NURS 6675 WEEK 11 FINAL EXAM – QUESTIONS AND ANSWERS | VERIFIED AND WELL DETAILED
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains:
Advanced Health Assessment
Psychopharmacology
Psychopathology and Diagnostic Reasoning
Therapeutic Communication and Interventions
Ethical and Legal Principles in Psychiatric-Mental Health Nursing
Care Coordination and Interprofessional Collaboration
Quality Improvement and Evidence-Based Practice
Health Promotion and Disease Prevention
Clinical Decision-Making and Critical Thinking
Introduction
This comprehensive examination is designed to evaluate the advanced practice registered nurse's
(APRN) proficiency in psychiatric-mental health nursing across the lifespan. It assesses the synthesis of
foundational theory, psychopharmacology, diagnostic reasoning, and therapeutic interventions,
integrating ethical and legal standards essential for safe, patient-centered care. The exam comprises
200 multiple-choice questions and scenario-based items that simulate real-world clinical situations,
challenging the test-taker to apply knowledge, prioritize actions, and demonstrate sound clinical
judgment. The focus is on the practical application of evidence-based guidelines, regulatory
compliance, and effective interprofessional collaboration to ensure optimal patient outcomes in
diverse mental health settings.
SECTION ONE: QUESTIONS 1 – 100
1. A 35-year-old male presents with a persistent depressed mood, anhedonia, and significant
weight loss over the past two months. He reports excessive guilt and difficulty concentrating.
Which of the following is the most appropriate initial step in the diagnostic process?
A. Order a complete blood count and thyroid function tests.
B. Begin a trial of an SSRI antidepressant.
C. Refer for cognitive-behavioral therapy.
D. Hospitalize for safety concerns.
🟢 A. Order a complete blood count and thyroid function tests.
🔴 Explanation: Before initiating treatment or confirming a psychiatric diagnosis, it is crucial to rule
out underlying medical conditions that may cause depressive symptoms. Hypothyroidism and
anemia are common medical causes of depressive symptoms. This aligns with the standard of care
in advanced practice, which mandates a thorough medical workup prior to psychiatric intervention.
2. A patient with schizophrenia has been non-adherent with their oral antipsychotic medication.
Which of the following interventions is the most appropriate for the PMHNP to discuss with the
patient?
A. Increase the dose of the current oral medication to compensate for missed doses.
B. Switch to a long-acting injectable antipsychotic (LAI).
,C. Discontinue the antipsychotic and monitor for symptoms.
D. Prescribe a different oral antipsychotic with fewer side effects.
🟢 B. Switch to a long-acting injectable antipsychotic (LAI).
🔴 Explanation: Long-acting injectable antipsychotics are a primary strategy for addressing non-
adherence, as they ensure consistent medication delivery over weeks or months. This intervention
directly targets the barrier of adherence, which is a common challenge in managing schizophrenia.
3. When conducting a mental status exam, a patient's speech is described as rapid, pressured,
and difficult to interrupt. This finding is most consistent with which of the following?
A. Depression
B. Catatonia
C. Mania
D. Anxiety
🟢 C. Mania
🔴 Explanation: Pressured speech, characterized by rapid, loud, and difficult-to-interrupt speech, is
a hallmark symptom of a manic episode, as seen in bipolar I disorder. It reflects the underlying
flight of ideas and increased goal-directed activity associated with mania.
4. The PMHNP is evaluating a patient with a history of trauma who has difficulty maintaining
stable relationships. The patient often idealizes others early in the relationship but then devalues
them. This pattern is most characteristic of which personality disorder?
A. Borderline Personality Disorder
B. Narcissistic Personality Disorder
C. Schizoid Personality Disorder
D. Obsessive-Compulsive Personality Disorder
🟢 A. Borderline Personality Disorder
🔴 Explanation: A pattern of unstable, intense relationships with alternating idealization and
devaluation is a core diagnostic criterion for Borderline Personality Disorder, as defined in the DSM-
5. This 'splitting' defense mechanism is a key feature.
5. A 72-year-old patient is brought to the clinic by his daughter due to memory loss. He is
unable to recall recent events and has difficulty with problem-solving. Which of the following is
the most appropriate initial screening tool for cognitive impairment?
A. Beck Depression Inventory (BDI)
B. Mini-Mental State Examination (MMSE)
C. Alcohol Use Disorders Identification Test (AUDIT)
D. Hamilton Anxiety Rating Scale (HAM-A)
🟢 B. Mini-Mental State Examination (MMSE)
🔴 Explanation: The MMSE is a brief, standardized tool used to screen for cognitive impairment. It
assesses orientation, registration, attention, recall, and language, making it an appropriate initial
screening tool for a patient presenting with memory and problem-solving difficulties.
, 6. A 16-year-old female is diagnosed with anorexia nervosa. The PMHNP recognizes that which
of the following is a critical element of medical monitoring in this patient?
A. Monitoring weight gain and vital signs.
B. Assessing for electrolyte imbalances like hypokalemia.
C. Evaluating for signs of metabolic syndrome.
D. Checking for elevated liver enzymes.
🟢 B. Assessing for electrolyte imbalances like hypokalemia.
🔴 Explanation: Anorexia nervosa, particularly with purging behaviors, can lead to severe
electrolyte disturbances such as hypokalemia, which can result in cardiac arrhythmias and is a life-
threatening complication. Close monitoring of electrolyte levels is a critical medical management
component.
7. A patient on clozapine for treatment-resistant schizophrenia needs monitoring for a
potentially fatal side effect. Which of the following blood tests is required according to the
REMS program?
A. Complete Blood Count (CBC) with differential
B. Basic Metabolic Panel (BMP)
C. Liver Function Tests (LFTs)
D. Thyroid Stimulating Hormone (TSH)
🟢 A. Complete Blood Count (CBC) with differential
🔴 Explanation: The clozapine REMS (Risk Evaluation and Mitigation Strategy) program mandates
absolute neutrophil count (ANC) monitoring due to the risk of severe neutropenia/agranulocytosis.
This is obtained through a CBC with differential.
8. During a psychiatric interview, the patient reports hearing voices that command them to harm
themselves. The PMHNP's priority action is to:
A. Ask the patient to describe the voices in more detail.
B. Conduct a suicide risk assessment and ensure patient safety.
C. Explore the patient's insight into the auditory hallucinations.
D. Educate the patient on coping mechanisms for auditory hallucinations.
🟢 B. Conduct a suicide risk assessment and ensure patient safety.
🔴 Explanation: Command hallucinations to self-harm represent an imminent safety risk. The
PMHNP's immediate priority is to assess the patient's intent and plan and to implement measures
to ensure safety, which may include hospitalization. Safety always supersedes other assessment or
educational interventions.
9. A 55-year-old male with a history of hypertension and diabetes presents with symptoms of
major depression. Which of the following antidepressants is generally preferred in this patient
due to a favorable side effect profile?
A. Amitriptyline
B. Phenelzine
C. Sertraline
D. Bupropion
ANSWERS | PLUS RATIONALES | GUARANTEED PASS | LATEST EXAM UPDATE
Core Domains:
Advanced Health Assessment
Psychopharmacology
Psychopathology and Diagnostic Reasoning
Therapeutic Communication and Interventions
Ethical and Legal Principles in Psychiatric-Mental Health Nursing
Care Coordination and Interprofessional Collaboration
Quality Improvement and Evidence-Based Practice
Health Promotion and Disease Prevention
Clinical Decision-Making and Critical Thinking
Introduction
This comprehensive examination is designed to evaluate the advanced practice registered nurse's
(APRN) proficiency in psychiatric-mental health nursing across the lifespan. It assesses the synthesis of
foundational theory, psychopharmacology, diagnostic reasoning, and therapeutic interventions,
integrating ethical and legal standards essential for safe, patient-centered care. The exam comprises
200 multiple-choice questions and scenario-based items that simulate real-world clinical situations,
challenging the test-taker to apply knowledge, prioritize actions, and demonstrate sound clinical
judgment. The focus is on the practical application of evidence-based guidelines, regulatory
compliance, and effective interprofessional collaboration to ensure optimal patient outcomes in
diverse mental health settings.
SECTION ONE: QUESTIONS 1 – 100
1. A 35-year-old male presents with a persistent depressed mood, anhedonia, and significant
weight loss over the past two months. He reports excessive guilt and difficulty concentrating.
Which of the following is the most appropriate initial step in the diagnostic process?
A. Order a complete blood count and thyroid function tests.
B. Begin a trial of an SSRI antidepressant.
C. Refer for cognitive-behavioral therapy.
D. Hospitalize for safety concerns.
🟢 A. Order a complete blood count and thyroid function tests.
🔴 Explanation: Before initiating treatment or confirming a psychiatric diagnosis, it is crucial to rule
out underlying medical conditions that may cause depressive symptoms. Hypothyroidism and
anemia are common medical causes of depressive symptoms. This aligns with the standard of care
in advanced practice, which mandates a thorough medical workup prior to psychiatric intervention.
2. A patient with schizophrenia has been non-adherent with their oral antipsychotic medication.
Which of the following interventions is the most appropriate for the PMHNP to discuss with the
patient?
A. Increase the dose of the current oral medication to compensate for missed doses.
B. Switch to a long-acting injectable antipsychotic (LAI).
,C. Discontinue the antipsychotic and monitor for symptoms.
D. Prescribe a different oral antipsychotic with fewer side effects.
🟢 B. Switch to a long-acting injectable antipsychotic (LAI).
🔴 Explanation: Long-acting injectable antipsychotics are a primary strategy for addressing non-
adherence, as they ensure consistent medication delivery over weeks or months. This intervention
directly targets the barrier of adherence, which is a common challenge in managing schizophrenia.
3. When conducting a mental status exam, a patient's speech is described as rapid, pressured,
and difficult to interrupt. This finding is most consistent with which of the following?
A. Depression
B. Catatonia
C. Mania
D. Anxiety
🟢 C. Mania
🔴 Explanation: Pressured speech, characterized by rapid, loud, and difficult-to-interrupt speech, is
a hallmark symptom of a manic episode, as seen in bipolar I disorder. It reflects the underlying
flight of ideas and increased goal-directed activity associated with mania.
4. The PMHNP is evaluating a patient with a history of trauma who has difficulty maintaining
stable relationships. The patient often idealizes others early in the relationship but then devalues
them. This pattern is most characteristic of which personality disorder?
A. Borderline Personality Disorder
B. Narcissistic Personality Disorder
C. Schizoid Personality Disorder
D. Obsessive-Compulsive Personality Disorder
🟢 A. Borderline Personality Disorder
🔴 Explanation: A pattern of unstable, intense relationships with alternating idealization and
devaluation is a core diagnostic criterion for Borderline Personality Disorder, as defined in the DSM-
5. This 'splitting' defense mechanism is a key feature.
5. A 72-year-old patient is brought to the clinic by his daughter due to memory loss. He is
unable to recall recent events and has difficulty with problem-solving. Which of the following is
the most appropriate initial screening tool for cognitive impairment?
A. Beck Depression Inventory (BDI)
B. Mini-Mental State Examination (MMSE)
C. Alcohol Use Disorders Identification Test (AUDIT)
D. Hamilton Anxiety Rating Scale (HAM-A)
🟢 B. Mini-Mental State Examination (MMSE)
🔴 Explanation: The MMSE is a brief, standardized tool used to screen for cognitive impairment. It
assesses orientation, registration, attention, recall, and language, making it an appropriate initial
screening tool for a patient presenting with memory and problem-solving difficulties.
, 6. A 16-year-old female is diagnosed with anorexia nervosa. The PMHNP recognizes that which
of the following is a critical element of medical monitoring in this patient?
A. Monitoring weight gain and vital signs.
B. Assessing for electrolyte imbalances like hypokalemia.
C. Evaluating for signs of metabolic syndrome.
D. Checking for elevated liver enzymes.
🟢 B. Assessing for electrolyte imbalances like hypokalemia.
🔴 Explanation: Anorexia nervosa, particularly with purging behaviors, can lead to severe
electrolyte disturbances such as hypokalemia, which can result in cardiac arrhythmias and is a life-
threatening complication. Close monitoring of electrolyte levels is a critical medical management
component.
7. A patient on clozapine for treatment-resistant schizophrenia needs monitoring for a
potentially fatal side effect. Which of the following blood tests is required according to the
REMS program?
A. Complete Blood Count (CBC) with differential
B. Basic Metabolic Panel (BMP)
C. Liver Function Tests (LFTs)
D. Thyroid Stimulating Hormone (TSH)
🟢 A. Complete Blood Count (CBC) with differential
🔴 Explanation: The clozapine REMS (Risk Evaluation and Mitigation Strategy) program mandates
absolute neutrophil count (ANC) monitoring due to the risk of severe neutropenia/agranulocytosis.
This is obtained through a CBC with differential.
8. During a psychiatric interview, the patient reports hearing voices that command them to harm
themselves. The PMHNP's priority action is to:
A. Ask the patient to describe the voices in more detail.
B. Conduct a suicide risk assessment and ensure patient safety.
C. Explore the patient's insight into the auditory hallucinations.
D. Educate the patient on coping mechanisms for auditory hallucinations.
🟢 B. Conduct a suicide risk assessment and ensure patient safety.
🔴 Explanation: Command hallucinations to self-harm represent an imminent safety risk. The
PMHNP's immediate priority is to assess the patient's intent and plan and to implement measures
to ensure safety, which may include hospitalization. Safety always supersedes other assessment or
educational interventions.
9. A 55-year-old male with a history of hypertension and diabetes presents with symptoms of
major depression. Which of the following antidepressants is generally preferred in this patient
due to a favorable side effect profile?
A. Amitriptyline
B. Phenelzine
C. Sertraline
D. Bupropion
