NR 668 PSYCHIATRIC-MENTAL HEALTH CAPSTONE
PRACTICUM & INTENSIVE CEA FINAL EXAM | PRACTICE
EXAM | ACTUAL STUDY GUIDE | TESTBANK | LATEST
UPDATE 2026/2027 | ADVANCED PRACTICE QUESTIONS
| 100% CORRECT ANSWERS | INSTANT PDF DOWNLOAD
TABLE OF CONTENTS
i. Advanced Psychiatric Assessment & Clinical Reasoning
ii. Psychiatric Diagnosis & Differential Diagnosis
iii. Psychopharmacology & Medication Management
iv. Psychotherapy & Evidence-Based Interventions
v. Safety, Suicide Risk & Crisis Management
vi. APRN Scope of Practice, Leadership & Professionalism
vii. Ethics, Legal Standards & Documentation
viii. Evidence-Based Practice, Quality Improvement & Patient Safety
ix. Cultural, Lifespan & Population-Focused Mental Health Care
x. Integrated Clinical Decision-Making & Complex PMHNP Cases
INTRODUCTION
This comprehensive NR 668 CEA practice examination is designed for advanced nursing
students preparing for the Psychiatric-Mental Health Capstone Practicum and Intensive
final assessment. It emphasizes advanced clinical reasoning, psychiatric assessment,
differential diagnosis, psychopharmacology, psychotherapy, safety management,
professional scope of practice, ethics, leadership, evidence-based practice, and quality
improvement. The questions are intentionally challenging and require application,
interpretation, prioritization, and professional judgment rather than simple
memorization. It contains 100+ questions and answers with rationales to reinforce
higher-level clinical decision-making. Purchase and instantly get a downloadable and
editable PDF for convenient study, review, and exam preparation.
QUESTIONS 1–30
Question 1
A PMHNP evaluates a 42-year-old patient with recurrent depressive episodes,
decreased need for sleep, increased goal-directed activity, impulsive spending, and
periods of unusually elevated mood lasting several days. The patient currently reports
,severe depression and passive suicidal ideation. Which finding is most important for
establishing the appropriate longitudinal diagnostic formulation?
A. The patient's current PHQ-9 score
B. The presence of passive suicidal ideation
C. A documented history of distinct episodes of elevated or expansive mood with
associated functional change
D. The patient's family history of major depressive disorder
Correct Answer: C. A documented history of distinct episodes of elevated or
expansive mood with associated functional change
Rationale: Distinguishing bipolar-spectrum illness from unipolar depression requires
careful longitudinal assessment for discrete manic or hypomanic episodes and associated
changes in functioning. Current depressive severity and suicidality remain clinically
important but do not independently establish the longitudinal diagnosis.
Question 2
A PMHNP is evaluating an older adult who developed new-onset psychotic symptoms
at age 72. The patient has no previous psychiatric history and demonstrates fluctuating
attention, intermittent disorientation, and visual hallucinations. Which action should
receive the highest priority?
A. Initiate an antipsychotic immediately
B. Obtain collateral information and evaluate for an underlying medical or neurologic
cause
C. Diagnose late-onset schizophrenia
D. Begin long-term antipsychotic maintenance therapy
Correct Answer: B. Obtain collateral information and evaluate for an underlying
medical or neurologic cause
Rationale: New-onset psychosis in an older adult, particularly with fluctuating attention
and disorientation, warrants evaluation for delirium, neurologic disease, medication
effects, metabolic abnormalities, or other medical causes before assuming a primary
psychotic disorder.
Question 3
A patient taking lithium for bipolar disorder presents with coarse tremor, vomiting,
diarrhea, ataxia, and increasing confusion. The patient recently began taking a
,medication for hypertension. Which interpretation is most appropriate?
A. The symptoms indicate expected therapeutic effects of lithium
B. The patient is experiencing serotonin syndrome
C. The presentation is concerning for lithium toxicity and requires urgent evaluation
D. The symptoms indicate emerging mania
Correct Answer: C. The presentation is concerning for lithium toxicity and requires
urgent evaluation
Rationale: Gastrointestinal symptoms, worsening tremor, ataxia, and altered mental
status are concerning for lithium toxicity. Several medications, including some
antihypertensive agents and diuretics, can increase lithium concentrations.
Question 4
A patient with major depressive disorder reports substantial improvement after six
weeks of an antidepressant but states, “I feel normal now, so I stopped taking it
yesterday.” Which response by the PMHNP best reflects evidence-based medication
management?
A. “Stopping immediately is appropriate because your symptoms resolved.”
B. “You should restart the medication at twice the previous dose.”
C. “Symptom improvement does not necessarily mean the underlying disorder has
resolved; discontinuation should be planned to reduce relapse and withdrawal risks.”
D. “Antidepressants must always be continued for life.”
Correct Answer: C. “Symptom improvement does not necessarily mean the
underlying disorder has resolved; discontinuation should be planned to reduce
relapse and withdrawal risks.”
Rationale: Maintenance treatment duration depends on factors such as recurrence history,
severity, comorbidity, and relapse risk. Abrupt discontinuation can produce
discontinuation symptoms and may increase the likelihood of relapse.
Question 5
A PMHNP assesses a patient who reports hearing a voice commenting on behavior. The
patient states that the voice is external, occurs when fully awake, and has progressively
become more threatening. Which assessment question is most important initially?
, A. “What is your highest level of education?”
B. “Does the voice tell you to harm yourself or someone else?”
C. “Did your parents experience hallucinations?”
D. “How often do you experience sadness?”
Correct Answer: B. “Does the voice tell you to harm yourself or someone else?”
Rationale: Command hallucinations require immediate assessment of content, intent,
access to means, ability to resist commands, and overall safety. Risk assessment takes
priority when psychotic symptoms may involve harm.
Question 6
A patient with generalized anxiety disorder has received an adequate trial of an SSRI
but continues to experience significant symptoms. The patient asks for a
benzodiazepine to use indefinitely. Which PMHNP response best reflects long-term
risk-benefit considerations?
A. Prescribe the benzodiazepine indefinitely because dependence occurs only at high
doses
B. Explain that benzodiazepines may have a role in selected situations but carry risks
including dependence, cognitive impairment, and withdrawal
C. Recommend combining two benzodiazepines to improve efficacy
D. Discontinue the SSRI immediately because persistent anxiety proves treatment
failure
Correct Answer: B. Explain that benzodiazepines may have a role in selected
situations but carry risks including dependence, cognitive impairment, and
withdrawal
Rationale: Benzodiazepines can provide short-term anxiolysis but require careful risk
assessment. Long-term use may lead to tolerance, dependence, withdrawal, falls, and
cognitive effects, particularly in vulnerable populations.
Question 7
A PMHNP evaluates a patient with severe depression who reports a specific suicide
plan, access to the intended method, escalating hopelessness, and inability to identify
protective factors. Which intervention is most appropriate?
A. Schedule routine follow-up in four weeks
B. Provide a list of outpatient psychotherapy providers
PRACTICUM & INTENSIVE CEA FINAL EXAM | PRACTICE
EXAM | ACTUAL STUDY GUIDE | TESTBANK | LATEST
UPDATE 2026/2027 | ADVANCED PRACTICE QUESTIONS
| 100% CORRECT ANSWERS | INSTANT PDF DOWNLOAD
TABLE OF CONTENTS
i. Advanced Psychiatric Assessment & Clinical Reasoning
ii. Psychiatric Diagnosis & Differential Diagnosis
iii. Psychopharmacology & Medication Management
iv. Psychotherapy & Evidence-Based Interventions
v. Safety, Suicide Risk & Crisis Management
vi. APRN Scope of Practice, Leadership & Professionalism
vii. Ethics, Legal Standards & Documentation
viii. Evidence-Based Practice, Quality Improvement & Patient Safety
ix. Cultural, Lifespan & Population-Focused Mental Health Care
x. Integrated Clinical Decision-Making & Complex PMHNP Cases
INTRODUCTION
This comprehensive NR 668 CEA practice examination is designed for advanced nursing
students preparing for the Psychiatric-Mental Health Capstone Practicum and Intensive
final assessment. It emphasizes advanced clinical reasoning, psychiatric assessment,
differential diagnosis, psychopharmacology, psychotherapy, safety management,
professional scope of practice, ethics, leadership, evidence-based practice, and quality
improvement. The questions are intentionally challenging and require application,
interpretation, prioritization, and professional judgment rather than simple
memorization. It contains 100+ questions and answers with rationales to reinforce
higher-level clinical decision-making. Purchase and instantly get a downloadable and
editable PDF for convenient study, review, and exam preparation.
QUESTIONS 1–30
Question 1
A PMHNP evaluates a 42-year-old patient with recurrent depressive episodes,
decreased need for sleep, increased goal-directed activity, impulsive spending, and
periods of unusually elevated mood lasting several days. The patient currently reports
,severe depression and passive suicidal ideation. Which finding is most important for
establishing the appropriate longitudinal diagnostic formulation?
A. The patient's current PHQ-9 score
B. The presence of passive suicidal ideation
C. A documented history of distinct episodes of elevated or expansive mood with
associated functional change
D. The patient's family history of major depressive disorder
Correct Answer: C. A documented history of distinct episodes of elevated or
expansive mood with associated functional change
Rationale: Distinguishing bipolar-spectrum illness from unipolar depression requires
careful longitudinal assessment for discrete manic or hypomanic episodes and associated
changes in functioning. Current depressive severity and suicidality remain clinically
important but do not independently establish the longitudinal diagnosis.
Question 2
A PMHNP is evaluating an older adult who developed new-onset psychotic symptoms
at age 72. The patient has no previous psychiatric history and demonstrates fluctuating
attention, intermittent disorientation, and visual hallucinations. Which action should
receive the highest priority?
A. Initiate an antipsychotic immediately
B. Obtain collateral information and evaluate for an underlying medical or neurologic
cause
C. Diagnose late-onset schizophrenia
D. Begin long-term antipsychotic maintenance therapy
Correct Answer: B. Obtain collateral information and evaluate for an underlying
medical or neurologic cause
Rationale: New-onset psychosis in an older adult, particularly with fluctuating attention
and disorientation, warrants evaluation for delirium, neurologic disease, medication
effects, metabolic abnormalities, or other medical causes before assuming a primary
psychotic disorder.
Question 3
A patient taking lithium for bipolar disorder presents with coarse tremor, vomiting,
diarrhea, ataxia, and increasing confusion. The patient recently began taking a
,medication for hypertension. Which interpretation is most appropriate?
A. The symptoms indicate expected therapeutic effects of lithium
B. The patient is experiencing serotonin syndrome
C. The presentation is concerning for lithium toxicity and requires urgent evaluation
D. The symptoms indicate emerging mania
Correct Answer: C. The presentation is concerning for lithium toxicity and requires
urgent evaluation
Rationale: Gastrointestinal symptoms, worsening tremor, ataxia, and altered mental
status are concerning for lithium toxicity. Several medications, including some
antihypertensive agents and diuretics, can increase lithium concentrations.
Question 4
A patient with major depressive disorder reports substantial improvement after six
weeks of an antidepressant but states, “I feel normal now, so I stopped taking it
yesterday.” Which response by the PMHNP best reflects evidence-based medication
management?
A. “Stopping immediately is appropriate because your symptoms resolved.”
B. “You should restart the medication at twice the previous dose.”
C. “Symptom improvement does not necessarily mean the underlying disorder has
resolved; discontinuation should be planned to reduce relapse and withdrawal risks.”
D. “Antidepressants must always be continued for life.”
Correct Answer: C. “Symptom improvement does not necessarily mean the
underlying disorder has resolved; discontinuation should be planned to reduce
relapse and withdrawal risks.”
Rationale: Maintenance treatment duration depends on factors such as recurrence history,
severity, comorbidity, and relapse risk. Abrupt discontinuation can produce
discontinuation symptoms and may increase the likelihood of relapse.
Question 5
A PMHNP assesses a patient who reports hearing a voice commenting on behavior. The
patient states that the voice is external, occurs when fully awake, and has progressively
become more threatening. Which assessment question is most important initially?
, A. “What is your highest level of education?”
B. “Does the voice tell you to harm yourself or someone else?”
C. “Did your parents experience hallucinations?”
D. “How often do you experience sadness?”
Correct Answer: B. “Does the voice tell you to harm yourself or someone else?”
Rationale: Command hallucinations require immediate assessment of content, intent,
access to means, ability to resist commands, and overall safety. Risk assessment takes
priority when psychotic symptoms may involve harm.
Question 6
A patient with generalized anxiety disorder has received an adequate trial of an SSRI
but continues to experience significant symptoms. The patient asks for a
benzodiazepine to use indefinitely. Which PMHNP response best reflects long-term
risk-benefit considerations?
A. Prescribe the benzodiazepine indefinitely because dependence occurs only at high
doses
B. Explain that benzodiazepines may have a role in selected situations but carry risks
including dependence, cognitive impairment, and withdrawal
C. Recommend combining two benzodiazepines to improve efficacy
D. Discontinue the SSRI immediately because persistent anxiety proves treatment
failure
Correct Answer: B. Explain that benzodiazepines may have a role in selected
situations but carry risks including dependence, cognitive impairment, and
withdrawal
Rationale: Benzodiazepines can provide short-term anxiolysis but require careful risk
assessment. Long-term use may lead to tolerance, dependence, withdrawal, falls, and
cognitive effects, particularly in vulnerable populations.
Question 7
A PMHNP evaluates a patient with severe depression who reports a specific suicide
plan, access to the intended method, escalating hopelessness, and inability to identify
protective factors. Which intervention is most appropriate?
A. Schedule routine follow-up in four weeks
B. Provide a list of outpatient psychotherapy providers
