NR 547 PMHNP Midterm & Final Exam Study Guide | Chamberlain
University | Practice Questions, Answers & Rationales | 2026–2028
Edition
Prepare for the NR 547 PMHNP Midterm and Final Exams with this comprehensive study guide featuring
original practice questions, accurate answers, and detailed rationales. Covers psychiatric assessment,
differential diagnosis, DSM-5-TR disorders, psychopharmacology, therapeutic communication, substance
use disorders, mood and personality disorders, anxiety disorders, psychotic disorders, and evidence-
based clinical decision-making. Perfect for focused review, self-assessment, and building confidence
throughout the NR 547 course
QUESTION 1
A 45-year-old female with major depressive disorder has been on fluoxetine 40 mg daily
for 8 weeks with minimal improvement. She reports continued low mood, anhedonia,
and fatigue. What is the most appropriate next step?
A) Increase fluoxetine to 60 mg daily
B) Add buspirone to augment therapy
C) Switch to a different SSRI
D) Add bupropion to augment therapy
ANSWER: D) Add bupropion to augment therapy
Rationale: For patients with incomplete response to an SSRI, augmentation with bupropion
is a well-supported strategy. Bupropion's noradrenergic and dopaminergic effects
complement the serotonergic effects of SSRIs and may help address residual fatigue and
anhedonia. Increasing the dose may be considered but is not the first-line augmentation
strategy .
,QUESTION 2
A 28-year-old male with generalized anxiety disorder is started on buspirone. What is
the most important teaching point regarding this medication?
A) It has a rapid onset of action within 24-48 hours
B) It has significant abuse potential
C) It may take 2-4 weeks to achieve therapeutic effect
D) It must be taken with food for optimal absorption
ANSWER: C) It may take 2-4 weeks to achieve therapeutic effect
Rationale: Buspirone has a delayed onset of action, typically requiring 2-4 weeks to
achieve therapeutic effect. Unlike benzodiazepines, it is not immediate-acting and does
not have abuse potential. Patients must be educated about this delayed onset to prevent
premature discontinuation .
QUESTION 3
A 32-year-old female with bipolar I disorder is currently stable on lithium. She presents
with a fine tremor and reports increased thirst and urination. Her lithium level is 1.2
mEq/L. What is the most appropriate action?
A) Decrease lithium dose
B) Add propranolol for tremor management
C) Monitor symptoms and continue current dose
D) Switch to valproic acid
ANSWER: A) Decrease lithium dose
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L for maintenance. A level of
1.2 mEq/L is at the upper limit. Fine tremor, polydipsia, and polyuria are dose-related side
,effects. Decreasing the dose is the most appropriate action, as continuing at this level may
lead to toxicity .
QUESTION 4
A 22-year-old male with schizophrenia has been on risperidone 4 mg daily for 6 weeks.
He reports no change in auditory hallucinations and continues to have disorganized
thinking. What is the most appropriate next step?
A) Increase risperidone to 6 mg daily
B) Switch to clozapine
C) Add aripiprazole
D) Switch to a different antipsychotic
ANSWER: D) Switch to a different antipsychotic
Rationale: A trial of 4-6 weeks is generally adequate to assess response to an
antipsychotic. If there is no improvement, switching to a different antipsychotic is
appropriate. Clozapine is reserved for treatment-resistant schizophrenia after trials of at
least two other antipsychotics. Increasing the dose beyond the recommended range is not
typically effective .
QUESTION 5
A 55-year-old male with Parkinson's disease develops psychotic symptoms including
visual hallucinations and paranoia. Which antipsychotic is most appropriate for this
patient?
A) Haloperidol
B) Quetiapine
C) Clozapine
D) Aripiprazole
, ANSWER: C) Clozapine
Rationale: Clozapine is the antipsychotic of choice for psychosis in Parkinson's disease. It
has a low risk of extrapyramidal symptoms and does not worsen motor symptoms.
Quetiapine is sometimes used but has less evidence. Haloperidol is contraindicated due to
high EPS risk .
QUESTION 6
A 26-year-old female with panic disorder is prescribed paroxetine. She is concerned
about weight gain. Which SSRI is least associated with weight gain?
A) Paroxetine
B) Sertraline
C) Fluoxetine
D) Citalopram
ANSWER: C) Fluoxetine
Rationale: Among SSRIs, fluoxetine is the least associated with weight gain. Paroxetine is
most commonly associated with weight gain. Sertraline and citalopram have intermediate
risk. Fluoxetine may even cause initial weight loss due to its activating effects .
QUESTION 7
A 42-year-old male with bipolar II disorder is started on lamotrigine. What is the most
important adverse effect to monitor?
A) Weight gain
B) Sedation
University | Practice Questions, Answers & Rationales | 2026–2028
Edition
Prepare for the NR 547 PMHNP Midterm and Final Exams with this comprehensive study guide featuring
original practice questions, accurate answers, and detailed rationales. Covers psychiatric assessment,
differential diagnosis, DSM-5-TR disorders, psychopharmacology, therapeutic communication, substance
use disorders, mood and personality disorders, anxiety disorders, psychotic disorders, and evidence-
based clinical decision-making. Perfect for focused review, self-assessment, and building confidence
throughout the NR 547 course
QUESTION 1
A 45-year-old female with major depressive disorder has been on fluoxetine 40 mg daily
for 8 weeks with minimal improvement. She reports continued low mood, anhedonia,
and fatigue. What is the most appropriate next step?
A) Increase fluoxetine to 60 mg daily
B) Add buspirone to augment therapy
C) Switch to a different SSRI
D) Add bupropion to augment therapy
ANSWER: D) Add bupropion to augment therapy
Rationale: For patients with incomplete response to an SSRI, augmentation with bupropion
is a well-supported strategy. Bupropion's noradrenergic and dopaminergic effects
complement the serotonergic effects of SSRIs and may help address residual fatigue and
anhedonia. Increasing the dose may be considered but is not the first-line augmentation
strategy .
,QUESTION 2
A 28-year-old male with generalized anxiety disorder is started on buspirone. What is
the most important teaching point regarding this medication?
A) It has a rapid onset of action within 24-48 hours
B) It has significant abuse potential
C) It may take 2-4 weeks to achieve therapeutic effect
D) It must be taken with food for optimal absorption
ANSWER: C) It may take 2-4 weeks to achieve therapeutic effect
Rationale: Buspirone has a delayed onset of action, typically requiring 2-4 weeks to
achieve therapeutic effect. Unlike benzodiazepines, it is not immediate-acting and does
not have abuse potential. Patients must be educated about this delayed onset to prevent
premature discontinuation .
QUESTION 3
A 32-year-old female with bipolar I disorder is currently stable on lithium. She presents
with a fine tremor and reports increased thirst and urination. Her lithium level is 1.2
mEq/L. What is the most appropriate action?
A) Decrease lithium dose
B) Add propranolol for tremor management
C) Monitor symptoms and continue current dose
D) Switch to valproic acid
ANSWER: A) Decrease lithium dose
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L for maintenance. A level of
1.2 mEq/L is at the upper limit. Fine tremor, polydipsia, and polyuria are dose-related side
,effects. Decreasing the dose is the most appropriate action, as continuing at this level may
lead to toxicity .
QUESTION 4
A 22-year-old male with schizophrenia has been on risperidone 4 mg daily for 6 weeks.
He reports no change in auditory hallucinations and continues to have disorganized
thinking. What is the most appropriate next step?
A) Increase risperidone to 6 mg daily
B) Switch to clozapine
C) Add aripiprazole
D) Switch to a different antipsychotic
ANSWER: D) Switch to a different antipsychotic
Rationale: A trial of 4-6 weeks is generally adequate to assess response to an
antipsychotic. If there is no improvement, switching to a different antipsychotic is
appropriate. Clozapine is reserved for treatment-resistant schizophrenia after trials of at
least two other antipsychotics. Increasing the dose beyond the recommended range is not
typically effective .
QUESTION 5
A 55-year-old male with Parkinson's disease develops psychotic symptoms including
visual hallucinations and paranoia. Which antipsychotic is most appropriate for this
patient?
A) Haloperidol
B) Quetiapine
C) Clozapine
D) Aripiprazole
, ANSWER: C) Clozapine
Rationale: Clozapine is the antipsychotic of choice for psychosis in Parkinson's disease. It
has a low risk of extrapyramidal symptoms and does not worsen motor symptoms.
Quetiapine is sometimes used but has less evidence. Haloperidol is contraindicated due to
high EPS risk .
QUESTION 6
A 26-year-old female with panic disorder is prescribed paroxetine. She is concerned
about weight gain. Which SSRI is least associated with weight gain?
A) Paroxetine
B) Sertraline
C) Fluoxetine
D) Citalopram
ANSWER: C) Fluoxetine
Rationale: Among SSRIs, fluoxetine is the least associated with weight gain. Paroxetine is
most commonly associated with weight gain. Sertraline and citalopram have intermediate
risk. Fluoxetine may even cause initial weight loss due to its activating effects .
QUESTION 7
A 42-year-old male with bipolar II disorder is started on lamotrigine. What is the most
important adverse effect to monitor?
A) Weight gain
B) Sedation
