Actual Chamberlain NR607 pre-diagnostic exam
practice set PMHNP diagnostic reasoning,
psychopathology, psychopharmacology, medical
rule-outs, and ethics/content areas Latest Update
This Year Instant Download Pdf
Q1. A 32-year-old patient reports persistent low mood, anhedonia, and fatigue for 3
weeks after a job loss. Which diagnosis is most appropriate at this time?*
Answer: Adjustment disorder with depressed mood is most appropriate at this time.
Explanation: Symptoms are tied to a stressor and duration is under 2 weeks for major
depression criteria; adjustment disorder fits best.
Q2. A 45-year-old patient with schizophrenia develops rigidity, tremor, and
bradykinesia after starting haloperidol. Which medication is most appropriate to treat
these symptoms?*
Answer: Benztropine or amantadine is most appropriate to treat these symptoms.
Explanation: These are anticholinergic or dopaminergic agents used for
antipsychotic-induced extrapyramidal symptoms.
Q3. A 28-year-old patient presents with pressured speech, decreased need for sleep,
and risky behavior for 10 days. Which diagnosis is most consistent with this
presentation?*
Answer: Bipolar I disorder, manic episode, is most consistent.
,Explanation: A distinct period of abnormally elevated mood and energy lasting at least 1
week defines mania.
Q4. A 50-year-old patient with major depression has failed two adequate SSRI trials.
Which next step is most evidence-based?*
Answer: Switching to a different class or augmenting with another agent is most
evidence-based.
Explanation: After two failures, strategies include switching to SNRI, bupropion, or
augmenting with atypical antipsychotic or lithium.
Q5. A 22-year-old college student has recurrent panic attacks and avoids classes due
to fear of another attack. Which diagnosis is most likely?*
Answer: Panic disorder with agoraphobia is most likely.
Explanation: Recurrent unexpected panic attacks plus avoidance behavior meet criteria for
panic disorder with agoraphobia.
Q6. A 35-year-old patient on lithium presents with coarse tremor, confusion, and
diarrhea. Which lab test is most important to obtain urgently?*
Answer: Serum lithium level is most important to obtain urgently.
Explanation: These symptoms suggest lithium toxicity, which requires prompt level check
and dose adjustment.
Q7. A 40-year-old patient with PTSD has severe nightmares and hypervigilance.
Which medication is most supported by evidence for nightmares?*
,Answer: Prazosin is most supported by evidence for PTSD-related nightmares.
Explanation: Alpha-1 blockade reduces adrenergic activity during sleep, improving
nightmare frequency and intensity.
Q8. A 19-year-old patient has social withdrawal, blunted affect, and odd beliefs for 8
months. Which diagnosis is most consistent?*
Answer: Schizophrenia is most consistent with this duration and symptom profile.
Explanation: Two or more core symptoms for at least 6 months with functional decline
support schizophrenia.
Q9. A 60-year-old patient with depression complains of memory loss and
psychomotor slowing. Which condition must be ruled out first?*
Answer: Neurocognitive disorder (dementia) or medical causes must be ruled out first.
Explanation: Pseudodementia from depression can mimic cognitive decline; medical workup
is essential in older adults.
Q10. A 30-year-old patient with bipolar disorder is planning pregnancy. Which mood
stabilizer is most teratogenic and should be avoided?*
Answer: Valproate is most teratogenic and should be avoided.
Explanation: Valproate carries high risk of neural tube defects and neurodevelopmental
issues in exposed fetuses.
Q11. A 25-year-old patient has intrusive memories, avoidance, and hyperarousal for 2
months after a motor vehicle accident. Which diagnosis is most appropriate?*
, Answer: Posttraumatic stress disorder is most appropriate.
Explanation: Symptoms persisting over 1 month after trauma meet criteria for PTSD.
Q12. A 48-year-old patient on clozapine develops fever, sore throat, and fatigue.
Which adverse effect is most concerning?*
Answer: Agranulocytosis is most concerning.
Explanation: Clozapine can cause severe neutropenia; infection signs require immediate
ANC check.
Q13. A 33-year-old patient has excessive worry about multiple domains for 7 months
with restlessness and muscle tension. Which diagnosis is most likely?*
Answer: Generalized anxiety disorder is most likely.
Explanation: Excessive anxiety and difficulty controlling worry for at least 6 months with
physical symptoms define GAD.
Q14. A 27-year-old patient with OCD has intrusive thoughts of contamination and
compulsive handwashing. Which therapy is most effective?*
Answer: Exposure and response prevention (ERP) is most effective.
Explanation: ERP, a form of CBT, is first-line for OCD and reduces compulsive behaviors.
Q15. A 55-year-old patient with bipolar disorder has tremor, weight gain, and
hypothyroidism. Which medication is most likely responsible?*
Answer: Lithium is most likely responsible.
Explanation: Lithium commonly causes tremor, weight gain, and can induce hypothyroidism.
practice set PMHNP diagnostic reasoning,
psychopathology, psychopharmacology, medical
rule-outs, and ethics/content areas Latest Update
This Year Instant Download Pdf
Q1. A 32-year-old patient reports persistent low mood, anhedonia, and fatigue for 3
weeks after a job loss. Which diagnosis is most appropriate at this time?*
Answer: Adjustment disorder with depressed mood is most appropriate at this time.
Explanation: Symptoms are tied to a stressor and duration is under 2 weeks for major
depression criteria; adjustment disorder fits best.
Q2. A 45-year-old patient with schizophrenia develops rigidity, tremor, and
bradykinesia after starting haloperidol. Which medication is most appropriate to treat
these symptoms?*
Answer: Benztropine or amantadine is most appropriate to treat these symptoms.
Explanation: These are anticholinergic or dopaminergic agents used for
antipsychotic-induced extrapyramidal symptoms.
Q3. A 28-year-old patient presents with pressured speech, decreased need for sleep,
and risky behavior for 10 days. Which diagnosis is most consistent with this
presentation?*
Answer: Bipolar I disorder, manic episode, is most consistent.
,Explanation: A distinct period of abnormally elevated mood and energy lasting at least 1
week defines mania.
Q4. A 50-year-old patient with major depression has failed two adequate SSRI trials.
Which next step is most evidence-based?*
Answer: Switching to a different class or augmenting with another agent is most
evidence-based.
Explanation: After two failures, strategies include switching to SNRI, bupropion, or
augmenting with atypical antipsychotic or lithium.
Q5. A 22-year-old college student has recurrent panic attacks and avoids classes due
to fear of another attack. Which diagnosis is most likely?*
Answer: Panic disorder with agoraphobia is most likely.
Explanation: Recurrent unexpected panic attacks plus avoidance behavior meet criteria for
panic disorder with agoraphobia.
Q6. A 35-year-old patient on lithium presents with coarse tremor, confusion, and
diarrhea. Which lab test is most important to obtain urgently?*
Answer: Serum lithium level is most important to obtain urgently.
Explanation: These symptoms suggest lithium toxicity, which requires prompt level check
and dose adjustment.
Q7. A 40-year-old patient with PTSD has severe nightmares and hypervigilance.
Which medication is most supported by evidence for nightmares?*
,Answer: Prazosin is most supported by evidence for PTSD-related nightmares.
Explanation: Alpha-1 blockade reduces adrenergic activity during sleep, improving
nightmare frequency and intensity.
Q8. A 19-year-old patient has social withdrawal, blunted affect, and odd beliefs for 8
months. Which diagnosis is most consistent?*
Answer: Schizophrenia is most consistent with this duration and symptom profile.
Explanation: Two or more core symptoms for at least 6 months with functional decline
support schizophrenia.
Q9. A 60-year-old patient with depression complains of memory loss and
psychomotor slowing. Which condition must be ruled out first?*
Answer: Neurocognitive disorder (dementia) or medical causes must be ruled out first.
Explanation: Pseudodementia from depression can mimic cognitive decline; medical workup
is essential in older adults.
Q10. A 30-year-old patient with bipolar disorder is planning pregnancy. Which mood
stabilizer is most teratogenic and should be avoided?*
Answer: Valproate is most teratogenic and should be avoided.
Explanation: Valproate carries high risk of neural tube defects and neurodevelopmental
issues in exposed fetuses.
Q11. A 25-year-old patient has intrusive memories, avoidance, and hyperarousal for 2
months after a motor vehicle accident. Which diagnosis is most appropriate?*
, Answer: Posttraumatic stress disorder is most appropriate.
Explanation: Symptoms persisting over 1 month after trauma meet criteria for PTSD.
Q12. A 48-year-old patient on clozapine develops fever, sore throat, and fatigue.
Which adverse effect is most concerning?*
Answer: Agranulocytosis is most concerning.
Explanation: Clozapine can cause severe neutropenia; infection signs require immediate
ANC check.
Q13. A 33-year-old patient has excessive worry about multiple domains for 7 months
with restlessness and muscle tension. Which diagnosis is most likely?*
Answer: Generalized anxiety disorder is most likely.
Explanation: Excessive anxiety and difficulty controlling worry for at least 6 months with
physical symptoms define GAD.
Q14. A 27-year-old patient with OCD has intrusive thoughts of contamination and
compulsive handwashing. Which therapy is most effective?*
Answer: Exposure and response prevention (ERP) is most effective.
Explanation: ERP, a form of CBT, is first-line for OCD and reduces compulsive behaviors.
Q15. A 55-year-old patient with bipolar disorder has tremor, weight gain, and
hypothyroidism. Which medication is most likely responsible?*
Answer: Lithium is most likely responsible.
Explanation: Lithium commonly causes tremor, weight gain, and can induce hypothyroidism.
