Psychiatric-Mental Health Nurse Practitioner Exam Comprehensive Mental Health and Psychiatric Nursing 2 — Questions and Answers
Question 1: A patient on clozapine has an ANC of 1,200 cells/mm³. What is the PMHNP's priority action?
- Continue clozapine and recheck ANC in one week
- Immediately discontinue clozapine and notify the prescriber (Correct answer)
- Reduce the clozapine dose by 50% and monitor closely
- Add lithium augmentation to support bone marrow function
Correct answer: Immediately discontinue clozapine and notify the prescriber
An ANC below 1,500 cells/mm³ (severe neutropenia threshold) requires immediate discontinuation of clozapine to prevent life-threatening agranulocytosis.
Question 2: Which neurotransmitter imbalance is most associated with the positive symptoms of schizophrenia?
- Serotonin excess in prefrontal cortex
- Dopamine excess in the mesolimbic pathway (Correct answer)
- GABA deficiency in the hippocampus
- Norepinephrine excess in the locus coeruleus
Correct answer: Dopamine excess in the mesolimbic pathway
Excess dopaminergic activity in the mesolimbic pathway is the primary mechanism underlying positive symptoms such as hallucinations and delusions in schizophrenia.
Question 3: A nurse practitioner is evaluating a 16-year-old who self-harms by cutting. Which therapeutic approach has the strongest evidence base for this population?
- Dialectical Behavior Therapy adapted for adolescents (DBT-A) (Correct answer)
- Psychodynamic therapy with weekly sessions
- Motivational interviewing focused on harm reduction
- Trauma-focused cognitive behavioral therapy (TF-CBT)
Correct answer: Dialectical Behavior Therapy adapted for adolescents (DBT-A)
DBT-A is specifically designed for suicidal and self-harming adolescents and has the strongest RCT evidence for reducing non-suicidal self-injury in this age group.
Question 4: A patient taking an MAOI needs analgesia for acute pain. Which agent is CONTRAINDICATED due to risk of serotonin syndrome?
- Acetaminophen
- Meperidine (Correct answer)
- Ibuprofen
- Ketorolac
Correct answer: Meperidine
Meperidine (pethidine) combined with MAOIs can precipitate a fatal serotonin syndrome or hypertensive crisis and is absolutely contraindicated.
Question 5: When assessing a patient using the Columbia Suicide Severity Rating Scale (C-SSRS), which finding indicates the HIGHEST level of ideation?
- Passive ideation with no intent or plan
- Active ideation with intent but no plan
- Active ideation with a specific plan and intent to act (Correct answer)
- Ideation only upon asking by the clinician
Correct answer: Active ideation with a specific plan and intent to act
On the C-SSRS, active suicidal ideation with a specific plan and intent to act represents the highest ideation severity and requires immediate intervention.
Question 6: A patient with bipolar I disorder is in a manic episode. Which medication is FDA-approved as monotherapy for acute mania?
- Lamotrigine
- Valproate (Correct answer)
- Buspirone
- Gabapentin
Correct answer: Valproate
Valproate (divalproex) is FDA-approved for acute manic episodes in bipolar I disorder and can be used as monotherapy.
Question 7: A PMHNP is initiating lithium therapy. Which baseline laboratory test is MOST critical before starting treatment?
- Hemoglobin A1c
- Serum creatinine and thyroid-stimulating hormone (TSH) (Correct answer)
- Lipid panel and fasting glucose
- Liver function tests and CBC
Correct answer: Serum creatinine and thyroid-stimulating hormone (TSH)
Renal function (creatinine/GFR) and thyroid function (TSH) must be assessed before lithium initiation because lithium is renally cleared and causes hypothyroidism with long-term use.
Psychiatric-Mental Health Nurse Practitioner Exam Comprehensive Mental Health and Psychiatric Nursing 2
A patient on clozapine has an ANC of 1,200 cells/mm³.
What is the PMHNP's priority action?