NR 547 MENTAL HEALTH
MIDTERM EXAM 2026 PRACTICE
QUESTIONS & ANSWERS WITH
RATIONALES
Q1. A 19-year-old college student is started on fluoxetine for major depressive
disorder. Which of the following is the most critical education point to provide to the
patient and their family during the first few weeks of treatment?
A. Risk of weight gain and metabolic syndrome.
B. Increased risk of suicidal ideation and behavior.
C. Need for regular blood pressure monitoring.
D. Potential for developing tardive dyskinesia.
Correct Answer: B
Rationale: The FDA black box warning for SSRIs highlights an increased risk of suicidal
thinking and behavior in children, adolescents, and young adults (up to age 24) during the
initial phases of treatment or during dosage adjustments. While weight gain is a potential side
effect of some SSRIs, and tardive dyskinesia is associated with antipsychotics or
metoclopramide, the immediate safety concern requiring close monitoring and family
education for a young adult initiating an SSRI is suicidality.
Q2. A patient presents with auditory hallucinations and delusions that have lasted for 6
weeks. During the first 4 weeks, the patient experienced a concurrent manic episode.
However, during the remaining 2 weeks, the psychotic symptoms persisted in the
absence of any mood symptoms. Which diagnosis is most appropriate?
A. Schizophrenia
B. Schizoaffective disorder, bipolar type
C. Bipolar I disorder with psychotic features
, D. Brief psychotic disorder
Correct Answer: B
Rationale: Schizoaffective disorder requires an uninterrupted period of illness during which
there is a major mood episode (major depressive or manic) concurrent with Criterion A of
schizophrenia. Crucially, delusions or hallucinations must also occur for at least 2 weeks in
the absence of a major mood episode during the lifetime duration of the illness. If the patient
had only experienced psychosis during the manic episode, the diagnosis would be Bipolar I
disorder with psychotic features. Schizophrenia requires at least 6 months of continuous
signs of the disturbance.
Q3. A patient with bipolar disorder stabilized on lithium presents to the clinic reporting
nausea, vomiting, severe diarrhea, and a coarse hand tremor. The patient's serum
lithium level is 1.9 mEq/L. What is the most appropriate next step in management?
A. Continue lithium and order a stat basic metabolic panel.
B. Advise the patient to increase fluid intake and reduce dietary sodium.
C. Hold the lithium dose and send the patient to the emergency department.
D. Decrease the lithium dose by 50% and recheck the level in one week.
Correct Answer: C
Rationale: A lithium level of 1.9 mEq/L indicates severe lithium toxicity (the standard
therapeutic maintenance range is typically 0.6–1.2 mEq/L, and toxicity is generally defined as
levels \>1.5 mEq/L). Symptoms like severe gastrointestinal distress, ataxia, and coarse
tremors are medical emergencies. Lithium must be held immediately, and the patient needs
evaluation in the emergency department for aggressive IV fluid resuscitation or potential
hemodialysis. Reducing the dose or increasing fluids in the outpatient setting is unsafe for a
patient exhibiting moderate-to-severe toxicity. 2/2 4-100 Thinking completed I can certainly
provide more original, high-yield practice questions to help you study for your psychiatric-
mental health nursing coursework. Please note that generating 97 questions in a single
response exceeds practical length limits. Below is Batch 1 (Questions 4–10) covering core
domains such as trauma, psychopharmacology, therapeutic communication, substance use,
personality disorders, child psychiatry, and legal/ethical standards. If you would like to
continue, simply reply with "Next batch" or specify a topic you want to focus on (e.g., "more
psychopharmacology" or "child and adolescent psychiatry").
,Q4. A patient diagnosed with Post-Traumatic Stress Disorder (PTSD) asks the
psychiatric-mental health nurse practitioner about the most effective non-
pharmacological treatment. Which of the following therapies has the strongest
evidence base as a first-line treatment for PTSD?
A. Psychodynamic psychotherapy
B. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) or Eye Movement
Desensitization and Reprocessing (EMDR)
C. Supportive group therapy
D. Dialectical Behavior Therapy (DBT)
Correct Answer: B
Rationale: Trauma-focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement
Desensitization and Reprocessing (EMDR) are widely recognized by clinical practice
guidelines (e.g., APA, VA/DoD) as first-line, evidence-based psychotherapies for PTSD.
While DBT is excellent for emotion dysregulation (often seen in borderline personality
disorder) and supportive therapy is helpful, TF-CBT and EMDR directly target the processing
of traumatic memories.
Q5. A patient with schizophrenia is admitted to the medical floor exhibiting a
temperature of 103.5°F (39.7°
C. , severe "lead-pipe" muscle rigidity, diaphoresis, tachycardia, and altered mental status.
The patient recently had their dose of haloperidol increased. What is the most likely
diagnosis and the immediate nursing action?
A. Acute dystonia; administer intramuscular benztropine.
B. Serotonin syndrome; discontinue serotonergic agents and administer cyproheptadine.
C. Neuroleptic Malignant Syndrome (NMS); hold the antipsychotic immediately and notify
the provider for medical emergency management. D) Tardive dyskinesia; schedule the
patient for a clozapine trial.
Correct Answer: C
Rationale: The classic tetrad of Neuroleptic Malignant Syndrome (NMS) includes fever,
severe muscle rigidity ("lead-pipe"), autonomic instability (tachycardia, diaphoresis, labile
BP), and altered mental status. It is a life-threatening emergency associated with dopamine
antagonists (like haloperidol). The immediate action is to hold the offending agent, provide
, supportive care (IV fluids, cooling), and notify the provider. Acute dystonia presents with
muscle spasms (e.g., torticollis) but not typically high fever or severe autonomic instability.
Q6. A patient in the psychiatric unit is pacing, clenching their fists, and yelling, "You're
all trying to control me!" Which of the following is the most therapeutic initial response
by the nurse?
A. "If you do not lower your voice, I will have to call security and restrain you."
B. "I can see that you are very upset. I am here to help you. Let's sit down and talk about
what is bothering you."
C. "You need to calm down right now so we can figure this out."
D. "Why do you feel like we are trying to control you?"
Correct Answer: B
Rationale: In de-escalation, the priority is to ensure safety while using a calm, non-
threatening, and validating approach. Acknowledging the patient's emotion ("I can see you
are upset") and offering collaborative support builds rapport and can reduce agitation. Option
A is an ultimatum that may escalate aggression. Option C is commanding and dismissive.
Option D asks a "why" question, which can make an agitated patient feel defensive or
interrogated.
Q7. A patient is admitted for alcohol use disorder. Their last drink was approximately
12 hours ago. The nurse assesses the patient using the CIWA-Ar scale and notes
moderate tremors, nausea, sweating, and anxiety. Which medication class is the gold
standard for managing this patient's withdrawal symptoms and preventing
progression to delirium tremens?
A. Anticonvulsants (e.g., carbamazepine)
B. Benzodiazepines (e.g., lorazepam, chlordiazepoxide)
C. Alpha-2 agonists (e.g., clonidine)
D. Antipsychotics (e.g., haloperidol)
Correct Answer: B
Rationale: Benzodiazepines are the gold standard and first-line treatment for alcohol
withdrawal. They act on GABA receptors, which are downregulated in chronic alcohol use,
thereby reducing withdrawal symptoms, preventing seizures, and preventing progression to
MIDTERM EXAM 2026 PRACTICE
QUESTIONS & ANSWERS WITH
RATIONALES
Q1. A 19-year-old college student is started on fluoxetine for major depressive
disorder. Which of the following is the most critical education point to provide to the
patient and their family during the first few weeks of treatment?
A. Risk of weight gain and metabolic syndrome.
B. Increased risk of suicidal ideation and behavior.
C. Need for regular blood pressure monitoring.
D. Potential for developing tardive dyskinesia.
Correct Answer: B
Rationale: The FDA black box warning for SSRIs highlights an increased risk of suicidal
thinking and behavior in children, adolescents, and young adults (up to age 24) during the
initial phases of treatment or during dosage adjustments. While weight gain is a potential side
effect of some SSRIs, and tardive dyskinesia is associated with antipsychotics or
metoclopramide, the immediate safety concern requiring close monitoring and family
education for a young adult initiating an SSRI is suicidality.
Q2. A patient presents with auditory hallucinations and delusions that have lasted for 6
weeks. During the first 4 weeks, the patient experienced a concurrent manic episode.
However, during the remaining 2 weeks, the psychotic symptoms persisted in the
absence of any mood symptoms. Which diagnosis is most appropriate?
A. Schizophrenia
B. Schizoaffective disorder, bipolar type
C. Bipolar I disorder with psychotic features
, D. Brief psychotic disorder
Correct Answer: B
Rationale: Schizoaffective disorder requires an uninterrupted period of illness during which
there is a major mood episode (major depressive or manic) concurrent with Criterion A of
schizophrenia. Crucially, delusions or hallucinations must also occur for at least 2 weeks in
the absence of a major mood episode during the lifetime duration of the illness. If the patient
had only experienced psychosis during the manic episode, the diagnosis would be Bipolar I
disorder with psychotic features. Schizophrenia requires at least 6 months of continuous
signs of the disturbance.
Q3. A patient with bipolar disorder stabilized on lithium presents to the clinic reporting
nausea, vomiting, severe diarrhea, and a coarse hand tremor. The patient's serum
lithium level is 1.9 mEq/L. What is the most appropriate next step in management?
A. Continue lithium and order a stat basic metabolic panel.
B. Advise the patient to increase fluid intake and reduce dietary sodium.
C. Hold the lithium dose and send the patient to the emergency department.
D. Decrease the lithium dose by 50% and recheck the level in one week.
Correct Answer: C
Rationale: A lithium level of 1.9 mEq/L indicates severe lithium toxicity (the standard
therapeutic maintenance range is typically 0.6–1.2 mEq/L, and toxicity is generally defined as
levels \>1.5 mEq/L). Symptoms like severe gastrointestinal distress, ataxia, and coarse
tremors are medical emergencies. Lithium must be held immediately, and the patient needs
evaluation in the emergency department for aggressive IV fluid resuscitation or potential
hemodialysis. Reducing the dose or increasing fluids in the outpatient setting is unsafe for a
patient exhibiting moderate-to-severe toxicity. 2/2 4-100 Thinking completed I can certainly
provide more original, high-yield practice questions to help you study for your psychiatric-
mental health nursing coursework. Please note that generating 97 questions in a single
response exceeds practical length limits. Below is Batch 1 (Questions 4–10) covering core
domains such as trauma, psychopharmacology, therapeutic communication, substance use,
personality disorders, child psychiatry, and legal/ethical standards. If you would like to
continue, simply reply with "Next batch" or specify a topic you want to focus on (e.g., "more
psychopharmacology" or "child and adolescent psychiatry").
,Q4. A patient diagnosed with Post-Traumatic Stress Disorder (PTSD) asks the
psychiatric-mental health nurse practitioner about the most effective non-
pharmacological treatment. Which of the following therapies has the strongest
evidence base as a first-line treatment for PTSD?
A. Psychodynamic psychotherapy
B. Trauma-focused Cognitive Behavioral Therapy (TF-CBT) or Eye Movement
Desensitization and Reprocessing (EMDR)
C. Supportive group therapy
D. Dialectical Behavior Therapy (DBT)
Correct Answer: B
Rationale: Trauma-focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement
Desensitization and Reprocessing (EMDR) are widely recognized by clinical practice
guidelines (e.g., APA, VA/DoD) as first-line, evidence-based psychotherapies for PTSD.
While DBT is excellent for emotion dysregulation (often seen in borderline personality
disorder) and supportive therapy is helpful, TF-CBT and EMDR directly target the processing
of traumatic memories.
Q5. A patient with schizophrenia is admitted to the medical floor exhibiting a
temperature of 103.5°F (39.7°
C. , severe "lead-pipe" muscle rigidity, diaphoresis, tachycardia, and altered mental status.
The patient recently had their dose of haloperidol increased. What is the most likely
diagnosis and the immediate nursing action?
A. Acute dystonia; administer intramuscular benztropine.
B. Serotonin syndrome; discontinue serotonergic agents and administer cyproheptadine.
C. Neuroleptic Malignant Syndrome (NMS); hold the antipsychotic immediately and notify
the provider for medical emergency management. D) Tardive dyskinesia; schedule the
patient for a clozapine trial.
Correct Answer: C
Rationale: The classic tetrad of Neuroleptic Malignant Syndrome (NMS) includes fever,
severe muscle rigidity ("lead-pipe"), autonomic instability (tachycardia, diaphoresis, labile
BP), and altered mental status. It is a life-threatening emergency associated with dopamine
antagonists (like haloperidol). The immediate action is to hold the offending agent, provide
, supportive care (IV fluids, cooling), and notify the provider. Acute dystonia presents with
muscle spasms (e.g., torticollis) but not typically high fever or severe autonomic instability.
Q6. A patient in the psychiatric unit is pacing, clenching their fists, and yelling, "You're
all trying to control me!" Which of the following is the most therapeutic initial response
by the nurse?
A. "If you do not lower your voice, I will have to call security and restrain you."
B. "I can see that you are very upset. I am here to help you. Let's sit down and talk about
what is bothering you."
C. "You need to calm down right now so we can figure this out."
D. "Why do you feel like we are trying to control you?"
Correct Answer: B
Rationale: In de-escalation, the priority is to ensure safety while using a calm, non-
threatening, and validating approach. Acknowledging the patient's emotion ("I can see you
are upset") and offering collaborative support builds rapport and can reduce agitation. Option
A is an ultimatum that may escalate aggression. Option C is commanding and dismissive.
Option D asks a "why" question, which can make an agitated patient feel defensive or
interrogated.
Q7. A patient is admitted for alcohol use disorder. Their last drink was approximately
12 hours ago. The nurse assesses the patient using the CIWA-Ar scale and notes
moderate tremors, nausea, sweating, and anxiety. Which medication class is the gold
standard for managing this patient's withdrawal symptoms and preventing
progression to delirium tremens?
A. Anticonvulsants (e.g., carbamazepine)
B. Benzodiazepines (e.g., lorazepam, chlordiazepoxide)
C. Alpha-2 agonists (e.g., clonidine)
D. Antipsychotics (e.g., haloperidol)
Correct Answer: B
Rationale: Benzodiazepines are the gold standard and first-line treatment for alcohol
withdrawal. They act on GABA receptors, which are downregulated in chronic alcohol use,
thereby reducing withdrawal symptoms, preventing seizures, and preventing progression to
