NR547 CEA EXAM 2026 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains
Advanced Health Assessment and Diagnostic Reasoning
Psychopharmacology and Biological Treatments
Psychotherapy and Therapeutic Interventions
Ethical and Legal Principles in Psychiatric-Mental Health Nursing
Professional Role Development and Interprofessional Collaboration
Quality Improvement and Evidence-Based Practice
Healthcare Policy, Finance, and Regulatory Compliance
Care Coordination and Transition Management
Crisis Intervention and Suicide Risk Assessment
Health Promotion and Disease Prevention
Introduction
This comprehensive examination is designed to assess the advanced knowledge, clinical reasoning, and decision-
making skills expected of a psychiatric-mental health nurse practitioner. The exam evaluates the candidate's ability
to integrate foundational theory with applied practice across core domains, including assessment,
psychopharmacology, psychotherapy, and ethics. Through a combination of multiple-choice and scenario-based
,questions, candidates will demonstrate their competence in real-world application and complex clinical decision-
making. The questions are structured to challenge the test-taker to think critically, apply evidence-based
guidelines, and navigate the nuances of patient care, professional standards, and legal regulations.
Section One: Questions 1-100
1. A 45-year-old patient with major depressive disorder has been on fluoxetine 40 mg daily for six months
with partial response. The PMHNP considers augmenting the regimen. Which of the following is the most
appropriate next step?
A. Add bupropion 150 mg daily
B. Increase fluoxetine to 60 mg daily
C. Add aripiprazole 2 mg daily
D. Switch to venlafaxine 75 mg daily
🟢 C. Add aripiprazole 2 mg daily
🔴 RATIONALE: The addition of a second-generation antipsychotic such as aripiprazole is a first-line
augmentation strategy for treatment-resistant depression and has strong evidence for efficacy. Increasing the
SSRI beyond the maximum recommended dose is not generally recommended and carries increased side effect
risk. Switching to another antidepressant or adding bupropion are also valid strategies but are typically
considered after failed augmentation.
2. A 72-year-old patient with Parkinson's disease and major depression is prescribed paroxetine. The PMHNP
should be most concerned about which potential adverse effect?
,A. Hyponatremia
B. QTc prolongation
C. Orthostatic hypotension
D. Extrapyramidal symptoms
🟢 A. Hyponatremia
🔴 RATIONALE: Elderly patients on SSRIs like paroxetine are at increased risk for syndrome of inappropriate
antidiuretic hormone (SIADH) and subsequent hyponatremia. While QTc prolongation and orthostatic
hypotension are concerns, hyponatremia is a more common and clinically significant risk in this specific age
group. Paroxetine is also associated with anticholinergic effects and withdrawal, but hyponatremia is the most
direct and severe concern in this demographic.
3. A 34-year-old patient with schizophrenia is currently stable on paliperidone palmitate 234 mg IM monthly.
At a follow-up visit, the patient reports a 5-pound weight gain over the past month. Which of the following
is the most appropriate management strategy?
A. Start metformin 500 mg BID
B. Switch to aripiprazole
C. Advise a low-calorie diet and exercise plan
D. Reduce paliperidone dose
🟢 A. Start metformin 500 mg BID
🔴 RATIONALE: Metformin is recommended as a first-line intervention for weight gain and metabolic
dysregulation associated with antipsychotics. Lifestyle modifications alone are often insufficient. Switching to
, aripiprazole may be effective but carries the risk of destabilizing the patient. Reducing the paliperidone dose is
inappropriate as it may lead to symptom exacerbation.
4. A patient is brought to the ED by police for bizarre behavior. They are disorganized, responding to internal
stimuli, and are unable to provide a coherent history. The PMHNP suspects a primary psychotic disorder.
What is the priority action for the PMHNP?
A. Perform a complete neurological examination
B. Obtain collateral information from family or police
C. Administer a urine drug screen
D. Order a stat head CT scan
🟢 C. Administer a urine drug screen
🔴 RATIONALE: In an acute presentation of psychosis, it is critical to rule out substance-induced psychosis as a
medical cause. A urine drug screen is the priority to differentiate between primary and substance-induced
psychotic disorder, ensuring appropriate treatment and management.
5. A patient with bipolar I disorder is prescribed lamotrigine. The PMHNP provides education on the
medication. Which of the following statements by the patient indicates adequate understanding of the
medication's most serious risk?
A. "I should report any fever and swollen lymph nodes immediately."
B. "It is important to stay out of the sun while taking this."
C. "My blood levels need to be checked every month."
D. "I may need to take a folic acid supplement."
🟢 A. "I should report any fever and swollen lymph nodes immediately."
2026 Q&A | LATEST EXAM UPDATE 2026/2027.
Core Domains
Advanced Health Assessment and Diagnostic Reasoning
Psychopharmacology and Biological Treatments
Psychotherapy and Therapeutic Interventions
Ethical and Legal Principles in Psychiatric-Mental Health Nursing
Professional Role Development and Interprofessional Collaboration
Quality Improvement and Evidence-Based Practice
Healthcare Policy, Finance, and Regulatory Compliance
Care Coordination and Transition Management
Crisis Intervention and Suicide Risk Assessment
Health Promotion and Disease Prevention
Introduction
This comprehensive examination is designed to assess the advanced knowledge, clinical reasoning, and decision-
making skills expected of a psychiatric-mental health nurse practitioner. The exam evaluates the candidate's ability
to integrate foundational theory with applied practice across core domains, including assessment,
psychopharmacology, psychotherapy, and ethics. Through a combination of multiple-choice and scenario-based
,questions, candidates will demonstrate their competence in real-world application and complex clinical decision-
making. The questions are structured to challenge the test-taker to think critically, apply evidence-based
guidelines, and navigate the nuances of patient care, professional standards, and legal regulations.
Section One: Questions 1-100
1. A 45-year-old patient with major depressive disorder has been on fluoxetine 40 mg daily for six months
with partial response. The PMHNP considers augmenting the regimen. Which of the following is the most
appropriate next step?
A. Add bupropion 150 mg daily
B. Increase fluoxetine to 60 mg daily
C. Add aripiprazole 2 mg daily
D. Switch to venlafaxine 75 mg daily
🟢 C. Add aripiprazole 2 mg daily
🔴 RATIONALE: The addition of a second-generation antipsychotic such as aripiprazole is a first-line
augmentation strategy for treatment-resistant depression and has strong evidence for efficacy. Increasing the
SSRI beyond the maximum recommended dose is not generally recommended and carries increased side effect
risk. Switching to another antidepressant or adding bupropion are also valid strategies but are typically
considered after failed augmentation.
2. A 72-year-old patient with Parkinson's disease and major depression is prescribed paroxetine. The PMHNP
should be most concerned about which potential adverse effect?
,A. Hyponatremia
B. QTc prolongation
C. Orthostatic hypotension
D. Extrapyramidal symptoms
🟢 A. Hyponatremia
🔴 RATIONALE: Elderly patients on SSRIs like paroxetine are at increased risk for syndrome of inappropriate
antidiuretic hormone (SIADH) and subsequent hyponatremia. While QTc prolongation and orthostatic
hypotension are concerns, hyponatremia is a more common and clinically significant risk in this specific age
group. Paroxetine is also associated with anticholinergic effects and withdrawal, but hyponatremia is the most
direct and severe concern in this demographic.
3. A 34-year-old patient with schizophrenia is currently stable on paliperidone palmitate 234 mg IM monthly.
At a follow-up visit, the patient reports a 5-pound weight gain over the past month. Which of the following
is the most appropriate management strategy?
A. Start metformin 500 mg BID
B. Switch to aripiprazole
C. Advise a low-calorie diet and exercise plan
D. Reduce paliperidone dose
🟢 A. Start metformin 500 mg BID
🔴 RATIONALE: Metformin is recommended as a first-line intervention for weight gain and metabolic
dysregulation associated with antipsychotics. Lifestyle modifications alone are often insufficient. Switching to
, aripiprazole may be effective but carries the risk of destabilizing the patient. Reducing the paliperidone dose is
inappropriate as it may lead to symptom exacerbation.
4. A patient is brought to the ED by police for bizarre behavior. They are disorganized, responding to internal
stimuli, and are unable to provide a coherent history. The PMHNP suspects a primary psychotic disorder.
What is the priority action for the PMHNP?
A. Perform a complete neurological examination
B. Obtain collateral information from family or police
C. Administer a urine drug screen
D. Order a stat head CT scan
🟢 C. Administer a urine drug screen
🔴 RATIONALE: In an acute presentation of psychosis, it is critical to rule out substance-induced psychosis as a
medical cause. A urine drug screen is the priority to differentiate between primary and substance-induced
psychotic disorder, ensuring appropriate treatment and management.
5. A patient with bipolar I disorder is prescribed lamotrigine. The PMHNP provides education on the
medication. Which of the following statements by the patient indicates adequate understanding of the
medication's most serious risk?
A. "I should report any fever and swollen lymph nodes immediately."
B. "It is important to stay out of the sun while taking this."
C. "My blood levels need to be checked every month."
D. "I may need to take a folic acid supplement."
🟢 A. "I should report any fever and swollen lymph nodes immediately."
