NR 668 CEA
FINAL EXAM
Practicum Capstone Intensive
Chamberlain University
150 Exam-Style Practice Questions
Psychiatric Mental Health Nurse Practitioner (PMHNP)
With Highlighted Answers & Detailed Rationales
✔ Correct answers are highlighted in green
📖 Rationales are highlighted in yellow
,1. A client with generalized anxiety disorder is asked to create coping cards as part of her C
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BT homework. What is the primary purpose of using coping cards in CBT?
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a. To record daily fluctuations in thoughts and corresponding moods
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b. To identify anxiety-provoking situations
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c. To provide immediate cognitive restructuring strategies
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d. To document automatic thoughts
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✔ Answer: c. To provide immediate cognitive restructuring strategies
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📖 Rationale: Coping cards are written cards used in CBT that contain helpful adaptive thoughts and co
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
ping strategies the client can refer to during moments of distress. Their primary purpose is to provide im
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mediate cognitive restructuring support—
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counteracting maladaptive automatic thoughts in real time when the therapist is not present.
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2. In a Gestalt therapy session, a therapist asks a patient to engage in a dialogue with an em
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pty chair, imagining that a significant person from their life is sitting in it. What is the primar
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y purpose of this technique?
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a. To explore and resolve unfinished business
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b. To develop a behavioral plan
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c. To identify cognitive distortions
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d. To analyze unconscious thoughts
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✔ Answer: a. To explore and resolve unfinished business
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📖 Rationale: The empty chair technique is a hallmark Gestalt therapy intervention. It is used to help cli
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
ents address unresolved emotions, conflicts, and 'unfinished business' with significant people in their lives
wn wn wn wn wn wn wn wn wn wn wn wn wn
(living or deceased). By externalizing the other person, the client can express unexpressed feelings and
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work toward psychological completion.
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3. The PMHNP has prescribed a patient naltrexone and bupropion for binge eating disorder. T
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he patient has lost 4 lbs. since her last visit. She states she finds it very difficult to not binge
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
eat when her emotions are intense, and expresses doubt in her ability to make a lasting cha
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nge. Which of the following is the best response?
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a. "I can increase your dose of medication or augment you with another agent."
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b. "Let's talk about what strategies you have tried so far."
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c. "You should consider an inpatient eating disorder program."
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d. "Give me an example of something in your life that you are most proud of achieving."
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✔ Answer: d. "Give me an example of something in your life that you are most proud of achi
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eving."
📖 Rationale: This motivational interviewing (MI) technique—eliciting past successes—
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is designed to build self-
wn wn wn wn
efficacy and counter the patient's expressed doubt in her ability to change. By asking about a personal ac
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
hievement, the PMHNP helps the patient access her own internal strengths and confidence, which is mor
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
e therapeutic than immediately adjusting medication or suggesting a higher level of care.
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4. The PMHNP is caring for a 20-year-
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old man with bipolar I disorder. The patient indicates that he does not have a problem becau
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Page 2 of 54 wn wn wn
,se he can accomplish so much during his manic episodes. Which stage of change is the pati
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ent in? wn
a. Action wn
b. Precontemplation
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c. Contemplation
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d. Preparation
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e. Maintenance
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✔ Answer: b. Precontemplation
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📖 Rationale: In Prochaska and DiClemente's Transtheoretical Model, the precontemplation stage is cha
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racterized by the individual not yet recognizing that a problem exists or not intending to change behavior i
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n the foreseeable future. This patient clearly does not see his manic episodes as problematic—
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he views them as beneficial, indicating he is not yet contemplating the need for change.
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5. A 55-year-
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old woman reports to the PMHNP that since she accepted early retirement last year she finds
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that her memory has gotten worse and she has trouble sleeping at night. She denies any m
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edical problems. What should the PMHNP do first?
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a. Prescribe mirtazapine 15mg PO at bedtime to help her sleep
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b. Refer her to her primary care provider for a physical exam
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c. Encourage her to volunteer with something she feels passionate about
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d. Perform a Mini-Mental State Exam and Confusion Assessment Methods Instrument
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✔ Answer: d. Perform a Mini-
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Mental State Exam and Confusion Assessment Methods Instrument
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📖 Rationale: Before making any clinical decisions, the PMHNP must first assess the extent of the cogni
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
tive complaint with validated screening tools. The MMSE quantifies cognitive function, and the Confusion
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Assessment Method (CAM) screens for delirium. This assessment guides differential diagnosis (depressio
wn wn wn wn wn wn wn wn wn wn wn
n, early dementia, sleep disorder, thyroid disease) and informs next steps, including whether referral or p
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harmacotherapy is appropriate. wn wn
6. A 70-year-
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old retired male with a history of hypertension is referred from his primary care physician du
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e to increasing difficulty copying geometric figures, which makes him feel self-
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conscious and anxious. In which portion of the mental status exam would the PMHNP expect
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to find a deficit?
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a. Orientation to person, time, and place
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b. Delayed recall wn wn
c. Abstract thinking wn wn
d. Intersecting pentagon
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✔ Answer: d. Intersecting pentagon
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📖 Rationale: Copying intersecting pentagons is the visuospatial/constructional task on the MMSE that a
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ssesses visuoconstructive ability and parietal lobe function. Difficulty copying geometric figures (constructi
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onal apraxia) is a deficit in visuospatial skill. This is distinct from orientation, recall, or abstract thinking. It
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is one of the earliest signs of parietal lobe dysfunction seen in Alzheimer's disease and other dementias.
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Page 3 of 54 wn wn wn
, 7. Pam is a 22-year-old female who lives alone and has Bipolar disorder (F31.2 -
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Manic, Severe with psychotic features). Pam stopped taking her Quetiapine and Lithium. Her
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delusions are worsening and she has been awake for 36 hours. Does the PMHNP have the ri
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ght to share this information with Pam's mother who lives in a neighboring state?
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a. Yes, Pam does not currently have the capacity to make decisions given her chief complaint, pr
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esentation, and history of a serious mental illness. wn wn wn wn wn wn wn
b. Yes, because the health care provider can always reach out to family as long as the informati
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on is limited to what is needed.
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c. No, because Pam is an adult and HIPAA protects private mental health information.
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d. No, because Pam has not signed a medical release form and is actively participating in her ca
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re as evidenced by showing up to the visit.
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✔ Answer: a. Yes, Pam does not currently have the capacity to make decisions given her chi
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ef complaint, presentation, and history of a serious mental illness.
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📖 Rationale: Under HIPAA, when a provider believes that a patient lacks the capacity to agree or objec
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t to sharing information, and that sharing would be in the patient's best interest, the provider may share p
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ertinent information with a family member who can assist with immediate care concerns. Pam's active psy
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chosis, medication non-adherence, and 36 hours of sleeplessness impair her decision-
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making capacity, justifying disclosure to her mother to support immediate safety needs.
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8. A PMHNP is conducting an initial psychiatric evaluation. Which of the following best descri
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bes the purpose of the mental status exam (MSE)?
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a. To establish a DSM-5 diagnosis
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b. To provide a systematic cross-
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sectional snapshot of a patient's current psychological functioning
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c. To assess for medical causes of psychiatric symptoms
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d. To evaluate the patient's past psychiatric history
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✔ Answer: b. To provide a systematic cross-
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sectional snapshot of a patient's current psychological functioning
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📖 Rationale: The Mental Status Exam is a structured assessment of a patient's appearance, behavior,
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speech, mood, affect, thought process, thought content, perceptions, cognition, insight, and judgment at a
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specific point in time. It is a cross-
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sectional (current) observation tool, not a historical record. It guides diagnosis, treatment planning, and m
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onitoring of psychiatric symptoms over time.
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9. Which of the following correctly pairs a CBT technique with its primary target?
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a. Thought records — behavioral activation
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b. Exposure and response prevention (ERP) — avoidance in OCD
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c. Behavioral activation — cognitive distortions
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d. Socratic questioning — physical relaxation
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✔ Answer: b. Exposure and response prevention (ERP) — avoidance in OCD
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📖 Rationale: Exposure and response prevention (ERP) is the gold-
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standard CBT technique for OCD. It involves systematically exposing the patient to feared stimuli (exposu
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re) while preventing the compulsive response (response prevention). This breaks the negative reinforcem
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ent cycle of obsessions and compulsions. Thought records target cognitive distortions, and behavioral acti
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vation targets depression-related withdrawal.
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Page 4 of 54 wn wn wn
FINAL EXAM
Practicum Capstone Intensive
Chamberlain University
150 Exam-Style Practice Questions
Psychiatric Mental Health Nurse Practitioner (PMHNP)
With Highlighted Answers & Detailed Rationales
✔ Correct answers are highlighted in green
📖 Rationales are highlighted in yellow
,1. A client with generalized anxiety disorder is asked to create coping cards as part of her C
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
BT homework. What is the primary purpose of using coping cards in CBT?
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a. To record daily fluctuations in thoughts and corresponding moods
wn wn wn wn wn wn wn wn wn
b. To identify anxiety-provoking situations
wn wn wn wn
c. To provide immediate cognitive restructuring strategies
wn wn wn wn wn wn
d. To document automatic thoughts
wn wn wn wn
✔ Answer: c. To provide immediate cognitive restructuring strategies
wn wn wn wn wn wn wn wn
📖 Rationale: Coping cards are written cards used in CBT that contain helpful adaptive thoughts and co
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
ping strategies the client can refer to during moments of distress. Their primary purpose is to provide im
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
mediate cognitive restructuring support—
wn wn wn
counteracting maladaptive automatic thoughts in real time when the therapist is not present.
wn wn wn wn wn wn wn wn wn wn wn wn
2. In a Gestalt therapy session, a therapist asks a patient to engage in a dialogue with an em
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
pty chair, imagining that a significant person from their life is sitting in it. What is the primar
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
y purpose of this technique?
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a. To explore and resolve unfinished business
wn wn wn wn wn wn
b. To develop a behavioral plan
wn wn wn wn wn
c. To identify cognitive distortions
wn wn wn wn
d. To analyze unconscious thoughts
wn wn wn wn
✔ Answer: a. To explore and resolve unfinished business
wn wn wn wn wn wn wn wn
📖 Rationale: The empty chair technique is a hallmark Gestalt therapy intervention. It is used to help cli
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
ents address unresolved emotions, conflicts, and 'unfinished business' with significant people in their lives
wn wn wn wn wn wn wn wn wn wn wn wn wn
(living or deceased). By externalizing the other person, the client can express unexpressed feelings and
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
work toward psychological completion.
wn wn wn
3. The PMHNP has prescribed a patient naltrexone and bupropion for binge eating disorder. T
wn wn wn wn wn wn wn wn wn wn wn wn wn wn
he patient has lost 4 lbs. since her last visit. She states she finds it very difficult to not binge
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
eat when her emotions are intense, and expresses doubt in her ability to make a lasting cha
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
nge. Which of the following is the best response?
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a. "I can increase your dose of medication or augment you with another agent."
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b. "Let's talk about what strategies you have tried so far."
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c. "You should consider an inpatient eating disorder program."
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d. "Give me an example of something in your life that you are most proud of achieving."
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
✔ Answer: d. "Give me an example of something in your life that you are most proud of achi
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
eving."
📖 Rationale: This motivational interviewing (MI) technique—eliciting past successes—
wn wn wn wn wn wn wn wn
is designed to build self-
wn wn wn wn
efficacy and counter the patient's expressed doubt in her ability to change. By asking about a personal ac
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
hievement, the PMHNP helps the patient access her own internal strengths and confidence, which is mor
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
e therapeutic than immediately adjusting medication or suggesting a higher level of care.
wn wn wn wn wn wn wn wn wn wn wn wn
4. The PMHNP is caring for a 20-year-
wn wn wn wn wn wn wn
old man with bipolar I disorder. The patient indicates that he does not have a problem becau
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
Page 2 of 54 wn wn wn
,se he can accomplish so much during his manic episodes. Which stage of change is the pati
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
ent in? wn
a. Action wn
b. Precontemplation
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c. Contemplation
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d. Preparation
wn
e. Maintenance
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✔ Answer: b. Precontemplation
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📖 Rationale: In Prochaska and DiClemente's Transtheoretical Model, the precontemplation stage is cha
wn wn wn wn wn wn wn wn wn wn wn wn
racterized by the individual not yet recognizing that a problem exists or not intending to change behavior i
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
n the foreseeable future. This patient clearly does not see his manic episodes as problematic—
wn wn wn wn wn wn wn wn wn wn wn wn wn wn
he views them as beneficial, indicating he is not yet contemplating the need for change.
wn wn wn wn wn wn wn wn wn wn wn wn wn wn
5. A 55-year-
wn wn
old woman reports to the PMHNP that since she accepted early retirement last year she finds
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
that her memory has gotten worse and she has trouble sleeping at night. She denies any m
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
edical problems. What should the PMHNP do first?
wn wn wn wn wn wn wn
a. Prescribe mirtazapine 15mg PO at bedtime to help her sleep
wn wn wn wn wn wn wn wn wn wn
b. Refer her to her primary care provider for a physical exam
wn wn wn wn wn wn wn wn wn wn wn
c. Encourage her to volunteer with something she feels passionate about
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d. Perform a Mini-Mental State Exam and Confusion Assessment Methods Instrument
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✔ Answer: d. Perform a Mini-
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Mental State Exam and Confusion Assessment Methods Instrument
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📖 Rationale: Before making any clinical decisions, the PMHNP must first assess the extent of the cogni
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
tive complaint with validated screening tools. The MMSE quantifies cognitive function, and the Confusion
wn wn wn wn wn wn wn wn wn wn wn wn wn wn
Assessment Method (CAM) screens for delirium. This assessment guides differential diagnosis (depressio
wn wn wn wn wn wn wn wn wn wn wn
n, early dementia, sleep disorder, thyroid disease) and informs next steps, including whether referral or p
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
harmacotherapy is appropriate. wn wn
6. A 70-year-
wn wn
old retired male with a history of hypertension is referred from his primary care physician du
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
e to increasing difficulty copying geometric figures, which makes him feel self-
wn wn wn wn wn wn wn wn wn wn wn
conscious and anxious. In which portion of the mental status exam would the PMHNP expect
wn wn wn wn wn wn wn wn wn wn wn wn wn wn w
to find a deficit?
n wn wn wn
a. Orientation to person, time, and place
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b. Delayed recall wn wn
c. Abstract thinking wn wn
d. Intersecting pentagon
wn wn
✔ Answer: d. Intersecting pentagon
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📖 Rationale: Copying intersecting pentagons is the visuospatial/constructional task on the MMSE that a
wn wn wn wn wn wn wn wn wn wn wn wn wn
ssesses visuoconstructive ability and parietal lobe function. Difficulty copying geometric figures (constructi
wn wn wn wn wn wn wn wn wn wn wn
onal apraxia) is a deficit in visuospatial skill. This is distinct from orientation, recall, or abstract thinking. It
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
is one of the earliest signs of parietal lobe dysfunction seen in Alzheimer's disease and other dementias.
wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
Page 3 of 54 wn wn wn
, 7. Pam is a 22-year-old female who lives alone and has Bipolar disorder (F31.2 -
wn wn wn wn wn wn wn wn wn wn wn wn wn wn
Manic, Severe with psychotic features). Pam stopped taking her Quetiapine and Lithium. Her
wn wn wn wn wn wn wn wn wn wn wn wn wn w
delusions are worsening and she has been awake for 36 hours. Does the PMHNP have the ri
n wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn wn
ght to share this information with Pam's mother who lives in a neighboring state?
wn wn wn wn wn wn wn wn wn wn wn wn wn
a. Yes, Pam does not currently have the capacity to make decisions given her chief complaint, pr
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esentation, and history of a serious mental illness. wn wn wn wn wn wn wn
b. Yes, because the health care provider can always reach out to family as long as the informati
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on is limited to what is needed.
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c. No, because Pam is an adult and HIPAA protects private mental health information.
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d. No, because Pam has not signed a medical release form and is actively participating in her ca
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re as evidenced by showing up to the visit.
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✔ Answer: a. Yes, Pam does not currently have the capacity to make decisions given her chi
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ef complaint, presentation, and history of a serious mental illness.
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📖 Rationale: Under HIPAA, when a provider believes that a patient lacks the capacity to agree or objec
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t to sharing information, and that sharing would be in the patient's best interest, the provider may share p
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ertinent information with a family member who can assist with immediate care concerns. Pam's active psy
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chosis, medication non-adherence, and 36 hours of sleeplessness impair her decision-
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making capacity, justifying disclosure to her mother to support immediate safety needs.
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8. A PMHNP is conducting an initial psychiatric evaluation. Which of the following best descri
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bes the purpose of the mental status exam (MSE)?
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a. To establish a DSM-5 diagnosis
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b. To provide a systematic cross-
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sectional snapshot of a patient's current psychological functioning
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c. To assess for medical causes of psychiatric symptoms
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d. To evaluate the patient's past psychiatric history
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✔ Answer: b. To provide a systematic cross-
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sectional snapshot of a patient's current psychological functioning
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📖 Rationale: The Mental Status Exam is a structured assessment of a patient's appearance, behavior,
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speech, mood, affect, thought process, thought content, perceptions, cognition, insight, and judgment at a
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specific point in time. It is a cross-
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sectional (current) observation tool, not a historical record. It guides diagnosis, treatment planning, and m
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onitoring of psychiatric symptoms over time.
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9. Which of the following correctly pairs a CBT technique with its primary target?
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a. Thought records — behavioral activation
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b. Exposure and response prevention (ERP) — avoidance in OCD
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c. Behavioral activation — cognitive distortions
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d. Socratic questioning — physical relaxation
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✔ Answer: b. Exposure and response prevention (ERP) — avoidance in OCD
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📖 Rationale: Exposure and response prevention (ERP) is the gold-
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standard CBT technique for OCD. It involves systematically exposing the patient to feared stimuli (exposu
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re) while preventing the compulsive response (response prevention). This breaks the negative reinforcem
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ent cycle of obsessions and compulsions. Thought records target cognitive distortions, and behavioral acti
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vation targets depression-related withdrawal.
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