NRNP 6675 WALDEN FINAL EXAM
Actual Questions and Answers Expert-
Verified Explanation
Question 1. Geriatric Psychopharmacology
An older adult begins taking a new antidepressant and develops dizziness, confusion, and
unsteadiness. Which factor is most important to consider?
A. Older adults always require higher medication doses.
B. Age-related changes in drug metabolism, renal clearance, and medication sensitivity may
increase adverse effects.
C. Older adults are generally resistant to medication adverse effects.
D. These symptoms are always signs of worsening depression.
Correct Answer: B.
Rationale: Older adults may experience changes in hepatic metabolism, renal clearance, body
composition, and sensitivity to medications. Polypharmacy and drug interactions can further
increase risk. The clinician should assess the timing of symptoms, review all medications,
evaluate for falls and delirium, and consider relevant laboratory testing.
Question 2. Ethical Principles
A psychiatric nurse practitioner ensures that patients receive fair access to appropriate mental
health services regardless of socioeconomic status. Which ethical principle is demonstrated?
A. Autonomy
B. Beneficence
C. Justice
D. Fidelity
Correct Answer: C. Justice
Rationale: Justice concerns fairness and equitable distribution of benefits, burdens, and
healthcare resources. Autonomy concerns a patient's right to make informed decisions;
,beneficence means promoting well-being; and fidelity involves honoring professional
commitments.
Question 3. Major Depressive Disorder
An adult reports depressed mood, loss of interest, fatigue, sleep disturbance, impaired
concentration, and feelings of worthlessness for three weeks. Which diagnostic consideration is
most appropriate?
A. Major depressive disorder, pending confirmation of full criteria and exclusion of other causes
B. Generalized anxiety disorder as the only possible diagnosis
C. Bipolar I disorder based solely on the presence of depression
D. Adjustment disorder automatically, regardless of symptom criteria
Correct Answer: A. Major depressive disorder, pending confirmation of full criteria and exclusion
of other causes
Rationale: Major depressive disorder generally requires at least five depressive symptoms
during the same two-week period, including depressed mood or loss of interest, with clinically
significant distress or impairment. The clinician must assess symptom severity, functional
impact, substance or medical causes, and any history of mania or hypomania. The information
given supports further assessment but does not independently establish every diagnostic
criterion.
Question 4. Suicide Risk Assessment
A patient with depression says, “My family would be better off without me.” What is the most
appropriate next step?
A. Reassure the patient that the family cares about them.
B. Ask directly about suicidal thoughts, intent, plans, access to means, and immediate safety.
C. Avoid discussing suicide because the question may increase risk.
D. Schedule a routine follow-up without further assessment.
Correct Answer: B.
Rationale: Statements suggesting hopelessness or perceived burdensomeness warrant direct,
compassionate suicide-risk assessment. The clinician should evaluate current thoughts, intent,
plans, access to lethal means, previous attempts, protective factors, and available support. If
,imminent danger is identified, urgent safety measures and emergency evaluation may be
necessary.
Question 5. Lithium Toxicity
A patient taking lithium develops vomiting, worsening tremor, unsteady gait, and confusion.
What is the priority action?
A. Recommend taking the next dose with food.
B. Increase the dose because the symptoms suggest undertreatment.
C. Withhold further lithium pending urgent clinical assessment and arrange emergency
evaluation.
D. Reassure the patient that these effects are expected during maintenance therapy.
Correct Answer: C.
Rationale: Gastrointestinal symptoms, worsening tremor, ataxia, and confusion can indicate
lithium toxicity. The medication should not be continued without urgent assessment. Evaluation
may include a serum lithium concentration, renal function, electrolytes, hydration status, and
medication-interaction review. Severe neurological symptoms require emergency care.
Question 6. Bipolar Disorder
A patient presents with elevated mood, markedly decreased need for sleep, pressured speech,
grandiosity, and risky spending. The symptoms have caused severe functional impairment and
required hospitalization. Which diagnosis should be considered?
A. Persistent depressive disorder
B. Bipolar I disorder with a manic episode
C. Generalized anxiety disorder
D. Adjustment disorder with anxiety
Correct Answer: B. Bipolar I disorder with a manic episode
Rationale: A manic episode involves a distinct period of elevated, expansive, or irritable mood
with increased energy or activity, generally lasting at least one week unless hospitalization is
required sooner. Marked impairment, hospitalization, or psychotic features can establish the
severity of mania. The clinician must also evaluate substance-induced and medical causes.
Question 7. Antipsychotic Adverse Effects
, A patient taking an antipsychotic develops high fever, severe muscle rigidity, altered mental
status, and autonomic instability. Which condition is the greatest concern?
A. Serotonin syndrome only
B. Neuroleptic malignant syndrome
C. Mild anticholinergic effects
D. Seasonal affective disorder
Correct Answer: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a potentially life-threatening reaction associated
with dopamine-blocking medications. Typical findings include hyperthermia, severe rigidity,
altered mental status, and autonomic instability. Immediate discontinuation of the suspected
causative medication and emergency medical treatment are required. Serotonin syndrome can
also cause fever and altered mental status but more often features clonus and hyperreflexia,
particularly following serotonergic drug exposure.
Question 8. Clozapine Monitoring
A patient taking clozapine reports fever, sore throat, and flu-like symptoms. What is the most
appropriate response?
A. Advise the patient to wait until the next routine appointment.
B. Recommend doubling the clozapine dose.
C. Arrange prompt medical assessment and appropriate blood testing for possible neutropenia.
D. Explain that these symptoms are unrelated to clozapine.
Correct Answer: C.
Rationale: Clozapine can cause severe neutropenia, including agranulocytosis, which increases
the risk of serious infection. Fever and sore throat require prompt evaluation and appropriate
absolute neutrophil count monitoring. The prescriber should follow current monitoring
requirements and determine whether treatment must be interrupted.
Question 9. Serotonin Syndrome
A patient recently started a serotonergic medication combination and develops agitation,
sweating, diarrhea, tremor, hyperreflexia, and inducible clonus. Which condition is most likely?
A. Neuroleptic malignant syndrome
Actual Questions and Answers Expert-
Verified Explanation
Question 1. Geriatric Psychopharmacology
An older adult begins taking a new antidepressant and develops dizziness, confusion, and
unsteadiness. Which factor is most important to consider?
A. Older adults always require higher medication doses.
B. Age-related changes in drug metabolism, renal clearance, and medication sensitivity may
increase adverse effects.
C. Older adults are generally resistant to medication adverse effects.
D. These symptoms are always signs of worsening depression.
Correct Answer: B.
Rationale: Older adults may experience changes in hepatic metabolism, renal clearance, body
composition, and sensitivity to medications. Polypharmacy and drug interactions can further
increase risk. The clinician should assess the timing of symptoms, review all medications,
evaluate for falls and delirium, and consider relevant laboratory testing.
Question 2. Ethical Principles
A psychiatric nurse practitioner ensures that patients receive fair access to appropriate mental
health services regardless of socioeconomic status. Which ethical principle is demonstrated?
A. Autonomy
B. Beneficence
C. Justice
D. Fidelity
Correct Answer: C. Justice
Rationale: Justice concerns fairness and equitable distribution of benefits, burdens, and
healthcare resources. Autonomy concerns a patient's right to make informed decisions;
,beneficence means promoting well-being; and fidelity involves honoring professional
commitments.
Question 3. Major Depressive Disorder
An adult reports depressed mood, loss of interest, fatigue, sleep disturbance, impaired
concentration, and feelings of worthlessness for three weeks. Which diagnostic consideration is
most appropriate?
A. Major depressive disorder, pending confirmation of full criteria and exclusion of other causes
B. Generalized anxiety disorder as the only possible diagnosis
C. Bipolar I disorder based solely on the presence of depression
D. Adjustment disorder automatically, regardless of symptom criteria
Correct Answer: A. Major depressive disorder, pending confirmation of full criteria and exclusion
of other causes
Rationale: Major depressive disorder generally requires at least five depressive symptoms
during the same two-week period, including depressed mood or loss of interest, with clinically
significant distress or impairment. The clinician must assess symptom severity, functional
impact, substance or medical causes, and any history of mania or hypomania. The information
given supports further assessment but does not independently establish every diagnostic
criterion.
Question 4. Suicide Risk Assessment
A patient with depression says, “My family would be better off without me.” What is the most
appropriate next step?
A. Reassure the patient that the family cares about them.
B. Ask directly about suicidal thoughts, intent, plans, access to means, and immediate safety.
C. Avoid discussing suicide because the question may increase risk.
D. Schedule a routine follow-up without further assessment.
Correct Answer: B.
Rationale: Statements suggesting hopelessness or perceived burdensomeness warrant direct,
compassionate suicide-risk assessment. The clinician should evaluate current thoughts, intent,
plans, access to lethal means, previous attempts, protective factors, and available support. If
,imminent danger is identified, urgent safety measures and emergency evaluation may be
necessary.
Question 5. Lithium Toxicity
A patient taking lithium develops vomiting, worsening tremor, unsteady gait, and confusion.
What is the priority action?
A. Recommend taking the next dose with food.
B. Increase the dose because the symptoms suggest undertreatment.
C. Withhold further lithium pending urgent clinical assessment and arrange emergency
evaluation.
D. Reassure the patient that these effects are expected during maintenance therapy.
Correct Answer: C.
Rationale: Gastrointestinal symptoms, worsening tremor, ataxia, and confusion can indicate
lithium toxicity. The medication should not be continued without urgent assessment. Evaluation
may include a serum lithium concentration, renal function, electrolytes, hydration status, and
medication-interaction review. Severe neurological symptoms require emergency care.
Question 6. Bipolar Disorder
A patient presents with elevated mood, markedly decreased need for sleep, pressured speech,
grandiosity, and risky spending. The symptoms have caused severe functional impairment and
required hospitalization. Which diagnosis should be considered?
A. Persistent depressive disorder
B. Bipolar I disorder with a manic episode
C. Generalized anxiety disorder
D. Adjustment disorder with anxiety
Correct Answer: B. Bipolar I disorder with a manic episode
Rationale: A manic episode involves a distinct period of elevated, expansive, or irritable mood
with increased energy or activity, generally lasting at least one week unless hospitalization is
required sooner. Marked impairment, hospitalization, or psychotic features can establish the
severity of mania. The clinician must also evaluate substance-induced and medical causes.
Question 7. Antipsychotic Adverse Effects
, A patient taking an antipsychotic develops high fever, severe muscle rigidity, altered mental
status, and autonomic instability. Which condition is the greatest concern?
A. Serotonin syndrome only
B. Neuroleptic malignant syndrome
C. Mild anticholinergic effects
D. Seasonal affective disorder
Correct Answer: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a potentially life-threatening reaction associated
with dopamine-blocking medications. Typical findings include hyperthermia, severe rigidity,
altered mental status, and autonomic instability. Immediate discontinuation of the suspected
causative medication and emergency medical treatment are required. Serotonin syndrome can
also cause fever and altered mental status but more often features clonus and hyperreflexia,
particularly following serotonergic drug exposure.
Question 8. Clozapine Monitoring
A patient taking clozapine reports fever, sore throat, and flu-like symptoms. What is the most
appropriate response?
A. Advise the patient to wait until the next routine appointment.
B. Recommend doubling the clozapine dose.
C. Arrange prompt medical assessment and appropriate blood testing for possible neutropenia.
D. Explain that these symptoms are unrelated to clozapine.
Correct Answer: C.
Rationale: Clozapine can cause severe neutropenia, including agranulocytosis, which increases
the risk of serious infection. Fever and sore throat require prompt evaluation and appropriate
absolute neutrophil count monitoring. The prescriber should follow current monitoring
requirements and determine whether treatment must be interrupted.
Question 9. Serotonin Syndrome
A patient recently started a serotonergic medication combination and develops agitation,
sweating, diarrhea, tremor, hyperreflexia, and inducible clonus. Which condition is most likely?
A. Neuroleptic malignant syndrome
