About One DNP

I earned my "terminal practice" degree in nursing from the University of Tennessee Health Sciences Center in a journey of excitement and challenge. It inspired me to advocate for an all encompassing clinical credential rather than continuing the hodgepodge of nonsensical initials. I hope these entries will provide entertainment and insight into the Doctor of Nursing Practice experience, which will soon be the entry standard for all advanced practice nurses.

Thursday, August 2, 2012

I Passed! A Review of the Review and Exam

In that which we are most confident often results in failure. At least, that was my fear going into the ANCC PMHNP certification exam. Despite hearing this exam was allegedly the easiest test I would take in the long series of nursing hoop jump-training, I did not want to get cavalier. Of all the boards I have taken, this was the most important and with hope, the last. As with my FNP, RN-BC, NCLEX, DOM, DilpAC, and DilpH preparation, I had a study plan, created a "cheat sheet" to write out on scratch paper before starting the test, and worried myself sick that I was a knowledge fraud who managed to graduate by luck or accident.

There is a DSM code for that.

After grabbing my usual eggs and lucky Indivisible Blend from Starbucks, I rolled into the parking lot of the testing center at 8:30am just in time to flip through every page of my review notes and psych myself up. After being ID'ed, wanded over, and searched for concealed textbooks, I was escorted to station 15 to live out the next 3.5 hours slugging through 175 questions, 25 of which were secret, experimental items that didn't count. 

Just 2 questions in and I was feeling nervous. By question 50, I doubted I was going to pass. By question 100, I had a boost of confidence. By question 125 I was trying to figure out if the 30-day test window would allow me to re-take the exam before Labor Day. By question 150 I just went numb and fuzzy. With a little over an hour on the timer to go, I ran back through the 45 questions I had marked, change a few answers, said a prayer, and hit submit. Five minutes later, I received the results and was officially certified! 

So, what was so hard?  This test had content that threw me for a bit of a loop. Unlike the Family NP exam that followed the "common diseases occur commonly" model of testing, the Psych Mental Health NP approach assumed you knew all the commonly occurring assessment and management of mood, personality, anxiety, and psychotic disorders and tested around it, with only a couple of bones thrown to topics like Lithium, psychosocial development, and dealing with a borderline in the milieu. 

There was a lot of neurobiology, pharmacokinetics and pharmacodynamics.  The time I put into neurotransmitter pathways, CYP450, and specific drug effects certainly paid off.  I did not spend as much time focusing in on the details of rating scales like the HAM-D, MMPI, and MMSE as I should have, though I was able to activate my hippocampus well enough to pull it out of my memory. There were a number of questions regarding collaboration and consultation, health policy, legal scenarios, and research. Knowing your role and scope was also included in several ways and folks who are FNPs need to be mindful - do not fall into the trap of treating or teaching beyond the scope of the PsychNP role.  There were a few obscure questions on nursing theorists and how to bill for certain procedures (had to be an experimental question). I felt my exam had an overabundance of child and adolescent content, yet not one questions on ADHD!

I used a number of references to prep for the test. 

The Barkley Review home study was an excellent content overview and helped my prioritize my study plan. Too often I go over what I already know to gain confidence and this helped me know what I really did not know. Copy for sale!

Kaplan & Sadock's Study Guide and Self-Examination Review in Psychiatry (STUDY GUIDE/SELF EXAM REV/ SYNOPSIS OF PSYCHIATRY (KAPLANS)
The MDs really like their background and history. Skip those chapters. NPs are more about the here and now of clinical management and interpersonal communication, which are well covered. Some of the questions reflect the essential differences coming from a disease versus a holistic-focus perspective, particularly when it comes to prioritization and adherence. The MDs go into greater depth than NPs when it comes to the "why," and this is particularly useful for psychopharmacology, etiology, and pathology. This book gives you a box of topics to review, several questions on content, and answers with rational.

Psychiatric Nursing Certification Review Guide for the Generalist and Advanced Practice Psychiatric and Mental Health Nurse, Third Edition (Mosack, ... Review Guide for the Generalist and Advance)
Content review is presented at the beginning of the chapter followed by questions. This does a great job going over the basics, which is invaluable for many PMHNPs who never worked in psych at the RN level or did not have experience during their clinical in group dynamics, milieu management, and staffing issues. Even if you are an old-pro, this one is still useful for the way the content blocks are organized, particularly policy and theory. These questions were most like what I encountered on the exam.

Psychopharmacology Demystified
If Stahl made a primer or Cliff's Notes version of Essential Psychopharmacology, this book would be it. The neuro content is well outlined with good visuals, no redundancy, and a clear picture how drugs work in the brain for the most common DSM disorders.

The Psychiatric Interview (Practical Guides in Psychiatry)
I referred to this a number of times while studying assessment. Great mnemonics for those that learn well that way.


  1. All of these books are in my study stash. Graduated August 4, and waiting for the process to test (testing of my patience primarily) to run its course. Thank you for your pointers. But, most importantly, CONGRATULATIONS!

  2. Congratulations to you and best of success!

  3. Congratulations.

  4. woo-woo!!!!!!!!!!!!! Congratz! Thanks for the tips, are you interested in selling any of your review materials?

  5. Hi Judy - Thanks! I already sold the Barkley, but if you are interested in either the Kaplan & Saddock or the ANCC review book, shoot me an email: onednp@gmail.com

  6. Hopefully PMHNP tomorrowMay 22, 2013 at 12:10 PM

    What did you put on your "cheat sheet?" I am thinking of making one but I have no clue what would be good to put on it!

  7. Good luck on your exam! I put down things that I did not want to stop and think about in the moment - key lab values and acronyms for assessments/diagnosis from Carlat were the main things.

  8. Hi OneDNP,
    I was reading your blog regarding the ANCC certification exam. I was unsucessful my first time taking it and I was curious if you had any tips for studying. I had Barkleys tapes but when I went into exam it seemed like nothing I studied hard was on the exam. I appeared to be mostly adolescent questions more theoretical questions than anything! I missed it by 6 points and am very disappointed. I you have any advice, I would greatly appreciate it :) Thanks so much in advance.

  9. Hi OneDNP,
    I have kind of a difficult circumstance. My state licensing board is changing their requirements and I have one chance to take this exam or I have to take my entire program of study all over again. I have the ancc book with addendum and have purchased their 150 online questions. I also have Psychiatric Secrets by Jacobsen and Jacobsen. I also purchased 1000 practice exam questions from http://www.adultpsychcns.com but have no idea if these questions are remotely helpful or like the ones on the exam. I really only have 3 to 4 weeks to study for this exam and am terrified. Could you please find it in your heart to have a couple of brief conversations with me to help guide me in my studies and give me pointers? I appreciate your comments so far but am trying to figure out if I should go buy new study materials or if what i have will be sufficient. Anyway, as much guidance as you are willing to give would be greatly appreciated.

  10. Excellent resource list. I understand the anxiety; I take the exam in April and am finding that my particular NP program had huge knowledge gaps that I am trying to fill in on my own. Rachel - how are you doing with studying? When do you write?

  11. I am scheduled to take the ANCC adult psych exam in about a month. What lab values and acronyms or mnemonics did you find useful for those of you that already have taken the test?
    My initial are CG. I didn't see a way to enter that so am choosing anonymous. But anybody out there please reply---.
    Thank you