NRNP 6665 PMHNP FINAL EXAM
PRACTICE QUESTIONS WITH
VERIFIED ANSWERS
1. When initiating Clozapine (Clozaril) therapy, the Psychiatric-Mental Health Nurse
Practitioner (PMHNP) must ensure the patient’s Absolute Neutrophil Count (ANC) is at least:
A. 500/mm³
B. 1000/mm³
C. 1500/mm³
D. 2000/mm³
Answer: C
Conceptual Explanation: For the general population, the ANC must be ≥ 1500/mm³
before starting Clozapine to minimize the risk of agranulocytosis.
2. A 24-year-old female patient with Bipolar I disorder is planning to become pregnant. Which
medication carries the highest risk for neural tube defects in the fetus?
A. Lithium
B. Valproate
,C. Quetiapine
D. Lamotrigine
Answer: B
Conceptual Explanation: Valproate (Depakote) is highly teratogenic, specifically
associated with a high risk of neural tube defects like spina bifida.
3. Which of the following physical symptoms is most characteristic of Serotonin Syndrome
rather than Neuroleptic Malignant Syndrome (NMS)?
A. Hyperthermia
B. Lead-pipe muscle rigidity
C. Hyperreflexia and myoclonus
D. Elevated Creatine Kinase
Answer: C
Conceptual Explanation: Serotonin syndrome typically presents with hyperreflexia and
myoclonus, whereas NMS is characterized by ‘lead-pipe’ muscle rigidity.
4. In a patient taking Lithium, which of the following lab findings would most likely indicate
toxicity?
A. Serum Creatinine of 2.5 mg/dL
B. Sodium level of 140 mEq/L
C. Lithium level of 0.8 mEq/L
, D. Potassium level of 4.0 mEq/L
Answer: A
Conceptual Explanation: Elevated creatinine suggests renal impairment, which can lead
to Lithium toxicity as Lithium is cleared almost exclusively by the kidneys.
5. According to Erikson’s Stages of Psychosocial Development, a 15-year-old adolescent is
primarily struggling with which conflict?
A. Intimacy vs. Isolation
B. Industry vs. Inferiority
C. Autonomy vs. Shame and Doubt
D. Identity vs. Role Confusion
Answer: D
Conceptual Explanation: Adolescents (ages 12-18) are in the stage of Identity vs. Role
Confusion, focusing on developing a personal identity and sense of self.
6. A patient presents with acute onset of confusion, fluctuating levels of consciousness, and
visual hallucinations. What is the most likely diagnosis?
A. Major Depressive Disorder with Psychotic Features
B. Dementia of the Alzheimer’s Type
C. Delirium
D. Schizophrenia
PRACTICE QUESTIONS WITH
VERIFIED ANSWERS
1. When initiating Clozapine (Clozaril) therapy, the Psychiatric-Mental Health Nurse
Practitioner (PMHNP) must ensure the patient’s Absolute Neutrophil Count (ANC) is at least:
A. 500/mm³
B. 1000/mm³
C. 1500/mm³
D. 2000/mm³
Answer: C
Conceptual Explanation: For the general population, the ANC must be ≥ 1500/mm³
before starting Clozapine to minimize the risk of agranulocytosis.
2. A 24-year-old female patient with Bipolar I disorder is planning to become pregnant. Which
medication carries the highest risk for neural tube defects in the fetus?
A. Lithium
B. Valproate
,C. Quetiapine
D. Lamotrigine
Answer: B
Conceptual Explanation: Valproate (Depakote) is highly teratogenic, specifically
associated with a high risk of neural tube defects like spina bifida.
3. Which of the following physical symptoms is most characteristic of Serotonin Syndrome
rather than Neuroleptic Malignant Syndrome (NMS)?
A. Hyperthermia
B. Lead-pipe muscle rigidity
C. Hyperreflexia and myoclonus
D. Elevated Creatine Kinase
Answer: C
Conceptual Explanation: Serotonin syndrome typically presents with hyperreflexia and
myoclonus, whereas NMS is characterized by ‘lead-pipe’ muscle rigidity.
4. In a patient taking Lithium, which of the following lab findings would most likely indicate
toxicity?
A. Serum Creatinine of 2.5 mg/dL
B. Sodium level of 140 mEq/L
C. Lithium level of 0.8 mEq/L
, D. Potassium level of 4.0 mEq/L
Answer: A
Conceptual Explanation: Elevated creatinine suggests renal impairment, which can lead
to Lithium toxicity as Lithium is cleared almost exclusively by the kidneys.
5. According to Erikson’s Stages of Psychosocial Development, a 15-year-old adolescent is
primarily struggling with which conflict?
A. Intimacy vs. Isolation
B. Industry vs. Inferiority
C. Autonomy vs. Shame and Doubt
D. Identity vs. Role Confusion
Answer: D
Conceptual Explanation: Adolescents (ages 12-18) are in the stage of Identity vs. Role
Confusion, focusing on developing a personal identity and sense of self.
6. A patient presents with acute onset of confusion, fluctuating levels of consciousness, and
visual hallucinations. What is the most likely diagnosis?
A. Major Depressive Disorder with Psychotic Features
B. Dementia of the Alzheimer’s Type
C. Delirium
D. Schizophrenia
