Advanced Practice Psychiatric Nursing 2026/2027 | Integrating Psychotherapy,
Psychopharmacology & Complementary and Alternative Approaches Across the Life
Span 4th Edition Study Guide, PMHNP Exam Prep, Psychiatric Mental Health Nursing
Practice Questions, Psychotherapy, Psychopharmacology, Psychiatric Assessment,
Treatment Planning, Psychopharmacology Management, Therapeutic Communication,
DSM-5-TR, Telehealth & Advanced Practice Nursing
Question 1: A nurse is assessing a client who has been taking clozapine for
treatment-resistant schizophrenia. Which laboratory value requires immediate
intervention?
A. White blood cell count of 3,500/mm³
B. Fasting blood glucose of 110 mg/dL
C. Serum potassium of 4.2 mEq/L
D. Hemoglobin of 13.5 g/dL
CORRECT ANSWER: A. White blood cell count of 3,500/mm³
Rationale: Clozapine carries a black box warning for severe neutropenia. A WBC
below 4,000/mm³ requires immediate notification of the provider and possible
discontinuation of the medication. The other values are within normal limits.
Question 2: A client on fluoxetine reports taking St. John's wort for depression.
Which adverse effect should the nurse monitor for?
A. Hypertensive crisis
B. Serotonin syndrome
C. Neuroleptic malignant syndrome
D. Anticholinergic toxicity
CORRECT ANSWER: B. Serotonin syndrome
Rationale: St. John's wort has serotonergic properties and combined with an SSRI
such as fluoxetine increases the risk of serotonin syndrome, characterized by
agitation, hyperthermia, clonus, and tachycardia.
Question 3: During a cognitive behavioral therapy session, a client states, "I
failed one exam, so I'm a complete failure." Which cognitive distortion is the
client exhibiting?
A. Catastrophizing
B. Overgeneralization
,C. Personalization
D. Mind reading
CORRECT ANSWER: B. Overgeneralization
Rationale: Overgeneralization involves drawing broad negative conclusions from a
single event. The client's leap from one failed exam to being a "complete failure"
exemplifies this distortion.
Question 4: A nurse is administering lithium carbonate to a client with bipolar
disorder. Which client statement indicates a need for further teaching?
A. "I will drink plenty of fluids, especially during exercise."
B. "I will take my lithium with food to reduce stomach upset."
C. "I will follow a low-sodium diet to prevent lithium toxicity."
D. "I will have my blood levels checked regularly."
CORRECT ANSWER: C. "I will follow a low-sodium diet to prevent lithium
toxicity."
Rationale: Sodium and lithium compete for renal reabsorption. A low-sodium diet
decreases lithium excretion, increasing the risk of toxicity. Clients should maintain
consistent, adequate sodium intake.
Question 5: A client with borderline personality disorder is using splitting
behavior on the unit. Which nursing intervention is most appropriate?
A. Allow the client to choose preferred staff members.
B. Rotate staff assignments frequently to prevent manipulation.
C. Confront the client aggressively about the behavior.
D. Assign a single primary nurse for the entire admission.
CORRECT ANSWER: B. Rotate staff assignments frequently to prevent
manipulation.
Rationale: Splitting occurs when clients idealize some staff and devalue others.
Consistent communication among staff and rotating assignments helps prevent
staff from being divided and maintains therapeutic boundaries.
Question 6: A nurse is teaching a client about the mechanism of action of
bupropion. Which statement by the client indicates correct understanding?
,A. "It works by increasing serotonin only."
B. "It blocks dopamine reuptake and has noradrenergic effects."
C. "It is a monoamine oxidase inhibitor."
D. "It primarily blocks histamine receptors."
CORRECT ANSWER: B. "It blocks dopamine reuptake and has noradrenergic
effects."
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI). It
does not significantly affect serotonin and is not an MAOI. This mechanism also
explains its use for smoking cessation.
Question 7: A client experiencing acute alcohol withdrawal is prescribed
chlordiazepoxide. Which assessment finding indicates the medication is
effective?
A. Blood pressure 88/54 mm Hg
B. Respiratory rate 10 breaths/min
C. Heart rate 110 beats/min and tremors
D. Client reports decreased anxiety and tremors are absent
CORRECT ANSWER: D. Client reports decreased anxiety and tremors are absent
Rationale: Chlordiazepoxide is a benzodiazepine used to manage alcohol
withdrawal symptoms. Effectiveness is indicated by reduced anxiety, tremor, and
autonomic hyperactivity without oversedation or hypotension.
Question 8: A nurse is conducting a suicide risk assessment. Which factor places
the client at highest risk?
A. A history of one prior suicide attempt
B. A specific plan with available means
C. Feelings of hopelessness without a plan
D. Passive suicidal ideation without intent
CORRECT ANSWER: B. A specific plan with available means
Rationale: The presence of a specific, lethal plan with accessible means
significantly increases imminent suicide risk. This requires immediate
intervention, including possible hospitalization and removal of means.
, Question 9: A client taking haloperidol develops muscle rigidity, fever, and
altered mental status. Which condition should the nurse suspect?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Tardive dyskinesia
D. Acute dystonia
CORRECT ANSWER: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to
antipsychotics characterized by hyperthermia, muscle rigidity, autonomic
instability, and altered mental status. Immediate discontinuation of the
antipsychotic and supportive care are required.
Question 10: In psychodynamic therapy, a client begins to treat the nurse as if
the nurse were the client's critical parent. This phenomenon is called:
A. Resistance
B. Transference
C. Countertransference
D. Projection
CORRECT ANSWER: B. Transference
Rationale: Transference occurs when clients unconsciously redirect feelings and
attitudes from significant figures in their past onto the therapist. Recognizing and
interpreting transference is a core component of psychodynamic therapy.
Question 11: A nurse is providing education about selective serotonin reuptake
inhibitors (SSRIs) to a client newly diagnosed with major depressive disorder.
Which statement indicates the client understands the teaching?
A. "I should feel better within 24 to 48 hours."
B. "I may experience increased anxiety initially, but it usually subsides."
C. "I can stop the medication once I feel better."
D. "I should avoid all dairy products while taking this."
CORRECT ANSWER: B. "I may experience increased anxiety initially, but it
usually subsides."
Psychopharmacology & Complementary and Alternative Approaches Across the Life
Span 4th Edition Study Guide, PMHNP Exam Prep, Psychiatric Mental Health Nursing
Practice Questions, Psychotherapy, Psychopharmacology, Psychiatric Assessment,
Treatment Planning, Psychopharmacology Management, Therapeutic Communication,
DSM-5-TR, Telehealth & Advanced Practice Nursing
Question 1: A nurse is assessing a client who has been taking clozapine for
treatment-resistant schizophrenia. Which laboratory value requires immediate
intervention?
A. White blood cell count of 3,500/mm³
B. Fasting blood glucose of 110 mg/dL
C. Serum potassium of 4.2 mEq/L
D. Hemoglobin of 13.5 g/dL
CORRECT ANSWER: A. White blood cell count of 3,500/mm³
Rationale: Clozapine carries a black box warning for severe neutropenia. A WBC
below 4,000/mm³ requires immediate notification of the provider and possible
discontinuation of the medication. The other values are within normal limits.
Question 2: A client on fluoxetine reports taking St. John's wort for depression.
Which adverse effect should the nurse monitor for?
A. Hypertensive crisis
B. Serotonin syndrome
C. Neuroleptic malignant syndrome
D. Anticholinergic toxicity
CORRECT ANSWER: B. Serotonin syndrome
Rationale: St. John's wort has serotonergic properties and combined with an SSRI
such as fluoxetine increases the risk of serotonin syndrome, characterized by
agitation, hyperthermia, clonus, and tachycardia.
Question 3: During a cognitive behavioral therapy session, a client states, "I
failed one exam, so I'm a complete failure." Which cognitive distortion is the
client exhibiting?
A. Catastrophizing
B. Overgeneralization
,C. Personalization
D. Mind reading
CORRECT ANSWER: B. Overgeneralization
Rationale: Overgeneralization involves drawing broad negative conclusions from a
single event. The client's leap from one failed exam to being a "complete failure"
exemplifies this distortion.
Question 4: A nurse is administering lithium carbonate to a client with bipolar
disorder. Which client statement indicates a need for further teaching?
A. "I will drink plenty of fluids, especially during exercise."
B. "I will take my lithium with food to reduce stomach upset."
C. "I will follow a low-sodium diet to prevent lithium toxicity."
D. "I will have my blood levels checked regularly."
CORRECT ANSWER: C. "I will follow a low-sodium diet to prevent lithium
toxicity."
Rationale: Sodium and lithium compete for renal reabsorption. A low-sodium diet
decreases lithium excretion, increasing the risk of toxicity. Clients should maintain
consistent, adequate sodium intake.
Question 5: A client with borderline personality disorder is using splitting
behavior on the unit. Which nursing intervention is most appropriate?
A. Allow the client to choose preferred staff members.
B. Rotate staff assignments frequently to prevent manipulation.
C. Confront the client aggressively about the behavior.
D. Assign a single primary nurse for the entire admission.
CORRECT ANSWER: B. Rotate staff assignments frequently to prevent
manipulation.
Rationale: Splitting occurs when clients idealize some staff and devalue others.
Consistent communication among staff and rotating assignments helps prevent
staff from being divided and maintains therapeutic boundaries.
Question 6: A nurse is teaching a client about the mechanism of action of
bupropion. Which statement by the client indicates correct understanding?
,A. "It works by increasing serotonin only."
B. "It blocks dopamine reuptake and has noradrenergic effects."
C. "It is a monoamine oxidase inhibitor."
D. "It primarily blocks histamine receptors."
CORRECT ANSWER: B. "It blocks dopamine reuptake and has noradrenergic
effects."
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI). It
does not significantly affect serotonin and is not an MAOI. This mechanism also
explains its use for smoking cessation.
Question 7: A client experiencing acute alcohol withdrawal is prescribed
chlordiazepoxide. Which assessment finding indicates the medication is
effective?
A. Blood pressure 88/54 mm Hg
B. Respiratory rate 10 breaths/min
C. Heart rate 110 beats/min and tremors
D. Client reports decreased anxiety and tremors are absent
CORRECT ANSWER: D. Client reports decreased anxiety and tremors are absent
Rationale: Chlordiazepoxide is a benzodiazepine used to manage alcohol
withdrawal symptoms. Effectiveness is indicated by reduced anxiety, tremor, and
autonomic hyperactivity without oversedation or hypotension.
Question 8: A nurse is conducting a suicide risk assessment. Which factor places
the client at highest risk?
A. A history of one prior suicide attempt
B. A specific plan with available means
C. Feelings of hopelessness without a plan
D. Passive suicidal ideation without intent
CORRECT ANSWER: B. A specific plan with available means
Rationale: The presence of a specific, lethal plan with accessible means
significantly increases imminent suicide risk. This requires immediate
intervention, including possible hospitalization and removal of means.
, Question 9: A client taking haloperidol develops muscle rigidity, fever, and
altered mental status. Which condition should the nurse suspect?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Tardive dyskinesia
D. Acute dystonia
CORRECT ANSWER: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to
antipsychotics characterized by hyperthermia, muscle rigidity, autonomic
instability, and altered mental status. Immediate discontinuation of the
antipsychotic and supportive care are required.
Question 10: In psychodynamic therapy, a client begins to treat the nurse as if
the nurse were the client's critical parent. This phenomenon is called:
A. Resistance
B. Transference
C. Countertransference
D. Projection
CORRECT ANSWER: B. Transference
Rationale: Transference occurs when clients unconsciously redirect feelings and
attitudes from significant figures in their past onto the therapist. Recognizing and
interpreting transference is a core component of psychodynamic therapy.
Question 11: A nurse is providing education about selective serotonin reuptake
inhibitors (SSRIs) to a client newly diagnosed with major depressive disorder.
Which statement indicates the client understands the teaching?
A. "I should feel better within 24 to 48 hours."
B. "I may experience increased anxiety initially, but it usually subsides."
C. "I can stop the medication once I feel better."
D. "I should avoid all dairy products while taking this."
CORRECT ANSWER: B. "I may experience increased anxiety initially, but it
usually subsides."
