Chamberlain University Nr 606 Final Exam
Diagnosis & Management In Psychiatric-
Mental Health- Pmhnp | All Questions And
Solutions (Rationales) 2026 | Exam Prep
Q&A 2026/2027
1. A 34-year-old female patient presents for an initial psychiatric evaluation complaining of
severe fatigue, low mood, and anhedonia lasting 6 weeks. She reports a history of one
episode 2 years ago where she felt "on top of the world" for 5 days, slept 2 hours per night
without feeling tired, spent $8,000 on home decor, and spoke so rapidly her family could
not interrupt her. She was not hospitalized during that time. Which primary diagnosis
should the Psychiatric-Mental Health Nurse Practitioner (PMHNP) document?
A. Major Depressive Disorder, Recurrent
B. Bipolar I Disorder, Current Episode Depressed
C. Bipolar II Disorder, Current Episode Depressed
D. Cyclothymic Disorder
Answer: C
Rationale: Bipolar II Disorder requires at least one major depressive episode and at least one
hypomanic episode (lasting at least 4 consecutive days, distinct from normal behavior,
without causing severe impairment or requiring hospitalization). The history of a 5-day period
of decreased need for sleep, elevated mood, hyper-verbosity, and excessive spending without
hospitalization or psychosis defines hypomania, ruling out Major Depressive Disorder and
Bipolar I Disorder.
2. A 28-year-old male with Schizophrenia, treatment-resistant type, has been taking
Clozapine for 6 months. His absolute neutrophil count (ANC) baseline was 2,100/µL.
Today's routine complete blood count (CBC) reveals an ANC of 950/µL. What is the most
appropriate clinical decision by the PMHNP?
A. Continue Clozapine at the current dose and recheck the ANC in 7 days.
B. Reduce the Clozapine dose by 50% and recheck the ANC twice weekly.
C. Interrupt Clozapine treatment immediately, consult hematology, and monitor ANC daily.
,D. Discontinue Clozapine permanently and immediately start Olanzapine.
Answer: C
Rationale: According to the FDA Clozapine Risk Evaluation and Mitigation Strategy (REMS)
guidelines, an ANC below 1,000/µL indicates severe neutropenia. The provider must interrupt
Clozapine therapy immediately, obtain a hematology consultation, and monitor the ANC daily
until it returns to >= 1,000/µL. Continuing or simply reducing the dose poses a life-threatening
risk of agranulocytosis and overwhelming infection.
3. A 42-year-old male patient with Generalized Anxiety Disorder and major depressive
symptoms is started on Duloxetine 30 mg daily. During a follow-up call at day 10, he
reports mild nausea and dry mouth but states his anxiety feels slightly elevated. Which
communication and management strategy is most appropriate?
A. Discontinue Duloxetine immediately and switch to Venlafaxine.
B. Reassure the patient that transient mild side effects and initial jitteriness often resolve within
2 to 4 weeks and encourage continued compliance.
C. Add Alprazolam 1 mg three times daily long-term to counteract the activation.
D. Immediately double the dose of Duloxetine to 60 mg daily to overcome side effects.
Answer: B
Rationale: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) like Duloxetine frequently
cause mild, transient gastrointestinal and activating side effects during the first 1 to 2 weeks
of initiation. Reassuring the patient, educating them about adaptation, and maintaining the
current regimen promotes adherence while avoiding unnecessary medication switches or
inappropriate long-term benzodiazepine prescriptions.
4. A 19-year-old college student is brought to the emergency department by roommates due
to acute agitation, confusion, visual hallucinations, and dilated pupils. Vital signs reveal
blood pressure 158/96 mmHg, heart rate 124 bpm, and temperature 100.8°F. The patient
keeps picking at his clothes and stating he sees "bugs crawling on the wall." Which
toxidrome or substance intoxication should the PMHNP suspect first?
A. Opioid intoxication
B. Amphetamine/Cocaine (Sympathomimetic) intoxication
C. Alcohol withdrawal delirium
D. Cannabis intoxication
,Answer: B
Rationale: Sympathomimetic intoxication (caused by amphetamines, cocaine, or synthetic
cathinones) presents with Mydriasis (dilated pupils), tachycardia, hypertension,
hyperthermia, agitation, tactile/visual hallucinations (formication), and diaphoresis. Opioid
intoxication causes miosis (constricted pupils) and respiratory depression; alcohol withdrawal
delirium typically occurs after chronic heavy drinking discontinuation, which is less likely in an
acute college exposure scenario.
5. A PMHNP is evaluating a 52-year-old male veteran for Post-Traumatic Stress Disorder
(PTSD). The patient experiences severe intrusive nightmares, hypervigilance, and
insomnia. Which evidence-based pharmacotherapy is most specifically indicated to target
PTSD-associated nightmares and sleep disturbance?
A. Sertraline
B. Prazosin
C. Lorazepam
D. Quetiapine
Answer: B
Rationale: Prazosin, an alpha-1 adrenergic antagonist, crosses the blood-brain barrier to
inhibit central noradrenergic hyperactivation during sleep, directly reducing trauma-related
nightmares and sleep fragmentation in PTSD. While SSRIs like Sertraline are FDA-approved
for overall PTSD core symptoms, Prazosin specifically targets night-time hyperarousal.
Benzodiazepines are contraindicated in PTSD.
6. A 67-year-old female patient with a history of Major Depressive Disorder is brought to
the clinic by her daughter, who reports her mother has become increasingly confused,
lethargic, and unsteady on her feet over the past 5 days. The patient was started on
Citalopram 20 mg daily 3 weeks ago. Laboratory work shows a serum sodium level of 122
mEq/L. What is the PMHNP's primary diagnostic impression?
A. Vascular Dementia progression
B. Selective Serotonin Reuptake Inhibitor (SSRI)-induced Syndrome of Inappropriate
Antidiuretic Hormone (SIADH)
C. Normal Pressure Hydrocephalus
D. Acute Anticholinergic Toxicity
Answer: B
, Rationale: SSRIs, particularly in elderly patients, are a well-documented cause of
hyponatremia secondary to SIADH. Symptoms include confusion, gait instability, lethargy,
disorientation, and seizures if severe. Citalopram should be discontinued, fluid restriction
initiated, and electrolyte correction managed promptly.
7. A 23-year-old graduate student reports incapacitating fear and anxiety whenever she has
to deliver presentations in front of her class. She experiences palpitations, trembling, and
sweating, leading her to avoid public speaking entirely. She has no anxiety in informal
social settings or small group discussions. What is the most appropriate first-line PRN
pharmacotherapy for this specific condition when presentations are required?
A. Paroxetine 20 mg daily
B. Propranolol 10–20 mg 30 to 60 minutes prior to the presentation
C. Clonazepam 1 mg daily continuously
D. Buspirone 10 mg twice daily
Answer: B
Rationale: Performance-only Social Anxiety Disorder is effectively managed with non-
selective beta-blockers like Propranolol taken 30–60 minutes prior to the performance.
Propranolol attenuates peripheral sympathetic symptoms (tachycardia, tremor, sweating)
without causing sedation or cognitive impairment. Continuous SSRIs are indicated for
generalized Social Anxiety Disorder, while daily benzodiazepines carry dependency risks.
8. During a psychotherapy session, a 30-year-old client with Borderline Personality
Disorder idealizes the PMHNP, calling her "the only provider who has ever truly cared
about me," while denigrating her previous therapist as "evil and incompetent." Which
defense mechanism is the client demonstrating?
A. Projection
B. Splitting
C. Intellectualization
D. Reaction Formation
Answer: B
Rationale: Splitting is a primitive defense mechanism common in Borderline Personality
Disorder wherein individuals view self or others in extreme, all-or-nothing terms ("all good"
or "all bad"). It reflects an inability to integrate positive and negative qualities of individuals
into a cohesive image.
Diagnosis & Management In Psychiatric-
Mental Health- Pmhnp | All Questions And
Solutions (Rationales) 2026 | Exam Prep
Q&A 2026/2027
1. A 34-year-old female patient presents for an initial psychiatric evaluation complaining of
severe fatigue, low mood, and anhedonia lasting 6 weeks. She reports a history of one
episode 2 years ago where she felt "on top of the world" for 5 days, slept 2 hours per night
without feeling tired, spent $8,000 on home decor, and spoke so rapidly her family could
not interrupt her. She was not hospitalized during that time. Which primary diagnosis
should the Psychiatric-Mental Health Nurse Practitioner (PMHNP) document?
A. Major Depressive Disorder, Recurrent
B. Bipolar I Disorder, Current Episode Depressed
C. Bipolar II Disorder, Current Episode Depressed
D. Cyclothymic Disorder
Answer: C
Rationale: Bipolar II Disorder requires at least one major depressive episode and at least one
hypomanic episode (lasting at least 4 consecutive days, distinct from normal behavior,
without causing severe impairment or requiring hospitalization). The history of a 5-day period
of decreased need for sleep, elevated mood, hyper-verbosity, and excessive spending without
hospitalization or psychosis defines hypomania, ruling out Major Depressive Disorder and
Bipolar I Disorder.
2. A 28-year-old male with Schizophrenia, treatment-resistant type, has been taking
Clozapine for 6 months. His absolute neutrophil count (ANC) baseline was 2,100/µL.
Today's routine complete blood count (CBC) reveals an ANC of 950/µL. What is the most
appropriate clinical decision by the PMHNP?
A. Continue Clozapine at the current dose and recheck the ANC in 7 days.
B. Reduce the Clozapine dose by 50% and recheck the ANC twice weekly.
C. Interrupt Clozapine treatment immediately, consult hematology, and monitor ANC daily.
,D. Discontinue Clozapine permanently and immediately start Olanzapine.
Answer: C
Rationale: According to the FDA Clozapine Risk Evaluation and Mitigation Strategy (REMS)
guidelines, an ANC below 1,000/µL indicates severe neutropenia. The provider must interrupt
Clozapine therapy immediately, obtain a hematology consultation, and monitor the ANC daily
until it returns to >= 1,000/µL. Continuing or simply reducing the dose poses a life-threatening
risk of agranulocytosis and overwhelming infection.
3. A 42-year-old male patient with Generalized Anxiety Disorder and major depressive
symptoms is started on Duloxetine 30 mg daily. During a follow-up call at day 10, he
reports mild nausea and dry mouth but states his anxiety feels slightly elevated. Which
communication and management strategy is most appropriate?
A. Discontinue Duloxetine immediately and switch to Venlafaxine.
B. Reassure the patient that transient mild side effects and initial jitteriness often resolve within
2 to 4 weeks and encourage continued compliance.
C. Add Alprazolam 1 mg three times daily long-term to counteract the activation.
D. Immediately double the dose of Duloxetine to 60 mg daily to overcome side effects.
Answer: B
Rationale: Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) like Duloxetine frequently
cause mild, transient gastrointestinal and activating side effects during the first 1 to 2 weeks
of initiation. Reassuring the patient, educating them about adaptation, and maintaining the
current regimen promotes adherence while avoiding unnecessary medication switches or
inappropriate long-term benzodiazepine prescriptions.
4. A 19-year-old college student is brought to the emergency department by roommates due
to acute agitation, confusion, visual hallucinations, and dilated pupils. Vital signs reveal
blood pressure 158/96 mmHg, heart rate 124 bpm, and temperature 100.8°F. The patient
keeps picking at his clothes and stating he sees "bugs crawling on the wall." Which
toxidrome or substance intoxication should the PMHNP suspect first?
A. Opioid intoxication
B. Amphetamine/Cocaine (Sympathomimetic) intoxication
C. Alcohol withdrawal delirium
D. Cannabis intoxication
,Answer: B
Rationale: Sympathomimetic intoxication (caused by amphetamines, cocaine, or synthetic
cathinones) presents with Mydriasis (dilated pupils), tachycardia, hypertension,
hyperthermia, agitation, tactile/visual hallucinations (formication), and diaphoresis. Opioid
intoxication causes miosis (constricted pupils) and respiratory depression; alcohol withdrawal
delirium typically occurs after chronic heavy drinking discontinuation, which is less likely in an
acute college exposure scenario.
5. A PMHNP is evaluating a 52-year-old male veteran for Post-Traumatic Stress Disorder
(PTSD). The patient experiences severe intrusive nightmares, hypervigilance, and
insomnia. Which evidence-based pharmacotherapy is most specifically indicated to target
PTSD-associated nightmares and sleep disturbance?
A. Sertraline
B. Prazosin
C. Lorazepam
D. Quetiapine
Answer: B
Rationale: Prazosin, an alpha-1 adrenergic antagonist, crosses the blood-brain barrier to
inhibit central noradrenergic hyperactivation during sleep, directly reducing trauma-related
nightmares and sleep fragmentation in PTSD. While SSRIs like Sertraline are FDA-approved
for overall PTSD core symptoms, Prazosin specifically targets night-time hyperarousal.
Benzodiazepines are contraindicated in PTSD.
6. A 67-year-old female patient with a history of Major Depressive Disorder is brought to
the clinic by her daughter, who reports her mother has become increasingly confused,
lethargic, and unsteady on her feet over the past 5 days. The patient was started on
Citalopram 20 mg daily 3 weeks ago. Laboratory work shows a serum sodium level of 122
mEq/L. What is the PMHNP's primary diagnostic impression?
A. Vascular Dementia progression
B. Selective Serotonin Reuptake Inhibitor (SSRI)-induced Syndrome of Inappropriate
Antidiuretic Hormone (SIADH)
C. Normal Pressure Hydrocephalus
D. Acute Anticholinergic Toxicity
Answer: B
, Rationale: SSRIs, particularly in elderly patients, are a well-documented cause of
hyponatremia secondary to SIADH. Symptoms include confusion, gait instability, lethargy,
disorientation, and seizures if severe. Citalopram should be discontinued, fluid restriction
initiated, and electrolyte correction managed promptly.
7. A 23-year-old graduate student reports incapacitating fear and anxiety whenever she has
to deliver presentations in front of her class. She experiences palpitations, trembling, and
sweating, leading her to avoid public speaking entirely. She has no anxiety in informal
social settings or small group discussions. What is the most appropriate first-line PRN
pharmacotherapy for this specific condition when presentations are required?
A. Paroxetine 20 mg daily
B. Propranolol 10–20 mg 30 to 60 minutes prior to the presentation
C. Clonazepam 1 mg daily continuously
D. Buspirone 10 mg twice daily
Answer: B
Rationale: Performance-only Social Anxiety Disorder is effectively managed with non-
selective beta-blockers like Propranolol taken 30–60 minutes prior to the performance.
Propranolol attenuates peripheral sympathetic symptoms (tachycardia, tremor, sweating)
without causing sedation or cognitive impairment. Continuous SSRIs are indicated for
generalized Social Anxiety Disorder, while daily benzodiazepines carry dependency risks.
8. During a psychotherapy session, a 30-year-old client with Borderline Personality
Disorder idealizes the PMHNP, calling her "the only provider who has ever truly cared
about me," while denigrating her previous therapist as "evil and incompetent." Which
defense mechanism is the client demonstrating?
A. Projection
B. Splitting
C. Intellectualization
D. Reaction Formation
Answer: B
Rationale: Splitting is a primitive defense mechanism common in Borderline Personality
Disorder wherein individuals view self or others in extreme, all-or-nothing terms ("all good"
or "all bad"). It reflects an inability to integrate positive and negative qualities of individuals
into a cohesive image.
