FLORIDA BOARD OF NURSING
PSYCHIATRIC NURSE PRACTITIONER
EXAM WITH ACTUAL QUESTIONS AND
VERIFIED ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
Question 1
A 32-year-old patient with major depressive disorder presents with
depressed mood, anhedonia, insomnia, guilt, poor concentration, and
recurrent thoughts that life is not worth living. The patient denies having
a current suicide plan but reports that the thoughts have increased over
the past week. Which action should the psychiatric nurse practitioner
take FIRST?
A. Increase the antidepressant dose immediately
B. Develop a detailed safety assessment and determine the patient's level
of suicide risk
C. Reassure the patient that suicidal thoughts are common in depression
D. Schedule a routine follow-up appointment in four weeks
Answer: B. Develop a detailed safety assessment and determine the
patient's level of suicide risk
Rationale: A patient reporting worsening suicidal ideation requires an
immediate, structured suicide-risk assessment. The clinician should
assess intent, plan, access to lethal means, previous attempts,
protective factors, substance use, psychosis, and the patient's ability to
maintain safety. Medication adjustment may ultimately be necessary,
but immediate safety assessment takes priority.
1
,Question 2
A patient with bipolar I disorder is experiencing a manic episode
characterized by decreased need for sleep, pressured speech, grandiosity,
impulsive spending, and aggressive behavior. Which finding most
strongly supports hospitalization?
A. Increased goal-directed activity
B. Sleeping four hours nightly
C. Financial irresponsibility
D. Imminent danger to self or others
Answer: D. Imminent danger to self or others
Rationale: The need for inpatient treatment in acute mania is driven
primarily by severity, inability to care for oneself, psychosis, or
significant danger to self or others. Decreased sleep, increased activity,
and impulsivity are characteristic of mania but do not independently
establish the need for hospitalization.
Question 3
A patient taking lithium for bipolar disorder develops coarse tremor,
vomiting, diarrhea, ataxia, and confusion. Which action is most
appropriate?
A. Administer the next scheduled dose with food
B. Increase lithium because the symptoms indicate uncontrolled mania
C. Hold lithium and obtain an urgent serum lithium level and medical
evaluation
D. Add an SSRI to treat the symptoms
Answer: C. Hold lithium and obtain an urgent serum lithium level
and medical evaluation
2
,Rationale: Coarse tremor, gastrointestinal symptoms, ataxia, and
confusion are concerning for lithium toxicity. Lithium has a narrow
therapeutic index. The medication should be held while the patient
receives urgent assessment, including a serum lithium concentration,
renal function, electrolytes, hydration assessment, and evaluation for
potentially serious toxicity.
Question 4
A patient taking lithium has recently started hydrochlorothiazide for
hypertension. Why is this combination clinically concerning?
A. Hydrochlorothiazide increases lithium clearance
B. Hydrochlorothiazide can decrease lithium clearance and increase
lithium concentrations
C. Lithium completely blocks the antihypertensive effects of
hydrochlorothiazide
D. The combination causes serotonin syndrome
Answer: B. Hydrochlorothiazide can decrease lithium clearance and
increase lithium concentrations
Rationale: Thiazide diuretics can reduce renal lithium clearance,
resulting in increased serum lithium concentrations and toxicity risk.
Patients receiving lithium require careful medication reconciliation
because numerous medications, including certain diuretics and
NSAIDs, can alter lithium levels.
Question 5
A 27-year-old patient taking sertraline develops agitation, diaphoresis,
hyperreflexia, clonus, diarrhea, and fever after another serotonergic
medication is added. Which diagnosis is most likely?
3
, A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Acute dystonia
D. Anticholinergic toxicity
Answer: B. Serotonin syndrome
Rationale: Serotonin syndrome results from excessive serotonergic
activity. Typical findings include agitation, autonomic instability,
diaphoresis, gastrointestinal symptoms, hyperreflexia, clonus, tremor,
and hyperthermia. Clonus and hyperreflexia are particularly useful
clinical clues distinguishing serotonin toxicity from neuroleptic
malignant syndrome.
Question 6
A patient receiving haloperidol develops severe muscle rigidity,
hyperthermia, altered mental status, diaphoresis, and autonomic
instability. Which condition should the psychiatric nurse practitioner
suspect?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Acute stress disorder
Answer: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a potentially life-
threatening reaction associated with dopamine blockade. The classic
presentation includes severe rigidity, hyperthermia, altered mental
status, and autonomic instability. Treatment requires immediate
discontinuation of the offending medication and urgent medical
management.
4
PSYCHIATRIC NURSE PRACTITIONER
EXAM WITH ACTUAL QUESTIONS AND
VERIFIED ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
Question 1
A 32-year-old patient with major depressive disorder presents with
depressed mood, anhedonia, insomnia, guilt, poor concentration, and
recurrent thoughts that life is not worth living. The patient denies having
a current suicide plan but reports that the thoughts have increased over
the past week. Which action should the psychiatric nurse practitioner
take FIRST?
A. Increase the antidepressant dose immediately
B. Develop a detailed safety assessment and determine the patient's level
of suicide risk
C. Reassure the patient that suicidal thoughts are common in depression
D. Schedule a routine follow-up appointment in four weeks
Answer: B. Develop a detailed safety assessment and determine the
patient's level of suicide risk
Rationale: A patient reporting worsening suicidal ideation requires an
immediate, structured suicide-risk assessment. The clinician should
assess intent, plan, access to lethal means, previous attempts,
protective factors, substance use, psychosis, and the patient's ability to
maintain safety. Medication adjustment may ultimately be necessary,
but immediate safety assessment takes priority.
1
,Question 2
A patient with bipolar I disorder is experiencing a manic episode
characterized by decreased need for sleep, pressured speech, grandiosity,
impulsive spending, and aggressive behavior. Which finding most
strongly supports hospitalization?
A. Increased goal-directed activity
B. Sleeping four hours nightly
C. Financial irresponsibility
D. Imminent danger to self or others
Answer: D. Imminent danger to self or others
Rationale: The need for inpatient treatment in acute mania is driven
primarily by severity, inability to care for oneself, psychosis, or
significant danger to self or others. Decreased sleep, increased activity,
and impulsivity are characteristic of mania but do not independently
establish the need for hospitalization.
Question 3
A patient taking lithium for bipolar disorder develops coarse tremor,
vomiting, diarrhea, ataxia, and confusion. Which action is most
appropriate?
A. Administer the next scheduled dose with food
B. Increase lithium because the symptoms indicate uncontrolled mania
C. Hold lithium and obtain an urgent serum lithium level and medical
evaluation
D. Add an SSRI to treat the symptoms
Answer: C. Hold lithium and obtain an urgent serum lithium level
and medical evaluation
2
,Rationale: Coarse tremor, gastrointestinal symptoms, ataxia, and
confusion are concerning for lithium toxicity. Lithium has a narrow
therapeutic index. The medication should be held while the patient
receives urgent assessment, including a serum lithium concentration,
renal function, electrolytes, hydration assessment, and evaluation for
potentially serious toxicity.
Question 4
A patient taking lithium has recently started hydrochlorothiazide for
hypertension. Why is this combination clinically concerning?
A. Hydrochlorothiazide increases lithium clearance
B. Hydrochlorothiazide can decrease lithium clearance and increase
lithium concentrations
C. Lithium completely blocks the antihypertensive effects of
hydrochlorothiazide
D. The combination causes serotonin syndrome
Answer: B. Hydrochlorothiazide can decrease lithium clearance and
increase lithium concentrations
Rationale: Thiazide diuretics can reduce renal lithium clearance,
resulting in increased serum lithium concentrations and toxicity risk.
Patients receiving lithium require careful medication reconciliation
because numerous medications, including certain diuretics and
NSAIDs, can alter lithium levels.
Question 5
A 27-year-old patient taking sertraline develops agitation, diaphoresis,
hyperreflexia, clonus, diarrhea, and fever after another serotonergic
medication is added. Which diagnosis is most likely?
3
, A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Acute dystonia
D. Anticholinergic toxicity
Answer: B. Serotonin syndrome
Rationale: Serotonin syndrome results from excessive serotonergic
activity. Typical findings include agitation, autonomic instability,
diaphoresis, gastrointestinal symptoms, hyperreflexia, clonus, tremor,
and hyperthermia. Clonus and hyperreflexia are particularly useful
clinical clues distinguishing serotonin toxicity from neuroleptic
malignant syndrome.
Question 6
A patient receiving haloperidol develops severe muscle rigidity,
hyperthermia, altered mental status, diaphoresis, and autonomic
instability. Which condition should the psychiatric nurse practitioner
suspect?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Acute stress disorder
Answer: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a potentially life-
threatening reaction associated with dopamine blockade. The classic
presentation includes severe rigidity, hyperthermia, altered mental
status, and autonomic instability. Treatment requires immediate
discontinuation of the offending medication and urgent medical
management.
4
