NR548 Exam 3 Actual Exam Style V3 | NR
548 Psychiatric Assessment for
Psychiatric-Mental Health Nurse
Practitioner Chamberlain
1. A patient on Clozapine presents with a fever and sore throat. What is the most critical
assessment the PMHNP must perform?
A. Check for a rash on the trunk
B. Order an immediate Absolute Neutrophil Count (ANC)
C. Assess for muscle rigidity
D. Perform an AIMS test
Correct Answer: B
Expert Explanation: Clozapine is associated with a risk of agranulocytosis, which
significantly lowers the white blood cell count. A fever and sore throat are early indicators
of potential infection due to low neutrophil levels. Immediate monitoring of the Absolute
Neutrophil Count is required to ensure patient safety and determine if the medication must
be discontinued.
2. During a Mental Status Exam, the PMHNP observes a patient moving from one topic to
another with only a marginal logic connection. This is described as:
A. Flight of ideas
B. Loose associations
,C. Tangentiality
D. Circumstantiality
Correct Answer: B
Expert Explanation: Loose associations occur when a patient’s thoughts are poorly
connected or lack a clear logical relationship. Unlike flight of ideas, which is rapid but often
has some discernible connection, loose associations are more fragmented. This symptom is
frequently seen in patients experiencing psychosis or schizophrenia.
3. When differentiating between Bipolar I and Bipolar II Disorder, which clinical feature is
required for a Bipolar I diagnosis?
A. At least one hypomanic episode
B. A history of major depressive episodes
C. At least one manic episode
D. Symptoms lasting at least two consecutive years
Correct Answer: C
Expert Explanation: Bipolar I Disorder requires the occurrence of at least one manic
episode lasting at least one week. While depressive episodes are common, they are not
strictly required for the Bipolar I diagnosis in the way they are for Bipolar II. Bipolar II
requires a hypomanic episode and a major depressive episode but never a full manic
episode.
, 4. A 72-year-old patient presents with acute onset confusion, fluctuating consciousness, and
visual hallucinations. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Delirium
C. Vascular Dementia
D. Major Depressive Disorder with Psychotic Features
Correct Answer: B
Expert Explanation: The acute onset and fluctuating nature of symptoms are hallmark
signs of delirium rather than a progressive dementia. Delirium is often caused by an
underlying medical condition, such as a urinary tract infection or metabolic imbalance in
older adults. Assessment must focus on identifying and treating the reversible cause to
prevent further cognitive decline.
5. Which laboratory value is most important to monitor in a patient being treated with
Valproic Acid (Depakote)?
A. Thyroid Stimulating Hormone (TSH)
B. Serum Creatinine
C. Liver Function Tests (LFTs)
D. Blood Urea Nitrogen (BUN)
D. AIMS
548 Psychiatric Assessment for
Psychiatric-Mental Health Nurse
Practitioner Chamberlain
1. A patient on Clozapine presents with a fever and sore throat. What is the most critical
assessment the PMHNP must perform?
A. Check for a rash on the trunk
B. Order an immediate Absolute Neutrophil Count (ANC)
C. Assess for muscle rigidity
D. Perform an AIMS test
Correct Answer: B
Expert Explanation: Clozapine is associated with a risk of agranulocytosis, which
significantly lowers the white blood cell count. A fever and sore throat are early indicators
of potential infection due to low neutrophil levels. Immediate monitoring of the Absolute
Neutrophil Count is required to ensure patient safety and determine if the medication must
be discontinued.
2. During a Mental Status Exam, the PMHNP observes a patient moving from one topic to
another with only a marginal logic connection. This is described as:
A. Flight of ideas
B. Loose associations
,C. Tangentiality
D. Circumstantiality
Correct Answer: B
Expert Explanation: Loose associations occur when a patient’s thoughts are poorly
connected or lack a clear logical relationship. Unlike flight of ideas, which is rapid but often
has some discernible connection, loose associations are more fragmented. This symptom is
frequently seen in patients experiencing psychosis or schizophrenia.
3. When differentiating between Bipolar I and Bipolar II Disorder, which clinical feature is
required for a Bipolar I diagnosis?
A. At least one hypomanic episode
B. A history of major depressive episodes
C. At least one manic episode
D. Symptoms lasting at least two consecutive years
Correct Answer: C
Expert Explanation: Bipolar I Disorder requires the occurrence of at least one manic
episode lasting at least one week. While depressive episodes are common, they are not
strictly required for the Bipolar I diagnosis in the way they are for Bipolar II. Bipolar II
requires a hypomanic episode and a major depressive episode but never a full manic
episode.
, 4. A 72-year-old patient presents with acute onset confusion, fluctuating consciousness, and
visual hallucinations. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Delirium
C. Vascular Dementia
D. Major Depressive Disorder with Psychotic Features
Correct Answer: B
Expert Explanation: The acute onset and fluctuating nature of symptoms are hallmark
signs of delirium rather than a progressive dementia. Delirium is often caused by an
underlying medical condition, such as a urinary tract infection or metabolic imbalance in
older adults. Assessment must focus on identifying and treating the reversible cause to
prevent further cognitive decline.
5. Which laboratory value is most important to monitor in a patient being treated with
Valproic Acid (Depakote)?
A. Thyroid Stimulating Hormone (TSH)
B. Serum Creatinine
C. Liver Function Tests (LFTs)
D. Blood Urea Nitrogen (BUN)
D. AIMS
