NR 668 CEA Final Exam – PMH Capstone Q&A
NR 668 CEA Final Exam
Psychiatric-Mental Health Capstone Practicum & Intensive
Questions and Answers| Latest Update
1
, NR 668 CEA Final Exam – PMH Capstone Q&A
1. A PMHNP is evaluating a 34-year-old patient for major depressive disorder.
According to DSM-5-TR, how many symptoms (including depressed mood or
anhedonia) must be present for at least 2 weeks to meet criteria?
Answer: At least 5 of 9 symptoms
Rationale: DSM-5-TR requires 5 or more of the 9 listed symptoms, with at
least one being depressed mood or loss of interest/pleasure, present nearly every
day for at least a 2-week period and representing a change from previous
functioning.
2. A patient started on sertraline 3 weeks ago reports new-onset agitation,
racing thoughts, and insomnia. What is the PMHNP's priority concern?
Answer: Possible unmasking of bipolar disorder (SSRI-induced manic switch)
Rationale: Antidepressants can precipitate a manic or hypomanic episode in
patients with undiagnosed bipolar disorder. The PMHNP should reassess mood
history, stop or adjust the antidepressant, and consider mood stabilization
before continuing antidepressant monotherapy.
3. Which black box warning is associated with all antidepressants in patients
under age 25?
Answer: Increased risk of suicidal thinking and behavior
Rationale: The FDA black box warning applies to all antidepressant classes
and requires close monitoring for emergence or worsening of suicidal ideation,
especially during the first 1-2 months of treatment or after dose changes, in
children, adolescents, and young adults up to age 24.
4. A patient on lithium presents with nausea, vomiting, coarse tremor, ataxia,
and confusion. Lithium level is 2.8 mEq/L. What is the priority nursing action?
Answer: Discontinue lithium immediately and prepare for possible
hemodialysis
Rationale: A level above 2.5 mEq/L with neurologic symptoms indicates
severe lithium toxicity, a medical emergency. Lithium should be held
immediately, supportive care and IV fluids initiated, and hemodialysis
considered for levels this high or with severe symptoms.
5. What baseline laboratory tests are required before initiating lithium
therapy?
2
, NR 668 CEA Final Exam – PMH Capstone Q&A
Answer: Renal function (BUN/creatinine), thyroid function (TSH), electrolytes,
ECG (if cardiac risk), and pregnancy test
Rationale: Lithium is renally excreted and affects thyroid function, so baseline
renal and thyroid panels are essential. An ECG is recommended in patients with
cardiac risk factors, and pregnancy status must be assessed due to teratogenicity
(Ebstein's anomaly).
6. A patient taking clozapine develops a sore throat and fever. What is the
priority action?
Answer: Obtain an immediate absolute neutrophil count (ANC) and hold the
medication if indicated
Rationale: Clozapine carries a risk of agranulocytosis. Fever and sore throat
are classic warning signs of neutropenia and require urgent ANC monitoring
per the Clozapine REMS program; the drug is held if ANC falls below the
safety threshold.
7. Which antipsychotic side effect is characterized by muscle rigidity,
hyperthermia, autonomic instability, and altered mental status?
Answer: Neuroleptic malignant syndrome (NMS)
Rationale: NMS is a life-threatening reaction to antipsychotics (especially
high-potency first-generation agents) marked by the tetrad of rigidity,
hyperthermia, autonomic instability, and altered consciousness. It requires
immediate discontinuation of the antipsychotic, supportive care, and sometimes
dantrolene or bromocriptine.
8. What distinguishes serotonin syndrome from neuroleptic malignant
syndrome?
Answer: Serotonin syndrome presents with hyperreflexia, clonus, and rapid
onset; NMS presents with lead-pipe rigidity and gradual onset over days
Rationale: Serotonin syndrome typically develops within 24 hours of
starting/increasing a serotonergic agent and features neuromuscular
hyperactivity (clonus, hyperreflexia, tremor). NMS develops over days and
features bradyreflexia and severe 'lead-pipe' rigidity, usually related to
dopamine antagonists.
9. A patient with schizophrenia reports 'the television is sending me special
messages.' This is an example of what type of delusion?
3
NR 668 CEA Final Exam
Psychiatric-Mental Health Capstone Practicum & Intensive
Questions and Answers| Latest Update
1
, NR 668 CEA Final Exam – PMH Capstone Q&A
1. A PMHNP is evaluating a 34-year-old patient for major depressive disorder.
According to DSM-5-TR, how many symptoms (including depressed mood or
anhedonia) must be present for at least 2 weeks to meet criteria?
Answer: At least 5 of 9 symptoms
Rationale: DSM-5-TR requires 5 or more of the 9 listed symptoms, with at
least one being depressed mood or loss of interest/pleasure, present nearly every
day for at least a 2-week period and representing a change from previous
functioning.
2. A patient started on sertraline 3 weeks ago reports new-onset agitation,
racing thoughts, and insomnia. What is the PMHNP's priority concern?
Answer: Possible unmasking of bipolar disorder (SSRI-induced manic switch)
Rationale: Antidepressants can precipitate a manic or hypomanic episode in
patients with undiagnosed bipolar disorder. The PMHNP should reassess mood
history, stop or adjust the antidepressant, and consider mood stabilization
before continuing antidepressant monotherapy.
3. Which black box warning is associated with all antidepressants in patients
under age 25?
Answer: Increased risk of suicidal thinking and behavior
Rationale: The FDA black box warning applies to all antidepressant classes
and requires close monitoring for emergence or worsening of suicidal ideation,
especially during the first 1-2 months of treatment or after dose changes, in
children, adolescents, and young adults up to age 24.
4. A patient on lithium presents with nausea, vomiting, coarse tremor, ataxia,
and confusion. Lithium level is 2.8 mEq/L. What is the priority nursing action?
Answer: Discontinue lithium immediately and prepare for possible
hemodialysis
Rationale: A level above 2.5 mEq/L with neurologic symptoms indicates
severe lithium toxicity, a medical emergency. Lithium should be held
immediately, supportive care and IV fluids initiated, and hemodialysis
considered for levels this high or with severe symptoms.
5. What baseline laboratory tests are required before initiating lithium
therapy?
2
, NR 668 CEA Final Exam – PMH Capstone Q&A
Answer: Renal function (BUN/creatinine), thyroid function (TSH), electrolytes,
ECG (if cardiac risk), and pregnancy test
Rationale: Lithium is renally excreted and affects thyroid function, so baseline
renal and thyroid panels are essential. An ECG is recommended in patients with
cardiac risk factors, and pregnancy status must be assessed due to teratogenicity
(Ebstein's anomaly).
6. A patient taking clozapine develops a sore throat and fever. What is the
priority action?
Answer: Obtain an immediate absolute neutrophil count (ANC) and hold the
medication if indicated
Rationale: Clozapine carries a risk of agranulocytosis. Fever and sore throat
are classic warning signs of neutropenia and require urgent ANC monitoring
per the Clozapine REMS program; the drug is held if ANC falls below the
safety threshold.
7. Which antipsychotic side effect is characterized by muscle rigidity,
hyperthermia, autonomic instability, and altered mental status?
Answer: Neuroleptic malignant syndrome (NMS)
Rationale: NMS is a life-threatening reaction to antipsychotics (especially
high-potency first-generation agents) marked by the tetrad of rigidity,
hyperthermia, autonomic instability, and altered consciousness. It requires
immediate discontinuation of the antipsychotic, supportive care, and sometimes
dantrolene or bromocriptine.
8. What distinguishes serotonin syndrome from neuroleptic malignant
syndrome?
Answer: Serotonin syndrome presents with hyperreflexia, clonus, and rapid
onset; NMS presents with lead-pipe rigidity and gradual onset over days
Rationale: Serotonin syndrome typically develops within 24 hours of
starting/increasing a serotonergic agent and features neuromuscular
hyperactivity (clonus, hyperreflexia, tremor). NMS develops over days and
features bradyreflexia and severe 'lead-pipe' rigidity, usually related to
dopamine antagonists.
9. A patient with schizophrenia reports 'the television is sending me special
messages.' This is an example of what type of delusion?
3
