NSG 526 Exam 3 | Clinical Modalities in Advanced Psychiatric Mental Health Nursing PracticeWilkes University | 2026/2027 Edition
NSG526 / NSG 526 EXAM 3 ( UPDATE)
Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Rated A Guide with Verified Answers | Wilkes University
Total Questions: 100 (Multiple Choice, A-D)
Sections: 6 sections covering NSG 526 core domains
Cognitive Distribution: 20% Recall | 50% Application | 30% Analysis
Format: 75% Scenario-based | 25% Direct Knowledge
Aligned With: AACN Essentials, PMHNP Competencies, NSG 526 Syllabus
Examination Instructions: This comprehensive examination consists of 100 multiple-choice questions across six
sections. Each question has four options (A-D) with exactly one best answer. Select the option that represents the
MOST appropriate clinical decision based on current evidence-based psychiatric-mental health nursing practice.
Verified answers and detailed rationales appear immediately following each question. This guide is aligned with the
Wilkes University NSG 526 course syllabus, AACN Essentials of Master's Education in Nursing, and PMHNP
Clinical Modalities Competencies (2026/2027 Edition).
Section 1: Advanced Psychopharmacology & Somatic Therapies
This section evaluates knowledge of psychopharmacologic agents, somatic therapies, medication management, monitoring
parameters, and prescriptive authority considerations across psychiatric conditions. Questions emphasize clinical
decision-making, adverse effect recognition, and evidence-based prescribing aligned with the NSG 526 curriculum and
PMHNP competencies.
Rated A Guide with Verified Answers Page 1 Confidential | For Educational Use
,NSG 526 Exam 3 | Clinical Modalities in Advanced Psychiatric Mental Health Nursing PracticeWilkes University | 2026/2027 Edition
Q1: A 34-year-old female with major depressive disorder has been started on fluoxetine 20 mg daily. Four
weeks later she reports new-onset restlessness, inability to sit still, and an inner sense of discomfort. Vital
signs are stable. Which of the following is the MOST appropriate initial nursing action?
A. Increase the fluoxetine dose to 40 mg daily to optimize therapeutic response.
B. Document the symptoms as expected SSRI therapeutic effects and reassure the patient.
C. Recognize the presentation as akathisia, contact the prescriber, and consider dose reduction
or beta-blocker addition. [CORRECT]
D. Discontinue fluoxetine immediately and switch to a tricyclic antidepressant.
Correct Answer: C
Rationale: Akathisia is a well-documented adverse effect of SSRIs mediated by serotonergic inhibition
of dopaminergic pathways in the nigrostriatal tract. The PMHNP's role per NSG 526
psychopharmacology competencies includes early recognition, prescriber collaboration, and
management with dose reduction, beta-blockers (propranolol), or benzodiazepines. Simply increasing
the dose (A) would worsen symptoms, and (B) misattributes akathisia to therapeutic effects. Abrupt
discontinuation (D) risks withdrawal and is not indicated.
Q2: A patient with bipolar I disorder is being maintained on lithium 1200 mg/day. The patient presents to
clinic with coarse tremor, ataxia, and confusion. Lithium level drawn that morning is 2.4 mEq/L. Which
nursing intervention is the PRIORITY?
A. Administer the next scheduled lithium dose and reassess in 4 hours.
B. Withhold lithium, initiate intravenous hydration with normal saline, and arrange emergency
medical evaluation. [CORRECT]
C. Administer a PRN dose of lorazepam to control the tremor and discharge home.
D. Reduce the lithium dose by 50% and recheck the level in one week.
Correct Answer: B
Rationale: A lithium level of 2.4 mEq/L represents severe toxicity (therapeutic range 0.6-1.2 mEq/L).
Coarse tremor, ataxia, and confusion indicate neurotoxicity requiring immediate discontinuation, IV
normal saline to enhance renal lithium clearance, and often hemodialysis when levels exceed 2.5
mEq/L or significant neurotoxicity is present. Continuing or reducing the dose (A, D) worsens toxicity.
Benzodiazepines (C) mask symptoms without addressing the underlying cause.
Rated A Guide with Verified Answers Page 2 Confidential | For Educational Use
,NSG 526 Exam 3 | Clinical Modalities in Advanced Psychiatric Mental Health Nursing PracticeWilkes University | 2026/2027 Edition
Q3: Which statement regarding clozapine monitoring is CORRECT according to FDA-mandated REMS
requirements and NSG 526 prescribing standards?
A. Absolute neutrophil count (ANC) must be monitored weekly for the first 6 months, then
every 2 weeks for the next 6 months, then monthly thereafter. [CORRECT]
B. CBC with differential is required monthly for the duration of treatment.
C. ANC monitoring is only necessary if the patient develops signs of infection.
D. Clozapine may be dispensed with a 90-day supply after the first month of stable therapy.
Correct Answer: A
Rationale: Clozapine carries a black box warning for agranulocytosis, severe neutropenia, orthostatic
hypotension, seizures, myocarditis, and increased mortality in elderly patients with dementia. The FDA
REMS program mandates weekly ANC monitoring for weeks 1-26, biweekly for weeks 27-52, and
monthly thereafter if ANC remains acceptable. Treatment must be discontinued if ANC falls below
1000/mm³. Options B, C, and D violate REMS requirements and would compromise patient safety.
Q4: A 28-year-old male is prescribed phenelzine, an MAOI, for treatment-resistant depression. He presents
to the emergency department with hypertensive crisis (BP 220/130), severe headache, and sweating after
eating a meal containing aged cheeses and cured sausage. Which pathophysiologic mechanism BEST
explains this presentation?
A. Serotonin syndrome caused by excessive serotonergic activity in the central nervous system.
B. Tyramine-induced displacement of norepinephrine from sympathetic nerve terminals due to
MAO-A inhibition. [CORRECT]
C. Anticholinergic toxicity from cross-reaction with dietary choline precursors.
D. Cytochrome P450 2D6 inhibition leading to accumulation of dietary tyramine.
Correct Answer: B
Rationale: MAO-A isoenzyme metabolizes dietary tyramine in the gut wall and liver. When inhibited
by phenelzine, ingested tyramine from fermented foods (aged cheeses, cured meats, fermented soy,
beer) enters systemic circulation and displaces norepinephrine from sympathetic nerve terminals,
producing hypertensive crisis. Serotonin syndrome (A) requires concomitant serotonergic agents.
Anticholinergic toxicity (C) does not present with hypertension of this magnitude. CYP 2D6 (D) is not
relevant to MAOI-tyramine interactions.
Rated A Guide with Verified Answers Page 3 Confidential | For Educational Use
, NSG 526 Exam 3 | Clinical Modalities in Advanced Psychiatric Mental Health Nursing PracticeWilkes University | 2026/2027 Edition
Q5: A patient with schizophrenia has been stabilized on haloperidol decanoate 100 mg IM every 4 weeks.
The patient now reports persistent lip smacking, tongue protrusion, and finger movements that began
gradually over the past 6 months. Which adverse effect is MOST likely, and what is the appropriate nursing
response?
A. Acute dystonia; administer diphenhydramine 50 mg IM immediately.
B. Tardive dyskinesia; document findings with AIMS, consult prescriber about switching to a
lower-risk agent such as aripiprazole or clozapine. [CORRECT]
C. Parkinsonism secondary to dopamine blockade; reduce antipsychotic dose by 25%.
D. Pseudoakathisia; reassure the patient and continue current therapy.
Correct Answer: B
Rationale: The presentation of orofacial and extremity choreoathetoid movements after prolonged
first-generation antipsychotic exposure is classic for tardive dyskinesia (TD), which occurs in
approximately 5% of patients per year of treatment with typical antipsychotics. The Abnormal
Involuntary Movement Scale (AIMS) is the standardized assessment tool. Management includes
risk-vs-benefit discussion, consideration of switching to lower-risk agents (aripiprazole, clozapine),
VMAT2 inhibitors (valbenazine, deutetrabenazine), and avoiding dose escalation. Acute dystonia (A)
occurs early and is reversible; parkinsonism (C) presents with bradykinesia, rigidity, and pill-rolling
tremor.
Q6: A 67-year-old male with treatment-resistant depression is scheduled for electroconvulsive therapy
(ECT). The PMHNP is providing pre-procedure patient education. Which statement by the patient indicates
a need for FURTHER teaching?
A. I will need to fast from midnight before each ECT session to reduce aspiration risk.
B. I should continue taking my lithium and valproic acid the morning of the procedure.
[CORRECT]
C. I may experience some short-term memory loss that usually resolves over several weeks.
D. A psychiatrist and anesthesiologist will both be present during the procedure.
Correct Answer: B
Rationale: Lithium should typically be held the night before and morning of ECT because it can
prolong the seizure and increase delirium risk post-treatment. Most psychotropics (especially
benzodiazepines, anticonvulsants, and lithium) are held or adjusted before ECT to optimize seizure
threshold and duration. Fasting (A), memory loss education (C), and team presence (D) all reflect
correct understanding. The NSG 526 somatic therapies module emphasizes pre-ECT medication
review as a critical nursing responsibility.
Rated A Guide with Verified Answers Page 4 Confidential | For Educational Use
NSG526 / NSG 526 EXAM 3 ( UPDATE)
Clinical Modalities in Advanced Psychiatric Mental Health Nursing Practice
Rated A Guide with Verified Answers | Wilkes University
Total Questions: 100 (Multiple Choice, A-D)
Sections: 6 sections covering NSG 526 core domains
Cognitive Distribution: 20% Recall | 50% Application | 30% Analysis
Format: 75% Scenario-based | 25% Direct Knowledge
Aligned With: AACN Essentials, PMHNP Competencies, NSG 526 Syllabus
Examination Instructions: This comprehensive examination consists of 100 multiple-choice questions across six
sections. Each question has four options (A-D) with exactly one best answer. Select the option that represents the
MOST appropriate clinical decision based on current evidence-based psychiatric-mental health nursing practice.
Verified answers and detailed rationales appear immediately following each question. This guide is aligned with the
Wilkes University NSG 526 course syllabus, AACN Essentials of Master's Education in Nursing, and PMHNP
Clinical Modalities Competencies (2026/2027 Edition).
Section 1: Advanced Psychopharmacology & Somatic Therapies
This section evaluates knowledge of psychopharmacologic agents, somatic therapies, medication management, monitoring
parameters, and prescriptive authority considerations across psychiatric conditions. Questions emphasize clinical
decision-making, adverse effect recognition, and evidence-based prescribing aligned with the NSG 526 curriculum and
PMHNP competencies.
Rated A Guide with Verified Answers Page 1 Confidential | For Educational Use
,NSG 526 Exam 3 | Clinical Modalities in Advanced Psychiatric Mental Health Nursing PracticeWilkes University | 2026/2027 Edition
Q1: A 34-year-old female with major depressive disorder has been started on fluoxetine 20 mg daily. Four
weeks later she reports new-onset restlessness, inability to sit still, and an inner sense of discomfort. Vital
signs are stable. Which of the following is the MOST appropriate initial nursing action?
A. Increase the fluoxetine dose to 40 mg daily to optimize therapeutic response.
B. Document the symptoms as expected SSRI therapeutic effects and reassure the patient.
C. Recognize the presentation as akathisia, contact the prescriber, and consider dose reduction
or beta-blocker addition. [CORRECT]
D. Discontinue fluoxetine immediately and switch to a tricyclic antidepressant.
Correct Answer: C
Rationale: Akathisia is a well-documented adverse effect of SSRIs mediated by serotonergic inhibition
of dopaminergic pathways in the nigrostriatal tract. The PMHNP's role per NSG 526
psychopharmacology competencies includes early recognition, prescriber collaboration, and
management with dose reduction, beta-blockers (propranolol), or benzodiazepines. Simply increasing
the dose (A) would worsen symptoms, and (B) misattributes akathisia to therapeutic effects. Abrupt
discontinuation (D) risks withdrawal and is not indicated.
Q2: A patient with bipolar I disorder is being maintained on lithium 1200 mg/day. The patient presents to
clinic with coarse tremor, ataxia, and confusion. Lithium level drawn that morning is 2.4 mEq/L. Which
nursing intervention is the PRIORITY?
A. Administer the next scheduled lithium dose and reassess in 4 hours.
B. Withhold lithium, initiate intravenous hydration with normal saline, and arrange emergency
medical evaluation. [CORRECT]
C. Administer a PRN dose of lorazepam to control the tremor and discharge home.
D. Reduce the lithium dose by 50% and recheck the level in one week.
Correct Answer: B
Rationale: A lithium level of 2.4 mEq/L represents severe toxicity (therapeutic range 0.6-1.2 mEq/L).
Coarse tremor, ataxia, and confusion indicate neurotoxicity requiring immediate discontinuation, IV
normal saline to enhance renal lithium clearance, and often hemodialysis when levels exceed 2.5
mEq/L or significant neurotoxicity is present. Continuing or reducing the dose (A, D) worsens toxicity.
Benzodiazepines (C) mask symptoms without addressing the underlying cause.
Rated A Guide with Verified Answers Page 2 Confidential | For Educational Use
,NSG 526 Exam 3 | Clinical Modalities in Advanced Psychiatric Mental Health Nursing PracticeWilkes University | 2026/2027 Edition
Q3: Which statement regarding clozapine monitoring is CORRECT according to FDA-mandated REMS
requirements and NSG 526 prescribing standards?
A. Absolute neutrophil count (ANC) must be monitored weekly for the first 6 months, then
every 2 weeks for the next 6 months, then monthly thereafter. [CORRECT]
B. CBC with differential is required monthly for the duration of treatment.
C. ANC monitoring is only necessary if the patient develops signs of infection.
D. Clozapine may be dispensed with a 90-day supply after the first month of stable therapy.
Correct Answer: A
Rationale: Clozapine carries a black box warning for agranulocytosis, severe neutropenia, orthostatic
hypotension, seizures, myocarditis, and increased mortality in elderly patients with dementia. The FDA
REMS program mandates weekly ANC monitoring for weeks 1-26, biweekly for weeks 27-52, and
monthly thereafter if ANC remains acceptable. Treatment must be discontinued if ANC falls below
1000/mm³. Options B, C, and D violate REMS requirements and would compromise patient safety.
Q4: A 28-year-old male is prescribed phenelzine, an MAOI, for treatment-resistant depression. He presents
to the emergency department with hypertensive crisis (BP 220/130), severe headache, and sweating after
eating a meal containing aged cheeses and cured sausage. Which pathophysiologic mechanism BEST
explains this presentation?
A. Serotonin syndrome caused by excessive serotonergic activity in the central nervous system.
B. Tyramine-induced displacement of norepinephrine from sympathetic nerve terminals due to
MAO-A inhibition. [CORRECT]
C. Anticholinergic toxicity from cross-reaction with dietary choline precursors.
D. Cytochrome P450 2D6 inhibition leading to accumulation of dietary tyramine.
Correct Answer: B
Rationale: MAO-A isoenzyme metabolizes dietary tyramine in the gut wall and liver. When inhibited
by phenelzine, ingested tyramine from fermented foods (aged cheeses, cured meats, fermented soy,
beer) enters systemic circulation and displaces norepinephrine from sympathetic nerve terminals,
producing hypertensive crisis. Serotonin syndrome (A) requires concomitant serotonergic agents.
Anticholinergic toxicity (C) does not present with hypertension of this magnitude. CYP 2D6 (D) is not
relevant to MAOI-tyramine interactions.
Rated A Guide with Verified Answers Page 3 Confidential | For Educational Use
, NSG 526 Exam 3 | Clinical Modalities in Advanced Psychiatric Mental Health Nursing PracticeWilkes University | 2026/2027 Edition
Q5: A patient with schizophrenia has been stabilized on haloperidol decanoate 100 mg IM every 4 weeks.
The patient now reports persistent lip smacking, tongue protrusion, and finger movements that began
gradually over the past 6 months. Which adverse effect is MOST likely, and what is the appropriate nursing
response?
A. Acute dystonia; administer diphenhydramine 50 mg IM immediately.
B. Tardive dyskinesia; document findings with AIMS, consult prescriber about switching to a
lower-risk agent such as aripiprazole or clozapine. [CORRECT]
C. Parkinsonism secondary to dopamine blockade; reduce antipsychotic dose by 25%.
D. Pseudoakathisia; reassure the patient and continue current therapy.
Correct Answer: B
Rationale: The presentation of orofacial and extremity choreoathetoid movements after prolonged
first-generation antipsychotic exposure is classic for tardive dyskinesia (TD), which occurs in
approximately 5% of patients per year of treatment with typical antipsychotics. The Abnormal
Involuntary Movement Scale (AIMS) is the standardized assessment tool. Management includes
risk-vs-benefit discussion, consideration of switching to lower-risk agents (aripiprazole, clozapine),
VMAT2 inhibitors (valbenazine, deutetrabenazine), and avoiding dose escalation. Acute dystonia (A)
occurs early and is reversible; parkinsonism (C) presents with bradykinesia, rigidity, and pill-rolling
tremor.
Q6: A 67-year-old male with treatment-resistant depression is scheduled for electroconvulsive therapy
(ECT). The PMHNP is providing pre-procedure patient education. Which statement by the patient indicates
a need for FURTHER teaching?
A. I will need to fast from midnight before each ECT session to reduce aspiration risk.
B. I should continue taking my lithium and valproic acid the morning of the procedure.
[CORRECT]
C. I may experience some short-term memory loss that usually resolves over several weeks.
D. A psychiatrist and anesthesiologist will both be present during the procedure.
Correct Answer: B
Rationale: Lithium should typically be held the night before and morning of ECT because it can
prolong the seizure and increase delirium risk post-treatment. Most psychotropics (especially
benzodiazepines, anticonvulsants, and lithium) are held or adjusted before ECT to optimize seizure
threshold and duration. Fasting (A), memory loss education (C), and team presence (D) all reflect
correct understanding. The NSG 526 somatic therapies module emphasizes pre-ECT medication
review as a critical nursing responsibility.
Rated A Guide with Verified Answers Page 4 Confidential | For Educational Use
