1|Page
NR 606 FINAL EXAM (CHAMBERLAIN) NEWEST 2026/
2027 ACTUAL EXAM TEST BANK| NR606 DIAGNOSIS &
MANAGEMENT IN PSYCHIATRIC MENTAL HEALTH
II PRACTICUM FINAL EXAM REVIEW WITH 300
REAL EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (BRAND NEW!!)
A 48-year-old man taking phenelzine for refractory depression presents
after eating aged cheese and cured meats at a party. Blood pressure is
224/126 mmHg with severe occipital headache, diaphoresis, and neck
stiffness. Which diagnosis should be suspected immediately?
a) Hypertensive crisis
b) Serotonin syndrome
c) Neuroleptic malignant syndrome
d) Acute stroke - Correct Answer - a) Hypertensive crisis
Tyramine ingestion while taking an MAOI may precipitate a life-
threatening hypertensive crisis.
A 31-year-old woman with generalized anxiety disorder has completed
six months of CBT while taking escitalopram 20 mg daily. Anxiety
remains severe and interferes with employment. She has no history of
substance misuse, bipolar disorder, or psychosis. Which medication
strategy has the strongest evidence as the next pharmacologic step?
a) Add buspirone
b) Initiate alprazolam indefinitely
c) Add haloperidol
d) Begin methylphenidate - Correct Answer - a) Add buspirone
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Buspirone is an evidence-supported augmentation strategy for persistent
generalized anxiety disorder after an adequate SSRI trial.
A 67-year-old man with major neurocognitive disorder becomes
increasingly paranoid, believing staff members are poisoning his food.
He has struck two caregivers this week. Nonpharmacologic interventions
have failed. Which medication carries the lowest effective starting dose
while acknowledging FDA boxed warning risks?
a) Risperidone
b) Bupropion
c) Lamotrigine
d) Clonazepam - Correct Answer - a) Risperidone
Low-dose atypical antipsychotics may be considered only when severe
aggression or psychosis threatens safety after nonpharmacologic
approaches fail.
A 24-year-old woman receiving lithium for bipolar I disorder presents
with coarse tremor, vomiting, diarrhea, confusion, and unsteady gait
after developing influenza. Which laboratory study is most urgent?
a) TSH
b) Lithium level
c) Hemoglobin A1c
d) Vitamin B12 - Correct Answer - b) Lithium level
Acute illness with dehydration significantly increases lithium toxicity
risk, requiring immediate serum lithium assessment.
A 15-year-old adolescent diagnosed with ADHD develops persistent
facial grimacing and shoulder shrugging three weeks after initiation of
,3|Page
amphetamine therapy. Symptoms disappear during sleep. What is the
best management decision?
a) Increase stimulant dose
b) Evaluate for stimulant-induced tic exacerbation
c) Add benztropine
d) Diagnose Tourette syndrome immediately - Correct Answer - b)
Evaluate for stimulant-induced tic exacerbation
Stimulants may worsen preexisting tic disorders or unmask mild tic
symptoms requiring reassessment.
A 38-year-old veteran reports intrusive combat memories, nightmares
four nights weekly, hypervigilance, exaggerated startle response, and
emotional detachment lasting over one year. He consumes alcohol
nightly to sleep. Which psychotherapy has the strongest evidence as
first-line treatment?
a) Exposure-based trauma-focused CBT
b) Supportive counseling alone
c) Psychoanalysis
d) Motivational interviewing only - Correct Answer - a) Exposure-based
trauma-focused CBT
Trauma-focused cognitive behavioral therapies remain first-line
evidence-based treatments for PTSD.
A patient taking valproate develops severe abdominal pain radiating to
the back, nausea, and repeated vomiting. Which adverse effect should
the PMHNP suspect first?
a) Pancreatitis
b) Gastritis
, 4|Page
c) Cholelithiasis
d) Peptic ulcer disease - Correct Answer - a) Pancreatitis
A 34-year-old woman presents with elevated mood, decreased need for
sleep, grandiosity, excessive spending, distractibility, and pressured
speech for nine consecutive days. She continues working but has
received multiple disciplinary actions. There are no psychotic
symptoms. Which diagnosis is most accurate?
a) Cyclothymic disorder
b) Bipolar II disorder
c) Bipolar I disorder
d) Persistent depressive disorder - Correct Answer - c) Bipolar I disorder
A manic episode lasting at least one week meets criteria for Bipolar I
disorder regardless of previous depression.
A 29-year-old woman reports repeated intrusive contamination fears and
spends nearly five hours daily washing her hands until bleeding occurs.
She recognizes the behavior is excessive but feels unable to stop. Which
medication is considered first-line pharmacotherapy?
a) Fluoxetine
b) Quetiapine
c) Alprazolam
d) Lamotrigine - Correct Answer - a) Fluoxetine
SSRIs at relatively higher therapeutic doses are first-line pharmacologic
treatment for OCD.
NR 606 FINAL EXAM (CHAMBERLAIN) NEWEST 2026/
2027 ACTUAL EXAM TEST BANK| NR606 DIAGNOSIS &
MANAGEMENT IN PSYCHIATRIC MENTAL HEALTH
II PRACTICUM FINAL EXAM REVIEW WITH 300
REAL EXAM QUESTIONS AND CORRECT VERIFIED
ANSWERS/ ALREADY GRADED A+ (BRAND NEW!!)
A 48-year-old man taking phenelzine for refractory depression presents
after eating aged cheese and cured meats at a party. Blood pressure is
224/126 mmHg with severe occipital headache, diaphoresis, and neck
stiffness. Which diagnosis should be suspected immediately?
a) Hypertensive crisis
b) Serotonin syndrome
c) Neuroleptic malignant syndrome
d) Acute stroke - Correct Answer - a) Hypertensive crisis
Tyramine ingestion while taking an MAOI may precipitate a life-
threatening hypertensive crisis.
A 31-year-old woman with generalized anxiety disorder has completed
six months of CBT while taking escitalopram 20 mg daily. Anxiety
remains severe and interferes with employment. She has no history of
substance misuse, bipolar disorder, or psychosis. Which medication
strategy has the strongest evidence as the next pharmacologic step?
a) Add buspirone
b) Initiate alprazolam indefinitely
c) Add haloperidol
d) Begin methylphenidate - Correct Answer - a) Add buspirone
,2|Page
Buspirone is an evidence-supported augmentation strategy for persistent
generalized anxiety disorder after an adequate SSRI trial.
A 67-year-old man with major neurocognitive disorder becomes
increasingly paranoid, believing staff members are poisoning his food.
He has struck two caregivers this week. Nonpharmacologic interventions
have failed. Which medication carries the lowest effective starting dose
while acknowledging FDA boxed warning risks?
a) Risperidone
b) Bupropion
c) Lamotrigine
d) Clonazepam - Correct Answer - a) Risperidone
Low-dose atypical antipsychotics may be considered only when severe
aggression or psychosis threatens safety after nonpharmacologic
approaches fail.
A 24-year-old woman receiving lithium for bipolar I disorder presents
with coarse tremor, vomiting, diarrhea, confusion, and unsteady gait
after developing influenza. Which laboratory study is most urgent?
a) TSH
b) Lithium level
c) Hemoglobin A1c
d) Vitamin B12 - Correct Answer - b) Lithium level
Acute illness with dehydration significantly increases lithium toxicity
risk, requiring immediate serum lithium assessment.
A 15-year-old adolescent diagnosed with ADHD develops persistent
facial grimacing and shoulder shrugging three weeks after initiation of
,3|Page
amphetamine therapy. Symptoms disappear during sleep. What is the
best management decision?
a) Increase stimulant dose
b) Evaluate for stimulant-induced tic exacerbation
c) Add benztropine
d) Diagnose Tourette syndrome immediately - Correct Answer - b)
Evaluate for stimulant-induced tic exacerbation
Stimulants may worsen preexisting tic disorders or unmask mild tic
symptoms requiring reassessment.
A 38-year-old veteran reports intrusive combat memories, nightmares
four nights weekly, hypervigilance, exaggerated startle response, and
emotional detachment lasting over one year. He consumes alcohol
nightly to sleep. Which psychotherapy has the strongest evidence as
first-line treatment?
a) Exposure-based trauma-focused CBT
b) Supportive counseling alone
c) Psychoanalysis
d) Motivational interviewing only - Correct Answer - a) Exposure-based
trauma-focused CBT
Trauma-focused cognitive behavioral therapies remain first-line
evidence-based treatments for PTSD.
A patient taking valproate develops severe abdominal pain radiating to
the back, nausea, and repeated vomiting. Which adverse effect should
the PMHNP suspect first?
a) Pancreatitis
b) Gastritis
, 4|Page
c) Cholelithiasis
d) Peptic ulcer disease - Correct Answer - a) Pancreatitis
A 34-year-old woman presents with elevated mood, decreased need for
sleep, grandiosity, excessive spending, distractibility, and pressured
speech for nine consecutive days. She continues working but has
received multiple disciplinary actions. There are no psychotic
symptoms. Which diagnosis is most accurate?
a) Cyclothymic disorder
b) Bipolar II disorder
c) Bipolar I disorder
d) Persistent depressive disorder - Correct Answer - c) Bipolar I disorder
A manic episode lasting at least one week meets criteria for Bipolar I
disorder regardless of previous depression.
A 29-year-old woman reports repeated intrusive contamination fears and
spends nearly five hours daily washing her hands until bleeding occurs.
She recognizes the behavior is excessive but feels unable to stop. Which
medication is considered first-line pharmacotherapy?
a) Fluoxetine
b) Quetiapine
c) Alprazolam
d) Lamotrigine - Correct Answer - a) Fluoxetine
SSRIs at relatively higher therapeutic doses are first-line pharmacologic
treatment for OCD.
