NR547 CEA EXAM 2026 ACTUAL] QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
1. Advanced Health Assessment and Diagnostic Reasoning
2. Psychopharmacology and Biologic Basis of Mental Illness
3. Psychotherapy and Therapeutic Interventions
4. Ethical and Legal Principles in Psychiatric-Mental Health Nursing
5. Healthcare Policy, Advocacy, and Interprofessional Collaboration
6. Quality Improvement and Evidence-Based Practice
7. Cultural Competence and Health Disparities
8. Crisis Intervention and Emergency Mental Health
9. Integration of Physical and Mental Healthcare
Introduction
This comprehensive examination is designed to assess the advanced knowledge, clinical reasoning, and decision-
making skills essential for the Psychiatric-Mental Health Nurse Practitioner (PMHNP). The exam evaluates your
ability to integrate foundational theory with applied professional knowledge across a spectrum of clinical
scenarios. It covers critical areas including psychopharmacology, psychotherapy, ethical-legal standards, and
healthcare policy. The questions are structured in a multiple-choice and scenario-based format to emphasize real-
world application and clinical judgment. Mastery of this content ensures you are prepared to deliver safe, patient-
centered, and evidence-based care in a variety of psychiatric settings.
SECTION ONE: QUESTIONS 1-100
,1. A 45-year-old patient with a history of major depressive disorder (MDD) has been on fluoxetine 40 mg
daily for 6 months with partial response. The patient now reports significant fatigue, anhedonia, and
decreased concentration. Which of the following is the MOST appropriate next step in management?
A. Switch to sertraline
B. Increase fluoxetine to 60 mg daily
C. Add a low dose of aripiprazole
D. Discontinue fluoxetine and start a MAOI
🟢 C. Add a low dose of aripiprazole
🔴 RATIONALE: For patients with MDD who have a partial response to an SSRI, augmentation with an atypical
antipsychotic like aripiprazole is an evidence-based strategy. This approach targets different neurotransmitter
systems and can be more effective than simply increasing the SSRI dose, which may lead to increased side
effects without additional therapeutic benefit.
2. According to the American Nurses Association (ANA) Code of Ethics, which of the following principles is
the foundation for a PMHNP’s duty to report suspected child abuse?
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice
🟢 C. Nonmaleficence
🔴 RATIONALE: The principle of nonmaleficence, or the duty to "do no harm," is the ethical foundation for
reporting abuse. The PMHNP must act to prevent further harm to a vulnerable child, which supersedes a
,parent's autonomy or the therapeutic relationship. It is a legal and ethical mandate to protect the patient from
harm.
3. A patient diagnosed with bipolar I disorder is being discharged on lithium. What is the MOST critical
patient education point regarding this medication?
A. "You should increase your fluid intake if you start sweating heavily."
B. "It is safe to take over-the-counter NSAIDs for headaches."
C. "You may notice a persistent, fine tremor that is harmless."
D. "You can expect to see therapeutic benefits within 24 hours."
🟢 A. "You should increase your fluid intake if you start sweating heavily."
🔴 RATIONALE: Lithium toxicity is a serious risk, especially when there are changes in fluid and electrolyte
balance. Heavy sweating can lead to dehydration and increased serum lithium levels. Patients must be educated
to maintain adequate hydration to prevent toxicity. NSAIDs should be avoided as they increase lithium levels.
Fine tremors are common but should be monitored.
4. During an initial psychiatric interview, a patient describes a pattern of intense, unstable relationships,
impulsivity, and chronic feelings of emptiness. The patient also reports engaging in self-harming behaviors
when feeling abandoned. Which personality disorder is MOST consistent with these symptoms?
A. Borderline Personality Disorder
B. Narcissistic Personality Disorder
C. Histrionic Personality Disorder
D. Antisocial Personality Disorder
🟢 A. Borderline Personality Disorder
, 🔴 RATIONALE: The core features of Borderline Personality Disorder (BPD) include a pervasive pattern of
instability in interpersonal relationships, self-image, and affects, as well as marked impulsivity. Key criteria
include frantic efforts to avoid abandonment, a pattern of unstable and intense relationships, identity
disturbance, impulsivity, recurrent suicidal behavior or self-mutilation, and chronic feelings of emptiness.
5. Which of the following is a key component of the Mental Status Examination (MSE) that assesses a
patient's ability to understand and use language?
A. Orientation
B. Attention
C. Memory
D. Speech and Language
🟢 D. Speech and Language
🔴 RATIONALE: Speech and language assessment in the MSE evaluates the patient's ability to express
themselves and comprehend language. It involves noting the rate, volume, and flow of speech (e.g., pressured,
slow) as well as any signs of aphasia, which is a language disorder affecting comprehension and production.
6. A patient with schizophrenia is being treated with clozapine. The PMHNP orders a complete blood count
(CBC) to monitor for which life-threatening adverse effect?
A. Thrombocytopenia
B. Agranulocytosis
C. Hemolytic anemia
D. Leukocytosis
🟢 B. Agranulocytosis
RATIONALES 2026 Q&A |LATEST EXAM UPDATE 2026/2027.
Core Domains
1. Advanced Health Assessment and Diagnostic Reasoning
2. Psychopharmacology and Biologic Basis of Mental Illness
3. Psychotherapy and Therapeutic Interventions
4. Ethical and Legal Principles in Psychiatric-Mental Health Nursing
5. Healthcare Policy, Advocacy, and Interprofessional Collaboration
6. Quality Improvement and Evidence-Based Practice
7. Cultural Competence and Health Disparities
8. Crisis Intervention and Emergency Mental Health
9. Integration of Physical and Mental Healthcare
Introduction
This comprehensive examination is designed to assess the advanced knowledge, clinical reasoning, and decision-
making skills essential for the Psychiatric-Mental Health Nurse Practitioner (PMHNP). The exam evaluates your
ability to integrate foundational theory with applied professional knowledge across a spectrum of clinical
scenarios. It covers critical areas including psychopharmacology, psychotherapy, ethical-legal standards, and
healthcare policy. The questions are structured in a multiple-choice and scenario-based format to emphasize real-
world application and clinical judgment. Mastery of this content ensures you are prepared to deliver safe, patient-
centered, and evidence-based care in a variety of psychiatric settings.
SECTION ONE: QUESTIONS 1-100
,1. A 45-year-old patient with a history of major depressive disorder (MDD) has been on fluoxetine 40 mg
daily for 6 months with partial response. The patient now reports significant fatigue, anhedonia, and
decreased concentration. Which of the following is the MOST appropriate next step in management?
A. Switch to sertraline
B. Increase fluoxetine to 60 mg daily
C. Add a low dose of aripiprazole
D. Discontinue fluoxetine and start a MAOI
🟢 C. Add a low dose of aripiprazole
🔴 RATIONALE: For patients with MDD who have a partial response to an SSRI, augmentation with an atypical
antipsychotic like aripiprazole is an evidence-based strategy. This approach targets different neurotransmitter
systems and can be more effective than simply increasing the SSRI dose, which may lead to increased side
effects without additional therapeutic benefit.
2. According to the American Nurses Association (ANA) Code of Ethics, which of the following principles is
the foundation for a PMHNP’s duty to report suspected child abuse?
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice
🟢 C. Nonmaleficence
🔴 RATIONALE: The principle of nonmaleficence, or the duty to "do no harm," is the ethical foundation for
reporting abuse. The PMHNP must act to prevent further harm to a vulnerable child, which supersedes a
,parent's autonomy or the therapeutic relationship. It is a legal and ethical mandate to protect the patient from
harm.
3. A patient diagnosed with bipolar I disorder is being discharged on lithium. What is the MOST critical
patient education point regarding this medication?
A. "You should increase your fluid intake if you start sweating heavily."
B. "It is safe to take over-the-counter NSAIDs for headaches."
C. "You may notice a persistent, fine tremor that is harmless."
D. "You can expect to see therapeutic benefits within 24 hours."
🟢 A. "You should increase your fluid intake if you start sweating heavily."
🔴 RATIONALE: Lithium toxicity is a serious risk, especially when there are changes in fluid and electrolyte
balance. Heavy sweating can lead to dehydration and increased serum lithium levels. Patients must be educated
to maintain adequate hydration to prevent toxicity. NSAIDs should be avoided as they increase lithium levels.
Fine tremors are common but should be monitored.
4. During an initial psychiatric interview, a patient describes a pattern of intense, unstable relationships,
impulsivity, and chronic feelings of emptiness. The patient also reports engaging in self-harming behaviors
when feeling abandoned. Which personality disorder is MOST consistent with these symptoms?
A. Borderline Personality Disorder
B. Narcissistic Personality Disorder
C. Histrionic Personality Disorder
D. Antisocial Personality Disorder
🟢 A. Borderline Personality Disorder
, 🔴 RATIONALE: The core features of Borderline Personality Disorder (BPD) include a pervasive pattern of
instability in interpersonal relationships, self-image, and affects, as well as marked impulsivity. Key criteria
include frantic efforts to avoid abandonment, a pattern of unstable and intense relationships, identity
disturbance, impulsivity, recurrent suicidal behavior or self-mutilation, and chronic feelings of emptiness.
5. Which of the following is a key component of the Mental Status Examination (MSE) that assesses a
patient's ability to understand and use language?
A. Orientation
B. Attention
C. Memory
D. Speech and Language
🟢 D. Speech and Language
🔴 RATIONALE: Speech and language assessment in the MSE evaluates the patient's ability to express
themselves and comprehend language. It involves noting the rate, volume, and flow of speech (e.g., pressured,
slow) as well as any signs of aphasia, which is a language disorder affecting comprehension and production.
6. A patient with schizophrenia is being treated with clozapine. The PMHNP orders a complete blood count
(CBC) to monitor for which life-threatening adverse effect?
A. Thrombocytopenia
B. Agranulocytosis
C. Hemolytic anemia
D. Leukocytosis
🟢 B. Agranulocytosis
