NR577 FINAL PRIMARY CARE MANAGEMENT
OF ADOLESCENTS AND ADULTS EXAMPREP
STUDY GUIDE 2026 PRACTICE QUESTIONS
AND SOLUTIONS
◉ Yolanda is a 20-year-old client who was referred to the PMHNP by
her college health clinic for symptoms consistent with bipolar II
disorder. She initiates the interview by stating that she is not willing
to take any medications but is willing to engage in counseling or
other therapies.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent. Answer: provide
additional education
Rationale: The client should receive education about the risks,
benefits, and appropriateness of pharmacological treatment. If, after
receiving education, the client still refuses medication therapy, it is
important to document the education provided and the client's
refusal of treatment.
,◉ Kevin is a 48-year-old with a 20-year history of schizophrenia. He
has decided to stop pharmacological treatment due to the
intolerable adverse effects of his medications. Kevin and the
provider have discussed the benefits and drawbacks of ceasing
treatment, and he has agreed to weekly telephone check-ins to
ensure his well-being.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent. Answer: document
refusal of treatment
Rationale: The client has the capacity to consent, and the situation is
not emergent. The ethic of autonomy provides for the client to
refuse treatment.
◉ Ashlei is a 19-year-old who presents to the clinic with severe
anxiety symptoms. As the PMHNP begins reviewing treatment
options, Ashlei interrupts and states, "Hearing about these
medications increases my anxiety. Please prescribe what you think is
best for me, and I will take it."
Which of the following is the most appropriate action?
provide additional education
,document refusal of treatment
initiate treatment without informed consent. Answer: initiate
treatment without informed consent
Rationale: Clients may choose to waive their right to informed
consent. The PMHNP should clearly document the client's waiver.
◉ Geoff is a 32-year-old who presents to the clinic with anhedonia,
fatigue, feelings of worthlessness, and a lack of focus. He admits to
thinking about death but denies suicidal ideations or a plan. He has
been taking sertraline 50 mg daily and wishes to stop taking the
medication as it does not seem to be helping.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent. Answer: provide
additional education
Rationale: The client has the capacity to provide consent and the
situation is not emergent; however, the client should receive
education about the risks, benefits, and appropriateness of
pharmacological treatment. At this time, the dose should be
increased to achieve efficacy. If, after receiving education, the client
, still refuses medication therapy, the PMHNP should document the
education provided and the client's refusal of treatment.
◉ Fritz is a 25-year-old who has been brought to the emergency
department by the police after threatening a server at a restaurant.
The PMHNP on call has treated Fritz for schizophrenia in the past.
He has a history of poor treatment adherence. While in the
emergency department, he admits to auditory hallucinations. He
becomes agitated and begins throwing items around the
examination room.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent. Answer: initiate
treatment without informed consent
Rationale: The client does not have the capacity to provide consent
at this time due to active hallucinations and agitation. For the safety
of the client and staff, treatment should be initiated without
obtaining informed consent.
◉ Acute inpatient care. Answer: short-term treatment to provide
care for acutely ill clients who are unable to meet basic needs due to
OF ADOLESCENTS AND ADULTS EXAMPREP
STUDY GUIDE 2026 PRACTICE QUESTIONS
AND SOLUTIONS
◉ Yolanda is a 20-year-old client who was referred to the PMHNP by
her college health clinic for symptoms consistent with bipolar II
disorder. She initiates the interview by stating that she is not willing
to take any medications but is willing to engage in counseling or
other therapies.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent. Answer: provide
additional education
Rationale: The client should receive education about the risks,
benefits, and appropriateness of pharmacological treatment. If, after
receiving education, the client still refuses medication therapy, it is
important to document the education provided and the client's
refusal of treatment.
,◉ Kevin is a 48-year-old with a 20-year history of schizophrenia. He
has decided to stop pharmacological treatment due to the
intolerable adverse effects of his medications. Kevin and the
provider have discussed the benefits and drawbacks of ceasing
treatment, and he has agreed to weekly telephone check-ins to
ensure his well-being.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent. Answer: document
refusal of treatment
Rationale: The client has the capacity to consent, and the situation is
not emergent. The ethic of autonomy provides for the client to
refuse treatment.
◉ Ashlei is a 19-year-old who presents to the clinic with severe
anxiety symptoms. As the PMHNP begins reviewing treatment
options, Ashlei interrupts and states, "Hearing about these
medications increases my anxiety. Please prescribe what you think is
best for me, and I will take it."
Which of the following is the most appropriate action?
provide additional education
,document refusal of treatment
initiate treatment without informed consent. Answer: initiate
treatment without informed consent
Rationale: Clients may choose to waive their right to informed
consent. The PMHNP should clearly document the client's waiver.
◉ Geoff is a 32-year-old who presents to the clinic with anhedonia,
fatigue, feelings of worthlessness, and a lack of focus. He admits to
thinking about death but denies suicidal ideations or a plan. He has
been taking sertraline 50 mg daily and wishes to stop taking the
medication as it does not seem to be helping.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent. Answer: provide
additional education
Rationale: The client has the capacity to provide consent and the
situation is not emergent; however, the client should receive
education about the risks, benefits, and appropriateness of
pharmacological treatment. At this time, the dose should be
increased to achieve efficacy. If, after receiving education, the client
, still refuses medication therapy, the PMHNP should document the
education provided and the client's refusal of treatment.
◉ Fritz is a 25-year-old who has been brought to the emergency
department by the police after threatening a server at a restaurant.
The PMHNP on call has treated Fritz for schizophrenia in the past.
He has a history of poor treatment adherence. While in the
emergency department, he admits to auditory hallucinations. He
becomes agitated and begins throwing items around the
examination room.
Which of the following is the most appropriate action?
provide additional education
document refusal of treatment
initiate treatment without informed consent. Answer: initiate
treatment without informed consent
Rationale: The client does not have the capacity to provide consent
at this time due to active hallucinations and agitation. For the safety
of the client and staff, treatment should be initiated without
obtaining informed consent.
◉ Acute inpatient care. Answer: short-term treatment to provide
care for acutely ill clients who are unable to meet basic needs due to
