRI; no sexual dysfunction or weight gain; lowers seizure threshold (avoid in eating/seizure disorders); aids smoking cessation.
Mirtazapine: Alpha-2 antagonist; sedating and increases appetite (useful for insomnia/low weight in depression).
Trazodone: Serotonin modulator; used off-label for insomnia; risk of priapism.
Vortioxetine: Multimodal antidepressant with possible pro-cognitive benefit.
Lithium: First-line for bipolar mania/maintenance; FDA range 0.8–1.2 acute / 0.8–1.0 maintenance mEq/L, toxicity $\ge 1.5$ ; monitor renal function and TSH; teratogenic (Ebstein anomaly).
Lithium toxicity: Tremor, ataxia, confusion, seizures; worsened by dehydration, NSAIDs, thiazides, and ACE inhibitors (reduce lithium clearance).
Valproate: For mania/seizures; monitor LFTs and platelets; boxed warnings for hepatotoxicity, pancreatitis, and teratogenicity (neural-tube defects).
Carbamazepine: Mood stabilizer/anticonvulsant; risk of agranulocytosis/aplastic anemia (monitor CBC), HLA-B*1502 SJS, autoinduction, and hyponatremia.
Lamotrigine: Bipolar-depression maintenance; titrate slowly to avoid Stevens-Johnson syndrome / TEN (boxed warning for serious rash).
First-generation (typical) antipsychotics: Haloperidol, chlorpromazine; high D2 blockade → more EPS.
Second-generation (atypical) antipsychotics: Risperidone, olanzapine, quetiapine, aripiprazole; less EPS, more metabolic side effects.
Metabolic monitoring (atypicals): Weight/BMI, fasting glucose, lipids, and blood pressure at baseline and periodically (weight gain, diabetes, dyslipidemia).
Clozapine: Most effective for treatment-resistant schizophrenia; boxed warnings: agranulocytosis (ANC monitoring), seizures, myocarditis, orthostatic hypotension, GI hypomotility/ileus.
Clozapine ANC monitoring: Weekly ANC initially; hold if ANC <1,000/µL (general population). The FDA REMOVED the Clozapine REMS in 2025, but label-schedule ANC monitoring is still recommended.
Antipsychotic + dementia boxed warning: Increased mortality in elderly patients with dementia-related psychosis (not an FDA-approved use).
QTc prolongation: Caused by many antipsychotics (e.g., ziprasidone, IV haloperidol); risk of torsades de pointes.
Aripiprazole: D2 partial agonist; lower metabolic burden; can cause akathisia.
Stimulants (ADHD): Methylphenidate, amphetamine salts; first-line for ADHD; controlled substances; boxed warning for abuse/dependence; monitor cardiovascular status, growth, BP/HR.
Atomoxetine: Nonstimulant (NRI) for ADHD; boxed warning for suicidal ideation in children/adolescents.
Benzodiazepines: Enhance GABA; rapid anxiolytic but risk of dependence/tolerance/withdrawal; boxed warning with opioids (respiratory depression/death).
Benzodiazepine withdrawal: Anxiety, insomnia, tremor, seizures; potentially life-threatening; taper gradually.
Buspirone: 5-HT1A partial agonist; non-sedating, non-dependence anxiolytic; takes 2–4 weeks (not PRN).
Naltrexone: Opioid antagonist for alcohol and opioid use disorder; must be opioid-free ~7–10 days first (precipitates withdrawal). Oral naltrexone NO LONGER carries a boxed warning — hepatotoxicity is now a Warnings-section caution.
Acamprosate: Reduces alcohol craving; renally cleared.
Disulfiram: Causes an aversive reaction (flushing, nausea) with alcohol by inhibiting aldehyde dehydrogenase.
Buprenorphine: Partial opioid agonist (often with naloxone) for OUD; induct in mild–moderate withdrawal (COWS-guided) to avoid precipitated withdrawal.
Methadone: Full opioid agonist for OUD; dispensed via licensed programs; QTc risk.
Naloxone: Opioid antagonist; reverses overdose.
Baseline labs for new psychiatric presentation: TSH, CBC, CMP (electrolytes, glucose, renal/hepatic), B12/folate, urine drug screen; consider HCG in females.
Hypothyroidism: Can mimic depression; check TSH.
Lithium baseline labs: Renal function (BUN/creatinine), TSH, pregnancy test, and ECG if cardiac risk.
St. John's Wort: Complementary agent; induces CYP3A4 and risks serotonin syndrome with serotonergic drugs.
First-line for treatment-resistant schizophrenia: Clozapine.
First-line for bipolar-depression maintenance: Lamotrigine (slow titration).
CBT: Identifies and restructures cognitive distortions; uses behavioral activation; first-line for depression/anxiety.
Cognitive distortions: All-or-nothing thinking, catastrophizing, overgeneralization, mind reading, personalization.
Exposure therapy: Graded exposure to feared stimuli; first-line for phobias, OCD (ERP), and PTSD.
Person-centered therapy (Rogers): Core conditions: unconditional positive regard, empathy, and congruence (genuineness).
IPT (interpersonal therapy): Time-limited; targets grief, role transitions, role disputes, and interpersonal deficits.
Behavioral therapy: Based on conditioning; uses reinforcement and extinction.
Classical conditioning: Pavlov; learning by pairing stimuli (associative learning).
Operant conditioning: Skinner; behavior shaped by consequences (reinforcement/punishment).
Positive vs negative reinforcement: Positive = add a stimulus to increase a behavior; negative = remove an aversive stimulus to increase a behavior.
DBT: For borderline PD/self-harm; four modules: mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness.
ACT: Acceptance and commitment therapy; builds psychological flexibility through values-based action and defusion.
Psychodynamic therapy: Explores unconscious conflicts; works with transference and countertransference.
Transference: The patient projects feelings about past figures onto the therapist.
Countertransference: The therapist's emotional reactions toward the patient.
Defense mechanisms: Unconscious coping: denial, projection, displacement, sublimation, regression, reaction formation.
Transtheoretical model (stages of change): Precontemplation → contemplation → preparation → action → maintenance ( $\pm$ relapse).
TTM intervention matching: Consciousness-raising in precontemplation; commitment/planning in preparation; relapse prevention in maintenance.
Lewin's change theory: Unfreeze → change → refreeze.
Erikson stage 1: Trust vs Mistrust (infancy, 0–18 months).
Erikson stage 2: Autonomy vs Shame/Doubt (toddler, 1–3 years).
Erikson stage 3: Initiative vs Guilt (preschool, 3–6 years).
Erikson stage 4: Industry vs Inferiority (school-age, 6–12 years).
Erikson stage 5: Identity vs Role Confusion (adolescence, 12–18 years).
Erikson stage 6: Intimacy vs Isolation (young adulthood).
Erikson stage 7: Generativity vs Stagnation (middle adulthood).
Erikson stage 8: Integrity vs Despair (late adulthood).
Piaget stages: Sensorimotor (0–2), preoperational (2–7), concrete operational (7–11), formal operational (11+).
Object permanence: Develops in Piaget's sensorimotor stage.
Kohlberg levels: Preconventional, conventional, and postconventional moral reasoning.
Attachment (Bowlby/Ainsworth): Secure, anxious-ambivalent, avoidant, and disorganized attachment styles.
Mahler separation-individuation: Process by which the infant develops a sense of self separate from the caregiver.
Structural family therapy (Minuchin): Focuses on family organization, boundaries, subsystems, and hierarchy.
Bowen family systems: Differentiation of self, triangulation, and multigenerational transmission.
Narrative therapy: Externalize the problem; re-author the patient's life story.
Therapeutic alliance: The collaborative bond; the strongest predictor of psychotherapy outcome.
Strongest predictor of psychotherapy outcome: The therapeutic alliance.
Trauma-informed care (SAMHSA 6 principles): Safety; Trustworthiness/Transparency; Peer support; Collaboration/Mutuality; Empowerment/Voice/Choice; Cultural/Historical/Gender issues.
SAMHSA 4 R's: Realize, Recognize, Respond, Resist re-traumatization.
Boundaries: Professional limits that protect the therapeutic relationship; crossings vs violations.
Informed-consent elements: Capacity, disclosure of information, understanding, and voluntariness.
Capacity vs competency: Capacity = a clinical, decision-specific determination by a provider; competency = a legal determination by a court.
Four-prong capacity assessment: Communicate a choice, understand the information, appreciate the situation/consequences, and reason about the options.
Right to refuse treatment: Competent patients may refuse, even life-sustaining treatment (with exceptions such as emergencies or court orders).
HIPAA Privacy Rule: Protects PHI; permits use/disclosure for treatment, payment, and operations without authorization.
42 CFR Part 2: Stricter than HIPAA; protects substance-use-disorder treatment records.
Tarasoff / duty to protect: Clinician duty to protect identifiable third parties from a patient's serious threat (warn, notify police, hospitalize).
Exceptions to confidentiality: Duty to warn/protect, mandatory abuse reporting, danger to self/others, and a court order.
Mandatory reporting: Child abuse, elder abuse, and dependent-adult abuse must be reported.
Minor consent: Varies by state; many allow minors to consent for SUD, mental-health, reproductive, or STI care.
Autonomy: Respect for the patient's right to self-determination.
Beneficence: Acting in the patient's best interest.
Nonmaleficence: 'Do no harm.'
Justice: Fair, equitable distribution of care and resources.
Civil-commitment criteria: Danger to self, danger to others, or grave disability (unable to meet basic needs).
Voluntary vs involuntary admission: Voluntary = the patient consents and may request discharge; involuntary = legally mandated based on commitment criteria.
Least restrictive environment: Use the least restrictive intervention that ensures safety.
Emergency hold: A short-term involuntary hold (commonly ~72 hours) for evaluation when criteria are met.
Boundary violation: A harmful breach of professional limits (e.g., a sexual or financial relationship with a patient).
ANA nursing-process standards: Assessment, diagnosis, outcomes identification, planning, implementation, and evaluation.
DSM-5-TR Cultural Formulation Interview (CFI): Structured questions that assess the cultural context of a patient's presentation.
Social determinants of mental health: Housing, income, education, discrimination, and access — drivers of mental-health disparities.
Affirming care: Respectful, identity-validating care for LGBTQ+ patients (correct names/pronouns; nonjudgmental).
IDEA / Section 504: Educational accommodations; IDEA provides IEPs for eligible students with disabilities; 504 provides accommodations.
ADA: Prohibits disability discrimination and mandates reasonable workplace accommodations.
FMLA: Up to 12 weeks of unpaid, job-protected leave for serious health conditions (including mental health).
Psychiatric advance directive (PAD): A document stating treatment preferences for future psychiatric crises when capacity is lost.
Tarasoff v. Regents: Established the duty to protect identifiable victims.
O'Connor v. Donaldson: A non-dangerous person capable of surviving safely in freedom cannot be confined.
Wyatt v. Stickney: Established a right to treatment for the involuntarily committed.
Rennie v. Klein / Rogers v. Commissioner: Established committed patients' right to refuse medication (with due process).

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Free PMHNP flashcards from Career Employer — active recall for the ANCC PMHNP-BC psychiatric-mental health nurse practitioner exam

Why Flashcards Work for the PMHNP-BC Exam

Advanced Practice Skills carries the heaviest weight at 27 percent, and its 32 cards drill the screening and assessment instruments you pick up, score, and act on in practice. You get tool cards like PHQ-9 and GAD-7 for mood and anxiety, COWS and CAGE for substance use, and population-specific measures such as GDS, EPDS, and PCL-5.

Scientific Foundation holds 22 percent and 34 cards covering the neurobiology and pharmacology that sit under every prescribing decision. Neurotransmitter cards such as GABA and Glutamate sit alongside structures like the Amygdala and the HPA axis, while ADME and CYP3A4 handle drug movement and metabolism, and Akathisia and AIMS connect to movement side effects.

Diagnosis and Treatment is also weighted at 22 percent and is the largest block in the deck at 67 cards, mixing disorder recognition with medication classes. Diagnostic fronts like OCD and PTSD run next to agent and class cards including SSRIs, SNRIs, TCAs, and MAOIs, plus specific drugs such as Lithium and Naloxone.

Ethics, Legal Principles & Cultural Care is worth 17 percent, and its 31 cards cover the principles and statutes that shape scope and consent. You work through Autonomy, Beneficence, Nonmaleficence, and Justice as ethical anchors, then apply law-facing cards like 42 CFR Part 2, Minor consent, ADA, and FMLA.

Psychotherapy and Related Theories is the lightest at 11 percent but still carries 39 cards, so treat it as high-yield per minute. Modality fronts such as CBT, DBT, and ACT sit beside process concepts like Boundaries and Transference, plus developmental and trauma frameworks including Piaget stages, Erikson stage 1, and the SAMHSA 4 R’s.

That matters on the PMHNP-BC, where psychopharmacology facts like lithium levels, black-box warnings, and screening cutoffs must be instantly available. Used alongside our practice test and study guide, flashcards turn review time into measurable progress.

PMHNP Flashcards by Topic

The cards are organized by the five ANCC PMHNP-BC content domains. Weight your study toward the heaviest ones — Advanced Practice Skills (27%) is the largest, and the diagnosis-and-treatment science is the highest-stakes:^[1]

PMHNP-BC content domains and ANCC weighting
ANCC content domain	Weight
II · Advanced Practice Skills	27%
I · Scientific Foundation	22%
III · Diagnosis and Treatment	22%
V · Ethics, Legal Principles & Cultural Care	17%
IV · Psychotherapy & Related Theories	11%

How to Get the Most Out of These Flashcards

Start where the weight is. Advanced Practice Skills is 27 percent of the exam, so run its 32 screening-tool cards first until the instrument, its purpose, and its population come back instantly.
Type-drill the confusable acronyms. Instruments like COWS and PCL-5 blur together under time pressure, so typing the term from the definition forces the distinction that recognition alone hides.
Use Match for the short-front families. Neurotransmitter and pharmacology cards such as GABA, CYP3A4, and ADME pair quickly, which makes Match a good warm-up before heavier diagnosis work.
Move to the practice test once recall holds. When Quiz runs clean across Diagnosis and Treatment and Scientific Foundation, switch to full-length questions where vignettes combine both, and use the study guide for gaps.
Keep a rotating cadence. With 203 cards, work one domain per session and re-flip the previous domain briefly, so Ethics, Legal Principles & Cultural Care and Psychotherapy and Related Theories never go cold.

PMHNP Flashcards FAQ

Hundreds of free PMHNP flashcards, organized across the five ANCC PMHNP-BC content domains — Scientific Foundation, Advanced Practice Skills, Diagnosis and Treatment, Psychotherapy, and Ethics, Legal Principles and Cultural Care. They're free with no account required.

References

1.American Nurses Credentialing Center (ANCC). “PMHNP-BC Test Content Outline.” ANCC. ↑
2.American Psychiatric Association. “DSM-5-TR — Diagnostic Criteria.” psychiatry.org. ↑
3.U.S. Food and Drug Administration / NIH National Library of Medicine. “DailyMed — psychotropic prescribing information.” DailyMed. ↑
4.National Institute of Mental Health (NIMH). “Mental Health Information — disorders & treatments.” NIMH. ↑

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