1
NR548 / NR 548 EXAM (1–4) – WEEKS 1 TO 8 COVERED]
ACTUAL QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026/2027 Q&A | INSTANT
DOWNLOAD PDF
*Core Domains:
• Advanced Psychiatric Assessment and Diagnostic Formulation
• Psychopathology Across the Lifespan
• Psychopharmacology and Neurobiology
• Psychotherapy Theories and Interventions
• Crisis Intervention and Suicide Risk Management
• Legal, Ethical, and Cultural Considerations
• Substance Use and Co-Occurring Disorders
• Trauma, Abuse, and Trauma-Informed Care
• Child, Adolescent, and Geriatric Mental Health
• Scope of Practice and Professional Role Development*
Introduction:
This comprehensive psychiatric-mental health nurse practitioner examination
assesses the advanced knowledge, diagnostic reasoning, and clinical judgment
required for safe, evidence-based, and recovery-oriented care across the lifespan.
The instrument includes scenario-based questions covering diagnostic criteria,
psychopharmacology, psychotherapy, crisis management, and ethical-legal
principles. Content reflects current DSM-5-TR criteria, national guidelines, and
advanced practice nursing competencies. Questions challenge the candidate to
integrate biopsychosocial data, differentiate complex presentations, and select
appropriate interventions. Successful performance confirms readiness to manage
,2
mental health conditions competently, collaborate interprofessionally, and
advocate for clients and families across diverse settings.
SECTION ONE: QUESTIONS 1–100
1. A 32-year-old woman reports 6 months of depressed mood, anhedonia,
fatigue, and difficulty concentrating. She denies suicidal ideation but feels
worthless. Which is the most likely diagnosis according to DSM-5-TR?
A. Persistent depressive disorder
B. Major depressive disorder, single episode
C. Bipolar II disorder
D. Generalized anxiety disorder
B. Major depressive disorder, single episode
RATIONALE: The client has had five or more symptoms of depression
(depressed mood, anhedonia, fatigue, impaired concentration,
worthlessness) for at least 2 weeks, meeting criteria for major depressive
disorder. Persistent depressive disorder requires at least 2 years of
symptoms. Bipolar II requires hypomania; GAD involves excessive worry,
not primarily depressed mood.
2. A 55-year-old man with alcohol use disorder is admitted with confusion,
ataxia, and ophthalmoplegia. Which vitamin deficiency is the most likely
cause?
A. Vitamin B12
B. Thiamine
C. Niacin
D. Folic acid
B. Thiamine
RATIONALE: The triad of confusion, ataxia, and ophthalmoplegia
indicates Wernicke encephalopathy due to thiamine deficiency. Immediate
thiamine administration is required before glucose to prevent Korsakoff
syndrome. B12 causes subacute combined degeneration; niacin causes
pellagra; folic acid causes macrocytic anemia.
,3
3. Which medication is first-line maintenance therapy for bipolar I disorder to
prevent manic and depressive episodes?
A. Sertraline
B. Lithium
C. Alprazolam
D. Bupropion
B. Lithium
RATIONALE: Lithium is a mood stabilizer and first-line maintenance
therapy for bipolar I disorder, reducing both manic and depressive episodes
and suicide risk. Antidepressants may precipitate mania and are not first-
line monotherapy. Benzodiazepines are adjunctive for acute agitation.
4. A 45-year-old woman taking paroxetine for depression begins a new
relationship and reports inability to achieve orgasm. This is most likely:
A. An allergic reaction to paroxetine
B. A common SSRI-induced sexual dysfunction
C. A sign of worsening depression
D. A symptom of serotonin syndrome
B. A common SSRI-induced sexual dysfunction
RATIONALE: Selective serotonin reuptake inhibitors commonly cause
sexual dysfunction, including decreased libido, delayed orgasm, and
anorgasmia. Management may include dose adjustment, adding bupropion,
or switching medications. It is not an allergic reaction or serotonin
syndrome.
5. A patient on clozapine must have which laboratory test monitored regularly
because of a life-threatening adverse effect?
A. Serum creatinine
B. White blood cell count and absolute neutrophil count
C. Thyroid-stimulating hormone
D. Serum lithium level
B. White blood cell count and absolute neutrophil count
RATIONALE: Clozapine can cause agranulocytosis, a severe drop in
granulocytes that can be fatal. WBC and ANC must be monitored per Risk
, 4
Evaluation and Mitigation Strategy requirements. Other labs are not the
primary clozapine monitoring.
6. Which of the following is a positive symptom of schizophrenia?
A. Alogia
B. Avolition
C. Auditory hallucinations
D. Flat affect
C. Auditory hallucinations
RATIONALE: Positive symptoms are added experiences such as
hallucinations, delusions, and disorganized speech/behavior. Negative
symptoms include alogia, avolition, and flat affect, which represent
diminished function.
7. A patient with schizophrenia is started on haloperidol. He develops high
fever, muscle rigidity, and altered mental status. Which condition is most
likely?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Tardive dyskinesia
D. Dystonia
B. Neuroleptic malignant syndrome
RATIONALE: Neuroleptic malignant syndrome is a life-threatening
reaction to antipsychotics characterized by fever, severe muscle rigidity,
autonomic instability, and altered consciousness. It requires immediate
discontinuation of the drug and supportive care. Serotonin syndrome
involves clonus and hyperreflexia; tardive dyskinesia is chronic movement
disorder; dystonia is acute muscle spasms.
8. A 12-year-old boy has persistent difficulty sustaining attention,
hyperactivity, and impulsivity in multiple settings. Which first-line
medication is most appropriate?
A. Risperidone
B. Methylphenidate
C. Clonazepam
D. Fluoxetine
NR548 / NR 548 EXAM (1–4) – WEEKS 1 TO 8 COVERED]
ACTUAL QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2026/2027 Q&A | INSTANT
DOWNLOAD PDF
*Core Domains:
• Advanced Psychiatric Assessment and Diagnostic Formulation
• Psychopathology Across the Lifespan
• Psychopharmacology and Neurobiology
• Psychotherapy Theories and Interventions
• Crisis Intervention and Suicide Risk Management
• Legal, Ethical, and Cultural Considerations
• Substance Use and Co-Occurring Disorders
• Trauma, Abuse, and Trauma-Informed Care
• Child, Adolescent, and Geriatric Mental Health
• Scope of Practice and Professional Role Development*
Introduction:
This comprehensive psychiatric-mental health nurse practitioner examination
assesses the advanced knowledge, diagnostic reasoning, and clinical judgment
required for safe, evidence-based, and recovery-oriented care across the lifespan.
The instrument includes scenario-based questions covering diagnostic criteria,
psychopharmacology, psychotherapy, crisis management, and ethical-legal
principles. Content reflects current DSM-5-TR criteria, national guidelines, and
advanced practice nursing competencies. Questions challenge the candidate to
integrate biopsychosocial data, differentiate complex presentations, and select
appropriate interventions. Successful performance confirms readiness to manage
,2
mental health conditions competently, collaborate interprofessionally, and
advocate for clients and families across diverse settings.
SECTION ONE: QUESTIONS 1–100
1. A 32-year-old woman reports 6 months of depressed mood, anhedonia,
fatigue, and difficulty concentrating. She denies suicidal ideation but feels
worthless. Which is the most likely diagnosis according to DSM-5-TR?
A. Persistent depressive disorder
B. Major depressive disorder, single episode
C. Bipolar II disorder
D. Generalized anxiety disorder
B. Major depressive disorder, single episode
RATIONALE: The client has had five or more symptoms of depression
(depressed mood, anhedonia, fatigue, impaired concentration,
worthlessness) for at least 2 weeks, meeting criteria for major depressive
disorder. Persistent depressive disorder requires at least 2 years of
symptoms. Bipolar II requires hypomania; GAD involves excessive worry,
not primarily depressed mood.
2. A 55-year-old man with alcohol use disorder is admitted with confusion,
ataxia, and ophthalmoplegia. Which vitamin deficiency is the most likely
cause?
A. Vitamin B12
B. Thiamine
C. Niacin
D. Folic acid
B. Thiamine
RATIONALE: The triad of confusion, ataxia, and ophthalmoplegia
indicates Wernicke encephalopathy due to thiamine deficiency. Immediate
thiamine administration is required before glucose to prevent Korsakoff
syndrome. B12 causes subacute combined degeneration; niacin causes
pellagra; folic acid causes macrocytic anemia.
,3
3. Which medication is first-line maintenance therapy for bipolar I disorder to
prevent manic and depressive episodes?
A. Sertraline
B. Lithium
C. Alprazolam
D. Bupropion
B. Lithium
RATIONALE: Lithium is a mood stabilizer and first-line maintenance
therapy for bipolar I disorder, reducing both manic and depressive episodes
and suicide risk. Antidepressants may precipitate mania and are not first-
line monotherapy. Benzodiazepines are adjunctive for acute agitation.
4. A 45-year-old woman taking paroxetine for depression begins a new
relationship and reports inability to achieve orgasm. This is most likely:
A. An allergic reaction to paroxetine
B. A common SSRI-induced sexual dysfunction
C. A sign of worsening depression
D. A symptom of serotonin syndrome
B. A common SSRI-induced sexual dysfunction
RATIONALE: Selective serotonin reuptake inhibitors commonly cause
sexual dysfunction, including decreased libido, delayed orgasm, and
anorgasmia. Management may include dose adjustment, adding bupropion,
or switching medications. It is not an allergic reaction or serotonin
syndrome.
5. A patient on clozapine must have which laboratory test monitored regularly
because of a life-threatening adverse effect?
A. Serum creatinine
B. White blood cell count and absolute neutrophil count
C. Thyroid-stimulating hormone
D. Serum lithium level
B. White blood cell count and absolute neutrophil count
RATIONALE: Clozapine can cause agranulocytosis, a severe drop in
granulocytes that can be fatal. WBC and ANC must be monitored per Risk
, 4
Evaluation and Mitigation Strategy requirements. Other labs are not the
primary clozapine monitoring.
6. Which of the following is a positive symptom of schizophrenia?
A. Alogia
B. Avolition
C. Auditory hallucinations
D. Flat affect
C. Auditory hallucinations
RATIONALE: Positive symptoms are added experiences such as
hallucinations, delusions, and disorganized speech/behavior. Negative
symptoms include alogia, avolition, and flat affect, which represent
diminished function.
7. A patient with schizophrenia is started on haloperidol. He develops high
fever, muscle rigidity, and altered mental status. Which condition is most
likely?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Tardive dyskinesia
D. Dystonia
B. Neuroleptic malignant syndrome
RATIONALE: Neuroleptic malignant syndrome is a life-threatening
reaction to antipsychotics characterized by fever, severe muscle rigidity,
autonomic instability, and altered consciousness. It requires immediate
discontinuation of the drug and supportive care. Serotonin syndrome
involves clonus and hyperreflexia; tardive dyskinesia is chronic movement
disorder; dystonia is acute muscle spasms.
8. A 12-year-old boy has persistent difficulty sustaining attention,
hyperactivity, and impulsivity in multiple settings. Which first-line
medication is most appropriate?
A. Risperidone
B. Methylphenidate
C. Clonazepam
D. Fluoxetine
