NRNP 6675 Final Exam Qs and Ans with Explanation
(Latest ) • 250-Question Comprehensive Exam-Style Review
Psychiatric emergencies & safety
1. A patient says, “I have a loaded gun and I plan to shoot myself tonight.” What is the priority action?
Arrange immediate emergency evaluation and restrict access to the firearm.
Schedule routine follow-up in one week.
Provide a sleep-hygiene handout.
Start a low-dose SSRI and discharge.
Explanation: A specific plan, means, and imminent time frame indicate high acute suicide risk requiring immediate safety intervention.
2. Which finding most strongly indicates imminent suicide risk?
Passive thoughts of death without intent.
A specific plan, intent, and access to lethal means.
Remote history of depression only.
Insomnia for three nights.
Explanation: Plan + intent + access to means is a major marker of acute risk.
3. A patient with severe agitation, command hallucinations, and access to a weapon arrives in clinic. What is the
best first step?
Ensure environmental safety and obtain emergency assistance.
Debate the hallucination content.
Leave the patient alone to calm down.
Ask the patient to return tomorrow.
Explanation: Safety of the patient, staff, and others comes first during an acute behavioral emergency.
4. A patient taking an antipsychotic develops fever, severe rigidity, altered mental status, and autonomic instability.
Which condition is most likely?
Serotonin syndrome.
Neuroleptic malignant syndrome.
Akathisia.
Tardive dyskinesia.
Explanation: Fever, lead-pipe rigidity, altered consciousness, and autonomic instability after dopamine blockade are classic for NMS.
NRNP 6675 • Original exam-style study bank • 250 questions Page 1
, 5. Which laboratory abnormality is most concerning in suspected neuroleptic malignant syndrome?
Creatine kinase elevation.
Mildly low HDL.
Slightly elevated LDL.
Low vitamin D.
Explanation: Muscle breakdown in NMS commonly produces markedly elevated CK and risk of rhabdomyolysis.
6. A patient taking an SSRI develops agitation, diaphoresis, diarrhea, tremor, and clonus after a serotonergic drug
was added. What is the likely diagnosis?
Serotonin syndrome.
NMS.
Lithium toxicity.
Anticholinergic toxicity.
Explanation: Rapid serotonergic excess commonly produces autonomic symptoms, GI hyperactivity, tremor, hyperreflexia, and clonus.
7. Which feature helps distinguish serotonin syndrome from NMS?
Hyperreflexia and clonus.
Fever.
Altered mental status.
Autonomic instability.
Explanation: Hyperreflexia and clonus are particularly characteristic of serotonin toxicity.
8. A patient is acutely intoxicated and threatening staff. Which intervention is most appropriate initially?
Use verbal de-escalation while maintaining a safe environment.
Immediately apply four-point restraints to every intoxicated patient.
Argue that the behavior is irrational.
Offer psychotherapy.
Explanation: Verbal de-escalation and environmental safety are preferred before coercive measures when feasible.
9. Which medication is commonly used for rapid control of severe agitation when clinically indicated?
An antipsychotic such as haloperidol or an appropriate second-generation agent.
Donepezil.
Atomoxetine.
Buspirone.
Explanation: Antipsychotics can rapidly reduce severe agitation depending on the cause and clinical setting.
10. A patient with alcohol dependence has tremor, diaphoresis, tachycardia, and anxiety 12 hours after stopping
alcohol. What is the priority treatment class?
Benzodiazepines.
SSRIs.
Stimulants.
Anticholinergics.
Explanation: Benzodiazepines are first-line for clinically significant alcohol withdrawal and reduce seizure/delirium risk.
NRNP 6675 • Original exam-style study bank • 250 questions Page 2
, 11. Which withdrawal syndrome can become life-threatening and include delirium, autonomic instability, and
hallucinations?
Alcohol withdrawal.
Caffeine withdrawal.
Nicotine withdrawal.
Cannabis withdrawal.
Explanation: Severe alcohol withdrawal can progress to delirium tremens with marked autonomic activation.
12. A patient with opioid use disorder has pinpoint pupils, respiratory depression, and decreased consciousness.
What is the priority medication?
Naloxone.
Naltrexone.
Acamprosate.
Disulfiram.
Explanation: Naloxone rapidly reverses opioid-induced respiratory depression.
13. After naloxone administration, what is a key concern?
Recurrent respiratory depression when naloxone wears off.
Permanent immunity to opioids.
Immediate cure of opioid use disorder.
Guaranteed absence of withdrawal.
Explanation: Naloxone may have a shorter duration than some opioids, so recurrent toxicity is possible.
14. Which assessment is essential before initiating a stimulant for ADHD?
Cardiovascular history and baseline vital signs.
Only a urine pregnancy test.
Only a liver biopsy.
Only a sleep study.
Explanation: Stimulants can affect heart rate and blood pressure, so cardiovascular assessment is clinically relevant.
15. A patient with mania has not slept for four days and is becoming increasingly disorganized. What is the most
appropriate immediate goal?
Stabilize safety, sleep, and severe behavioral symptoms.
Begin long-term insight-oriented psychotherapy only.
Encourage more daytime stimulation.
Avoid all medications.
Explanation: Acute mania requires stabilization of safety, sleep, psychosis/agitation, and mood symptoms.
16. Which symptom most strongly suggests psychosis requiring urgent assessment?
Command hallucinations telling the patient to kill someone.
Mild worry about work.
Occasional sadness.
Preference for solitude.
Explanation: Command hallucinations with harmful content can create immediate safety risk.
NRNP 6675 • Original exam-style study bank • 250 questions Page 3
, 17. A patient reports voices telling them to self-harm. What should the PMHNP assess next?
Content, intent, ability to resist, access to means, and overall suicide risk.
Favorite foods.
Childhood hobbies only.
Only medication adherence.
Explanation: The clinician must determine whether hallucinations create actionable risk.
18. Which finding is most concerning for delirium rather than a primary psychotic disorder?
Acute fluctuating attention and awareness.
Stable hallucinations for ten years.
Long-standing negative symptoms.
Chronic social withdrawal.
Explanation: Delirium is characterized by acute onset and fluctuating attention/awareness.
19. A patient suddenly becomes confused after starting an anticholinergic medication. What is a likely contributor?
Anticholinergic toxicity.
Serotonin deficiency.
Dopamine depletion.
Low melatonin.
Explanation: Anticholinergic burden can cause confusion, agitation, dry mouth, urinary retention, and tachycardia.
20. Which intervention is appropriate for a patient experiencing acute panic in the office?
Reduce stimulation, use calm communication, assess safety, and coach slow breathing.
Tell the patient the symptoms are imaginary.
Force prolonged exposure immediately.
Ignore the patient until symptoms stop.
Explanation: Calm containment and physiologic regulation are appropriate during acute panic.
21. A patient with severe depression develops psychotic features and cannot maintain nutrition. Which treatment
may be especially appropriate?
Electroconvulsive therapy (ECT).
Sleep restriction alone.
Caffeine reduction only.
Routine psychotherapy without medical assessment.
Explanation: ECT is highly effective for severe depression with psychosis, suicidality, or refusal/inability to eat.
22. What is a major acute risk after ECT?
Transient confusion and memory impairment.
Permanent renal failure in all patients.
Universal seizures for days.
Severe neutropenia.
Explanation: Short-term confusion and anterograde/retrograde memory effects can occur after ECT.
NRNP 6675 • Original exam-style study bank • 250 questions Page 4
(Latest ) • 250-Question Comprehensive Exam-Style Review
Psychiatric emergencies & safety
1. A patient says, “I have a loaded gun and I plan to shoot myself tonight.” What is the priority action?
Arrange immediate emergency evaluation and restrict access to the firearm.
Schedule routine follow-up in one week.
Provide a sleep-hygiene handout.
Start a low-dose SSRI and discharge.
Explanation: A specific plan, means, and imminent time frame indicate high acute suicide risk requiring immediate safety intervention.
2. Which finding most strongly indicates imminent suicide risk?
Passive thoughts of death without intent.
A specific plan, intent, and access to lethal means.
Remote history of depression only.
Insomnia for three nights.
Explanation: Plan + intent + access to means is a major marker of acute risk.
3. A patient with severe agitation, command hallucinations, and access to a weapon arrives in clinic. What is the
best first step?
Ensure environmental safety and obtain emergency assistance.
Debate the hallucination content.
Leave the patient alone to calm down.
Ask the patient to return tomorrow.
Explanation: Safety of the patient, staff, and others comes first during an acute behavioral emergency.
4. A patient taking an antipsychotic develops fever, severe rigidity, altered mental status, and autonomic instability.
Which condition is most likely?
Serotonin syndrome.
Neuroleptic malignant syndrome.
Akathisia.
Tardive dyskinesia.
Explanation: Fever, lead-pipe rigidity, altered consciousness, and autonomic instability after dopamine blockade are classic for NMS.
NRNP 6675 • Original exam-style study bank • 250 questions Page 1
, 5. Which laboratory abnormality is most concerning in suspected neuroleptic malignant syndrome?
Creatine kinase elevation.
Mildly low HDL.
Slightly elevated LDL.
Low vitamin D.
Explanation: Muscle breakdown in NMS commonly produces markedly elevated CK and risk of rhabdomyolysis.
6. A patient taking an SSRI develops agitation, diaphoresis, diarrhea, tremor, and clonus after a serotonergic drug
was added. What is the likely diagnosis?
Serotonin syndrome.
NMS.
Lithium toxicity.
Anticholinergic toxicity.
Explanation: Rapid serotonergic excess commonly produces autonomic symptoms, GI hyperactivity, tremor, hyperreflexia, and clonus.
7. Which feature helps distinguish serotonin syndrome from NMS?
Hyperreflexia and clonus.
Fever.
Altered mental status.
Autonomic instability.
Explanation: Hyperreflexia and clonus are particularly characteristic of serotonin toxicity.
8. A patient is acutely intoxicated and threatening staff. Which intervention is most appropriate initially?
Use verbal de-escalation while maintaining a safe environment.
Immediately apply four-point restraints to every intoxicated patient.
Argue that the behavior is irrational.
Offer psychotherapy.
Explanation: Verbal de-escalation and environmental safety are preferred before coercive measures when feasible.
9. Which medication is commonly used for rapid control of severe agitation when clinically indicated?
An antipsychotic such as haloperidol or an appropriate second-generation agent.
Donepezil.
Atomoxetine.
Buspirone.
Explanation: Antipsychotics can rapidly reduce severe agitation depending on the cause and clinical setting.
10. A patient with alcohol dependence has tremor, diaphoresis, tachycardia, and anxiety 12 hours after stopping
alcohol. What is the priority treatment class?
Benzodiazepines.
SSRIs.
Stimulants.
Anticholinergics.
Explanation: Benzodiazepines are first-line for clinically significant alcohol withdrawal and reduce seizure/delirium risk.
NRNP 6675 • Original exam-style study bank • 250 questions Page 2
, 11. Which withdrawal syndrome can become life-threatening and include delirium, autonomic instability, and
hallucinations?
Alcohol withdrawal.
Caffeine withdrawal.
Nicotine withdrawal.
Cannabis withdrawal.
Explanation: Severe alcohol withdrawal can progress to delirium tremens with marked autonomic activation.
12. A patient with opioid use disorder has pinpoint pupils, respiratory depression, and decreased consciousness.
What is the priority medication?
Naloxone.
Naltrexone.
Acamprosate.
Disulfiram.
Explanation: Naloxone rapidly reverses opioid-induced respiratory depression.
13. After naloxone administration, what is a key concern?
Recurrent respiratory depression when naloxone wears off.
Permanent immunity to opioids.
Immediate cure of opioid use disorder.
Guaranteed absence of withdrawal.
Explanation: Naloxone may have a shorter duration than some opioids, so recurrent toxicity is possible.
14. Which assessment is essential before initiating a stimulant for ADHD?
Cardiovascular history and baseline vital signs.
Only a urine pregnancy test.
Only a liver biopsy.
Only a sleep study.
Explanation: Stimulants can affect heart rate and blood pressure, so cardiovascular assessment is clinically relevant.
15. A patient with mania has not slept for four days and is becoming increasingly disorganized. What is the most
appropriate immediate goal?
Stabilize safety, sleep, and severe behavioral symptoms.
Begin long-term insight-oriented psychotherapy only.
Encourage more daytime stimulation.
Avoid all medications.
Explanation: Acute mania requires stabilization of safety, sleep, psychosis/agitation, and mood symptoms.
16. Which symptom most strongly suggests psychosis requiring urgent assessment?
Command hallucinations telling the patient to kill someone.
Mild worry about work.
Occasional sadness.
Preference for solitude.
Explanation: Command hallucinations with harmful content can create immediate safety risk.
NRNP 6675 • Original exam-style study bank • 250 questions Page 3
, 17. A patient reports voices telling them to self-harm. What should the PMHNP assess next?
Content, intent, ability to resist, access to means, and overall suicide risk.
Favorite foods.
Childhood hobbies only.
Only medication adherence.
Explanation: The clinician must determine whether hallucinations create actionable risk.
18. Which finding is most concerning for delirium rather than a primary psychotic disorder?
Acute fluctuating attention and awareness.
Stable hallucinations for ten years.
Long-standing negative symptoms.
Chronic social withdrawal.
Explanation: Delirium is characterized by acute onset and fluctuating attention/awareness.
19. A patient suddenly becomes confused after starting an anticholinergic medication. What is a likely contributor?
Anticholinergic toxicity.
Serotonin deficiency.
Dopamine depletion.
Low melatonin.
Explanation: Anticholinergic burden can cause confusion, agitation, dry mouth, urinary retention, and tachycardia.
20. Which intervention is appropriate for a patient experiencing acute panic in the office?
Reduce stimulation, use calm communication, assess safety, and coach slow breathing.
Tell the patient the symptoms are imaginary.
Force prolonged exposure immediately.
Ignore the patient until symptoms stop.
Explanation: Calm containment and physiologic regulation are appropriate during acute panic.
21. A patient with severe depression develops psychotic features and cannot maintain nutrition. Which treatment
may be especially appropriate?
Electroconvulsive therapy (ECT).
Sleep restriction alone.
Caffeine reduction only.
Routine psychotherapy without medical assessment.
Explanation: ECT is highly effective for severe depression with psychosis, suicidality, or refusal/inability to eat.
22. What is a major acute risk after ECT?
Transient confusion and memory impairment.
Permanent renal failure in all patients.
Universal seizures for days.
Severe neutropenia.
Explanation: Short-term confusion and anterograde/retrograde memory effects can occur after ECT.
NRNP 6675 • Original exam-style study bank • 250 questions Page 4
