1|Page
NR 668 FINAL EXAM NEWEST 2026/ 2027 ACTUAL
EXAM TEST BANK| NR668 PSYCHIATRIC-MENTAL
HEALTH CAPSTONE PRACTICUM & INTENSIVE
FINAL EXAM REVIEW WITH COMPLETE 500 REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (MOST RECENT!!)
A 42-year-old woman with bipolar I disorder presents with increased
energy, decreased need for sleep, pressured speech, and impulsive
spending. She has been taking lithium 900 mg/day and her serum
lithium level is 0.4 mEq/L. Which intervention is the PMHNP's priority?
a) Add sertraline 50 mg/day immediately
b) Increase lithium dosage and obtain repeat serum level
c) Discontinue lithium and start fluoxetine
d) Recommend psychotherapy only - Correct Answer - b) Increase
lithium dosage and obtain repeat serum level
A lithium level of 0.4 mEq/L is subtherapeutic for acute mania. The
priority is optimization of the mood stabilizer while monitoring for
toxicity and renal function.
A 67-year-old man with schizophrenia is receiving clozapine. His
absolute neutrophil count is 450/µL. What action should the PMHNP
take?
a) Continue clozapine and repeat CBC in 1 month
b) Increase the clozapine dose
c) Hold clozapine and notify the prescriber immediately
,2|Page
d) Add benztropine 1 mg twice daily - Correct Answer - c) Hold
clozapine and notify the prescriber immediately
ANC below 500/µL indicates severe neutropenia/agranulocytosis risk.
Clozapine must be stopped and appropriate monitoring initiated.
A patient taking sertraline, tramadol, and linezolid develops agitation,
diaphoresis, hyperreflexia, tremor, and fever. Which condition is most
likely?
a) Neuroleptic malignant syndrome
b) Serotonin syndrome
c) Anticholinergic toxicity
d) Alcohol withdrawal - Correct Answer - b) Serotonin syndrome
The combination of serotonergic agents plus autonomic instability,
hyperreflexia, and clonus is classic for serotonin syndrome.
A 29-year-old woman presents with sadness, anhedonia, insomnia, and
low energy for 5 weeks after the death of her spouse. She denies suicidal
ideation, psychosis, or functional collapse. Which diagnosis is most
appropriate?
a) Persistent depressive disorder
b) Major depressive disorder
c) Normal bereavement/grief reaction
d) Bipolar II disorder - Correct Answer - c) Normal bereavement/grief
reaction
The symptoms are temporally related to a major loss and do not yet
demonstrate severe impairment, psychosis, or suicidal intent requiring a
major depressive diagnosis.
,3|Page
A 36-year-old woman with panic disorder has failed trials of sertraline
and escitalopram. She experiences daily panic attacks and significant
avoidance behavior. Which next step is most evidence-based?
a) Begin cognitive behavioral therapy
b) Start disulfiram
c) Prescribe lithium
d) Recommend no treatment - Correct Answer - a) Begin cognitive
behavioral therapy
CBT is a first-line treatment for panic disorder and is particularly
valuable when medication response is incomplete.
A patient with treatment-resistant schizophrenia has persistent
hallucinations despite adequate trials of risperidone, olanzapine, and
aripiprazole. Which medication is indicated?
a) Clozapine
b) Fluoxetine
c) Buspirone
d) Lamotrigine - Correct Answer - a) Clozapine
Clozapine is the gold-standard treatment for treatment-resistant
schizophrenia after failure of at least two antipsychotic trials.
A 58-year-old patient with alcohol use disorder presents 12 hours after
the last drink with tremors, tachycardia, hypertension, and anxiety.
Which medication is the first-line treatment?
a) Haloperidol
b) Lorazepam
c) Fluoxetine
, 4|Page
d) Methylphenidate - Correct Answer - b) Lorazepam
Benzodiazepines are first-line for alcohol withdrawal because they
reduce the risk of seizures and delirium tremens.
A patient taking an MAOI develops a severe occipital headache, blood
pressure of 220/118 mm Hg, diaphoresis, and palpitations after eating
aged cheese. What is the priority diagnosis?
a) Hypertensive crisis
b) Lithium toxicity
c) Serotonin syndrome
d) Benzodiazepine withdrawal - Correct Answer - a) Hypertensive crisis
Tyramine ingestion while taking an MAOI can precipitate life-
threatening hypertensive crisis requiring emergency treatment.
A 40-year-old patient with PTSD has nightmares, hypervigilance, and
avoidance after a traumatic assault. Which medication has evidence for
trauma-related nightmares?
a) Prazosin
b) Benztropine
c) Lithium
d) Memantine - Correct Answer - a) Prazosin
Prazosin is commonly used to reduce PTSD-associated nightmares and
sleep disruption.
A 68-year-old man with no past psychiatric history but with a history of
poly substance use disorder is admitted for psychosis (disorganized
thoughts, rapid pressured speech, persistent rumination, paranoid
NR 668 FINAL EXAM NEWEST 2026/ 2027 ACTUAL
EXAM TEST BANK| NR668 PSYCHIATRIC-MENTAL
HEALTH CAPSTONE PRACTICUM & INTENSIVE
FINAL EXAM REVIEW WITH COMPLETE 500 REAL
EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (MOST RECENT!!)
A 42-year-old woman with bipolar I disorder presents with increased
energy, decreased need for sleep, pressured speech, and impulsive
spending. She has been taking lithium 900 mg/day and her serum
lithium level is 0.4 mEq/L. Which intervention is the PMHNP's priority?
a) Add sertraline 50 mg/day immediately
b) Increase lithium dosage and obtain repeat serum level
c) Discontinue lithium and start fluoxetine
d) Recommend psychotherapy only - Correct Answer - b) Increase
lithium dosage and obtain repeat serum level
A lithium level of 0.4 mEq/L is subtherapeutic for acute mania. The
priority is optimization of the mood stabilizer while monitoring for
toxicity and renal function.
A 67-year-old man with schizophrenia is receiving clozapine. His
absolute neutrophil count is 450/µL. What action should the PMHNP
take?
a) Continue clozapine and repeat CBC in 1 month
b) Increase the clozapine dose
c) Hold clozapine and notify the prescriber immediately
,2|Page
d) Add benztropine 1 mg twice daily - Correct Answer - c) Hold
clozapine and notify the prescriber immediately
ANC below 500/µL indicates severe neutropenia/agranulocytosis risk.
Clozapine must be stopped and appropriate monitoring initiated.
A patient taking sertraline, tramadol, and linezolid develops agitation,
diaphoresis, hyperreflexia, tremor, and fever. Which condition is most
likely?
a) Neuroleptic malignant syndrome
b) Serotonin syndrome
c) Anticholinergic toxicity
d) Alcohol withdrawal - Correct Answer - b) Serotonin syndrome
The combination of serotonergic agents plus autonomic instability,
hyperreflexia, and clonus is classic for serotonin syndrome.
A 29-year-old woman presents with sadness, anhedonia, insomnia, and
low energy for 5 weeks after the death of her spouse. She denies suicidal
ideation, psychosis, or functional collapse. Which diagnosis is most
appropriate?
a) Persistent depressive disorder
b) Major depressive disorder
c) Normal bereavement/grief reaction
d) Bipolar II disorder - Correct Answer - c) Normal bereavement/grief
reaction
The symptoms are temporally related to a major loss and do not yet
demonstrate severe impairment, psychosis, or suicidal intent requiring a
major depressive diagnosis.
,3|Page
A 36-year-old woman with panic disorder has failed trials of sertraline
and escitalopram. She experiences daily panic attacks and significant
avoidance behavior. Which next step is most evidence-based?
a) Begin cognitive behavioral therapy
b) Start disulfiram
c) Prescribe lithium
d) Recommend no treatment - Correct Answer - a) Begin cognitive
behavioral therapy
CBT is a first-line treatment for panic disorder and is particularly
valuable when medication response is incomplete.
A patient with treatment-resistant schizophrenia has persistent
hallucinations despite adequate trials of risperidone, olanzapine, and
aripiprazole. Which medication is indicated?
a) Clozapine
b) Fluoxetine
c) Buspirone
d) Lamotrigine - Correct Answer - a) Clozapine
Clozapine is the gold-standard treatment for treatment-resistant
schizophrenia after failure of at least two antipsychotic trials.
A 58-year-old patient with alcohol use disorder presents 12 hours after
the last drink with tremors, tachycardia, hypertension, and anxiety.
Which medication is the first-line treatment?
a) Haloperidol
b) Lorazepam
c) Fluoxetine
, 4|Page
d) Methylphenidate - Correct Answer - b) Lorazepam
Benzodiazepines are first-line for alcohol withdrawal because they
reduce the risk of seizures and delirium tremens.
A patient taking an MAOI develops a severe occipital headache, blood
pressure of 220/118 mm Hg, diaphoresis, and palpitations after eating
aged cheese. What is the priority diagnosis?
a) Hypertensive crisis
b) Lithium toxicity
c) Serotonin syndrome
d) Benzodiazepine withdrawal - Correct Answer - a) Hypertensive crisis
Tyramine ingestion while taking an MAOI can precipitate life-
threatening hypertensive crisis requiring emergency treatment.
A 40-year-old patient with PTSD has nightmares, hypervigilance, and
avoidance after a traumatic assault. Which medication has evidence for
trauma-related nightmares?
a) Prazosin
b) Benztropine
c) Lithium
d) Memantine - Correct Answer - a) Prazosin
Prazosin is commonly used to reduce PTSD-associated nightmares and
sleep disruption.
A 68-year-old man with no past psychiatric history but with a history of
poly substance use disorder is admitted for psychosis (disorganized
thoughts, rapid pressured speech, persistent rumination, paranoid
