NR 668 CEA FINAL EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD AND PASS | LATEST
EXAM UPDATE 2026/2027
Core Domains
Advanced Psychiatric-Mental Health Nursing Practice
Psychopharmacology and Biological Basis of Treatment
Psychotherapy and Therapeutic Interventions
Assessment, Diagnosis, and Differential Diagnosis
Ethics, Legal, and Regulatory Standards
Quality Improvement and Evidence-Based Practice
Collaborative Care and Interprofessional Communication
Population Health and Health Promotion
Crisis Intervention and Suicide Prevention
Introduction
This comprehensive examination is designed to evaluate the advanced practice
registered nurse's (APRN) readiness for the certification exam in psychiatric-mental
health nursing. It assesses a broad spectrum of knowledge including foundational
theory, applied clinical skills, and complex decision-making capabilities necessary
for autonomous practice. The exam employs a mix of direct knowledge questions
and detailed clinical scenarios to challenge the test-taker's ability to synthesize
information, prioritize care, and apply evidence-based interventions in real-world
settings. Emphasis is placed on safe, ethical, and patient-centered care, reflecting
the full scope of the PMHNP role.
SECTION ONE: QUESTIONS 1 – 50
,1. A 68-year-old patient with major depressive disorder has not responded to
two adequate trials of SSRIs. Which of the following is the MOST appropriate
next step in management?
A. Add aripiprazole as an adjunctive therapy.
B. Discontinue all antidepressants and start a monoamine oxidase inhibitor
(MAOI).
C. Begin a trial of electroconvulsive therapy (ECT).
D. Switch to a different SSRI.
🟢 Correct Answer: A. Add aripiprazole as an adjunctive therapy.
🔴 Explanation: Augmentation of an SSRI with a second-generation antipsychotic
like aripiprazole is a first-line, evidence-based strategy for treatment-resistant
depression. While ECT is an option, it is typically reserved for more severe or life-
threatening cases after other strategies fail.
2. A 24-year-old female presents with a two-week history of elevated mood,
decreased need for sleep, and excessive involvement in risky activities. She
reports this is a distinct change from her baseline. She has no previous
psychiatric history. Which of the following is the MOST likely diagnosis?
A. Cyclothymic disorder
B. Bipolar I disorder, most recent episode manic
C. Bipolar II disorder, most recent episode hypomanic
D. Substance/medication-induced bipolar and related disorder
🟢 Correct Answer: B. Bipolar I disorder, most recent episode manic
🔴 Explanation: The patient's symptoms, including elevated mood, decreased
need for sleep, and risky behavior, meet the criteria for a manic episode, which is
required for a diagnosis of Bipolar I disorder. The duration of one week and the
significant functional impairment are key differentiators.
,3. A patient on clozapine for treatment-resistant schizophrenia has a white
blood cell (WBC) count of 2,800/mm³. What is the MOST appropriate
immediate action?
A. Obtain a repeat WBC count in one week.
B. Continue clozapine but decrease the dose.
C. Immediately discontinue clozapine and initiate the REMS protocol.
D. Add filgrastim to the treatment regimen.
🟢 Correct Answer: C. Immediately discontinue clozapine and initiate the REMS
protocol.
🔴 Explanation: A WBC count below 3,000/mm³ is a critical value indicating
severe neutropenia. The REMS (Risk Evaluation and Mitigation Strategy) protocol
mandates the immediate discontinuation of clozapine and daily monitoring of
WBC and ANC to mitigate the risk of life-threatening agranulocytosis.
4. A 15-year-old patient with ADHD is being treated with a long-acting
stimulant. He reports a racing heart and feeling "jittery" two hours after taking
his medication. Which of the following is the MOST appropriate initial nursing
action?
A. Reassure the patient and instruct him to take the medication with food.
B. Assess vital signs and inquire about caffeine intake.
C. Discontinue the stimulant immediately.
D. Instruct the patient to take the medication at bedtime.
🟢 Correct Answer: B. Assess vital signs and inquire about caffeine intake.
🔴 Explanation: Tachycardia and jitteriness are common side effects of stimulants
and can be exacerbated by caffeine. The initial, priority action is to assess the
patient's current physiological status (vital signs) and potential contributing
factors before making any changes to the medication regimen.
, 5. The therapeutic relationship is the foundation of psychiatric nursing. Which
of the following actions BEST demonstrates the establishment of a therapeutic
alliance?
A. Offering advice when the patient asks for a solution.
B. Maintaining a social relationship with the patient to build trust.
C. Engaging in active listening and validating the patient's feelings.
D. Avoiding discussions about difficult topics to prevent patient distress.
🟢 Correct Answer: C. Engaging in active listening and validating the patient's
feelings.
🔴 Explanation: Active listening and validation are core components of a
therapeutic alliance. They demonstrate empathy, respect, and understanding,
which are crucial for building trust and a safe environment for the patient to
explore their thoughts and feelings.
6. A 45-year-old patient with a history of chronic pain and opioid use disorder
is being discharged. The patient expresses a desire to manage pain without
opioids. In addition to non-opioid analgesics, which of the following is the
MOST appropriate recommendation?
A. Biofeedback and cognitive-behavioral therapy (CBT).
B. Referral to a local gym for a rigorous exercise program.
C. A low-dose opioid maintenance program to manage pain.
D. A strict regimen of acetaminophen and ibuprofen.
🟢 Correct Answer: A. Biofeedback and cognitive-behavioral therapy (CBT).
🔴 Explanation: Evidence-based non-pharmacological interventions like CBT and
biofeedback are effective for managing chronic pain. CBT helps patients develop
coping skills, and biofeedback can teach them to modulate their physiological
responses to pain, reducing reliance on opioids.
DETAILED ANSWERS | PLUS RATIONALES | DOWNLOAD AND PASS | LATEST
EXAM UPDATE 2026/2027
Core Domains
Advanced Psychiatric-Mental Health Nursing Practice
Psychopharmacology and Biological Basis of Treatment
Psychotherapy and Therapeutic Interventions
Assessment, Diagnosis, and Differential Diagnosis
Ethics, Legal, and Regulatory Standards
Quality Improvement and Evidence-Based Practice
Collaborative Care and Interprofessional Communication
Population Health and Health Promotion
Crisis Intervention and Suicide Prevention
Introduction
This comprehensive examination is designed to evaluate the advanced practice
registered nurse's (APRN) readiness for the certification exam in psychiatric-mental
health nursing. It assesses a broad spectrum of knowledge including foundational
theory, applied clinical skills, and complex decision-making capabilities necessary
for autonomous practice. The exam employs a mix of direct knowledge questions
and detailed clinical scenarios to challenge the test-taker's ability to synthesize
information, prioritize care, and apply evidence-based interventions in real-world
settings. Emphasis is placed on safe, ethical, and patient-centered care, reflecting
the full scope of the PMHNP role.
SECTION ONE: QUESTIONS 1 – 50
,1. A 68-year-old patient with major depressive disorder has not responded to
two adequate trials of SSRIs. Which of the following is the MOST appropriate
next step in management?
A. Add aripiprazole as an adjunctive therapy.
B. Discontinue all antidepressants and start a monoamine oxidase inhibitor
(MAOI).
C. Begin a trial of electroconvulsive therapy (ECT).
D. Switch to a different SSRI.
🟢 Correct Answer: A. Add aripiprazole as an adjunctive therapy.
🔴 Explanation: Augmentation of an SSRI with a second-generation antipsychotic
like aripiprazole is a first-line, evidence-based strategy for treatment-resistant
depression. While ECT is an option, it is typically reserved for more severe or life-
threatening cases after other strategies fail.
2. A 24-year-old female presents with a two-week history of elevated mood,
decreased need for sleep, and excessive involvement in risky activities. She
reports this is a distinct change from her baseline. She has no previous
psychiatric history. Which of the following is the MOST likely diagnosis?
A. Cyclothymic disorder
B. Bipolar I disorder, most recent episode manic
C. Bipolar II disorder, most recent episode hypomanic
D. Substance/medication-induced bipolar and related disorder
🟢 Correct Answer: B. Bipolar I disorder, most recent episode manic
🔴 Explanation: The patient's symptoms, including elevated mood, decreased
need for sleep, and risky behavior, meet the criteria for a manic episode, which is
required for a diagnosis of Bipolar I disorder. The duration of one week and the
significant functional impairment are key differentiators.
,3. A patient on clozapine for treatment-resistant schizophrenia has a white
blood cell (WBC) count of 2,800/mm³. What is the MOST appropriate
immediate action?
A. Obtain a repeat WBC count in one week.
B. Continue clozapine but decrease the dose.
C. Immediately discontinue clozapine and initiate the REMS protocol.
D. Add filgrastim to the treatment regimen.
🟢 Correct Answer: C. Immediately discontinue clozapine and initiate the REMS
protocol.
🔴 Explanation: A WBC count below 3,000/mm³ is a critical value indicating
severe neutropenia. The REMS (Risk Evaluation and Mitigation Strategy) protocol
mandates the immediate discontinuation of clozapine and daily monitoring of
WBC and ANC to mitigate the risk of life-threatening agranulocytosis.
4. A 15-year-old patient with ADHD is being treated with a long-acting
stimulant. He reports a racing heart and feeling "jittery" two hours after taking
his medication. Which of the following is the MOST appropriate initial nursing
action?
A. Reassure the patient and instruct him to take the medication with food.
B. Assess vital signs and inquire about caffeine intake.
C. Discontinue the stimulant immediately.
D. Instruct the patient to take the medication at bedtime.
🟢 Correct Answer: B. Assess vital signs and inquire about caffeine intake.
🔴 Explanation: Tachycardia and jitteriness are common side effects of stimulants
and can be exacerbated by caffeine. The initial, priority action is to assess the
patient's current physiological status (vital signs) and potential contributing
factors before making any changes to the medication regimen.
, 5. The therapeutic relationship is the foundation of psychiatric nursing. Which
of the following actions BEST demonstrates the establishment of a therapeutic
alliance?
A. Offering advice when the patient asks for a solution.
B. Maintaining a social relationship with the patient to build trust.
C. Engaging in active listening and validating the patient's feelings.
D. Avoiding discussions about difficult topics to prevent patient distress.
🟢 Correct Answer: C. Engaging in active listening and validating the patient's
feelings.
🔴 Explanation: Active listening and validation are core components of a
therapeutic alliance. They demonstrate empathy, respect, and understanding,
which are crucial for building trust and a safe environment for the patient to
explore their thoughts and feelings.
6. A 45-year-old patient with a history of chronic pain and opioid use disorder
is being discharged. The patient expresses a desire to manage pain without
opioids. In addition to non-opioid analgesics, which of the following is the
MOST appropriate recommendation?
A. Biofeedback and cognitive-behavioral therapy (CBT).
B. Referral to a local gym for a rigorous exercise program.
C. A low-dose opioid maintenance program to manage pain.
D. A strict regimen of acetaminophen and ibuprofen.
🟢 Correct Answer: A. Biofeedback and cognitive-behavioral therapy (CBT).
🔴 Explanation: Evidence-based non-pharmacological interventions like CBT and
biofeedback are effective for managing chronic pain. CBT helps patients develop
coping skills, and biofeedback can teach them to modulate their physiological
responses to pain, reducing reliance on opioids.
