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
,NR 668 CEA | Practicum Capstone Intensive – Final Exam Practice
1. A client with generalized anxiety disorder is asked to create coping cards as part of her CBT
homework. What is the primary purpose of using coping cards in CBT?
a. To record daily fluctuations in thoughts and corresponding moods
b. To identify anxiety-provoking situations
c. To provide immediate cognitive restructuring strategies
d. To document automatic thoughts
✔ Answer: c. To provide immediate cognitive restructuring strategies
📖 Rationale: Coping cards are written cards used in CBT that contain helpful adaptive thoughts and
coping strategies the client can refer to during moments of distress. Their primary purpose is to provide
immediate cognitive restructuring support—counteracting maladaptive automatic thoughts in real time when
the therapist is not present.
2. In a Gestalt therapy session, a therapist asks a patient to engage in a dialogue with an empty
chair, imagining that a significant person from their life is sitting in it. What is the primary
purpose of this technique?
a. To explore and resolve unfinished business
b. To develop a behavioral plan
c. To identify cognitive distortions
d. To analyze unconscious thoughts
✔ Answer: a. To explore and resolve unfinished business
📖 Rationale: The empty chair technique is a hallmark Gestalt therapy intervention. It is used to help clients
address unresolved emotions, conflicts, and 'unfinished business' with significant people in their lives (living
or deceased). By externalizing the other person, the client can express unexpressed feelings and work
toward psychological completion.
3. The PMHNP has prescribed a patient naltrexone and bupropion for binge eating disorder. The
patient has lost 4 lbs. since her last visit. She states she finds it very difficult to not binge eat
when her emotions are intense, and expresses doubt in her ability to make a lasting change.
Which of the following is the best response?
a. "I can increase your dose of medication or augment you with another agent."
b. "Let's talk about what strategies you have tried so far."
c. "You should consider an inpatient eating disorder program."
d. "Give me an example of something in your life that you are most proud of achieving."
✔ Answer: d. "Give me an example of something in your life that you are most proud of
achieving."
📖 Rationale: This motivational interviewing (MI) technique—eliciting past successes—is designed to build
self-efficacy and counter the patient's expressed doubt in her ability to change. By asking about a personal
achievement, the PMHNP helps the patient access her own internal strengths and confidence, which is
more therapeutic than immediately adjusting medication or suggesting a higher level of care.
Page 2 of 52
,NR 668 CEA | Practicum Capstone Intensive – Final Exam Practice
4. The PMHNP is caring for a 20-year-old man with bipolar I disorder. The patient indicates that
he does not have a problem because he can accomplish so much during his manic episodes.
Which stage of change is the patient in?
a. Action
b. Precontemplation
c. Contemplation
d. Preparation
e. Maintenance
✔ Answer: b. Precontemplation
📖 Rationale: In Prochaska and DiClemente's Transtheoretical Model, the precontemplation stage is
characterized by the individual not yet recognizing that a problem exists or not intending to change behavior
in the foreseeable future. This patient clearly does not see his manic episodes as problematic—he views
them as beneficial, indicating he is not yet contemplating the need for change.
5. A 55-year-old woman reports to the PMHNP that since she accepted early retirement last year
she finds that her memory has gotten worse and she has trouble sleeping at night. She denies
any medical problems. What should the PMHNP do first?
a. Prescribe mirtazapine 15mg PO at bedtime to help her sleep
b. Refer her to her primary care provider for a physical exam
c. Encourage her to volunteer with something she feels passionate about
d. Perform a Mini-Mental State Exam and Confusion Assessment Methods Instrument
✔ Answer: d. Perform a Mini-Mental State Exam and Confusion Assessment Methods
Instrument
📖 Rationale: Before making any clinical decisions, the PMHNP must first assess the extent of the
cognitive complaint with validated screening tools. The MMSE quantifies cognitive function, and the
Confusion Assessment Method (CAM) screens for delirium. This assessment guides differential diagnosis
(depression, early dementia, sleep disorder, thyroid disease) and informs next steps, including whether
referral or pharmacotherapy is appropriate.
6. A 70-year-old retired male with a history of hypertension is referred from his primary care
physician due to increasing difficulty copying geometric figures, which makes him feel self-
conscious and anxious. In which portion of the mental status exam would the PMHNP expect to
find a deficit?
a. Orientation to person, time, and place
b. Delayed recall
c. Abstract thinking
d. Intersecting pentagon
✔ Answer: d. Intersecting pentagon
📖 Rationale: Copying intersecting pentagons is the visuospatial/constructional task on the MMSE that
assesses visuoconstructive ability and parietal lobe function. Difficulty copying geometric figures
(constructional apraxia) is a deficit in visuospatial skill. This is distinct from orientation, recall, or abstract
thinking. It is one of the earliest signs of parietal lobe dysfunction seen in Alzheimer's disease and other
dementias.
Page 3 of 52
, NR 668 CEA | Practicum Capstone Intensive – Final Exam Practice
7. Pam is a 22-year-old female who lives alone and has Bipolar disorder (F31.2 - Manic, Severe
with psychotic features). Pam stopped taking her Quetiapine and Lithium. Her delusions are
worsening and she has been awake for 36 hours. Does the PMHNP have the right to share this
information with Pam's mother who lives in a neighboring state?
a. Yes, Pam does not currently have the capacity to make decisions given her chief complaint,
presentation, and history of a serious mental illness.
b. Yes, because the health care provider can always reach out to family as long as the information
is limited to what is needed.
c. No, because Pam is an adult and HIPAA protects private mental health information.
d. No, because Pam has not signed a medical release form and is actively participating in her care
as evidenced by showing up to the visit.
✔ Answer: a. Yes, Pam does not currently have the capacity to make decisions given her chief
complaint, presentation, and history of a serious mental illness.
📖 Rationale: Under HIPAA, when a provider believes that a patient lacks the capacity to agree or object to
sharing information, and that sharing would be in the patient's best interest, the provider may share pertinent
information with a family member who can assist with immediate care concerns. Pam's active psychosis,
medication non-adherence, and 36 hours of sleeplessness impair her decision-making capacity, justifying
disclosure to her mother to support immediate safety needs.
8. A PMHNP is conducting an initial psychiatric evaluation. Which of the following best
describes the purpose of the mental status exam (MSE)?
a. To establish a DSM-5 diagnosis
b. To provide a systematic cross-sectional snapshot of a patient's current psychological functioning
c. To assess for medical causes of psychiatric symptoms
d. To evaluate the patient's past psychiatric history
✔ Answer: b. To provide a systematic cross-sectional snapshot of a patient's current
psychological functioning
📖 Rationale: The Mental Status Exam is a structured assessment of a patient's appearance, behavior,
speech, mood, affect, thought process, thought content, perceptions, cognition, insight, and judgment at a
specific point in time. It is a cross-sectional (current) observation tool, not a historical record. It guides
diagnosis, treatment planning, and monitoring of psychiatric symptoms over time.
9. Which of the following correctly pairs a CBT technique with its primary target?
a. Thought records — behavioral activation
b. Exposure and response prevention (ERP) — avoidance in OCD
c. Behavioral activation — cognitive distortions
d. Socratic questioning — physical relaxation
✔ Answer: b. Exposure and response prevention (ERP) — avoidance in OCD
📖 Rationale: Exposure and response prevention (ERP) is the gold-standard CBT technique for OCD. It
involves systematically exposing the patient to feared stimuli (exposure) while preventing the compulsive
response (response prevention). This breaks the negative reinforcement cycle of obsessions and
compulsions. Thought records target cognitive distortions, and behavioral activation targets depression-
related withdrawal.
Page 4 of 52
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
,NR 668 CEA | Practicum Capstone Intensive – Final Exam Practice
1. A client with generalized anxiety disorder is asked to create coping cards as part of her CBT
homework. What is the primary purpose of using coping cards in CBT?
a. To record daily fluctuations in thoughts and corresponding moods
b. To identify anxiety-provoking situations
c. To provide immediate cognitive restructuring strategies
d. To document automatic thoughts
✔ Answer: c. To provide immediate cognitive restructuring strategies
📖 Rationale: Coping cards are written cards used in CBT that contain helpful adaptive thoughts and
coping strategies the client can refer to during moments of distress. Their primary purpose is to provide
immediate cognitive restructuring support—counteracting maladaptive automatic thoughts in real time when
the therapist is not present.
2. In a Gestalt therapy session, a therapist asks a patient to engage in a dialogue with an empty
chair, imagining that a significant person from their life is sitting in it. What is the primary
purpose of this technique?
a. To explore and resolve unfinished business
b. To develop a behavioral plan
c. To identify cognitive distortions
d. To analyze unconscious thoughts
✔ Answer: a. To explore and resolve unfinished business
📖 Rationale: The empty chair technique is a hallmark Gestalt therapy intervention. It is used to help clients
address unresolved emotions, conflicts, and 'unfinished business' with significant people in their lives (living
or deceased). By externalizing the other person, the client can express unexpressed feelings and work
toward psychological completion.
3. The PMHNP has prescribed a patient naltrexone and bupropion for binge eating disorder. The
patient has lost 4 lbs. since her last visit. She states she finds it very difficult to not binge eat
when her emotions are intense, and expresses doubt in her ability to make a lasting change.
Which of the following is the best response?
a. "I can increase your dose of medication or augment you with another agent."
b. "Let's talk about what strategies you have tried so far."
c. "You should consider an inpatient eating disorder program."
d. "Give me an example of something in your life that you are most proud of achieving."
✔ Answer: d. "Give me an example of something in your life that you are most proud of
achieving."
📖 Rationale: This motivational interviewing (MI) technique—eliciting past successes—is designed to build
self-efficacy and counter the patient's expressed doubt in her ability to change. By asking about a personal
achievement, the PMHNP helps the patient access her own internal strengths and confidence, which is
more therapeutic than immediately adjusting medication or suggesting a higher level of care.
Page 2 of 52
,NR 668 CEA | Practicum Capstone Intensive – Final Exam Practice
4. The PMHNP is caring for a 20-year-old man with bipolar I disorder. The patient indicates that
he does not have a problem because he can accomplish so much during his manic episodes.
Which stage of change is the patient in?
a. Action
b. Precontemplation
c. Contemplation
d. Preparation
e. Maintenance
✔ Answer: b. Precontemplation
📖 Rationale: In Prochaska and DiClemente's Transtheoretical Model, the precontemplation stage is
characterized by the individual not yet recognizing that a problem exists or not intending to change behavior
in the foreseeable future. This patient clearly does not see his manic episodes as problematic—he views
them as beneficial, indicating he is not yet contemplating the need for change.
5. A 55-year-old woman reports to the PMHNP that since she accepted early retirement last year
she finds that her memory has gotten worse and she has trouble sleeping at night. She denies
any medical problems. What should the PMHNP do first?
a. Prescribe mirtazapine 15mg PO at bedtime to help her sleep
b. Refer her to her primary care provider for a physical exam
c. Encourage her to volunteer with something she feels passionate about
d. Perform a Mini-Mental State Exam and Confusion Assessment Methods Instrument
✔ Answer: d. Perform a Mini-Mental State Exam and Confusion Assessment Methods
Instrument
📖 Rationale: Before making any clinical decisions, the PMHNP must first assess the extent of the
cognitive complaint with validated screening tools. The MMSE quantifies cognitive function, and the
Confusion Assessment Method (CAM) screens for delirium. This assessment guides differential diagnosis
(depression, early dementia, sleep disorder, thyroid disease) and informs next steps, including whether
referral or pharmacotherapy is appropriate.
6. A 70-year-old retired male with a history of hypertension is referred from his primary care
physician due to increasing difficulty copying geometric figures, which makes him feel self-
conscious and anxious. In which portion of the mental status exam would the PMHNP expect to
find a deficit?
a. Orientation to person, time, and place
b. Delayed recall
c. Abstract thinking
d. Intersecting pentagon
✔ Answer: d. Intersecting pentagon
📖 Rationale: Copying intersecting pentagons is the visuospatial/constructional task on the MMSE that
assesses visuoconstructive ability and parietal lobe function. Difficulty copying geometric figures
(constructional apraxia) is a deficit in visuospatial skill. This is distinct from orientation, recall, or abstract
thinking. It is one of the earliest signs of parietal lobe dysfunction seen in Alzheimer's disease and other
dementias.
Page 3 of 52
, NR 668 CEA | Practicum Capstone Intensive – Final Exam Practice
7. Pam is a 22-year-old female who lives alone and has Bipolar disorder (F31.2 - Manic, Severe
with psychotic features). Pam stopped taking her Quetiapine and Lithium. Her delusions are
worsening and she has been awake for 36 hours. Does the PMHNP have the right to share this
information with Pam's mother who lives in a neighboring state?
a. Yes, Pam does not currently have the capacity to make decisions given her chief complaint,
presentation, and history of a serious mental illness.
b. Yes, because the health care provider can always reach out to family as long as the information
is limited to what is needed.
c. No, because Pam is an adult and HIPAA protects private mental health information.
d. No, because Pam has not signed a medical release form and is actively participating in her care
as evidenced by showing up to the visit.
✔ Answer: a. Yes, Pam does not currently have the capacity to make decisions given her chief
complaint, presentation, and history of a serious mental illness.
📖 Rationale: Under HIPAA, when a provider believes that a patient lacks the capacity to agree or object to
sharing information, and that sharing would be in the patient's best interest, the provider may share pertinent
information with a family member who can assist with immediate care concerns. Pam's active psychosis,
medication non-adherence, and 36 hours of sleeplessness impair her decision-making capacity, justifying
disclosure to her mother to support immediate safety needs.
8. A PMHNP is conducting an initial psychiatric evaluation. Which of the following best
describes the purpose of the mental status exam (MSE)?
a. To establish a DSM-5 diagnosis
b. To provide a systematic cross-sectional snapshot of a patient's current psychological functioning
c. To assess for medical causes of psychiatric symptoms
d. To evaluate the patient's past psychiatric history
✔ Answer: b. To provide a systematic cross-sectional snapshot of a patient's current
psychological functioning
📖 Rationale: The Mental Status Exam is a structured assessment of a patient's appearance, behavior,
speech, mood, affect, thought process, thought content, perceptions, cognition, insight, and judgment at a
specific point in time. It is a cross-sectional (current) observation tool, not a historical record. It guides
diagnosis, treatment planning, and monitoring of psychiatric symptoms over time.
9. Which of the following correctly pairs a CBT technique with its primary target?
a. Thought records — behavioral activation
b. Exposure and response prevention (ERP) — avoidance in OCD
c. Behavioral activation — cognitive distortions
d. Socratic questioning — physical relaxation
✔ Answer: b. Exposure and response prevention (ERP) — avoidance in OCD
📖 Rationale: Exposure and response prevention (ERP) is the gold-standard CBT technique for OCD. It
involves systematically exposing the patient to feared stimuli (exposure) while preventing the compulsive
response (response prevention). This breaks the negative reinforcement cycle of obsessions and
compulsions. Thought records target cognitive distortions, and behavioral activation targets depression-
related withdrawal.
Page 4 of 52
