NRNP 6675 PMHNP CARE ACROSS THE LIFESPAN FINAL EXAM
CHAMBERLAIN UNIVERSITY ACTUAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
1. A 72-year-old patient with recurrent major depressive disorder has responded
well to an SSRI but develops dizziness when standing after the dose is increased.
Blood pressure is 138/76 mm Hg while seated and 108/62 mm Hg after standing.
Which age-related change most likely contributes to this patient's increased
susceptibility to the adverse effect?
A. Increased hepatic blood flow
B. Increased total body water
C. Reduced renal and hepatic clearance
D. Increased plasma albumin concentration
Answer: C
Rationale: Older adults commonly experience reduced renal function and
decreased hepatic blood flow and metabolic capacity. These changes can increase
medication exposure and susceptibility to adverse effects. Orthostatic symptoms
may be particularly clinically significant in older adults because they increase fall
risk. Psychotropic medications should generally be initiated at lower doses and
titrated cautiously.
,2. A 16-year-old adolescent presents with 2 months of persistent irritability, loss of
interest in friends, declining grades, fatigue, insomnia, and recurrent thoughts that
"everyone would be better off without me." There is no history of mania,
psychosis, or substance use. Which intervention is the highest priority during the
initial psychiatric evaluation?
A. Determine whether the patient meets criteria for generalized anxiety disorder
B. Assess the severity and immediacy of suicide risk
C. Begin a stimulant to improve academic functioning
D. Obtain permission from the school to review academic records
Answer: B
Rationale: Suicidal thoughts require immediate risk assessment before proceeding
with routine diagnostic or academic concerns. The PMHNP should evaluate intent,
plan, access to lethal means, previous attempts, protective factors, and ability to
maintain safety. Diagnostic clarification and treatment planning follow
stabilization of immediate safety concerns.
3. A 79-year-old patient begins a medication with a long elimination half-life. The
patient develops excessive sedation several days after initiation despite receiving
the recommended starting dose. Which pharmacokinetic principle best explains
this finding?
A. Older adults usually have increased hepatic metabolism
B. Reduced clearance can cause drug accumulation over time
C. Aging consistently increases renal drug elimination
D. Shorter half-lives produce greater accumulation
Answer: B
Rationale: Reduced hepatic and renal clearance in older adults can prolong
medication elimination and increase accumulation, particularly with drugs that
have long half-lives. Adverse effects may become apparent only after repeated
dosing because steady-state concentrations are reached gradually.
,4. A 34-year-old patient reports spending nearly every evening searching for
discarded furniture, appliances, clothing, and household objects. The home has
become so cluttered that several rooms cannot be used for their intended purposes.
The patient becomes extremely distressed when family members suggest throwing
anything away. Which diagnosis best fits this presentation?
A. Obsessive-compulsive disorder
B. Hoarding disorder
C. Obsessive-compulsive personality disorder
D. Generalized anxiety disorder
Answer: B
Rationale: Hoarding disorder involves persistent difficulty discarding or parting
with possessions regardless of their actual value, accompanied by accumulation
that compromises intended use of living spaces or causes significant distress or
impairment. The behavior is distinct from simply having a large collection of
valued objects.
5. A patient taking lithium for bipolar disorder reports worsening hand tremor,
nausea, diarrhea, and difficulty walking. The patient recently began taking an over-
the-counter medication for knee pain. Which medication most likely contributed to
the presentation?
A. Ibuprofen
B. Loratadine
C. Famotidine
D. Calcium carbonate
Answer: A
Rationale: NSAIDs such as ibuprofen can reduce renal lithium clearance and
increase serum lithium concentrations. The combination can precipitate lithium
toxicity. Symptoms such as gastrointestinal upset, worsening tremor, ataxia,
confusion, and neuromuscular abnormalities warrant prompt evaluation and serum
lithium measurement.
, 6. A 68-year-old patient with schizophrenia has persistent hallucinations despite
adherence to an antipsychotic regimen. The patient also has Parkinson disease and
experiences substantial rigidity and bradykinesia. Which pharmacologic
consideration is most important when selecting an alternative antipsychotic?
A. Choose an agent with a high likelihood of dopamine D2 blockade
B. Select an agent with minimal risk of worsening extrapyramidal symptoms
C. Use the highest tolerated dose to suppress hallucinations rapidly
D. Add a typical antipsychotic before assessing the current regimen
Answer: B
Rationale: Patients with Parkinson disease are particularly vulnerable to
worsening motor symptoms from dopamine blockade. An antipsychotic with lower
propensity for extrapyramidal adverse effects may be preferred when antipsychotic
treatment is necessary. Older adults also require cautious dosing because of
increased vulnerability to adverse effects.
7. A 29-year-old patient has recurrent episodes of elevated mood, decreased need
for sleep, grandiosity, pressured speech, impulsive spending, and increased goal-
directed activity. Several episodes have required hospitalization. Between
episodes, the patient returns to baseline functioning. Which diagnosis is most
consistent with this history?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Borderline personality disorder
Answer: A
Rationale: Bipolar I disorder requires at least one manic episode. Mania is
characterized by a distinct period of abnormally elevated, expansive, or irritable
mood and increased energy or activity accompanied by associated symptoms and
significant impairment, hospitalization, or psychosis. A history of major depression
is not required for the diagnosis.
CHAMBERLAIN UNIVERSITY ACTUAL EXAM QUESTIONS AND
CORRECT VERIFIED ANSWERS WITH RATIONALES
100% GUARANTEED PASS!!
<LATEST VERSION>
1. A 72-year-old patient with recurrent major depressive disorder has responded
well to an SSRI but develops dizziness when standing after the dose is increased.
Blood pressure is 138/76 mm Hg while seated and 108/62 mm Hg after standing.
Which age-related change most likely contributes to this patient's increased
susceptibility to the adverse effect?
A. Increased hepatic blood flow
B. Increased total body water
C. Reduced renal and hepatic clearance
D. Increased plasma albumin concentration
Answer: C
Rationale: Older adults commonly experience reduced renal function and
decreased hepatic blood flow and metabolic capacity. These changes can increase
medication exposure and susceptibility to adverse effects. Orthostatic symptoms
may be particularly clinically significant in older adults because they increase fall
risk. Psychotropic medications should generally be initiated at lower doses and
titrated cautiously.
,2. A 16-year-old adolescent presents with 2 months of persistent irritability, loss of
interest in friends, declining grades, fatigue, insomnia, and recurrent thoughts that
"everyone would be better off without me." There is no history of mania,
psychosis, or substance use. Which intervention is the highest priority during the
initial psychiatric evaluation?
A. Determine whether the patient meets criteria for generalized anxiety disorder
B. Assess the severity and immediacy of suicide risk
C. Begin a stimulant to improve academic functioning
D. Obtain permission from the school to review academic records
Answer: B
Rationale: Suicidal thoughts require immediate risk assessment before proceeding
with routine diagnostic or academic concerns. The PMHNP should evaluate intent,
plan, access to lethal means, previous attempts, protective factors, and ability to
maintain safety. Diagnostic clarification and treatment planning follow
stabilization of immediate safety concerns.
3. A 79-year-old patient begins a medication with a long elimination half-life. The
patient develops excessive sedation several days after initiation despite receiving
the recommended starting dose. Which pharmacokinetic principle best explains
this finding?
A. Older adults usually have increased hepatic metabolism
B. Reduced clearance can cause drug accumulation over time
C. Aging consistently increases renal drug elimination
D. Shorter half-lives produce greater accumulation
Answer: B
Rationale: Reduced hepatic and renal clearance in older adults can prolong
medication elimination and increase accumulation, particularly with drugs that
have long half-lives. Adverse effects may become apparent only after repeated
dosing because steady-state concentrations are reached gradually.
,4. A 34-year-old patient reports spending nearly every evening searching for
discarded furniture, appliances, clothing, and household objects. The home has
become so cluttered that several rooms cannot be used for their intended purposes.
The patient becomes extremely distressed when family members suggest throwing
anything away. Which diagnosis best fits this presentation?
A. Obsessive-compulsive disorder
B. Hoarding disorder
C. Obsessive-compulsive personality disorder
D. Generalized anxiety disorder
Answer: B
Rationale: Hoarding disorder involves persistent difficulty discarding or parting
with possessions regardless of their actual value, accompanied by accumulation
that compromises intended use of living spaces or causes significant distress or
impairment. The behavior is distinct from simply having a large collection of
valued objects.
5. A patient taking lithium for bipolar disorder reports worsening hand tremor,
nausea, diarrhea, and difficulty walking. The patient recently began taking an over-
the-counter medication for knee pain. Which medication most likely contributed to
the presentation?
A. Ibuprofen
B. Loratadine
C. Famotidine
D. Calcium carbonate
Answer: A
Rationale: NSAIDs such as ibuprofen can reduce renal lithium clearance and
increase serum lithium concentrations. The combination can precipitate lithium
toxicity. Symptoms such as gastrointestinal upset, worsening tremor, ataxia,
confusion, and neuromuscular abnormalities warrant prompt evaluation and serum
lithium measurement.
, 6. A 68-year-old patient with schizophrenia has persistent hallucinations despite
adherence to an antipsychotic regimen. The patient also has Parkinson disease and
experiences substantial rigidity and bradykinesia. Which pharmacologic
consideration is most important when selecting an alternative antipsychotic?
A. Choose an agent with a high likelihood of dopamine D2 blockade
B. Select an agent with minimal risk of worsening extrapyramidal symptoms
C. Use the highest tolerated dose to suppress hallucinations rapidly
D. Add a typical antipsychotic before assessing the current regimen
Answer: B
Rationale: Patients with Parkinson disease are particularly vulnerable to
worsening motor symptoms from dopamine blockade. An antipsychotic with lower
propensity for extrapyramidal adverse effects may be preferred when antipsychotic
treatment is necessary. Older adults also require cautious dosing because of
increased vulnerability to adverse effects.
7. A 29-year-old patient has recurrent episodes of elevated mood, decreased need
for sleep, grandiosity, pressured speech, impulsive spending, and increased goal-
directed activity. Several episodes have required hospitalization. Between
episodes, the patient returns to baseline functioning. Which diagnosis is most
consistent with this history?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
D. Borderline personality disorder
Answer: A
Rationale: Bipolar I disorder requires at least one manic episode. Mania is
characterized by a distinct period of abnormally elevated, expansive, or irritable
mood and increased energy or activity accompanied by associated symptoms and
significant impairment, hospitalization, or psychosis. A history of major depression
is not required for the diagnosis.
