Academic Year 2026–2027 NRNP 6675 Advanced
Practice Psychiatric-Mental Health | 190+ Practice
Questions & Verified Answers | Latest Study Guide,
Test Bank, Practice Exam, Comprehensive Review &
Exam Prep | NRNP 6675 PMHNP, Advanced
Psychiatric Nursing, Mental Health Assessment,
Psychiatric Diagnosis, Differential Diagnosis,
Psychopharmacology, Psychotherapy, Therapeutic
Communication, Clinical Management, DSM-5-TR &
Evidence-Based Psychiatric Care
Question 1: A 68-year-old patient with a history of Parkinson's disease has
been on a stable dose of carbidopa-levodopa for three years. He is now
diagnosed with major depressive disorder and requires antidepressant therapy.
Which of the following antidepressants is most appropriate for the PMHNP to
prescribe to minimize adverse effects and drug interactions?
A. Fluoxetine
B. Paroxetine
C. Bupropion
D. Sertraline
CORRECT ANSWER: C. Bupropion
Rationale: Bupropion has minimal serotonergic activity and is less likely to interact with
carbidopa-levodopa, reducing the risk of serotonin syndrome. It can be used safely in
Parkinson's disease and may improve comorbid symptoms like fatigue or apathy. SSRIs
like fluoxetine, paroxetine, and sertraline can worsen motor symptoms or increase the
risk of serotonin syndrome in patients on dopaminergic agents due to complex drug-
drug interactions and enzyme inhibition (e.g., paroxetine is a strong CYP2D6 inhibitor) .
Question 2: A 16-year-old female presents to the PMHNP with her mother. She
reports depressed mood, difficulty concentrating, and a significant decline in
academic performance over the past 3 months. The mother reports that the
patient has been irritable at home, has withdrawn from friends, and has had a
10-pound weight gain. Which of the following is the most appropriate initial
screening tool for this patient?
A. Hamilton Depression Rating Scale (HAM-D)
B. Patient Health Questionnaire-9 (PHQ-9)
C. Beck Depression Inventory-II (BDI-II)
D. Columbia-Suicide Severity Rating Scale (C-SSRS)
CORRECT ANSWER: B. Patient Health Questionnaire-9 (PHQ-9)
Rationale: The PHQ-9 is a widely used, validated screening tool for adolescents and
adults in primary and psychiatric care settings. It is brief, aligns with DSM-5 criteria, and
,can track symptom severity. While the BDI-II and HAM-D are also used for depression,
the PHQ-9 is particularly efficient for initial screening in busy clinical settings. The C-
SSRS is essential for suicide risk assessment but is not a primary screening tool for
depression itself.
Question 3: A 45-year-old male with a history of bipolar I disorder is currently
stable on lithium and quetiapine. He presents with a 3-day history of coarse
tremors, ataxia, confusion, and nausea. His most recent serum lithium level is
2.1 mEq/L. He reports starting a new medication for hypertension prescribed
by his primary care provider. Which of the following medications is most likely
responsible for the increased lithium level?
A. Lisinopril
B. Losartan
C. Hydrochlorothiazide
D. Amlodipine
CORRECT ANSWER: C. Hydrochlorothiazide
Rationale: Thiazide diuretics, such as hydrochlorothiazide, reduce renal clearance of
lithium, leading to increased serum lithium levels and potential toxicity. This interaction
is a critical concern for PMHNPs prescribing for patients on maintenance lithium
therapy. ACE inhibitors (lisinopril) and ARBs (losartan) may also cause lithium
accumulation but are less likely to be the culprit compared to thiazides. Amlodipine, a
calcium channel blocker, does not have a significant interaction with lithium .
Question 4: According to the American Nurses Credentialing Center (ANCC)
PMHNP certification examination content outline, which domain accounts for
the highest percentage of exam items?
A. Assess
B. Diagnose
C. Plan
D. Evaluate
CORRECT ANSWER: A. Assess
Rationale: The ANCC PMHNP exam blueprint allocates the largest proportion of items
to the "Assess" domain, covering psychiatric and physical assessment, screening, and
diagnostic procedures. Approximately 33% of the exam focuses on this foundational
competency, underscoring its importance in PMHNP practice .
Question 5: A 30-year-old patient with borderline personality disorder
frequently threatens self-harm during therapy sessions, particularly when the
PMHNP sets boundaries. The patient states, "You wouldn't have to worry
about me if you really cared." Which therapeutic approach is most appropriate
for the PMHNP to use initially?
,A. Validate the underlying distress while maintaining treatment boundaries.
B. Hospitalize the patient emergently for each threat of self-harm.
C. Increase the frequency of therapy sessions to reduce the patient's anxiety.
D. Interpret the behavior as a primitive defense mechanism and confront it directly.
CORRECT ANSWER: A. Validate the underlying distress while maintaining
treatment boundaries.
Rationale: Patients with borderline personality disorder often use threats of self-harm to
manage fears of abandonment or rejection. Dialectical behavior therapy (DBT)
principles emphasize validating the patient's emotional experience while maintaining
clear boundaries and not reinforcing maladaptive behaviors. This approach balances
empathy with structure, preventing escalation. Hospitalization may be needed if there is
imminent risk, but it should not be used punitively for every threat. Direct confrontation
can damage the therapeutic alliance. Increasing session frequency in response to threats
reinforces the behavior.
Question 6: A PMHNP is evaluating a 75-year-old patient with treatment-
resistant depression. The patient has a history of hypertension managed with
metoprolol. Which augmentation strategy should be used with caution due to
the risk of bradycardia and hypotension?
A. Aripiprazole augmentation
B. Quetiapine augmentation
C. Lithium augmentation
D. Mirtazapine augmentation
CORRECT ANSWER: A. Aripiprazole augmentation
Rationale: Aripiprazole has alpha-1 adrenergic antagonism, which can cause orthostatic
hypotension and, when combined with beta-blockers like metoprolol, may increase the
risk of hypotension and bradycardia. Quetiapine also has alpha-1 antagonism but is less
potent. Lithium augmentation is generally safe but requires careful monitoring of renal
function and serum levels in older adults due to reduced clearance. Mirtazapine may
cause sedation, but its cardiovascular effect profile is generally milder than aripiprazole.
Question 7: A 25-year-old patient with schizophrenia presents with severe
extrapyramidal symptoms, including torticollis and oculogyric crisis, following
a single dose of haloperidol. Which of the following medications is the first-
line treatment for this acute dystonic reaction?
A. Benztropine
B. Diphenhydramine
C. Propranolol
D. Lorazepam
CORRECT ANSWER: B. Diphenhydramine
, Rationale: Acute dystonia is an extrapyramidal side effect caused by dopamine blockade
in the nigrostriatal pathway. Anticholinergic agents are the first-line treatment to correct
the dopamine-acetylcholine imbalance. IV or IM diphenhydramine is preferred for
immediate treatment of severe dystonia due to its rapid onset of action. Benztropine is
also an anticholinergic but is more commonly used for prophylaxis or less severe
symptoms. Propranolol is used for akathisia, and lorazepam is not a specific treatment
for dystonia .
Question 8: A 42-year-old patient with major depressive disorder has been on
fluoxetine 40 mg daily for 6 weeks with only partial response. The PMHNP
decides to augment with olanzapine. Which of the following laboratory tests is
most important to monitor in this patient?
A. Fasting blood glucose and lipid profile
B. Serum sodium
C. Complete blood count
D. Serum creatinine
CORRECT ANSWER: A. Fasting blood glucose and lipid profile
Rationale: Olanzapine is an atypical antipsychotic associated with significant metabolic
side effects, including weight gain, hyperglycemia, and dyslipidemia. This metabolic
syndrome increases the risk of diabetes and cardiovascular disease. Baseline and
periodic monitoring of fasting blood glucose and lipid profile is mandatory when
prescribing olanzapine. Serum sodium is important for SSRIs like fluoxetine due to the
risk of SIADH, but olanzapine's metabolic effects are the primary monitoring concern.
Question 9: A 55-year-old male with a history of alcohol use disorder is being
evaluated for a liver transplant. He has been abstinent for 10 months and is
engaged in treatment. During his psychiatric evaluation, he expresses shame
and guilt about his past behavior and reports feeling "unworthy" of a
transplant. Which of the following best describes the ethical principle that the
PMHNP should prioritize in this case?
A. Beneficence
B. Non-maleficence
C. Autonomy
D. Justice
CORRECT ANSWER: D. Justice
Rationale: Justice in healthcare ethics refers to fairness and equitable distribution of
resources. Transplant candidacy should be based on medical criteria, prognosis, and the
patient's commitment to treatment, not on moral judgment. The PMHNP must advocate
for unbiased evaluation of all patients, ensuring that feelings of guilt or shame do not
bias the assessment. Beneficence, non-maleficence, and autonomy are also important
ethical principles, but justice is most directly relevant to equitable access to
transplantation.
Practice Psychiatric-Mental Health | 190+ Practice
Questions & Verified Answers | Latest Study Guide,
Test Bank, Practice Exam, Comprehensive Review &
Exam Prep | NRNP 6675 PMHNP, Advanced
Psychiatric Nursing, Mental Health Assessment,
Psychiatric Diagnosis, Differential Diagnosis,
Psychopharmacology, Psychotherapy, Therapeutic
Communication, Clinical Management, DSM-5-TR &
Evidence-Based Psychiatric Care
Question 1: A 68-year-old patient with a history of Parkinson's disease has
been on a stable dose of carbidopa-levodopa for three years. He is now
diagnosed with major depressive disorder and requires antidepressant therapy.
Which of the following antidepressants is most appropriate for the PMHNP to
prescribe to minimize adverse effects and drug interactions?
A. Fluoxetine
B. Paroxetine
C. Bupropion
D. Sertraline
CORRECT ANSWER: C. Bupropion
Rationale: Bupropion has minimal serotonergic activity and is less likely to interact with
carbidopa-levodopa, reducing the risk of serotonin syndrome. It can be used safely in
Parkinson's disease and may improve comorbid symptoms like fatigue or apathy. SSRIs
like fluoxetine, paroxetine, and sertraline can worsen motor symptoms or increase the
risk of serotonin syndrome in patients on dopaminergic agents due to complex drug-
drug interactions and enzyme inhibition (e.g., paroxetine is a strong CYP2D6 inhibitor) .
Question 2: A 16-year-old female presents to the PMHNP with her mother. She
reports depressed mood, difficulty concentrating, and a significant decline in
academic performance over the past 3 months. The mother reports that the
patient has been irritable at home, has withdrawn from friends, and has had a
10-pound weight gain. Which of the following is the most appropriate initial
screening tool for this patient?
A. Hamilton Depression Rating Scale (HAM-D)
B. Patient Health Questionnaire-9 (PHQ-9)
C. Beck Depression Inventory-II (BDI-II)
D. Columbia-Suicide Severity Rating Scale (C-SSRS)
CORRECT ANSWER: B. Patient Health Questionnaire-9 (PHQ-9)
Rationale: The PHQ-9 is a widely used, validated screening tool for adolescents and
adults in primary and psychiatric care settings. It is brief, aligns with DSM-5 criteria, and
,can track symptom severity. While the BDI-II and HAM-D are also used for depression,
the PHQ-9 is particularly efficient for initial screening in busy clinical settings. The C-
SSRS is essential for suicide risk assessment but is not a primary screening tool for
depression itself.
Question 3: A 45-year-old male with a history of bipolar I disorder is currently
stable on lithium and quetiapine. He presents with a 3-day history of coarse
tremors, ataxia, confusion, and nausea. His most recent serum lithium level is
2.1 mEq/L. He reports starting a new medication for hypertension prescribed
by his primary care provider. Which of the following medications is most likely
responsible for the increased lithium level?
A. Lisinopril
B. Losartan
C. Hydrochlorothiazide
D. Amlodipine
CORRECT ANSWER: C. Hydrochlorothiazide
Rationale: Thiazide diuretics, such as hydrochlorothiazide, reduce renal clearance of
lithium, leading to increased serum lithium levels and potential toxicity. This interaction
is a critical concern for PMHNPs prescribing for patients on maintenance lithium
therapy. ACE inhibitors (lisinopril) and ARBs (losartan) may also cause lithium
accumulation but are less likely to be the culprit compared to thiazides. Amlodipine, a
calcium channel blocker, does not have a significant interaction with lithium .
Question 4: According to the American Nurses Credentialing Center (ANCC)
PMHNP certification examination content outline, which domain accounts for
the highest percentage of exam items?
A. Assess
B. Diagnose
C. Plan
D. Evaluate
CORRECT ANSWER: A. Assess
Rationale: The ANCC PMHNP exam blueprint allocates the largest proportion of items
to the "Assess" domain, covering psychiatric and physical assessment, screening, and
diagnostic procedures. Approximately 33% of the exam focuses on this foundational
competency, underscoring its importance in PMHNP practice .
Question 5: A 30-year-old patient with borderline personality disorder
frequently threatens self-harm during therapy sessions, particularly when the
PMHNP sets boundaries. The patient states, "You wouldn't have to worry
about me if you really cared." Which therapeutic approach is most appropriate
for the PMHNP to use initially?
,A. Validate the underlying distress while maintaining treatment boundaries.
B. Hospitalize the patient emergently for each threat of self-harm.
C. Increase the frequency of therapy sessions to reduce the patient's anxiety.
D. Interpret the behavior as a primitive defense mechanism and confront it directly.
CORRECT ANSWER: A. Validate the underlying distress while maintaining
treatment boundaries.
Rationale: Patients with borderline personality disorder often use threats of self-harm to
manage fears of abandonment or rejection. Dialectical behavior therapy (DBT)
principles emphasize validating the patient's emotional experience while maintaining
clear boundaries and not reinforcing maladaptive behaviors. This approach balances
empathy with structure, preventing escalation. Hospitalization may be needed if there is
imminent risk, but it should not be used punitively for every threat. Direct confrontation
can damage the therapeutic alliance. Increasing session frequency in response to threats
reinforces the behavior.
Question 6: A PMHNP is evaluating a 75-year-old patient with treatment-
resistant depression. The patient has a history of hypertension managed with
metoprolol. Which augmentation strategy should be used with caution due to
the risk of bradycardia and hypotension?
A. Aripiprazole augmentation
B. Quetiapine augmentation
C. Lithium augmentation
D. Mirtazapine augmentation
CORRECT ANSWER: A. Aripiprazole augmentation
Rationale: Aripiprazole has alpha-1 adrenergic antagonism, which can cause orthostatic
hypotension and, when combined with beta-blockers like metoprolol, may increase the
risk of hypotension and bradycardia. Quetiapine also has alpha-1 antagonism but is less
potent. Lithium augmentation is generally safe but requires careful monitoring of renal
function and serum levels in older adults due to reduced clearance. Mirtazapine may
cause sedation, but its cardiovascular effect profile is generally milder than aripiprazole.
Question 7: A 25-year-old patient with schizophrenia presents with severe
extrapyramidal symptoms, including torticollis and oculogyric crisis, following
a single dose of haloperidol. Which of the following medications is the first-
line treatment for this acute dystonic reaction?
A. Benztropine
B. Diphenhydramine
C. Propranolol
D. Lorazepam
CORRECT ANSWER: B. Diphenhydramine
, Rationale: Acute dystonia is an extrapyramidal side effect caused by dopamine blockade
in the nigrostriatal pathway. Anticholinergic agents are the first-line treatment to correct
the dopamine-acetylcholine imbalance. IV or IM diphenhydramine is preferred for
immediate treatment of severe dystonia due to its rapid onset of action. Benztropine is
also an anticholinergic but is more commonly used for prophylaxis or less severe
symptoms. Propranolol is used for akathisia, and lorazepam is not a specific treatment
for dystonia .
Question 8: A 42-year-old patient with major depressive disorder has been on
fluoxetine 40 mg daily for 6 weeks with only partial response. The PMHNP
decides to augment with olanzapine. Which of the following laboratory tests is
most important to monitor in this patient?
A. Fasting blood glucose and lipid profile
B. Serum sodium
C. Complete blood count
D. Serum creatinine
CORRECT ANSWER: A. Fasting blood glucose and lipid profile
Rationale: Olanzapine is an atypical antipsychotic associated with significant metabolic
side effects, including weight gain, hyperglycemia, and dyslipidemia. This metabolic
syndrome increases the risk of diabetes and cardiovascular disease. Baseline and
periodic monitoring of fasting blood glucose and lipid profile is mandatory when
prescribing olanzapine. Serum sodium is important for SSRIs like fluoxetine due to the
risk of SIADH, but olanzapine's metabolic effects are the primary monitoring concern.
Question 9: A 55-year-old male with a history of alcohol use disorder is being
evaluated for a liver transplant. He has been abstinent for 10 months and is
engaged in treatment. During his psychiatric evaluation, he expresses shame
and guilt about his past behavior and reports feeling "unworthy" of a
transplant. Which of the following best describes the ethical principle that the
PMHNP should prioritize in this case?
A. Beneficence
B. Non-maleficence
C. Autonomy
D. Justice
CORRECT ANSWER: D. Justice
Rationale: Justice in healthcare ethics refers to fairness and equitable distribution of
resources. Transplant candidacy should be based on medical criteria, prognosis, and the
patient's commitment to treatment, not on moral judgment. The PMHNP must advocate
for unbiased evaluation of all patients, ensuring that feelings of guilt or shame do not
bias the assessment. Beneficence, non-maleficence, and autonomy are also important
ethical principles, but justice is most directly relevant to equitable access to
transplantation.
