NR 668 FINAL EXAM 2025/2026 QUESTIONS AND CORRECT
ANSWERS GRADED A+ SPRING- SUMMER CHAMBERLAIN
UNIVERSITY
The clinical management of patients differs depending on the substance-related syndrome
exhibited. A patient with a history of alcohol use disorder who presents for a monthly injection
of naltrexone is disinhibited, emotionally labile, inattentive, and impulsive and is likely in which
of the following phases?
Acute intoxication
An 8-year-old boy diagnosed with leukemia is referred to child psychiatry because he is
consistently displaying a flat affect, irritability, angry acting out, and occasional physical
aggression toward his 6-year-old brother. What approach should the PMHNP take when
interviewing this child?
Provide toys and allow the child to play
Which eating disorder is considered ego syntonic?
Anorexia Nervosa (Anorexia Nervosa is challenging to treat because it is ego syntonic. In other
words, one's behaviors, feelings and values are in line with the needs of the ego and reliable to
one's self image.)
A 30-year-old G1P0,1 has become increasingly oddly related, neglecting self-care, sleeping
much of the day, eating minimally, crying easily, and despite reassurance that her pregnancy is
progressing normally, worries that she will lose the pregnancy. Which of the following
medications is considered least harmful in pregnancy?
Sertraline
,A 10-year-old boy who had been prescribed fluoxetine for major depressive disorder presents to
the psychiatric emergency department for running into the street in front of a car on the way
home from school. In the emergency department, he has been selectively mute, but the nurse
practitioner student was able to elicit his desire to be dead. He has been medically cleared
pending a psychiatric evaluation. What is the most common sign of major depressive disorder in
children?
Psychomotor agitation
A 38-year-old male presents for follow up chronic back pain and spasm. Four years earlier, he
sustained a motorcycle accident. He has been taking morphine extended release 40mg PO BID
and Hydrocodone 10mg IR Qd PRN. Today he complains that the medication is no longer
effective. He notes diarrhea and restlessness when he skips a dose. He continues to be employed
and has not missed any work days. He has been filling the prescription 1 day early each month
and visited an urgent care twice this summer requesting additional pain control. The are no
changes on exam today and no focal deficits. Which of the following do you recommend for this
patient?
Evaluate for Opioid use disorder, recommend a slow taper off full opioid agonists and then start
buprenorphine. (This patient has signs of OUD. This is little evidence supporting opioids for
chronic pain syndromes. The patient remains functional at work so no need for acute
hospitalization. Benzodiazepines and opioids should not be combined given the increase risk of
death when used together.)
Which of the following is NOT a symptom of Alcohol Withdrawal as listed in the Criterion B of
the DSM-5?
Hypothermia (The signs and symptoms of alcohol withdrawal as noted in criterion B of the
DSM-5 include autonomic hyperactivity, increased hand tremor, insomnia, nausea or vomiting,
hallucinations, psychomotor agitation, anxiety and generalized tonic clonic seizures.)
,A patient presents for a follow-up visit and has a dual diagnosis of substance use disorder and
major depressive disorder. He reports that he has been feeling increasingly anxious, having
difficulty sleeping. He continues to attend his Alcoholics Anonymous meetings regularly, but
reports he had two beers 3 days ago and feels very guilty. Which of the following best describes
this patient's situation?
Lapse
A patient who has been drinking a six-pack of beer each night to relax after work has been
having trouble staying asleep through the night. When she wakes up at 2 a.m. she takes
diphenhydramine 25 mg to help her fall back asleep, but this makes her sleep through the alarm
clock and late for work. She also reports having a headache through midmorning until she gets
her second cup of coffee. She thinks this is related to her alcohol use and has unsuccessfully tried
to cut down several times in the past year. Which of the following disorders best describes this
patient's condition?
Alcohol use disorder
Which of the following best represents the theory of resilience as it applies to psychiatric
advanced practice nursing?
Adapting and accepting something you cannot change
A phenomenon in which a markedly increased dose of a substance is required to achieve the
desired effect or a markedly reduced effect is experienced when the usual (original) dose is
consumed is better known as what?
Tolerance (Tolerance is a phenomenon in which after repeated administration, a given dose of a
substance produces a decreased effect or larger doses are required to achieve the same effect as
the original dose.)
, A 29-year-old man presents to the emergency department stating he is very anxious and feels his
heart is going to beat out of his chest. He is diaphoretic, with pressured speech and unable to be
calmed. A psychiatric consult was called because the patient seems uncooperative and a proper
history cannot be obtained. Which of the following conditions must be excluded first?
Cocaine-induced mood disorder
A patient who has been sober for 20 years is anticipating some major life changes in the next 3
months and is very worried about relapse. Which of the following actions should the PMHNP do
first?
Assess this coping strategies
Marjorie decided to cancel her upcoming appointment with her PMHNP and avoid potential
treatment out of fear that her peers may find out and think she is "crazy". This behavior is best
described as what?
Label avoidance (Label avoidance occurs when one avoids treatment out of fear of the future
negative label or view associated with having a mental illness. Public stigma occurs AFTER
individuals are stereotyped because of their mental illness. Beneficence and Persona non grata do
not apply to the provided scenario here.)
A 49-year-old female is on Fentanyl patch at 25 mcg/hr. In the last week the patient's valproate
was increased from 750mg po BID to 1000mg po BID. In the last 4 days the patient was placed
on clarithromycin for strep throat and started cepacol lozenges. This morning she was
resuscitated with Naloxone and she returned to baseline mantation. Which medication likely
contributed to her unresponsive episode?
All of these contributed to this episode. (The patient was on Fentanyl and recently started a
strong CYP3A4 inhibitor (Macrolide antibiotics include clarithromycin). This led to a
REDUCTION in the clearance of the opioid resulting in sedation.Cepacol lozenges, Valproate &
Clarithromycin)
ANSWERS GRADED A+ SPRING- SUMMER CHAMBERLAIN
UNIVERSITY
The clinical management of patients differs depending on the substance-related syndrome
exhibited. A patient with a history of alcohol use disorder who presents for a monthly injection
of naltrexone is disinhibited, emotionally labile, inattentive, and impulsive and is likely in which
of the following phases?
Acute intoxication
An 8-year-old boy diagnosed with leukemia is referred to child psychiatry because he is
consistently displaying a flat affect, irritability, angry acting out, and occasional physical
aggression toward his 6-year-old brother. What approach should the PMHNP take when
interviewing this child?
Provide toys and allow the child to play
Which eating disorder is considered ego syntonic?
Anorexia Nervosa (Anorexia Nervosa is challenging to treat because it is ego syntonic. In other
words, one's behaviors, feelings and values are in line with the needs of the ego and reliable to
one's self image.)
A 30-year-old G1P0,1 has become increasingly oddly related, neglecting self-care, sleeping
much of the day, eating minimally, crying easily, and despite reassurance that her pregnancy is
progressing normally, worries that she will lose the pregnancy. Which of the following
medications is considered least harmful in pregnancy?
Sertraline
,A 10-year-old boy who had been prescribed fluoxetine for major depressive disorder presents to
the psychiatric emergency department for running into the street in front of a car on the way
home from school. In the emergency department, he has been selectively mute, but the nurse
practitioner student was able to elicit his desire to be dead. He has been medically cleared
pending a psychiatric evaluation. What is the most common sign of major depressive disorder in
children?
Psychomotor agitation
A 38-year-old male presents for follow up chronic back pain and spasm. Four years earlier, he
sustained a motorcycle accident. He has been taking morphine extended release 40mg PO BID
and Hydrocodone 10mg IR Qd PRN. Today he complains that the medication is no longer
effective. He notes diarrhea and restlessness when he skips a dose. He continues to be employed
and has not missed any work days. He has been filling the prescription 1 day early each month
and visited an urgent care twice this summer requesting additional pain control. The are no
changes on exam today and no focal deficits. Which of the following do you recommend for this
patient?
Evaluate for Opioid use disorder, recommend a slow taper off full opioid agonists and then start
buprenorphine. (This patient has signs of OUD. This is little evidence supporting opioids for
chronic pain syndromes. The patient remains functional at work so no need for acute
hospitalization. Benzodiazepines and opioids should not be combined given the increase risk of
death when used together.)
Which of the following is NOT a symptom of Alcohol Withdrawal as listed in the Criterion B of
the DSM-5?
Hypothermia (The signs and symptoms of alcohol withdrawal as noted in criterion B of the
DSM-5 include autonomic hyperactivity, increased hand tremor, insomnia, nausea or vomiting,
hallucinations, psychomotor agitation, anxiety and generalized tonic clonic seizures.)
,A patient presents for a follow-up visit and has a dual diagnosis of substance use disorder and
major depressive disorder. He reports that he has been feeling increasingly anxious, having
difficulty sleeping. He continues to attend his Alcoholics Anonymous meetings regularly, but
reports he had two beers 3 days ago and feels very guilty. Which of the following best describes
this patient's situation?
Lapse
A patient who has been drinking a six-pack of beer each night to relax after work has been
having trouble staying asleep through the night. When she wakes up at 2 a.m. she takes
diphenhydramine 25 mg to help her fall back asleep, but this makes her sleep through the alarm
clock and late for work. She also reports having a headache through midmorning until she gets
her second cup of coffee. She thinks this is related to her alcohol use and has unsuccessfully tried
to cut down several times in the past year. Which of the following disorders best describes this
patient's condition?
Alcohol use disorder
Which of the following best represents the theory of resilience as it applies to psychiatric
advanced practice nursing?
Adapting and accepting something you cannot change
A phenomenon in which a markedly increased dose of a substance is required to achieve the
desired effect or a markedly reduced effect is experienced when the usual (original) dose is
consumed is better known as what?
Tolerance (Tolerance is a phenomenon in which after repeated administration, a given dose of a
substance produces a decreased effect or larger doses are required to achieve the same effect as
the original dose.)
, A 29-year-old man presents to the emergency department stating he is very anxious and feels his
heart is going to beat out of his chest. He is diaphoretic, with pressured speech and unable to be
calmed. A psychiatric consult was called because the patient seems uncooperative and a proper
history cannot be obtained. Which of the following conditions must be excluded first?
Cocaine-induced mood disorder
A patient who has been sober for 20 years is anticipating some major life changes in the next 3
months and is very worried about relapse. Which of the following actions should the PMHNP do
first?
Assess this coping strategies
Marjorie decided to cancel her upcoming appointment with her PMHNP and avoid potential
treatment out of fear that her peers may find out and think she is "crazy". This behavior is best
described as what?
Label avoidance (Label avoidance occurs when one avoids treatment out of fear of the future
negative label or view associated with having a mental illness. Public stigma occurs AFTER
individuals are stereotyped because of their mental illness. Beneficence and Persona non grata do
not apply to the provided scenario here.)
A 49-year-old female is on Fentanyl patch at 25 mcg/hr. In the last week the patient's valproate
was increased from 750mg po BID to 1000mg po BID. In the last 4 days the patient was placed
on clarithromycin for strep throat and started cepacol lozenges. This morning she was
resuscitated with Naloxone and she returned to baseline mantation. Which medication likely
contributed to her unresponsive episode?
All of these contributed to this episode. (The patient was on Fentanyl and recently started a
strong CYP3A4 inhibitor (Macrolide antibiotics include clarithromycin). This led to a
REDUCTION in the clearance of the opioid resulting in sedation.Cepacol lozenges, Valproate &
Clarithromycin)
