NR 607 FINAL EXAM PREP – DIAGNOSIS & MANAGEMENT IN PSYCHIATRIC-MENTAL HEALTH
PRACTICUM III
Complete Practice Examination – 250 Questions with Verified
Answers & Detailed Rationales
Chamberlain University | PMHNP Program | 2026 Edition
SECTION 1: PSYCHIATRIC ASSESSMENT & DIFFERENTIAL
DIAGNOSIS (Questions 1-50)
Question 1
1. A 32-year-old woman reports depressed mood, anhedonia, fatigue, and poor concentration
for 3 weeks. She also has increased appetite and sleeps 11 hours per night. What is the most
likely diagnosis?
A) Major Depressive Disorder, melancholic features
B) Major Depressive Disorder, atypical features
C) Persistent Depressive Disorder (Dysthymia)
D) Bipolar II Disorder, depressive episode
Answer
Answer B: Major Depressive Disorder, atypical features
Rationale
Atypical features of depression include hypersomnia, increased appetite/weight gain, leaden paralysis,
and mood reactivity. The patient's symptoms of increased sleep (11 hours) and increased appetite are
characteristic of atypical depression. ---
,Question 2
2. A patient experiences recurrent panic attacks followed by 4 months of persistent worry
about having another attack. He avoids the gym where the first attack occurred. What
diagnosis best fits?
A) Panic Disorder without Agoraphobia
B) Panic Disorder with Agoraphobia
C) Agoraphobia without Panic Disorder
D) Generalized Anxiety Disorder
Answer
Answer B: Panic Disorder with Agoraphobia
Rationale
Panic Disorder requires recurrent unexpected panic attacks followed by ≥1 month of persistent
concern/worry about additional attacks or a significant maladaptive change in behavior related to the
attacks. This patient has 4 months of worry and avoids the location where the attack occurred, meeting
criteria for agoraphobia. ---
Question 3
3. A 45-year-old patient on Lithium for Bipolar I Disorder presents with coarse tremors, ataxia,
and a serum lithium level of 1.8 mEq/L. What is the most appropriate action?
A) Increase the Lithium dose
B) Hold Lithium, assess for signs of toxicity, and consider IV fluids if indicated
C) Add a beta-blocker for tremor control
D) Continue current dose and monitor
Answer
Answer B: Hold Lithium, assess for signs of toxicity, and consider IV fluids if indicated
Rationale
A lithium level of 1.8 mEq/L with coarse tremors and ataxia indicates lithium toxicity. The therapeutic
range is 0.6-1.2 mEq/L. The lithium should be held, and the patient should be assessed for signs of
toxicity (gastrointestinal symptoms, confusion, seizures). ---
Question 4
,4. A PMHNP is evaluating a 10-year-old boy referred by the school nurse because of persistent
stomachache every morning before school. The boy does not like to go to school and insists
on coming home immediately after arrival. What is the most likely diagnosis?
A) Illness Anxiety Disorder
B) Separation Anxiety Disorder
C) Social Anxiety Disorder
D) Somatic Symptom Disorder
Answer
Answer B: Separation Anxiety Disorder
Rationale
Separation anxiety disorder involves developmentally inappropriate and excessive fear/anxiety
concerning separation from attachment figures. Physical symptoms (stomachaches) are common,
especially on school days. ---
Question 5
5. A 60-year-old male with a history of traumatic brain injury (TBI) is prescribed bupropion for
depression. For which adverse effect should the client carefully monitor?
A) Memory loss
B) Sleep disturbances
C) Seizures
D) Aggression
Answer
Answer B: Seizures
Rationale
Bupropion lowers the seizure threshold. Patients with a history of TBI have an increased baseline
seizure risk. The client should monitor for seizure activity or new neurologic changes. ---
Question 6
6. A client with major depressive disorder has been on an SSRI for 8 weeks with minimal
response. What is the next best step according to STARD guidelines?
A) Switch to a different SSRI
, B) Augment with a second-generation antipsychotic (e.g., aripiprazole)
C) Add lithium
D) Increase the SSRI dose to maximum
Answer
Answer B: Augment with a second-generation antipsychotic (e.g., aripiprazole)
Rationale
For treatment-resistant depression after an adequate SSRI trial, augmentation with a second-
generation antipsychotic (e.g., aripiprazole) is first-line per STARD and CANMAT guidelines. ---
Question 7
7. A patient presents with auditory hallucinations, delusions of persecution, disorganized
speech, and negative symptoms for 8 months. What is the most likely diagnosis?
A) Schizophreniform Disorder
B) Schizophrenia
C) Brief Psychotic Disorder
D) Delusional Disorder
Answer
Answer B: Schizophrenia
Rationale
Schizophrenia requires two or more symptoms (delusions, hallucinations, disorganized speech,
grossly disorganized/catatonic behavior, negative symptoms) for a significant portion of time during a
1-month period, with continuous signs of disturbance persisting for at least 6 months. ---
Question 8
8. A 28-year-old female presents with episodes of elevated mood, decreased need for sleep,
grandiosity, and increased goal-directed activity lasting 5 days. She has had two similar
episodes in the past year, each lasting 4-7 days. She also experiences depressive episodes
lasting 2-3 weeks. What is the most likely diagnosis?
A) Bipolar I Disorder
B) Bipolar II Disorder
C) Cyclothymic Disorder
PRACTICUM III
Complete Practice Examination – 250 Questions with Verified
Answers & Detailed Rationales
Chamberlain University | PMHNP Program | 2026 Edition
SECTION 1: PSYCHIATRIC ASSESSMENT & DIFFERENTIAL
DIAGNOSIS (Questions 1-50)
Question 1
1. A 32-year-old woman reports depressed mood, anhedonia, fatigue, and poor concentration
for 3 weeks. She also has increased appetite and sleeps 11 hours per night. What is the most
likely diagnosis?
A) Major Depressive Disorder, melancholic features
B) Major Depressive Disorder, atypical features
C) Persistent Depressive Disorder (Dysthymia)
D) Bipolar II Disorder, depressive episode
Answer
Answer B: Major Depressive Disorder, atypical features
Rationale
Atypical features of depression include hypersomnia, increased appetite/weight gain, leaden paralysis,
and mood reactivity. The patient's symptoms of increased sleep (11 hours) and increased appetite are
characteristic of atypical depression. ---
,Question 2
2. A patient experiences recurrent panic attacks followed by 4 months of persistent worry
about having another attack. He avoids the gym where the first attack occurred. What
diagnosis best fits?
A) Panic Disorder without Agoraphobia
B) Panic Disorder with Agoraphobia
C) Agoraphobia without Panic Disorder
D) Generalized Anxiety Disorder
Answer
Answer B: Panic Disorder with Agoraphobia
Rationale
Panic Disorder requires recurrent unexpected panic attacks followed by ≥1 month of persistent
concern/worry about additional attacks or a significant maladaptive change in behavior related to the
attacks. This patient has 4 months of worry and avoids the location where the attack occurred, meeting
criteria for agoraphobia. ---
Question 3
3. A 45-year-old patient on Lithium for Bipolar I Disorder presents with coarse tremors, ataxia,
and a serum lithium level of 1.8 mEq/L. What is the most appropriate action?
A) Increase the Lithium dose
B) Hold Lithium, assess for signs of toxicity, and consider IV fluids if indicated
C) Add a beta-blocker for tremor control
D) Continue current dose and monitor
Answer
Answer B: Hold Lithium, assess for signs of toxicity, and consider IV fluids if indicated
Rationale
A lithium level of 1.8 mEq/L with coarse tremors and ataxia indicates lithium toxicity. The therapeutic
range is 0.6-1.2 mEq/L. The lithium should be held, and the patient should be assessed for signs of
toxicity (gastrointestinal symptoms, confusion, seizures). ---
Question 4
,4. A PMHNP is evaluating a 10-year-old boy referred by the school nurse because of persistent
stomachache every morning before school. The boy does not like to go to school and insists
on coming home immediately after arrival. What is the most likely diagnosis?
A) Illness Anxiety Disorder
B) Separation Anxiety Disorder
C) Social Anxiety Disorder
D) Somatic Symptom Disorder
Answer
Answer B: Separation Anxiety Disorder
Rationale
Separation anxiety disorder involves developmentally inappropriate and excessive fear/anxiety
concerning separation from attachment figures. Physical symptoms (stomachaches) are common,
especially on school days. ---
Question 5
5. A 60-year-old male with a history of traumatic brain injury (TBI) is prescribed bupropion for
depression. For which adverse effect should the client carefully monitor?
A) Memory loss
B) Sleep disturbances
C) Seizures
D) Aggression
Answer
Answer B: Seizures
Rationale
Bupropion lowers the seizure threshold. Patients with a history of TBI have an increased baseline
seizure risk. The client should monitor for seizure activity or new neurologic changes. ---
Question 6
6. A client with major depressive disorder has been on an SSRI for 8 weeks with minimal
response. What is the next best step according to STARD guidelines?
A) Switch to a different SSRI
, B) Augment with a second-generation antipsychotic (e.g., aripiprazole)
C) Add lithium
D) Increase the SSRI dose to maximum
Answer
Answer B: Augment with a second-generation antipsychotic (e.g., aripiprazole)
Rationale
For treatment-resistant depression after an adequate SSRI trial, augmentation with a second-
generation antipsychotic (e.g., aripiprazole) is first-line per STARD and CANMAT guidelines. ---
Question 7
7. A patient presents with auditory hallucinations, delusions of persecution, disorganized
speech, and negative symptoms for 8 months. What is the most likely diagnosis?
A) Schizophreniform Disorder
B) Schizophrenia
C) Brief Psychotic Disorder
D) Delusional Disorder
Answer
Answer B: Schizophrenia
Rationale
Schizophrenia requires two or more symptoms (delusions, hallucinations, disorganized speech,
grossly disorganized/catatonic behavior, negative symptoms) for a significant portion of time during a
1-month period, with continuous signs of disturbance persisting for at least 6 months. ---
Question 8
8. A 28-year-old female presents with episodes of elevated mood, decreased need for sleep,
grandiosity, and increased goal-directed activity lasting 5 days. She has had two similar
episodes in the past year, each lasting 4-7 days. She also experiences depressive episodes
lasting 2-3 weeks. What is the most likely diagnosis?
A) Bipolar I Disorder
B) Bipolar II Disorder
C) Cyclothymic Disorder
