NR 546 FINAL EXAM-CHAMBERLAIN UNIVERSITY–COMPLETE
STUDY GUIDE | PRACTICE QUESTIONS AND ANSWERS-
RATIONALES | EXAM PREP | DOWNLOAD INSTANT PDF |
GUARANTEED PASS || LATEST EXAM 2026-2027
1. A 34-year-old female presents to the psychiatric mental health nurse practitioner
(PMHNP) for evaluation of recurrent, severe depressive episodes that occur exclusively
during the luteal phase of her menstrual cycle. She reports prominent irritability, lethargy,
and food cravings that resolve shortly after menses begins. Which therapeutic option
represents the most appropriate evidence-based first-line pharmacological intervention for
this condition?
A. Continuous daily administration of a low-dose selective serotonin reuptake inhibitor (SSRI)
or intermittent dosing during the luteal phase
B. Immediate initiation of a high-potency typical antipsychotic combined with prophylactic
anticholinergic coverage
C. Long-term treatment with therapeutic doses of a monoamine oxidase inhibitor (MAOI)
requiring strict dietary tyrosine restriction
D. Daily administration of high-potency benzodiazepines on an ongoing schedule to suppress
acute limbic system hyperactivity
Answer: A
Intermittent or continuous dosing with a selective serotonin reuptake inhibitor during the
luteal phase is a well-established, first-line pharmacological strategy for premenstrual
dysphoric disorder, capitalizing on rapid central nervous system serotonergic modulation to
mitigate cyclical mood lability.
2. A PMHNP is managing a 45-year-old male with bipolar I disorder who is stabilized on
lithium carbonate with a serum concentration of 0.8 mEq/L. The patient reports new-onset
polyuria and polydipsia. Subsequent laboratory evaluation confirms nephrogenic diabetes
insipidus secondary to long-term lithium exposure. If lithium cannot be discontinued due to
high risk of relapse, which potassium-sparing diuretic is specifically utilized to counteract
this renal complication?
A. Spironolactone
B. Amiloride
C. Furosemide
D. Hydrochlorothiazide
Answer: B
Amiloride is the preferred potassium-sparing diuretic for lithium-induced nephrogenic
diabetes insipidus because it blocks epithelial sodium channels in the collecting duct principal
,cells, preventing intracellular lithium entry and protecting against aquaporin-2 down-
regulation.
3. A 28-year-old male is evaluated for recurrent unexpected panic attacks accompanied by
severe anticipatory anxiety and agoraphobia. The PMHNP plans to initiate sertraline.
Which clinical strategy is essential when initiating an SSRI in a patient with panic disorder
to prevent early treatment discontinuation?
A. Initiating treatment at a very low dosage and titrating upward very slowly to minimize
transient somatic activation and initial jitteriness
B. Prescribing the maximal therapeutic dose immediately to achieve rapid plasma saturation and
immediate therapeutic blockage of panic loops
C. Advising the patient to consume high doses of caffeine concurrently to counteract potential
treatment-emergent sedation
D. Utilizing a high-potency monoamine oxidase inhibitor from day one to bypass the latency
period associated with selective serotonin reuptake inhibitors
Answer: A
Patients with panic disorder exhibit heightened sensitivity to somatic sensations and early
treatment activation, making it essential to start at sub-therapeutic doses and titrate slowly to
prevent premature discontinuation driven by transient drug-induced anxiety.
4. A PMHNP is assessing a 15-year-old adolescent with a history of chronic rule-breaking,
physical aggression toward peers, destruction of property, and deceitfulness starting at age
12. During the evaluation, the patient displays a persistent lack of remorse, shallow affect,
and an unconcerned attitude regarding academic and behavioral performance. Which
diagnostic specifier is most appropriate?
A. With limited prosocial emotions
B. With rapid cycling features
C. With catatonic specifiers
D. With seasonal variation patterns
Answer: A
The "with limited prosocial emotions" specifier is applied to individuals meeting criteria for
conduct disorder who display a callous and unemotional interpersonal style characterized by a
lack of remorse, empathy, and unconcern over performance across multiple settings.
5. A 50-year-old male with treatment-resistant major depressive disorder is referred for
repetitive transcranial magnetic stimulation (rTMS). What is the primary biophysical
mechanism of standard rTMS directed at the left dorsolateral prefrontal cortex (DLPFC)?
A. Generating rapid, localized magnetic field pulses that induce electrical currents to depolarize
neurons and stimulate hypoactive prefrontal cortical structures
, B. Delivering direct high-voltage electrical current through surgically implanted epidural
electrodes to generate generalized cerebral focal seizures
C. Utilizing focused ultrasound waves to permanently ablate the anterior cingulate cortex and
disrupt hyperactive limbic feedback loops
D. Administering transcutaneous electrical nerve stimulation across the mastoid processes to
activate cranial nerve tenth branches
Answer: A
Repetitive transcranial magnetic stimulation utilizes a rapidly alternating magnetic coil to
generate localized electrical currents that depolarize cortical neurons, effectively upregulating
metabolic activity within the underactive left dorsolateral prefrontal cortex without anesthesia.
6. A PMHNP is evaluating a 68-year-old female who presents with progressive cognitive
decline, prominent visual hallucinations, fluctuating levels of alertness with significant
variations in attention, and spontaneous parkinsonism. What is the most likely diagnosis?
A. Dementia with Lewy bodies
B. Huntington’s disease
C. Creutzfeldt-Jakob disease
D. Frontotemporal lobar degeneration
Answer: A
Dementia with Lewy bodies is characterized by progressive cognitive impairment accompanied
by three core clinical features: fluctuating attention and alertness, recurrent visual
hallucinations, and spontaneous motor features of parkinsonism.
7. A 22-year-old female presents with severe social anxiety disorder, reporting debilitating
panic symptoms, tachycardia, and dry mouth strictly prior to academic presentations.
Which medication class is frequently prescribed on an as-needed basis for performance-
only social anxiety disorder to blunt peripheral autonomic arousal?
A. Beta-adrenergic receptor antagonists (e.g., propranolol)
B. High-potency typical antipsychotics (e.g., haloperidol)
C. Selective serotonin reuptake inhibitors taken sublingually 5 minutes prior
D. Non-benzodiazepine GABA receptor partial agonists
Answer: A
Beta-adrenergic receptor antagonists block peripheral beta-adrenergic receptors, effectively
dampening somatic manifestations of sympathetic nervous system activation such as
tachycardia and tremor during performance situations without causing sedation.
, 8. A PMHNP is managing a patient with bipolar I disorder maintained on chronic lithium
therapy. Which baseline and ongoing laboratory assessments are required to monitor for
potential renal complications of this treatment?
A. Serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR),
and urinalysis for specific gravity
B. Complete blood count with differential and reticulocyte count evaluated every two weeks
C. Fasting serum lipid panel and hepatic transaminases monitored monthly
D. Serum electrolytes coupled with arterial blood gas analysis performed twice weekly
Answer: A
Chronic lithium therapy can impair renal concentrating ability and lead to tubulointerstitial
nephritis; consequently, ongoing assessment must include baseline and periodic checks of
serum creatinine, BUN, eGFR, and urinalysis.
9. A 39-year-old male presents with depressive symptoms, psychomotor slowing, and severe
fatigue. The PMHNP considers prescribing an atypical antidepressant that acts primarily
as a norepinephrine-dopamine reuptake inhibitor (NDRI) and is devoid of direct
serotonergic effects. Which medication fits this profile?
A. Bupropion
B. Mirtazapine
C. Trazodone
D. Paroxetine
Answer: A
Bupropion functions uniquely as a norepinephrine-dopamine reuptake inhibitor, providing
activating properties and weight neutrality while avoiding the sexual side effects common to
serotonergic antidepressants.
10. A PMHNP is assessing a patient with schizophrenia who exhibits bizarre posturing,
waxy flexibility, profound negativism, and mutism during an inpatient psychiatric
interview. What clinical syndrome is present?
A. Catatonia
B. Delusional disorder
C. Schizoaffective disorder
D. Dissociative fugue
Answer: A
Catatonia is a neuropsychiatric syndrome characterized by marked motor abnormalities
including catalepsy, waxy flexibility, posturing, mutism, and negativism, which can manifest
across various psychiatric and medical conditions.
STUDY GUIDE | PRACTICE QUESTIONS AND ANSWERS-
RATIONALES | EXAM PREP | DOWNLOAD INSTANT PDF |
GUARANTEED PASS || LATEST EXAM 2026-2027
1. A 34-year-old female presents to the psychiatric mental health nurse practitioner
(PMHNP) for evaluation of recurrent, severe depressive episodes that occur exclusively
during the luteal phase of her menstrual cycle. She reports prominent irritability, lethargy,
and food cravings that resolve shortly after menses begins. Which therapeutic option
represents the most appropriate evidence-based first-line pharmacological intervention for
this condition?
A. Continuous daily administration of a low-dose selective serotonin reuptake inhibitor (SSRI)
or intermittent dosing during the luteal phase
B. Immediate initiation of a high-potency typical antipsychotic combined with prophylactic
anticholinergic coverage
C. Long-term treatment with therapeutic doses of a monoamine oxidase inhibitor (MAOI)
requiring strict dietary tyrosine restriction
D. Daily administration of high-potency benzodiazepines on an ongoing schedule to suppress
acute limbic system hyperactivity
Answer: A
Intermittent or continuous dosing with a selective serotonin reuptake inhibitor during the
luteal phase is a well-established, first-line pharmacological strategy for premenstrual
dysphoric disorder, capitalizing on rapid central nervous system serotonergic modulation to
mitigate cyclical mood lability.
2. A PMHNP is managing a 45-year-old male with bipolar I disorder who is stabilized on
lithium carbonate with a serum concentration of 0.8 mEq/L. The patient reports new-onset
polyuria and polydipsia. Subsequent laboratory evaluation confirms nephrogenic diabetes
insipidus secondary to long-term lithium exposure. If lithium cannot be discontinued due to
high risk of relapse, which potassium-sparing diuretic is specifically utilized to counteract
this renal complication?
A. Spironolactone
B. Amiloride
C. Furosemide
D. Hydrochlorothiazide
Answer: B
Amiloride is the preferred potassium-sparing diuretic for lithium-induced nephrogenic
diabetes insipidus because it blocks epithelial sodium channels in the collecting duct principal
,cells, preventing intracellular lithium entry and protecting against aquaporin-2 down-
regulation.
3. A 28-year-old male is evaluated for recurrent unexpected panic attacks accompanied by
severe anticipatory anxiety and agoraphobia. The PMHNP plans to initiate sertraline.
Which clinical strategy is essential when initiating an SSRI in a patient with panic disorder
to prevent early treatment discontinuation?
A. Initiating treatment at a very low dosage and titrating upward very slowly to minimize
transient somatic activation and initial jitteriness
B. Prescribing the maximal therapeutic dose immediately to achieve rapid plasma saturation and
immediate therapeutic blockage of panic loops
C. Advising the patient to consume high doses of caffeine concurrently to counteract potential
treatment-emergent sedation
D. Utilizing a high-potency monoamine oxidase inhibitor from day one to bypass the latency
period associated with selective serotonin reuptake inhibitors
Answer: A
Patients with panic disorder exhibit heightened sensitivity to somatic sensations and early
treatment activation, making it essential to start at sub-therapeutic doses and titrate slowly to
prevent premature discontinuation driven by transient drug-induced anxiety.
4. A PMHNP is assessing a 15-year-old adolescent with a history of chronic rule-breaking,
physical aggression toward peers, destruction of property, and deceitfulness starting at age
12. During the evaluation, the patient displays a persistent lack of remorse, shallow affect,
and an unconcerned attitude regarding academic and behavioral performance. Which
diagnostic specifier is most appropriate?
A. With limited prosocial emotions
B. With rapid cycling features
C. With catatonic specifiers
D. With seasonal variation patterns
Answer: A
The "with limited prosocial emotions" specifier is applied to individuals meeting criteria for
conduct disorder who display a callous and unemotional interpersonal style characterized by a
lack of remorse, empathy, and unconcern over performance across multiple settings.
5. A 50-year-old male with treatment-resistant major depressive disorder is referred for
repetitive transcranial magnetic stimulation (rTMS). What is the primary biophysical
mechanism of standard rTMS directed at the left dorsolateral prefrontal cortex (DLPFC)?
A. Generating rapid, localized magnetic field pulses that induce electrical currents to depolarize
neurons and stimulate hypoactive prefrontal cortical structures
, B. Delivering direct high-voltage electrical current through surgically implanted epidural
electrodes to generate generalized cerebral focal seizures
C. Utilizing focused ultrasound waves to permanently ablate the anterior cingulate cortex and
disrupt hyperactive limbic feedback loops
D. Administering transcutaneous electrical nerve stimulation across the mastoid processes to
activate cranial nerve tenth branches
Answer: A
Repetitive transcranial magnetic stimulation utilizes a rapidly alternating magnetic coil to
generate localized electrical currents that depolarize cortical neurons, effectively upregulating
metabolic activity within the underactive left dorsolateral prefrontal cortex without anesthesia.
6. A PMHNP is evaluating a 68-year-old female who presents with progressive cognitive
decline, prominent visual hallucinations, fluctuating levels of alertness with significant
variations in attention, and spontaneous parkinsonism. What is the most likely diagnosis?
A. Dementia with Lewy bodies
B. Huntington’s disease
C. Creutzfeldt-Jakob disease
D. Frontotemporal lobar degeneration
Answer: A
Dementia with Lewy bodies is characterized by progressive cognitive impairment accompanied
by three core clinical features: fluctuating attention and alertness, recurrent visual
hallucinations, and spontaneous motor features of parkinsonism.
7. A 22-year-old female presents with severe social anxiety disorder, reporting debilitating
panic symptoms, tachycardia, and dry mouth strictly prior to academic presentations.
Which medication class is frequently prescribed on an as-needed basis for performance-
only social anxiety disorder to blunt peripheral autonomic arousal?
A. Beta-adrenergic receptor antagonists (e.g., propranolol)
B. High-potency typical antipsychotics (e.g., haloperidol)
C. Selective serotonin reuptake inhibitors taken sublingually 5 minutes prior
D. Non-benzodiazepine GABA receptor partial agonists
Answer: A
Beta-adrenergic receptor antagonists block peripheral beta-adrenergic receptors, effectively
dampening somatic manifestations of sympathetic nervous system activation such as
tachycardia and tremor during performance situations without causing sedation.
, 8. A PMHNP is managing a patient with bipolar I disorder maintained on chronic lithium
therapy. Which baseline and ongoing laboratory assessments are required to monitor for
potential renal complications of this treatment?
A. Serum creatinine, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR),
and urinalysis for specific gravity
B. Complete blood count with differential and reticulocyte count evaluated every two weeks
C. Fasting serum lipid panel and hepatic transaminases monitored monthly
D. Serum electrolytes coupled with arterial blood gas analysis performed twice weekly
Answer: A
Chronic lithium therapy can impair renal concentrating ability and lead to tubulointerstitial
nephritis; consequently, ongoing assessment must include baseline and periodic checks of
serum creatinine, BUN, eGFR, and urinalysis.
9. A 39-year-old male presents with depressive symptoms, psychomotor slowing, and severe
fatigue. The PMHNP considers prescribing an atypical antidepressant that acts primarily
as a norepinephrine-dopamine reuptake inhibitor (NDRI) and is devoid of direct
serotonergic effects. Which medication fits this profile?
A. Bupropion
B. Mirtazapine
C. Trazodone
D. Paroxetine
Answer: A
Bupropion functions uniquely as a norepinephrine-dopamine reuptake inhibitor, providing
activating properties and weight neutrality while avoiding the sexual side effects common to
serotonergic antidepressants.
10. A PMHNP is assessing a patient with schizophrenia who exhibits bizarre posturing,
waxy flexibility, profound negativism, and mutism during an inpatient psychiatric
interview. What clinical syndrome is present?
A. Catatonia
B. Delusional disorder
C. Schizoaffective disorder
D. Dissociative fugue
Answer: A
Catatonia is a neuropsychiatric syndrome characterized by marked motor abnormalities
including catalepsy, waxy flexibility, posturing, mutism, and negativism, which can manifest
across various psychiatric and medical conditions.
