NR 547 Final Exam Practice Questions & Answers
Bundle (Chamberlain University) — Verified
Explanations & Rationales (UPDATED 2026)
1. A PMHNP is conducting a routine outpatient evaluation for a 44-year-old patient
who has been maintained on Fluphenazine (a first-generation antipsychotic) for
the past seven years. During the physical assessment, the nurse practitioner
notices rhythmic, involuntary movements of the tongue and occasional puckering
of the lips. Which standardized clinical rating scale must be administered
immediately to quantify these movements, and what is the underlying
pathophysiology?
A) Abnormal Involuntary Movement Scale (AIMS); Dopamine receptor hypersensitivity
in the nigrostriatal pathway.
B) Brief Psychiatric Rating Scale (BPRS); Serotonin depletion in the prefrontal cortex.
C) Clinical Global Impression (CGI) Scale; Acetylcholine excess in the basal ganglia.
D) Hamilton Rating Scale for Depression (HAM-D); GABA receptor down-regulation in
the limbic system.
Correct Answer: A
Rationale: The Abnormal Involuntary Movement Scale (AIMS) is the gold-standard tool
utilized to screen for and track Tardive Dyskinesia (TD) in patients taking antipsychotic
medications. TD is caused by long-term blockade of dopamine (D₂) receptors, which
, induces postsynaptic dopamine receptor hypersensitivity and upregulation within the
nigrostriatal pathway.
2. Geriatric Depression Screening (GDS) Interpretation
Question: An 81-year-old male residing in an assisted living facility is administered the
Geriatric Depression Scale (GDS) Short Form by the consulting PMHNP due to recent
social withdrawal and changes in sleep. The patient scores an 8 on the 15-item self-
report scale. How should the nurse practitioner interpret this score and proceed with the
clinical plan?
A) The score indicates normal aging changes; no clinical action or follow-up is
necessary.
B) The score is suggestive of mild-to-moderate depression; a formal diagnostic
interview and safety risk assessment are indicated.
C) The score indicates severe, psychotic-level depression requiring immediate
emergency psychiatric commitment.
D) The score confirms a primary neurocognitive disorder (dementia) rather than a mood
disorder.
Correct Answer: B
Rationale: On the Geriatric Depression Scale (GDS) Short Form, a score of 0 to 4 is
considered normal, while a score above 5 is suggestive of depression and warrants a
thorough diagnostic and clinical investigation. A score of 8 indicates mild-to-moderate
depressive symptoms, requiring the clinician to complete a comprehensive mental
status evaluation and suicide risk assessment.
3. Opioid Withdrawal Emergency Presentation
Question: A 28-year-old female is brought to the crisis stabilization unit experiencing
intense abdominal cramping, severe rhinorrhea, lacrimation, diffuse pupillary dilation
(mydriasis), piloerection ("goosebumps"), and marked yawning. She is highly anxious
and begging for medication. Which substance withdrawal syndrome is this patient
experiencing, and what is a first-line non-opioid pharmacological choice for autonomic
symptom control?
A) Alcohol withdrawal; treat with Lorazepam.
B) Benzodiazepine withdrawal; treat with Phenobarbital.
C) Opioid withdrawal; treat with Clonidine.
, D) Amphetamine withdrawal; treat with Haloperidol.
Correct Answer: C
Rationale: The clinical presentation of severe rhinorrhea, lacrimation, pupillary dilation,
piloerection, yawning, and gastrointestinal cramping is classic for opioid withdrawal.
While not typically life-threatening like alcohol or benzodiazepine withdrawal, it causes
intense distress. Clonidine, an alpha-2 adrenergic agonist, is utilized as a first-line non-
opioid intervention to reduce the central autonomic hyperactivity (tachycardia,
hypertension, sweating) associated with withdrawal.
4. Extrapyramidal Symptoms: Acute Dystonic Reactions
Question: A 19-year-old male is admitted to an inpatient psychiatric unit for acute
psychosis and receives his first intramuscular dose of Haloperidol. Three hours later,
the nurse practitioner is called to the bedside because the patient’s head is involuntarily
twisted to the right side, his neck muscles are rigidly spasming, and his eyes are rolled
upward. What is the clinical term for this reaction, and what is the immediate medication
of choice?
A) Akathisia; treat with Propranolol.
B) Acute Dystonia (Torticollis and Oculogyric Crisis); treat with Benztropine or
Diphenhydramine.
C) Neuroleptic Malignant Syndrome; treat with Dantrolene.
D) Drug-Induced Parkinsonism; treat with Amantadine.
Correct Answer: B
Rationale: Acute dystonic reactions involve sudden, painful muscle spasms typically
affecting the neck (torticollis), eyes (oculogyric crisis), tongue, or jaw, occurring within
hours to days of starting high-potency first-generation antipsychotics. The immediate
treatment of choice is an intravenous or intramuscular anticholinergic agent, such as
Benztropine (Cogentin) or Diphenhydramine (Benadryl), to restore the balance between
dopamine and acetylcholine in the basal ganglia.
5. Stimulant-Induced Psychosis vs. Primary Psychosis
Question: A 23-year-old male college student is brought to the clinic by security after
being found standing on a desk claiming he can read everyone's thoughts. He is highly
agitated, tachycardic at 128 bpm, severely diaphoretic, has a significant fine motor
tremor, and his pupils are widely dilated and reactive. His roommates state he has been
, awake for 4 days straight studying for finals. What is the priority differential diagnostic
step?
A) Diagnose Schizophrenia, Paranoid Type, and start a long-acting injectable
antipsychotic.
B) Obtain a urine drug screen to rule out Amphetamine-Induced Psychotic Disorder
before diagnosing a primary psychotic disorder.
C) Diagnose Bipolar I Disorder, Manic Episode, and initiate Lithium Carbonate.
D) Diagnose Panic Disorder and prescribe high-dose Alprazolam.
Correct Answer: B
Rationale: Sympathomimetic toxicity from amphetamine or cocaine abuse can perfectly
mimic an acute manic or paranoid psychotic episode. The presence of marked physical
signs of autonomic arousal (extreme tachycardia, diaphoresis, tremors, pupillary
dilation) combined with prolonged sleep deprivation strongly points toward a substance-
induced etiology. A urine drug screen must be performed to differentiate it from a
primary psychiatric episode.
6. Pediatric Psychopharmacology: Treating Enuresis
Question: The parents of a 7-year-old boy report that despite extensive behavioral
modifications, fluid restrictions before bed, and moisture alarms, their child continues to
wet the bed 4 to 5 nights per week, causing him severe social embarrassment. If a
pharmacological intervention is deemed necessary after ruling out organic urological
causes, which medication option is FDA-approved for nocturnal enuresis?
A) Methylphenidate
B) Desmopressin (DDAVP) or Imipramine
C) Guanfacine
D) Fluoxetine
Correct Answer: B
Rationale: Desmopressin (an antidiuretic hormone analogue) and Imipramine (a
tricyclic antidepressant) are pharmacological options utilized for the treatment of
refractory nocturnal enuresis in children when non-pharmacological therapies fail.
Imipramine works via its anticholinergic properties to increase bladder capacity and alter
sleep/arousal patterns, though Desmopressin is often preferred first due to a safer side-
effect profile.
7. Assessing Treatment-Resistant Schizophrenia: Clozapine
Protocols
Bundle (Chamberlain University) — Verified
Explanations & Rationales (UPDATED 2026)
1. A PMHNP is conducting a routine outpatient evaluation for a 44-year-old patient
who has been maintained on Fluphenazine (a first-generation antipsychotic) for
the past seven years. During the physical assessment, the nurse practitioner
notices rhythmic, involuntary movements of the tongue and occasional puckering
of the lips. Which standardized clinical rating scale must be administered
immediately to quantify these movements, and what is the underlying
pathophysiology?
A) Abnormal Involuntary Movement Scale (AIMS); Dopamine receptor hypersensitivity
in the nigrostriatal pathway.
B) Brief Psychiatric Rating Scale (BPRS); Serotonin depletion in the prefrontal cortex.
C) Clinical Global Impression (CGI) Scale; Acetylcholine excess in the basal ganglia.
D) Hamilton Rating Scale for Depression (HAM-D); GABA receptor down-regulation in
the limbic system.
Correct Answer: A
Rationale: The Abnormal Involuntary Movement Scale (AIMS) is the gold-standard tool
utilized to screen for and track Tardive Dyskinesia (TD) in patients taking antipsychotic
medications. TD is caused by long-term blockade of dopamine (D₂) receptors, which
, induces postsynaptic dopamine receptor hypersensitivity and upregulation within the
nigrostriatal pathway.
2. Geriatric Depression Screening (GDS) Interpretation
Question: An 81-year-old male residing in an assisted living facility is administered the
Geriatric Depression Scale (GDS) Short Form by the consulting PMHNP due to recent
social withdrawal and changes in sleep. The patient scores an 8 on the 15-item self-
report scale. How should the nurse practitioner interpret this score and proceed with the
clinical plan?
A) The score indicates normal aging changes; no clinical action or follow-up is
necessary.
B) The score is suggestive of mild-to-moderate depression; a formal diagnostic
interview and safety risk assessment are indicated.
C) The score indicates severe, psychotic-level depression requiring immediate
emergency psychiatric commitment.
D) The score confirms a primary neurocognitive disorder (dementia) rather than a mood
disorder.
Correct Answer: B
Rationale: On the Geriatric Depression Scale (GDS) Short Form, a score of 0 to 4 is
considered normal, while a score above 5 is suggestive of depression and warrants a
thorough diagnostic and clinical investigation. A score of 8 indicates mild-to-moderate
depressive symptoms, requiring the clinician to complete a comprehensive mental
status evaluation and suicide risk assessment.
3. Opioid Withdrawal Emergency Presentation
Question: A 28-year-old female is brought to the crisis stabilization unit experiencing
intense abdominal cramping, severe rhinorrhea, lacrimation, diffuse pupillary dilation
(mydriasis), piloerection ("goosebumps"), and marked yawning. She is highly anxious
and begging for medication. Which substance withdrawal syndrome is this patient
experiencing, and what is a first-line non-opioid pharmacological choice for autonomic
symptom control?
A) Alcohol withdrawal; treat with Lorazepam.
B) Benzodiazepine withdrawal; treat with Phenobarbital.
C) Opioid withdrawal; treat with Clonidine.
, D) Amphetamine withdrawal; treat with Haloperidol.
Correct Answer: C
Rationale: The clinical presentation of severe rhinorrhea, lacrimation, pupillary dilation,
piloerection, yawning, and gastrointestinal cramping is classic for opioid withdrawal.
While not typically life-threatening like alcohol or benzodiazepine withdrawal, it causes
intense distress. Clonidine, an alpha-2 adrenergic agonist, is utilized as a first-line non-
opioid intervention to reduce the central autonomic hyperactivity (tachycardia,
hypertension, sweating) associated with withdrawal.
4. Extrapyramidal Symptoms: Acute Dystonic Reactions
Question: A 19-year-old male is admitted to an inpatient psychiatric unit for acute
psychosis and receives his first intramuscular dose of Haloperidol. Three hours later,
the nurse practitioner is called to the bedside because the patient’s head is involuntarily
twisted to the right side, his neck muscles are rigidly spasming, and his eyes are rolled
upward. What is the clinical term for this reaction, and what is the immediate medication
of choice?
A) Akathisia; treat with Propranolol.
B) Acute Dystonia (Torticollis and Oculogyric Crisis); treat with Benztropine or
Diphenhydramine.
C) Neuroleptic Malignant Syndrome; treat with Dantrolene.
D) Drug-Induced Parkinsonism; treat with Amantadine.
Correct Answer: B
Rationale: Acute dystonic reactions involve sudden, painful muscle spasms typically
affecting the neck (torticollis), eyes (oculogyric crisis), tongue, or jaw, occurring within
hours to days of starting high-potency first-generation antipsychotics. The immediate
treatment of choice is an intravenous or intramuscular anticholinergic agent, such as
Benztropine (Cogentin) or Diphenhydramine (Benadryl), to restore the balance between
dopamine and acetylcholine in the basal ganglia.
5. Stimulant-Induced Psychosis vs. Primary Psychosis
Question: A 23-year-old male college student is brought to the clinic by security after
being found standing on a desk claiming he can read everyone's thoughts. He is highly
agitated, tachycardic at 128 bpm, severely diaphoretic, has a significant fine motor
tremor, and his pupils are widely dilated and reactive. His roommates state he has been
, awake for 4 days straight studying for finals. What is the priority differential diagnostic
step?
A) Diagnose Schizophrenia, Paranoid Type, and start a long-acting injectable
antipsychotic.
B) Obtain a urine drug screen to rule out Amphetamine-Induced Psychotic Disorder
before diagnosing a primary psychotic disorder.
C) Diagnose Bipolar I Disorder, Manic Episode, and initiate Lithium Carbonate.
D) Diagnose Panic Disorder and prescribe high-dose Alprazolam.
Correct Answer: B
Rationale: Sympathomimetic toxicity from amphetamine or cocaine abuse can perfectly
mimic an acute manic or paranoid psychotic episode. The presence of marked physical
signs of autonomic arousal (extreme tachycardia, diaphoresis, tremors, pupillary
dilation) combined with prolonged sleep deprivation strongly points toward a substance-
induced etiology. A urine drug screen must be performed to differentiate it from a
primary psychiatric episode.
6. Pediatric Psychopharmacology: Treating Enuresis
Question: The parents of a 7-year-old boy report that despite extensive behavioral
modifications, fluid restrictions before bed, and moisture alarms, their child continues to
wet the bed 4 to 5 nights per week, causing him severe social embarrassment. If a
pharmacological intervention is deemed necessary after ruling out organic urological
causes, which medication option is FDA-approved for nocturnal enuresis?
A) Methylphenidate
B) Desmopressin (DDAVP) or Imipramine
C) Guanfacine
D) Fluoxetine
Correct Answer: B
Rationale: Desmopressin (an antidiuretic hormone analogue) and Imipramine (a
tricyclic antidepressant) are pharmacological options utilized for the treatment of
refractory nocturnal enuresis in children when non-pharmacological therapies fail.
Imipramine works via its anticholinergic properties to increase bladder capacity and alter
sleep/arousal patterns, though Desmopressin is often preferred first due to a safer side-
effect profile.
7. Assessing Treatment-Resistant Schizophrenia: Clozapine
Protocols
