Chamberlain College of Nursing | NR 605 Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan I Practicum
NR 605 Diagnosis & Management in
Psychiatric-Mental Health across the Lifespan
I Practicum Final Examination 2026/2027 |
Verified Questions
Chamberlain College of Nursing | NR 605 Diagnosis & Management in Psychiatric-Mental Health across the
Lifespan I Practicum | University-Level Advanced Practice Nursing Students
100 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Chamberlain College of Nursing | NR 605 Diagnosis & Management in Psychiatric-Mental Health across the
Lifespan I Practicum
Final Comprehensive Examination Actual Exam | Academic Year 2026/2027
NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum Final Examination 2026/2027 | Verified
Questions
,INTRODUCTION
This collection presents one hundred (100) original, university-level questions developed for the NR 605
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum Final Comprehensive
Examination at Chamberlain College of Nursing. The material is organized into four core domains: Mood and
Anxiety Disorders in Adults and Older Adults; Psychotic and Cognitive Disorders Management; Substance
Use and Addictive Disorders; and Crisis Intervention, Trauma, and Special Populations. Every item is written
to reinforce the official NR 605 Final Comprehensive Examination course objectives, supporting actual exam
readiness and the development of clinical proficiency in psychiatric-mental health diagnostic reasoning,
psychopharmacologic decision making, and trauma-informed care for adults, older adults, and vulnerable
populations. All content is aligned to the 2026/2027 academic year and reflects current DSM-5-TR
diagnostic criteria, established psychiatric-mental health nursing methodology, and evidence-based clinical
standards.
ACTUAL QUESTIONS
Domain 1: Mood and Anxiety Disorders in Adults and Older Adults
Question 1. A 42-year-old client reports depressed mood and loss of interest nearly every day
for the past 3 weeks, together with insomnia, fatigue, difficulty concentrating, and feelings of
worthlessness. According to DSM-5-TR, which criterion establishes a major depressive
episode?
A. Three of nine criterion symptoms present for at least 1 month with occupational impairment
B. Five symptoms present for at least 1 week, with severity determined by suicide risk alone
C. Six symptoms that appear only around the anniversary of a significant loss and resolve within 2
months
D. Five or more of nine criterion symptoms present during the same 2-week period, representing a
change from previous functioning, with at least one symptom being depressed mood or loss of interest
or pleasure
Correct Answer: D
Rationale: Townsend and the DSM-5-TR require five or more of the nine SIGECAPS symptoms during the
same 2-week period, with depressed mood or anhedonia as a required symptom. A 1-month or 1-week
window, or a presentation confined to an anniversary reaction, does not satisfy the criterion, and the
disturbance must represent a change from previous functioning.
Question 2. A client describes feeling down most days for the past 2 years, with low energy,
poor appetite, low self-esteem, and hopelessness, and reports no period of more than 2
months without symptoms. Which diagnosis best fits?
A. Major depressive disorder, because any 2-year duration is automatically classified as major
depression
B. Persistent depressive disorder, with depressed mood for most of the day, more days than not, for at
least 2 years plus two or more additional criterion symptoms
C. Cyclothymic disorder, because chronic low mood alone establishes the diagnosis
D. Adjustment disorder with depressed mood, because chronic stressors are present
Correct Answer: B
Rationale: Sadock and Sadock and the DSM-5-TR define persistent depressive disorder as chronic
depressed mood of at least 2 years with two or more additional symptoms and no symptom-free interval
longer than 2 months. Separating it from major depressive disorder matters because care combines long-
term psychotherapy with pharmacotherapy and addresses entrenched cognitive patterns.
Question 3. A 29-year-old client has had an elevated, expansive mood for 9 days with
decreased need for sleep, pressured speech, grandiosity, distractibility, and excessive
involvement in risky financial ventures. Which criterion defines a manic episode?
A. A period of elevated mood lasting at least 4 days with two symptoms and no change in functioning
B. Recurrent episodes of elevated mood lasting at least 2 years without a depressive episode
C. Any elevation in mood accompanied by psychosis, regardless of duration or symptom count
NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum Final Examination 2026/2027 | Verified
Questions
, D. A distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least
1 week, with three or more DIGFAST symptoms, or four if the mood is only irritable
Correct Answer: D
Rationale: Chamberlain NR 605 course materials use the DIGFAST mnemonic for distractibility,
indiscretion or risk-taking, grandiosity, flight of ideas, activity increase, sleep deficit, and talkativeness.
DSM-5-TR requires a full week of elevated, expansive, or irritable mood present most of the day, nearly
every day; a 4-day duration indicates hypomania rather than mania.
Question 4. A client reports several 5-day episodes of unusually productive, energetic mood
with increased goal-directed activity that others noticed but that caused no marked
impairment or hospitalization, along with two past depressive episodes. What is the most
likely diagnosis?
A. Bipolar I disorder, because recurrent mood elevation is sufficient regardless of duration
B. Cyclothymic disorder, because the episodes did not cause marked impairment
C. Bipolar II disorder, defined by at least one hypomanic episode of at least 4 consecutive days plus at
least one major depressive episode, without any manic episode
D. Major depressive disorder with atypical features, because depression predominates
Correct Answer: C
Rationale: DSM-5-TR separates bipolar II from bipolar I by the absence of a full manic episode.
Hypomania lasts a minimum of 4 consecutive days, is observable by others, is not severe enough to cause
marked impairment or require hospitalization, and never includes psychosis. Missing this distinction risks
antidepressant-induced mood switching.
Question 5. A 35-year-old reports at least 3 years of alternating periods of hypomanic
symptoms and depressive symptoms that never meet full criteria for a hypomanic or major
depressive episode, with symptoms present more than half the time. What is the diagnosis?
A. Bipolar II disorder, because subsyndromal mood elevation is equivalent to hypomania
B. Schizoaffective disorder, because chronic mood instability implies a psychotic diathesis
C. Borderline personality disorder, because the mood shifts are frequent and reactive
D. Cyclothymic disorder, with symptoms present at least half the time for 2 years or more and no
symptom-free period longer than 2 months
Correct Answer: D
Rationale: DSM-5-TR requires numerous periods of hypomanic and depressive symptoms that fall short of
full episodes for at least 2 years, with symptoms present at least half the time and no asymptomatic
interval exceeding 2 months. Recognition matters because of the high rate of progression to bipolar I or
bipolar II disorder.
Question 6. A PMHNP initiates lithium for a client with bipolar I disorder. Which
maintenance plan reflects the accepted standard of care?
A. Target a maintenance serum level of 0.6 to 1.2 mEq/L drawn 12 hours after the last dose, and assess
renal function, thyroid function, and calcium at baseline and periodically thereafter
B. Target a maintenance level of 1.5 to 2.0 mEq/L to maximize mood stabilization
C. Check the lithium level annually and assess renal function only if the client reports symptoms
D. Draw the level 1 hour after the dose and assess thyroid function only in clients over age 65
Correct Answer: A
Rationale: Townsend and the APA guideline describe a narrow therapeutic window, with maintenance
levels of 0.6 to 1.2 mEq/L obtained as a 12-hour trough. Lithium is renally cleared and commonly causes
hypothyroidism, hyperparathyroidism with hypercalcemia, and reduced urinary concentrating ability, so
baseline and periodic renal, thyroid, and calcium monitoring is required.
Question 7. A client taking lithium presents with coarse hand tremor, confusion, ataxia,
slurred speech, and nausea, and the lithium level is 2.1 mEq/L. What is the priority action?
A. Continue lithium and add propranolol for the tremor, then recheck the level in 4 weeks
B. Give an antiemetic and increase oral fluid intake at home, then recheck the level in 1 week
NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum Final Examination 2026/2027 | Verified
Questions
, C. Hold lithium immediately, obtain urgent renal function and electrolytes, begin IV normal saline
hydration, and arrange assessment for hemodialysis given severe neurotoxicity
D. Halve the lithium dose and schedule the next level for the following month
Correct Answer: C
Rationale: Per Townsend and the current DSM-5-TR criteria, levels above 1.5 mEq/L produce toxicity, and
levels above 2.0 mEq/L with confusion, coarse tremor, and ataxia constitute severe toxicity with risk of
seizures, coma, and permanent cerebellar damage. Because lithium is renally eliminated and has no
antidote, prompt discontinuation, saline hydration, and hemodialysis for severe cases or renal impairment
are the standard interventions.
Question 8. A client of childbearing potential with bipolar disorder is stabilized on valproate
and is considering pregnancy. What should the PMHNP explain?
A. Valproate is the preferred mood stabilizer in pregnancy and requires no change
B. Valproate risks are limited to the third trimester, when the medication may be continued
C. Only lithium carries fetal risk, because valproate is safe in the first trimester
D. Valproate carries a markedly increased risk of neural tube defects along with lower cognitive and
language outcomes and increased autism risk, so a mood stabilizer with a safer reproductive profile
should be considered before conception
Correct Answer: D
Rationale: Sadock and Sadock and the APA guideline identify first-trimester valproate exposure as among
the highest-risk teratogenic exposures in psychopharmacology, with neural tube defects estimated at
roughly 1 to 5 percent plus measurable neurodevelopmental effects. Preconception counseling, folic acid
supplementation, and an individualized risk-benefit discussion are required before continuing.
Question 9. A PMHNP starts lamotrigine for bipolar depression. Which safety instruction is
most important?
A. Start at the full therapeutic dose, because slow titration delays mood stabilization by months
B. Titrate slowly and stop the medication immediately at the first sign of rash, because rapid titration,
especially with valproate co-administration, raises the risk of Stevens-Johnson syndrome
C. Continue the medication through any rash unless fever and mucosal involvement develop
D. Combine lamotrigine with valproate at standard doses to reach the target range faster
Correct Answer: B
Rationale: Townsend emphasizes that lamotrigine's serious cutaneous reactions, including Stevens-
Johnson syndrome and toxic epidermal necrolysis, are mitigated by slow titration beginning at 25 mg
daily and by reducing the target dose by about half when valproate inhibits glucuronidation. Any rash
warrants immediate discontinuation and urgent assessment.
Question 10. When starting an SSRI in a 22-year-old client with major depressive disorder,
what should the PMHNP discuss and document?
A. That SSRIs are contraindicated in clients under 25 because of the boxed warning
B. That suicide risk falls immediately after the first dose, so monthly contact is sufficient
C. The boxed warning for increased suicidal thinking and behavior in clients through age 24, with close
monitoring weekly for the first several weeks after initiation or any dose change
D. That the warning applies only to clients with a prior suicide attempt
Correct Answer: C
Rationale: The FDA boxed warning and the APA guideline direct clinicians to inform clients and families
about the small absolute increase in suicidal ideation early in treatment among children, adolescents, and
young adults and to monitor frequently. Untreated depression itself carries far greater suicide risk than
closely monitored treatment.
Question 11. A client taking sertraline is prescribed tramadol and linezolid and develops
agitation, diaphoresis, inducible clonus, hyperreflexia, tremor, and a temperature of 38.9 C.
What is the most appropriate action?
A. Recognize neuroleptic malignant syndrome and administer dantrolene and bromocriptine
NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum Final Examination 2026/2027 | Verified
Questions
Health across the Lifespan I Practicum
NR 605 Diagnosis & Management in
Psychiatric-Mental Health across the Lifespan
I Practicum Final Examination 2026/2027 |
Verified Questions
Chamberlain College of Nursing | NR 605 Diagnosis & Management in Psychiatric-Mental Health across the
Lifespan I Practicum | University-Level Advanced Practice Nursing Students
100 Verified Questions | 4 Core Domains | Academic Year 2026/2027
Prepared by
Chamberlain College of Nursing | NR 605 Diagnosis & Management in Psychiatric-Mental Health across the
Lifespan I Practicum
Final Comprehensive Examination Actual Exam | Academic Year 2026/2027
NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum Final Examination 2026/2027 | Verified
Questions
,INTRODUCTION
This collection presents one hundred (100) original, university-level questions developed for the NR 605
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum Final Comprehensive
Examination at Chamberlain College of Nursing. The material is organized into four core domains: Mood and
Anxiety Disorders in Adults and Older Adults; Psychotic and Cognitive Disorders Management; Substance
Use and Addictive Disorders; and Crisis Intervention, Trauma, and Special Populations. Every item is written
to reinforce the official NR 605 Final Comprehensive Examination course objectives, supporting actual exam
readiness and the development of clinical proficiency in psychiatric-mental health diagnostic reasoning,
psychopharmacologic decision making, and trauma-informed care for adults, older adults, and vulnerable
populations. All content is aligned to the 2026/2027 academic year and reflects current DSM-5-TR
diagnostic criteria, established psychiatric-mental health nursing methodology, and evidence-based clinical
standards.
ACTUAL QUESTIONS
Domain 1: Mood and Anxiety Disorders in Adults and Older Adults
Question 1. A 42-year-old client reports depressed mood and loss of interest nearly every day
for the past 3 weeks, together with insomnia, fatigue, difficulty concentrating, and feelings of
worthlessness. According to DSM-5-TR, which criterion establishes a major depressive
episode?
A. Three of nine criterion symptoms present for at least 1 month with occupational impairment
B. Five symptoms present for at least 1 week, with severity determined by suicide risk alone
C. Six symptoms that appear only around the anniversary of a significant loss and resolve within 2
months
D. Five or more of nine criterion symptoms present during the same 2-week period, representing a
change from previous functioning, with at least one symptom being depressed mood or loss of interest
or pleasure
Correct Answer: D
Rationale: Townsend and the DSM-5-TR require five or more of the nine SIGECAPS symptoms during the
same 2-week period, with depressed mood or anhedonia as a required symptom. A 1-month or 1-week
window, or a presentation confined to an anniversary reaction, does not satisfy the criterion, and the
disturbance must represent a change from previous functioning.
Question 2. A client describes feeling down most days for the past 2 years, with low energy,
poor appetite, low self-esteem, and hopelessness, and reports no period of more than 2
months without symptoms. Which diagnosis best fits?
A. Major depressive disorder, because any 2-year duration is automatically classified as major
depression
B. Persistent depressive disorder, with depressed mood for most of the day, more days than not, for at
least 2 years plus two or more additional criterion symptoms
C. Cyclothymic disorder, because chronic low mood alone establishes the diagnosis
D. Adjustment disorder with depressed mood, because chronic stressors are present
Correct Answer: B
Rationale: Sadock and Sadock and the DSM-5-TR define persistent depressive disorder as chronic
depressed mood of at least 2 years with two or more additional symptoms and no symptom-free interval
longer than 2 months. Separating it from major depressive disorder matters because care combines long-
term psychotherapy with pharmacotherapy and addresses entrenched cognitive patterns.
Question 3. A 29-year-old client has had an elevated, expansive mood for 9 days with
decreased need for sleep, pressured speech, grandiosity, distractibility, and excessive
involvement in risky financial ventures. Which criterion defines a manic episode?
A. A period of elevated mood lasting at least 4 days with two symptoms and no change in functioning
B. Recurrent episodes of elevated mood lasting at least 2 years without a depressive episode
C. Any elevation in mood accompanied by psychosis, regardless of duration or symptom count
NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum Final Examination 2026/2027 | Verified
Questions
, D. A distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least
1 week, with three or more DIGFAST symptoms, or four if the mood is only irritable
Correct Answer: D
Rationale: Chamberlain NR 605 course materials use the DIGFAST mnemonic for distractibility,
indiscretion or risk-taking, grandiosity, flight of ideas, activity increase, sleep deficit, and talkativeness.
DSM-5-TR requires a full week of elevated, expansive, or irritable mood present most of the day, nearly
every day; a 4-day duration indicates hypomania rather than mania.
Question 4. A client reports several 5-day episodes of unusually productive, energetic mood
with increased goal-directed activity that others noticed but that caused no marked
impairment or hospitalization, along with two past depressive episodes. What is the most
likely diagnosis?
A. Bipolar I disorder, because recurrent mood elevation is sufficient regardless of duration
B. Cyclothymic disorder, because the episodes did not cause marked impairment
C. Bipolar II disorder, defined by at least one hypomanic episode of at least 4 consecutive days plus at
least one major depressive episode, without any manic episode
D. Major depressive disorder with atypical features, because depression predominates
Correct Answer: C
Rationale: DSM-5-TR separates bipolar II from bipolar I by the absence of a full manic episode.
Hypomania lasts a minimum of 4 consecutive days, is observable by others, is not severe enough to cause
marked impairment or require hospitalization, and never includes psychosis. Missing this distinction risks
antidepressant-induced mood switching.
Question 5. A 35-year-old reports at least 3 years of alternating periods of hypomanic
symptoms and depressive symptoms that never meet full criteria for a hypomanic or major
depressive episode, with symptoms present more than half the time. What is the diagnosis?
A. Bipolar II disorder, because subsyndromal mood elevation is equivalent to hypomania
B. Schizoaffective disorder, because chronic mood instability implies a psychotic diathesis
C. Borderline personality disorder, because the mood shifts are frequent and reactive
D. Cyclothymic disorder, with symptoms present at least half the time for 2 years or more and no
symptom-free period longer than 2 months
Correct Answer: D
Rationale: DSM-5-TR requires numerous periods of hypomanic and depressive symptoms that fall short of
full episodes for at least 2 years, with symptoms present at least half the time and no asymptomatic
interval exceeding 2 months. Recognition matters because of the high rate of progression to bipolar I or
bipolar II disorder.
Question 6. A PMHNP initiates lithium for a client with bipolar I disorder. Which
maintenance plan reflects the accepted standard of care?
A. Target a maintenance serum level of 0.6 to 1.2 mEq/L drawn 12 hours after the last dose, and assess
renal function, thyroid function, and calcium at baseline and periodically thereafter
B. Target a maintenance level of 1.5 to 2.0 mEq/L to maximize mood stabilization
C. Check the lithium level annually and assess renal function only if the client reports symptoms
D. Draw the level 1 hour after the dose and assess thyroid function only in clients over age 65
Correct Answer: A
Rationale: Townsend and the APA guideline describe a narrow therapeutic window, with maintenance
levels of 0.6 to 1.2 mEq/L obtained as a 12-hour trough. Lithium is renally cleared and commonly causes
hypothyroidism, hyperparathyroidism with hypercalcemia, and reduced urinary concentrating ability, so
baseline and periodic renal, thyroid, and calcium monitoring is required.
Question 7. A client taking lithium presents with coarse hand tremor, confusion, ataxia,
slurred speech, and nausea, and the lithium level is 2.1 mEq/L. What is the priority action?
A. Continue lithium and add propranolol for the tremor, then recheck the level in 4 weeks
B. Give an antiemetic and increase oral fluid intake at home, then recheck the level in 1 week
NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum Final Examination 2026/2027 | Verified
Questions
, C. Hold lithium immediately, obtain urgent renal function and electrolytes, begin IV normal saline
hydration, and arrange assessment for hemodialysis given severe neurotoxicity
D. Halve the lithium dose and schedule the next level for the following month
Correct Answer: C
Rationale: Per Townsend and the current DSM-5-TR criteria, levels above 1.5 mEq/L produce toxicity, and
levels above 2.0 mEq/L with confusion, coarse tremor, and ataxia constitute severe toxicity with risk of
seizures, coma, and permanent cerebellar damage. Because lithium is renally eliminated and has no
antidote, prompt discontinuation, saline hydration, and hemodialysis for severe cases or renal impairment
are the standard interventions.
Question 8. A client of childbearing potential with bipolar disorder is stabilized on valproate
and is considering pregnancy. What should the PMHNP explain?
A. Valproate is the preferred mood stabilizer in pregnancy and requires no change
B. Valproate risks are limited to the third trimester, when the medication may be continued
C. Only lithium carries fetal risk, because valproate is safe in the first trimester
D. Valproate carries a markedly increased risk of neural tube defects along with lower cognitive and
language outcomes and increased autism risk, so a mood stabilizer with a safer reproductive profile
should be considered before conception
Correct Answer: D
Rationale: Sadock and Sadock and the APA guideline identify first-trimester valproate exposure as among
the highest-risk teratogenic exposures in psychopharmacology, with neural tube defects estimated at
roughly 1 to 5 percent plus measurable neurodevelopmental effects. Preconception counseling, folic acid
supplementation, and an individualized risk-benefit discussion are required before continuing.
Question 9. A PMHNP starts lamotrigine for bipolar depression. Which safety instruction is
most important?
A. Start at the full therapeutic dose, because slow titration delays mood stabilization by months
B. Titrate slowly and stop the medication immediately at the first sign of rash, because rapid titration,
especially with valproate co-administration, raises the risk of Stevens-Johnson syndrome
C. Continue the medication through any rash unless fever and mucosal involvement develop
D. Combine lamotrigine with valproate at standard doses to reach the target range faster
Correct Answer: B
Rationale: Townsend emphasizes that lamotrigine's serious cutaneous reactions, including Stevens-
Johnson syndrome and toxic epidermal necrolysis, are mitigated by slow titration beginning at 25 mg
daily and by reducing the target dose by about half when valproate inhibits glucuronidation. Any rash
warrants immediate discontinuation and urgent assessment.
Question 10. When starting an SSRI in a 22-year-old client with major depressive disorder,
what should the PMHNP discuss and document?
A. That SSRIs are contraindicated in clients under 25 because of the boxed warning
B. That suicide risk falls immediately after the first dose, so monthly contact is sufficient
C. The boxed warning for increased suicidal thinking and behavior in clients through age 24, with close
monitoring weekly for the first several weeks after initiation or any dose change
D. That the warning applies only to clients with a prior suicide attempt
Correct Answer: C
Rationale: The FDA boxed warning and the APA guideline direct clinicians to inform clients and families
about the small absolute increase in suicidal ideation early in treatment among children, adolescents, and
young adults and to monitor frequently. Untreated depression itself carries far greater suicide risk than
closely monitored treatment.
Question 11. A client taking sertraline is prescribed tramadol and linezolid and develops
agitation, diaphoresis, inducible clonus, hyperreflexia, tremor, and a temperature of 38.9 C.
What is the most appropriate action?
A. Recognize neuroleptic malignant syndrome and administer dantrolene and bromocriptine
NR 605 Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum Final Examination 2026/2027 | Verified
Questions
