EXAM ELITE NU 578 UNIT 5 ULTIMATE
PMHNP TEST BANK 200 QUESTIONS AND
ANSWERS WITH RATIONALES
(2024/2025)
NU 578: Psychiatric-Mental Health Nurse Practitioner – Unit 5
Exam
1. A 42-year-old male patient with a history of chronic
schizophrenia is brought to the clinic by his sister, who
reports that over the past three days, he has become
increasingly rigid, has a high fever of 103.8°F, and is
displaying fluctuating levels of consciousness. The patient has
been taking haloperidol for several years. Upon assessment,
the nurse practitioner notes "lead-pipe" muscular rigidity and
autonomic instability. Which of the following is the most
appropriate immediate intervention for this patient?
A. Increase the dose of haloperidol to manage acute agitation.
B. Administer a dose of benztropine to counteract extrapyramidal
symptoms.
C. Discontinue all antipsychotic medications and transfer to
the ICU for hydration and dantrolene administration.
D. Initiate a trial of clozapine as it has a lower risk of neurological side
effects.
Rationale: The patient is presenting with classic signs of
Neuroleptic Malignant Syndrome (NMS), a life-threatening
reaction to antipsychotics. The priority is to stop the
causative agent and provide supportive care, often involving
muscle relaxants like dantrolene.
2. A 29-year-old female presents for a follow-up appointment
regarding her Bipolar I disorder. She has been stable on
Lithium Carbonate 900mg daily for six months. During the
interview, she mentions she is planning to become pregnant
and asks about the risks associated with her medication.
Which cardiac malformation is most specifically associated
with Lithium use during the first trimester of pregnancy?
A. Ventricular septal defect.
B. Tetralogy of Fallot.
,C. Ebstein’s anomaly.
D. Patent ductus arteriosus.
Rationale: Ebstein’s anomaly, a displacement of the tricuspid
valve into the right ventricle, is a rare but specific teratogenic
risk associated with lithium exposure in utero.
3. An elderly patient is diagnosed with Major Depressive
Disorder with psychotic features. The family is concerned
about the side effects of medications due to the patient's
sensitive renal function and history of arrhythmias. After
discussing options, the Nurse Practitioner suggests
Electroconvulsive Therapy (ECT). Which of the following
conditions is considered the only absolute contraindication
for ECT?
A. History of myocardial infarction within the last three months.
B. Pregnancy in the third trimester.
C. Increased intracranial pressure (ICP).
D. Severe osteoporosis with risk of vertebral fracture.
Rationale: Increased intracranial pressure is the primary
absolute contraindication because the procedure increases
cerebral blood flow and can lead to brain herniation.
4. A patient is being treated with Phenelzine, a Monoamine
Oxidase Inhibitor (MAOI), for treatment-resistant depression.
He arrives at the emergency department complaining of a
"pounding" headache, neck stiffness, and nausea after
attending a wine and cheese party. His blood pressure is
210/120 mmHg. This clinical presentation is most likely due to
an interaction between the medication and which substance?
A. Tryptophan.
B. Tyramine.
C. Phenylalanine.
D. Glucosamine.
Rationale: MAOIs prevent the breakdown of tyramine; high
levels of tyramine cause a massive release of norepinephrine,
leading to a hypertensive crisis.
5. When evaluating a 19-year-old college student for potential
Schizophrenia, the Nurse Practitioner notes that the patient
experiences auditory hallucinations and believes the local
news anchor is sending him secret coded messages through
the television. According to the DSM-5, which of the following
,symptom clusters represents the "negative symptoms" of this
disorder?
A. Affective flattening, alogia, and avolition.
B. Delusions, hallucinations, and disorganized speech.
C. Catatonic behavior and gross motor agitation.
D. Ideas of reference and magical thinking.
Rationale: Negative symptoms refer to a "subtraction" from
normal function, including diminished emotional expression
(flattening), poverty of speech (alogia), and lack of
motivation (avolition).
6. A patient who recently started Clozapine for treatment-
resistant schizophrenia is required to undergo frequent
laboratory monitoring. The Nurse Practitioner explains that
the medication will be discontinued if the Absolute Neutrophil
Count (ANC) falls below a specific threshold. What is the
minimum ANC required to continue Clozapine therapy in a
general population patient?
A. 500/mm³.
B. 1,000/mm³.
C. 1,500/mm³.
D. 2,000/mm³.
Rationale: To mitigate the risk of agranulocytosis, Clozapine
must be withheld if the ANC drops below 1,500/mm³ (though
protocols for Benign Ethnic Neutropenia differ).
7. A 35-year-old male with a history of alcohol use disorder is
admitted for detoxification. On day three of abstinence, he
becomes agitated, diaphoretic, and begins shouting that there
are spiders crawling on the ceiling that no one else sees. His
heart rate is 125 bpm. What is the most appropriate
pharmacological treatment to prevent seizures and manage
these symptoms?
A. Haloperidol.
B. Lorazepam.
C. Valproic Acid.
D. Quetiapine.
Rationale: Benzodiazepines like lorazepam are the gold
standard for managing alcohol withdrawal symptoms and
preventing progression to Delirium Tremens or withdrawal
seizures.
, 8. A patient is diagnosed with Obsessive-Compulsive Disorder
(OCD) and has not responded to trials of two different
Selective Serotonin Reuptake Inhibitors (SSRIs) at maximum
dosages. Which Tricyclic Antidepressant (TCA) is considered
the "gold standard" for OCD due to its potent serotonin
reuptake inhibition?
A. Amitriptyline.
B. Nortriptyline.
C. Clomipramine.
D. Imipramine.
Rationale: Clomipramine is unique among TCAs for its high
affinity for the serotonin transporter, making it highly
effective for OCD, though often reserved for second-line due
to its side effect profile.
9. A Nurse Practitioner is assessing a 24-year-old female who
reports intense fear of abandonment, a pattern of unstable
and intense relationships, and frequent episodes of self-
mutilation when feeling rejected. She describes feeling
"empty" and has difficulty controlling her anger. Which
personality disorder is most consistent with this presentation?
A. Histrionic Personality Disorder.
B. Borderline Personality Disorder.
C. Antisocial Personality Disorder.
D. Avoidant Personality Disorder.
Rationale: Borderline Personality Disorder is characterized
by instability in relationships, self-image, affect, and marked
impulsivity, including self-harm.
10. A patient is prescribed Lamotrigine for the maintenance
treatment of Bipolar II disorder. The Nurse Practitioner
provides extensive education regarding the "slow titration"
schedule. What is the primary reason for slowly increasing the
dosage of Lamotrigine?
A. To prevent the onset of weight gain.
B. To minimize the risk of sedation.
C. To reduce the risk of Stevens-Johnson Syndrome (SJS).
D. To avoid the development of therapeutic tolerance.
Rationale: Rapid titration of Lamotrigine is significantly
associated with the development of SJS, a life-threatening
dermatological emergency.
PMHNP TEST BANK 200 QUESTIONS AND
ANSWERS WITH RATIONALES
(2024/2025)
NU 578: Psychiatric-Mental Health Nurse Practitioner – Unit 5
Exam
1. A 42-year-old male patient with a history of chronic
schizophrenia is brought to the clinic by his sister, who
reports that over the past three days, he has become
increasingly rigid, has a high fever of 103.8°F, and is
displaying fluctuating levels of consciousness. The patient has
been taking haloperidol for several years. Upon assessment,
the nurse practitioner notes "lead-pipe" muscular rigidity and
autonomic instability. Which of the following is the most
appropriate immediate intervention for this patient?
A. Increase the dose of haloperidol to manage acute agitation.
B. Administer a dose of benztropine to counteract extrapyramidal
symptoms.
C. Discontinue all antipsychotic medications and transfer to
the ICU for hydration and dantrolene administration.
D. Initiate a trial of clozapine as it has a lower risk of neurological side
effects.
Rationale: The patient is presenting with classic signs of
Neuroleptic Malignant Syndrome (NMS), a life-threatening
reaction to antipsychotics. The priority is to stop the
causative agent and provide supportive care, often involving
muscle relaxants like dantrolene.
2. A 29-year-old female presents for a follow-up appointment
regarding her Bipolar I disorder. She has been stable on
Lithium Carbonate 900mg daily for six months. During the
interview, she mentions she is planning to become pregnant
and asks about the risks associated with her medication.
Which cardiac malformation is most specifically associated
with Lithium use during the first trimester of pregnancy?
A. Ventricular septal defect.
B. Tetralogy of Fallot.
,C. Ebstein’s anomaly.
D. Patent ductus arteriosus.
Rationale: Ebstein’s anomaly, a displacement of the tricuspid
valve into the right ventricle, is a rare but specific teratogenic
risk associated with lithium exposure in utero.
3. An elderly patient is diagnosed with Major Depressive
Disorder with psychotic features. The family is concerned
about the side effects of medications due to the patient's
sensitive renal function and history of arrhythmias. After
discussing options, the Nurse Practitioner suggests
Electroconvulsive Therapy (ECT). Which of the following
conditions is considered the only absolute contraindication
for ECT?
A. History of myocardial infarction within the last three months.
B. Pregnancy in the third trimester.
C. Increased intracranial pressure (ICP).
D. Severe osteoporosis with risk of vertebral fracture.
Rationale: Increased intracranial pressure is the primary
absolute contraindication because the procedure increases
cerebral blood flow and can lead to brain herniation.
4. A patient is being treated with Phenelzine, a Monoamine
Oxidase Inhibitor (MAOI), for treatment-resistant depression.
He arrives at the emergency department complaining of a
"pounding" headache, neck stiffness, and nausea after
attending a wine and cheese party. His blood pressure is
210/120 mmHg. This clinical presentation is most likely due to
an interaction between the medication and which substance?
A. Tryptophan.
B. Tyramine.
C. Phenylalanine.
D. Glucosamine.
Rationale: MAOIs prevent the breakdown of tyramine; high
levels of tyramine cause a massive release of norepinephrine,
leading to a hypertensive crisis.
5. When evaluating a 19-year-old college student for potential
Schizophrenia, the Nurse Practitioner notes that the patient
experiences auditory hallucinations and believes the local
news anchor is sending him secret coded messages through
the television. According to the DSM-5, which of the following
,symptom clusters represents the "negative symptoms" of this
disorder?
A. Affective flattening, alogia, and avolition.
B. Delusions, hallucinations, and disorganized speech.
C. Catatonic behavior and gross motor agitation.
D. Ideas of reference and magical thinking.
Rationale: Negative symptoms refer to a "subtraction" from
normal function, including diminished emotional expression
(flattening), poverty of speech (alogia), and lack of
motivation (avolition).
6. A patient who recently started Clozapine for treatment-
resistant schizophrenia is required to undergo frequent
laboratory monitoring. The Nurse Practitioner explains that
the medication will be discontinued if the Absolute Neutrophil
Count (ANC) falls below a specific threshold. What is the
minimum ANC required to continue Clozapine therapy in a
general population patient?
A. 500/mm³.
B. 1,000/mm³.
C. 1,500/mm³.
D. 2,000/mm³.
Rationale: To mitigate the risk of agranulocytosis, Clozapine
must be withheld if the ANC drops below 1,500/mm³ (though
protocols for Benign Ethnic Neutropenia differ).
7. A 35-year-old male with a history of alcohol use disorder is
admitted for detoxification. On day three of abstinence, he
becomes agitated, diaphoretic, and begins shouting that there
are spiders crawling on the ceiling that no one else sees. His
heart rate is 125 bpm. What is the most appropriate
pharmacological treatment to prevent seizures and manage
these symptoms?
A. Haloperidol.
B. Lorazepam.
C. Valproic Acid.
D. Quetiapine.
Rationale: Benzodiazepines like lorazepam are the gold
standard for managing alcohol withdrawal symptoms and
preventing progression to Delirium Tremens or withdrawal
seizures.
, 8. A patient is diagnosed with Obsessive-Compulsive Disorder
(OCD) and has not responded to trials of two different
Selective Serotonin Reuptake Inhibitors (SSRIs) at maximum
dosages. Which Tricyclic Antidepressant (TCA) is considered
the "gold standard" for OCD due to its potent serotonin
reuptake inhibition?
A. Amitriptyline.
B. Nortriptyline.
C. Clomipramine.
D. Imipramine.
Rationale: Clomipramine is unique among TCAs for its high
affinity for the serotonin transporter, making it highly
effective for OCD, though often reserved for second-line due
to its side effect profile.
9. A Nurse Practitioner is assessing a 24-year-old female who
reports intense fear of abandonment, a pattern of unstable
and intense relationships, and frequent episodes of self-
mutilation when feeling rejected. She describes feeling
"empty" and has difficulty controlling her anger. Which
personality disorder is most consistent with this presentation?
A. Histrionic Personality Disorder.
B. Borderline Personality Disorder.
C. Antisocial Personality Disorder.
D. Avoidant Personality Disorder.
Rationale: Borderline Personality Disorder is characterized
by instability in relationships, self-image, affect, and marked
impulsivity, including self-harm.
10. A patient is prescribed Lamotrigine for the maintenance
treatment of Bipolar II disorder. The Nurse Practitioner
provides extensive education regarding the "slow titration"
schedule. What is the primary reason for slowly increasing the
dosage of Lamotrigine?
A. To prevent the onset of weight gain.
B. To minimize the risk of sedation.
C. To reduce the risk of Stevens-Johnson Syndrome (SJS).
D. To avoid the development of therapeutic tolerance.
Rationale: Rapid titration of Lamotrigine is significantly
associated with the development of SJS, a life-threatening
dermatological emergency.
