Psychiatric-Mental Health Nurse Practitioner Exam Nursing MCQ 2 — Questions and Answers
Question 1: A patient with bipolar I disorder is prescribed lithium. Which laboratory value requires the most immediate intervention?
- Serum lithium level of 0.8 mEq/L
- Serum lithium level of 1.8 mEq/L (Correct answer)
- Serum creatinine of 0.9 mg/dL
- TSH of 3.2 mIU/L
Correct answer: Serum lithium level of 1.8 mEq/L
A serum lithium level of 1.8 mEq/L is above the therapeutic range (0.6–1.2 mEq/L) and indicates toxicity requiring immediate intervention.
Question 2: A PMHNP is evaluating a patient who reports 'hearing voices telling me to hurt myself.' What is the priority intervention?
- Administer a PRN antipsychotic
- Assess the nature, frequency, and command quality of the hallucinations (Correct answer)
- Immediately initiate involuntary hospitalization
- Teach the patient to distract from the voices
Correct answer: Assess the nature, frequency, and command quality of the hallucinations
A thorough assessment of command hallucinations—including content, frequency, and the patient's intent to act—is the priority before determining next steps.
Question 3: Which neurotransmitter imbalance is most strongly associated with the positive symptoms of schizophrenia?
- Serotonin excess in the prefrontal cortex
- Dopamine excess in the mesolimbic pathway (Correct answer)
- GABA deficiency in the hippocampus
- Norepinephrine deficiency in the locus coeruleus
Correct answer: Dopamine excess in the mesolimbic pathway
Hyperactivity of dopamine in the mesolimbic pathway is the primary mechanism underlying positive symptoms such as hallucinations and delusions.
Question 4: A patient on clozapine develops a fever, sore throat, and absolute neutrophil count (ANC) of 400 cells/mm³. What is the appropriate action?
- Reduce the clozapine dose by 50%
- Discontinue clozapine immediately and notify the prescriber (Correct answer)
- Administer prophylactic antibiotics and continue clozapine
- Recheck the ANC in 48 hours before making changes
Correct answer: Discontinue clozapine immediately and notify the prescriber
An ANC below 500 cells/mm³ indicates severe neutropenia (agranulocytosis), requiring immediate discontinuation of clozapine to prevent fatal infection.
Question 5: A patient with PTSD is treated with Prolonged Exposure (PE) therapy. What is the core mechanism of this treatment?
- Replacing traumatic memories with positive ones through EMDR
- Reducing avoidance by systematically confronting trauma-related stimuli (Correct answer)
- Restructuring maladaptive core beliefs through Socratic questioning
- Teaching relaxation skills to manage physiological arousal
Correct answer: Reducing avoidance by systematically confronting trauma-related stimuli
PE works through extinction learning by having patients repeatedly confront avoided trauma cues, reducing fear responses over time.
Question 6: A PMHNP prescribes an SSRI for a 16-year-old with major depressive disorder. Which FDA-mandated action is required?
- Obtain written parental consent before prescribing
- Provide a black box warning about increased suicidal ideation risk in children and adolescents (Correct answer)
- Limit the prescription to a 2-week supply
- Order a baseline EEG before initiating treatment
Correct answer: Provide a black box warning about increased suicidal ideation risk in children and adolescents
The FDA requires clinicians to counsel patients and families about the black box warning for increased suicidality risk with antidepressants in those under 25.
Question 7: Which statement best describes the ethical principle of autonomy in psychiatric nursing practice?
- The provider acts in the patient's best interest even against their stated wishes
- The patient has the right to make informed decisions about their own care (Correct answer)
- Resources are distributed fairly across all patients in the system
- The nurse avoids actions that could harm the patient
Correct answer: The patient has the right to make informed decisions about their own care
Autonomy means respecting the patient's right to self-determination and informed decision-making in their own healthcare.
Psychiatric-Mental Health Nurse Practitioner Exam Nursing MCQ 2
A patient with bipolar I disorder is prescribed lithium.
Which laboratory value requires the most immediate intervention?