NSG 526 ADVANCED PSYCHIATRIC NURSING EXAM 2 EXAM PRACTICE | STUDY
GUIDE | TESTBANK | PRACTICE QUESTIONS & ANSWERS | EXAM PREPARATION |
ADVANCED REVIEW | COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE
2026/2027
Examiner:
Course faculty and graduate nursing program (institution-specific)
TABLE OF CONTENTS
1. Psychiatric Assessment and Diagnostic Reasoning
2. DSM-5-TR Diagnostic Concepts
3. Psychopharmacology
4. Mood Disorders
5. Anxiety and Trauma-Related Disorders
6. Psychotic Disorders
7. Substance Use Disorders
8. Crisis Intervention and Suicide Risk Assessment
9. Psychotherapy Principles
10. Ethical, Legal, and Professional Practice
PSYCHIATRIC ASSESSMENT || DSM-5-TR || DIFFERENTIAL DIAGNOSIS ||
PSYCHOPHARMACOLOGY || MOOD DISORDERS || PSYCHOSIS || ANXIETY
DISORDERS || SUBSTANCE USE || SUICIDE RISK || THERAPEUTIC
COMMUNICATION || ETHICS || ADVANCED PRACTICE || EVIDENCE-BASED CARE ||
PROFESSIONAL JUDGMENT || CLINICAL DECISION-MAKING
QUESTION 1.
A 34-year-old patient presents with insomnia, racing thoughts, impulsive spending,
and elevated mood lasting 8 days with significant impairment in occupational
functioning. Which diagnosis is most consistent with this presentation?
A. Cyclothymic disorder
B. Bipolar I disorder, current manic episode
,C. Bipolar II disorder, hypomanic episode
D. Persistent depressive disorder
🔴 Correct Answer: B. Bipolar I disorder, current manic episode
🔵 Explanation: A manic episode lasting at least one week or requiring
hospitalization with marked functional impairment is diagnostic of Bipolar I disorder.
Hypomania causes less impairment and characterizes Bipolar II disorder. Cyclothymic
disorder involves chronic fluctuating symptoms that do not meet full episode criteria,
while persistent depressive disorder is characterized by chronic depression.
QUESTION 2.
A patient taking lithium reports persistent vomiting, coarse tremor, ataxia, and
increasing confusion. What is the most appropriate immediate action?
A. Increase fluid intake and continue lithium
B. Hold lithium and obtain an urgent serum lithium level
C. Reduce the dose by half and reassess in one week
D. Add propranolol for tremor management
🔴 Correct Answer: B. Hold lithium and obtain an urgent serum lithium level
🔵 Explanation: These findings strongly suggest lithium toxicity, requiring immediate
discontinuation of lithium and urgent evaluation. Continuing or simply reducing
therapy may allow toxicity to worsen. Symptomatic treatment without addressing the
underlying toxicity is inappropriate.
QUESTION 3.
During a suicide risk assessment, which finding represents the highest level of
immediate concern?
A. Passive thoughts of death without intent
B. Previous depressive episode five years ago
,C. Specific suicide plan with access to the identified method
D. Occasional hopelessness during stressful situations
🔴 Correct Answer: C. Specific suicide plan with access to the identified method
🔵 Explanation: A detailed plan combined with access to the intended means
substantially increases imminent suicide risk and requires immediate intervention.
Passive thoughts, prior depression, and transient hopelessness warrant assessment
but generally indicate lower immediate risk.
QUESTION 4.
A patient with schizophrenia has persistent auditory hallucinations despite
adequate trials of two different antipsychotic medications at therapeutic doses.
Which intervention is most appropriate?
A. Initiate clozapine after appropriate baseline evaluation
B. Continue the current medication indefinitely
C. Switch to an antidepressant
D. Discontinue pharmacotherapy and begin psychotherapy alone
🔴 Correct Answer: A. Initiate clozapine after appropriate baseline evaluation
🔵 Explanation: Clozapine is indicated for treatment-resistant schizophrenia after
failure of two adequate antipsychotic trials. Baseline laboratory monitoring is required
because of risks including agranulocytosis. The remaining options fail to address
evidence-based management of treatment-resistant illness.
QUESTION 5.
A patient with generalized anxiety disorder has completed six months of cognitive
behavioral therapy but continues to experience clinically significant symptoms.
Which pharmacologic option is supported as an appropriate first-line medication?
A. Sertraline
B. Haloperidol
, C. Carbamazepine
D. Benztropine
🔴 Correct Answer: A. Sertraline
🔵 Explanation: SSRIs such as sertraline are considered first-line pharmacologic
treatment for generalized anxiety disorder. Haloperidol is an antipsychotic,
carbamazepine is primarily used for seizures and mood stabilization, and benztropine
treats extrapyramidal symptoms.
QUESTION 6.
A patient taking phenelzine develops severe headache, diaphoresis, hypertension,
and palpitations after eating aged cheese. What is the most likely explanation?
A. Serotonin syndrome
B. Hypertensive crisis caused by tyramine interaction
C. Neuroleptic malignant syndrome
D. Acute withdrawal syndrome
🔴 Correct Answer: B. Hypertensive crisis caused by tyramine interaction
🔵 Explanation: Monoamine oxidase inhibitors require avoidance of tyramine-
containing foods because the interaction can precipitate a hypertensive crisis.
Serotonin syndrome usually involves serotonergic drug combinations rather than
dietary tyramine. Neuroleptic malignant syndrome is associated with dopamine
blockade.
QUESTION 7.
Which patient demonstrates the strongest indication for involuntary psychiatric
hospitalization?
A. A patient requesting medication adjustment
B. A patient experiencing insomnia without psychosis
GUIDE | TESTBANK | PRACTICE QUESTIONS & ANSWERS | EXAM PREPARATION |
ADVANCED REVIEW | COMPREHENSIVE PRACTICE EXAM | LATEST UPDATE
2026/2027
Examiner:
Course faculty and graduate nursing program (institution-specific)
TABLE OF CONTENTS
1. Psychiatric Assessment and Diagnostic Reasoning
2. DSM-5-TR Diagnostic Concepts
3. Psychopharmacology
4. Mood Disorders
5. Anxiety and Trauma-Related Disorders
6. Psychotic Disorders
7. Substance Use Disorders
8. Crisis Intervention and Suicide Risk Assessment
9. Psychotherapy Principles
10. Ethical, Legal, and Professional Practice
PSYCHIATRIC ASSESSMENT || DSM-5-TR || DIFFERENTIAL DIAGNOSIS ||
PSYCHOPHARMACOLOGY || MOOD DISORDERS || PSYCHOSIS || ANXIETY
DISORDERS || SUBSTANCE USE || SUICIDE RISK || THERAPEUTIC
COMMUNICATION || ETHICS || ADVANCED PRACTICE || EVIDENCE-BASED CARE ||
PROFESSIONAL JUDGMENT || CLINICAL DECISION-MAKING
QUESTION 1.
A 34-year-old patient presents with insomnia, racing thoughts, impulsive spending,
and elevated mood lasting 8 days with significant impairment in occupational
functioning. Which diagnosis is most consistent with this presentation?
A. Cyclothymic disorder
B. Bipolar I disorder, current manic episode
,C. Bipolar II disorder, hypomanic episode
D. Persistent depressive disorder
🔴 Correct Answer: B. Bipolar I disorder, current manic episode
🔵 Explanation: A manic episode lasting at least one week or requiring
hospitalization with marked functional impairment is diagnostic of Bipolar I disorder.
Hypomania causes less impairment and characterizes Bipolar II disorder. Cyclothymic
disorder involves chronic fluctuating symptoms that do not meet full episode criteria,
while persistent depressive disorder is characterized by chronic depression.
QUESTION 2.
A patient taking lithium reports persistent vomiting, coarse tremor, ataxia, and
increasing confusion. What is the most appropriate immediate action?
A. Increase fluid intake and continue lithium
B. Hold lithium and obtain an urgent serum lithium level
C. Reduce the dose by half and reassess in one week
D. Add propranolol for tremor management
🔴 Correct Answer: B. Hold lithium and obtain an urgent serum lithium level
🔵 Explanation: These findings strongly suggest lithium toxicity, requiring immediate
discontinuation of lithium and urgent evaluation. Continuing or simply reducing
therapy may allow toxicity to worsen. Symptomatic treatment without addressing the
underlying toxicity is inappropriate.
QUESTION 3.
During a suicide risk assessment, which finding represents the highest level of
immediate concern?
A. Passive thoughts of death without intent
B. Previous depressive episode five years ago
,C. Specific suicide plan with access to the identified method
D. Occasional hopelessness during stressful situations
🔴 Correct Answer: C. Specific suicide plan with access to the identified method
🔵 Explanation: A detailed plan combined with access to the intended means
substantially increases imminent suicide risk and requires immediate intervention.
Passive thoughts, prior depression, and transient hopelessness warrant assessment
but generally indicate lower immediate risk.
QUESTION 4.
A patient with schizophrenia has persistent auditory hallucinations despite
adequate trials of two different antipsychotic medications at therapeutic doses.
Which intervention is most appropriate?
A. Initiate clozapine after appropriate baseline evaluation
B. Continue the current medication indefinitely
C. Switch to an antidepressant
D. Discontinue pharmacotherapy and begin psychotherapy alone
🔴 Correct Answer: A. Initiate clozapine after appropriate baseline evaluation
🔵 Explanation: Clozapine is indicated for treatment-resistant schizophrenia after
failure of two adequate antipsychotic trials. Baseline laboratory monitoring is required
because of risks including agranulocytosis. The remaining options fail to address
evidence-based management of treatment-resistant illness.
QUESTION 5.
A patient with generalized anxiety disorder has completed six months of cognitive
behavioral therapy but continues to experience clinically significant symptoms.
Which pharmacologic option is supported as an appropriate first-line medication?
A. Sertraline
B. Haloperidol
, C. Carbamazepine
D. Benztropine
🔴 Correct Answer: A. Sertraline
🔵 Explanation: SSRIs such as sertraline are considered first-line pharmacologic
treatment for generalized anxiety disorder. Haloperidol is an antipsychotic,
carbamazepine is primarily used for seizures and mood stabilization, and benztropine
treats extrapyramidal symptoms.
QUESTION 6.
A patient taking phenelzine develops severe headache, diaphoresis, hypertension,
and palpitations after eating aged cheese. What is the most likely explanation?
A. Serotonin syndrome
B. Hypertensive crisis caused by tyramine interaction
C. Neuroleptic malignant syndrome
D. Acute withdrawal syndrome
🔴 Correct Answer: B. Hypertensive crisis caused by tyramine interaction
🔵 Explanation: Monoamine oxidase inhibitors require avoidance of tyramine-
containing foods because the interaction can precipitate a hypertensive crisis.
Serotonin syndrome usually involves serotonergic drug combinations rather than
dietary tyramine. Neuroleptic malignant syndrome is associated with dopamine
blockade.
QUESTION 7.
Which patient demonstrates the strongest indication for involuntary psychiatric
hospitalization?
A. A patient requesting medication adjustment
B. A patient experiencing insomnia without psychosis
