NR 6 0 7 · MI DTERM E XAM PREP · 2 0 2 6\2027
update
Diagnosis &
Management
in Psychiatric-Mental
Health Practicum III
A 100-question practice examination with correct
answers and evidence-based rationales, covering
psychopharmacology, diagnostic reasoning, treatment
guidelines , ethics and law, and special populations
across the lifespan .
100 Questions & Answers with Rationales
Sin g l e Best An swer Format ( A–D)
2 0 2 6 E D I T I O N · P R A C T I C E E X A M I N AT I O N
,NR 607 MIDTERM EXAM PREP 2026 PRACTICE EXAM
NR 607 Midterm Exam Prep
Diagnosis & Management in Psychiatric-Mental Health Practicum III (2026)
100 single-best-answer questions with correct answers and rationales. Answers follow each question.
1. Which criterion is required to diagnose antisocial personality disorder?
A. Evidence of conduct disorder before age 15
B. Onset of symptoms after age 25
C. At least one manic episode
D. Pathological hoarding
Correct Answer: A — Evidence of conduct disorder before age 15
Rationale. Antisocial personality disorder requires a pervasive pattern of disregard for and violation of the
rights of others since age 15, with at least three of seven criteria including deceitfulness, impulsivity,
irritability and aggressiveness, reckless disregard for safety, consistent irresponsibility, and lack of remorse,
plus evidence of conduct disorder with onset before age 15 and current age at least 18. Personality disorders
by definition begin by early adulthood, and ASPD cannot be diagnosed before 18. Manic episodes suggest
bipolar disorder, and hoarding belongs to obsessive-compulsive spectrum diagnoses.
2. A patient with severe alcohol use disorder has not used opioids. Which medication is an
appropriate evidence-based option to reduce heavy drinking days?
A. Naltrexone
B. Buprenorphine
C. Methadone
D. Lorazepam
Correct Answer: A — Naltrexone
Rationale. Naltrexone, an opioid antagonist available as 50 mg daily oral tablets or a monthly
extended-release injection, is FDA-approved to reduce heavy drinking and craving in alcohol use disorder
and to prevent relapse in opioid use disorder. Buprenorphine and methadone treat opioid use disorder, not
alcohol use disorder. Lorazepam is used for acute alcohol withdrawal management, not long-term relapse
prevention, and its dependence profile makes it unsuitable for chronic therapy. Patients must be opioid-free
for 7 to 10 days before naltrexone to avoid precipitated withdrawal, and liver function should be assessed.
NR 607 Midterm Exam Prep 1
,NR 607 MIDTERM EXAM PREP 2026 PRACTICE EXAM
3. Records from a federally assisted substance use disorder treatment program are protected by 42
CFR Part 2. Which action is MOST consistent with these rules?
A. Releasing SUD treatment records with the patient's specific written consent, or without
consent only in narrow circumstances such as medical emergency or court order meeting
statutory requirements
B. Posting summaries in the shared clinic dashboard for all staff
C. Faxing records to an employer on request
D. Discussing the patient's SUD treatment at a community meeting
Correct Answer: A — Releasing SUD treatment records with the patient's specific written
consent, or without consent only in narrow circumstances such as medical emergency or court
order meeting statutory requirements
Rationale. 42 CFR Part 2 provides heightened confidentiality for patient records from federally assisted
substance use disorder programs, stricter than HIPAA. Disclosure generally requires specific patient written
consent identifying the information and recipient, with narrow exceptions including medical emergencies,
audits, research with protections, and certain court orders. Casual sharing with employers, community
members, or broadly across an electronic dashboard violates the rule. Although 2020-2024 alignment rules
improved care coordination, the core consent architecture remains. Violations carry substantial penalties and
destroy patient trust in treatment-seeking.
4. A PMHNP is offered a weekend hunting trip by a patient with whom she has a therapeutic
relationship. The MOST appropriate response is:
A. Accept because gifts and activities strengthen rapport
B. Decline, set a professional boundary, explore the meaning of the invitation therapeutically,
and document the exchange
C. Accept but pay her own way
D. Terminate the patient immediately
Correct Answer: B — Decline, set a professional boundary, explore the meaning of the invitation
therapeutically, and document the exchange
Rationale. Dual or multiple relationships that risk exploiting the power differential or impairing clinical
judgment are prohibited or tightly restricted by professional ethics codes including the ANA and APNA
standards. Accepting personal favors, gifts of significant value, social relationships, or business dealings with
current patients erodes boundaries and objectivity. The therapeutic response is to decline clearly and
respectfully, explore what the invitation means in the patient's context, protect the alliance, and document.
Immediate termination is usually unnecessary and can itself be harmful; minor gifts of nominal value may be
handled with sensitivity per policy rather than reflexively refused.
NR 607 Midterm Exam Prep 2
, NR 607 MIDTERM EXAM PREP 2026 PRACTICE EXAM
5. The psychotherapy with the strongest evidence for reducing self-harm and suicidality in
borderline personality disorder is:
A. Psychoanalytic dream interpretation
B. Dialectical behavior therapy (DBT)
C. Eye movement desensitization and reprocessing
D. Supportive weekly exercise coaching
Correct Answer: B — Dialectical behavior therapy (DBT)
Rationale. DBT, developed by Marsha Linehan, has the strongest trial evidence for reducing self-directed
violence, suicide attempts, and psychiatric hospitalization in borderline personality disorder. It combines
individual therapy, skills training in mindfulness, distress tolerance, emotion regulation, and interpersonal
effectiveness, coaching, and a consultation team, explicitly targeting emotion dysregulation. Other structured
therapies with supportive evidence include mentalization-based therapy and transference-focused
psychotherapy. Medications treat comorbidity and target symptoms but are adjunctive, with no
FDA-approved drug for BPD itself.
6. A patient with panic disorder and comorbid asthma uses an albuterol inhaler frequently. Which
consideration is MOST important when treating the panic attacks?
A. Beta-agonist overuse can mimic or worsen panic symptoms such as palpitations and
tremor, so asthma control should be optimized alongside anxiety treatment
B. Albuterol is an anxiolytic
C. Panic attacks cause asthma
D. All asthma inhalers cause panic disorder
Correct Answer: A — Beta-agonist overuse can mimic or worsen panic symptoms such as
palpitations and tremor, so asthma control should be optimized alongside anxiety treatment
Rationale. Short-acting beta-agonists commonly produce palpitations, tremor, and subjective restlessness
that overlap with panic attacks, and poor asthma control itself generates dyspneic fear cycles; optimizing
asthma therapy reduces symptom confounding and supports accurate response tracking. SSRIs with CBT
treat the panic disorder, and clinicians should distinguish medication effects from illness. The relationship is
bidirectional in burden but beta-agonists do not cause panic disorder. This question tests integration of
medical comorbidity into psychiatric prescribing, a core PMHNP competency.
NR 607 Midterm Exam Prep 3
update
Diagnosis &
Management
in Psychiatric-Mental
Health Practicum III
A 100-question practice examination with correct
answers and evidence-based rationales, covering
psychopharmacology, diagnostic reasoning, treatment
guidelines , ethics and law, and special populations
across the lifespan .
100 Questions & Answers with Rationales
Sin g l e Best An swer Format ( A–D)
2 0 2 6 E D I T I O N · P R A C T I C E E X A M I N AT I O N
,NR 607 MIDTERM EXAM PREP 2026 PRACTICE EXAM
NR 607 Midterm Exam Prep
Diagnosis & Management in Psychiatric-Mental Health Practicum III (2026)
100 single-best-answer questions with correct answers and rationales. Answers follow each question.
1. Which criterion is required to diagnose antisocial personality disorder?
A. Evidence of conduct disorder before age 15
B. Onset of symptoms after age 25
C. At least one manic episode
D. Pathological hoarding
Correct Answer: A — Evidence of conduct disorder before age 15
Rationale. Antisocial personality disorder requires a pervasive pattern of disregard for and violation of the
rights of others since age 15, with at least three of seven criteria including deceitfulness, impulsivity,
irritability and aggressiveness, reckless disregard for safety, consistent irresponsibility, and lack of remorse,
plus evidence of conduct disorder with onset before age 15 and current age at least 18. Personality disorders
by definition begin by early adulthood, and ASPD cannot be diagnosed before 18. Manic episodes suggest
bipolar disorder, and hoarding belongs to obsessive-compulsive spectrum diagnoses.
2. A patient with severe alcohol use disorder has not used opioids. Which medication is an
appropriate evidence-based option to reduce heavy drinking days?
A. Naltrexone
B. Buprenorphine
C. Methadone
D. Lorazepam
Correct Answer: A — Naltrexone
Rationale. Naltrexone, an opioid antagonist available as 50 mg daily oral tablets or a monthly
extended-release injection, is FDA-approved to reduce heavy drinking and craving in alcohol use disorder
and to prevent relapse in opioid use disorder. Buprenorphine and methadone treat opioid use disorder, not
alcohol use disorder. Lorazepam is used for acute alcohol withdrawal management, not long-term relapse
prevention, and its dependence profile makes it unsuitable for chronic therapy. Patients must be opioid-free
for 7 to 10 days before naltrexone to avoid precipitated withdrawal, and liver function should be assessed.
NR 607 Midterm Exam Prep 1
,NR 607 MIDTERM EXAM PREP 2026 PRACTICE EXAM
3. Records from a federally assisted substance use disorder treatment program are protected by 42
CFR Part 2. Which action is MOST consistent with these rules?
A. Releasing SUD treatment records with the patient's specific written consent, or without
consent only in narrow circumstances such as medical emergency or court order meeting
statutory requirements
B. Posting summaries in the shared clinic dashboard for all staff
C. Faxing records to an employer on request
D. Discussing the patient's SUD treatment at a community meeting
Correct Answer: A — Releasing SUD treatment records with the patient's specific written
consent, or without consent only in narrow circumstances such as medical emergency or court
order meeting statutory requirements
Rationale. 42 CFR Part 2 provides heightened confidentiality for patient records from federally assisted
substance use disorder programs, stricter than HIPAA. Disclosure generally requires specific patient written
consent identifying the information and recipient, with narrow exceptions including medical emergencies,
audits, research with protections, and certain court orders. Casual sharing with employers, community
members, or broadly across an electronic dashboard violates the rule. Although 2020-2024 alignment rules
improved care coordination, the core consent architecture remains. Violations carry substantial penalties and
destroy patient trust in treatment-seeking.
4. A PMHNP is offered a weekend hunting trip by a patient with whom she has a therapeutic
relationship. The MOST appropriate response is:
A. Accept because gifts and activities strengthen rapport
B. Decline, set a professional boundary, explore the meaning of the invitation therapeutically,
and document the exchange
C. Accept but pay her own way
D. Terminate the patient immediately
Correct Answer: B — Decline, set a professional boundary, explore the meaning of the invitation
therapeutically, and document the exchange
Rationale. Dual or multiple relationships that risk exploiting the power differential or impairing clinical
judgment are prohibited or tightly restricted by professional ethics codes including the ANA and APNA
standards. Accepting personal favors, gifts of significant value, social relationships, or business dealings with
current patients erodes boundaries and objectivity. The therapeutic response is to decline clearly and
respectfully, explore what the invitation means in the patient's context, protect the alliance, and document.
Immediate termination is usually unnecessary and can itself be harmful; minor gifts of nominal value may be
handled with sensitivity per policy rather than reflexively refused.
NR 607 Midterm Exam Prep 2
, NR 607 MIDTERM EXAM PREP 2026 PRACTICE EXAM
5. The psychotherapy with the strongest evidence for reducing self-harm and suicidality in
borderline personality disorder is:
A. Psychoanalytic dream interpretation
B. Dialectical behavior therapy (DBT)
C. Eye movement desensitization and reprocessing
D. Supportive weekly exercise coaching
Correct Answer: B — Dialectical behavior therapy (DBT)
Rationale. DBT, developed by Marsha Linehan, has the strongest trial evidence for reducing self-directed
violence, suicide attempts, and psychiatric hospitalization in borderline personality disorder. It combines
individual therapy, skills training in mindfulness, distress tolerance, emotion regulation, and interpersonal
effectiveness, coaching, and a consultation team, explicitly targeting emotion dysregulation. Other structured
therapies with supportive evidence include mentalization-based therapy and transference-focused
psychotherapy. Medications treat comorbidity and target symptoms but are adjunctive, with no
FDA-approved drug for BPD itself.
6. A patient with panic disorder and comorbid asthma uses an albuterol inhaler frequently. Which
consideration is MOST important when treating the panic attacks?
A. Beta-agonist overuse can mimic or worsen panic symptoms such as palpitations and
tremor, so asthma control should be optimized alongside anxiety treatment
B. Albuterol is an anxiolytic
C. Panic attacks cause asthma
D. All asthma inhalers cause panic disorder
Correct Answer: A — Beta-agonist overuse can mimic or worsen panic symptoms such as
palpitations and tremor, so asthma control should be optimized alongside anxiety treatment
Rationale. Short-acting beta-agonists commonly produce palpitations, tremor, and subjective restlessness
that overlap with panic attacks, and poor asthma control itself generates dyspneic fear cycles; optimizing
asthma therapy reduces symptom confounding and supports accurate response tracking. SSRIs with CBT
treat the panic disorder, and clinicians should distinguish medication effects from illness. The relationship is
bidirectional in burden but beta-agonists do not cause panic disorder. This question tests integration of
medical comorbidity into psychiatric prescribing, a core PMHNP competency.
NR 607 Midterm Exam Prep 3
