NR 668 CEA Final Exam (2026) | Chamberlain
Practicum
Comprehensive Examination with ANSWER✔✨-
s and Rationales
1. A client with generalized anxiety disorder is asked to create coping cards as part of her CBT
homework. What is the primary purpose of using coping cards in CBT?
A. To record daily fluctuations in thoughts and corresponding moods
B. To identify anxiety provoking situations
C. To provide immediate cognitive restructuring strategies
D. To document automatic thoughts
ANSWER✔✨-: C. To provide immediate cognitive restructuring strategies
Rationale: Coping cards serve as portable tools that contain helpful thoughts, affirmations, and
strategies that clients can reference during moments of distress. Option A describes thought records,
not coping cards. Option B relates to exposure hierarchies or fear inventories. Option D describes
automatic thought records, which are different from coping cards.
2. In a Gestalt therapy session, a therapist asks a patient to engage in a dialogue with an empty chair,
imagining that a significant person from their life is sitting in it. What is the primary purpose of this
technique?
A. To explore and resolve unfinished business
B. To develop a behavioral plan
,C. To identify cognitive distortions
D. To analyze unconscious thoughts
ANSWER✔✨-: A. To explore and resolve unfinished business
Rationale: The empty chair technique is a hallmark Gestalt therapy intervention designed to help
patients address unresolved emotions, conflicts, and "unfinished business" with significant others.
Option B relates to behavioral therapy approaches. Option C is characteristic of cognitive therapy.
Option D is associated with psychodynamic therapy.
3. The PMHNP has prescribed a patient naltrexone and bupropion for binge eating disorder. The patient
has lost 4 lbs. since her last visit 1 month ago. The patient states that sometimes she finds it very
difficult to not binge eat when her emotions are intense, and expresses doubt in her ability to make a
lasting change. Which of the following is the best response?
A. "I can increase your dose of medication or augment you with another medication"
B. "On a scale of 1 to 10 how important is this change for you to make?"
C. "Would you like a referral to a dietician?"
D. "Give me an example of something in your life that you are most proud of achieving."
ANSWER✔✨-: D. "Give me an example of something in your life that you are most proud of
achieving."
Rationale: This response utilizes motivational interviewing techniques by exploring the patient's
strengths and past successes, which can enhance self-efficacy and motivation for change. Option A
prematurely focuses on medication changes without addressing the psychological aspects. Option B,
while using scaling questions, may not be as empowering as exploring past achievements. Option C
focuses on dietary intervention rather than the emotional and motivational aspects of the patient's
struggle.
4. The PMHNP is caring for a 20-year-old man with bipolar I disorder. The patient indicates that he does
not have a problem because he can accomplish so much during his manic episodes. Which stage of
change is the patient in?
,A. Action
B. Precontemplation
C. Contemplation
D. Preparation
E. Maintenance
ANSWER✔✨-: B. Precontemplation
Rationale: The patient is in the precontemplation stage as he does not recognize his manic episodes as
problematic and sees them as beneficial. Option A (Action) involves actively making changes. Option C
(Contemplation) involves recognizing the problem but being ambivalent. Option D (Preparation) involves
planning for change. Option E (Maintenance) involves sustaining changes already made.
5. A 55-year-old woman reports to the PMHNP that since she accepted early retirement last year she
finds that her memory has gotten worse and she has trouble sleeping at night. She denies any medical
problems. What should the PMHNP do first?
A. Prescribe mirtazapine 15mg PO at bedtime to help her sleep
B. Refer her to her primary care provider for a physical exam
C. Encourage her to volunteer with something she feels passionate about
D. Perform a Mini-Mental State Exam and Confusion Assessment Methods Instrument
ANSWER✔✨-: B. Refer her to her primary care provider for a physical exam
Rationale: Before initiating psychiatric treatment, it is essential to rule out medical causes for cognitive
and sleep changes. The patient's denial of medical problems does not preclude underlying physical
conditions that could be contributing to her symptoms. Option A is premature without ruling out
medical causes. Option C may be helpful later but is not the first step. Option D would be appropriate if
cognitive impairment is suspected after medical causes are ruled out.
6. A 70-year-old retired male with a history of hypertension controlled with amlodipine, metoprolol,
valsartan, and furosemide has been referred from his primary care provider for depression. Formerly an
, avid reader, the patient has lost interest in reading and has become increasingly isolative as he has been
spilling things during his lunch club meetings and finds this embarrassing. What should the PMHNP
consider as the priority assessment?
A. The patient's medication regimen for potential side effects
B. The patient's social support network
C. The patient's nutritional status
D. The patient's sleep patterns
ANSWER✔✨-: A. The patient's medication regimen for potential side effects
Rationale: The patient is on multiple antihypertensive medications (amlodipine, metoprolol, valsartan,
furosemide). The spilling incidents could indicate medication-induced orthostatic hypotension or other
side effects. Additionally, beta-blockers like metoprolol can cause depressive symptoms. A medication
review should be the priority. Options B, C, and D are important but secondary to addressing potential
medication-related causes of his symptoms.
7. A 45-year-old female with major depressive disorder has been on sertraline 100mg daily for 8 weeks
with partial response. She reports persistent anhedonia and low energy. The PMHNP decides to add
bupropion. What is the most important consideration when combining these medications?
A. Risk of serotonin syndrome
B. Risk of hypertension
C. Risk of seizure
D. Risk of weight gain
ANSWER✔✨-: C. Risk of seizure
Rationale: Bupropion lowers the seizure threshold, and combining it with sertraline requires careful
consideration of this risk. The seizure risk with bupropion is dose-dependent, with higher doses
increasing risk. Option A is more relevant when combining serotonergic agents. Option B is a concern
with bupropion but not the most important consideration in this combination. Option D is incorrect as
bupropion is more commonly associated with weight loss than weight gain.
Practicum
Comprehensive Examination with ANSWER✔✨-
s and Rationales
1. A client with generalized anxiety disorder is asked to create coping cards as part of her CBT
homework. What is the primary purpose of using coping cards in CBT?
A. To record daily fluctuations in thoughts and corresponding moods
B. To identify anxiety provoking situations
C. To provide immediate cognitive restructuring strategies
D. To document automatic thoughts
ANSWER✔✨-: C. To provide immediate cognitive restructuring strategies
Rationale: Coping cards serve as portable tools that contain helpful thoughts, affirmations, and
strategies that clients can reference during moments of distress. Option A describes thought records,
not coping cards. Option B relates to exposure hierarchies or fear inventories. Option D describes
automatic thought records, which are different from coping cards.
2. In a Gestalt therapy session, a therapist asks a patient to engage in a dialogue with an empty chair,
imagining that a significant person from their life is sitting in it. What is the primary purpose of this
technique?
A. To explore and resolve unfinished business
B. To develop a behavioral plan
,C. To identify cognitive distortions
D. To analyze unconscious thoughts
ANSWER✔✨-: A. To explore and resolve unfinished business
Rationale: The empty chair technique is a hallmark Gestalt therapy intervention designed to help
patients address unresolved emotions, conflicts, and "unfinished business" with significant others.
Option B relates to behavioral therapy approaches. Option C is characteristic of cognitive therapy.
Option D is associated with psychodynamic therapy.
3. The PMHNP has prescribed a patient naltrexone and bupropion for binge eating disorder. The patient
has lost 4 lbs. since her last visit 1 month ago. The patient states that sometimes she finds it very
difficult to not binge eat when her emotions are intense, and expresses doubt in her ability to make a
lasting change. Which of the following is the best response?
A. "I can increase your dose of medication or augment you with another medication"
B. "On a scale of 1 to 10 how important is this change for you to make?"
C. "Would you like a referral to a dietician?"
D. "Give me an example of something in your life that you are most proud of achieving."
ANSWER✔✨-: D. "Give me an example of something in your life that you are most proud of
achieving."
Rationale: This response utilizes motivational interviewing techniques by exploring the patient's
strengths and past successes, which can enhance self-efficacy and motivation for change. Option A
prematurely focuses on medication changes without addressing the psychological aspects. Option B,
while using scaling questions, may not be as empowering as exploring past achievements. Option C
focuses on dietary intervention rather than the emotional and motivational aspects of the patient's
struggle.
4. The PMHNP is caring for a 20-year-old man with bipolar I disorder. The patient indicates that he does
not have a problem because he can accomplish so much during his manic episodes. Which stage of
change is the patient in?
,A. Action
B. Precontemplation
C. Contemplation
D. Preparation
E. Maintenance
ANSWER✔✨-: B. Precontemplation
Rationale: The patient is in the precontemplation stage as he does not recognize his manic episodes as
problematic and sees them as beneficial. Option A (Action) involves actively making changes. Option C
(Contemplation) involves recognizing the problem but being ambivalent. Option D (Preparation) involves
planning for change. Option E (Maintenance) involves sustaining changes already made.
5. A 55-year-old woman reports to the PMHNP that since she accepted early retirement last year she
finds that her memory has gotten worse and she has trouble sleeping at night. She denies any medical
problems. What should the PMHNP do first?
A. Prescribe mirtazapine 15mg PO at bedtime to help her sleep
B. Refer her to her primary care provider for a physical exam
C. Encourage her to volunteer with something she feels passionate about
D. Perform a Mini-Mental State Exam and Confusion Assessment Methods Instrument
ANSWER✔✨-: B. Refer her to her primary care provider for a physical exam
Rationale: Before initiating psychiatric treatment, it is essential to rule out medical causes for cognitive
and sleep changes. The patient's denial of medical problems does not preclude underlying physical
conditions that could be contributing to her symptoms. Option A is premature without ruling out
medical causes. Option C may be helpful later but is not the first step. Option D would be appropriate if
cognitive impairment is suspected after medical causes are ruled out.
6. A 70-year-old retired male with a history of hypertension controlled with amlodipine, metoprolol,
valsartan, and furosemide has been referred from his primary care provider for depression. Formerly an
, avid reader, the patient has lost interest in reading and has become increasingly isolative as he has been
spilling things during his lunch club meetings and finds this embarrassing. What should the PMHNP
consider as the priority assessment?
A. The patient's medication regimen for potential side effects
B. The patient's social support network
C. The patient's nutritional status
D. The patient's sleep patterns
ANSWER✔✨-: A. The patient's medication regimen for potential side effects
Rationale: The patient is on multiple antihypertensive medications (amlodipine, metoprolol, valsartan,
furosemide). The spilling incidents could indicate medication-induced orthostatic hypotension or other
side effects. Additionally, beta-blockers like metoprolol can cause depressive symptoms. A medication
review should be the priority. Options B, C, and D are important but secondary to addressing potential
medication-related causes of his symptoms.
7. A 45-year-old female with major depressive disorder has been on sertraline 100mg daily for 8 weeks
with partial response. She reports persistent anhedonia and low energy. The PMHNP decides to add
bupropion. What is the most important consideration when combining these medications?
A. Risk of serotonin syndrome
B. Risk of hypertension
C. Risk of seizure
D. Risk of weight gain
ANSWER✔✨-: C. Risk of seizure
Rationale: Bupropion lowers the seizure threshold, and combining it with sertraline requires careful
consideration of this risk. The seizure risk with bupropion is dose-dependent, with higher doses
increasing risk. Option A is more relevant when combining serotonergic agents. Option B is a concern
with bupropion but not the most important consideration in this combination. Option D is incorrect as
bupropion is more commonly associated with weight loss than weight gain.
