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NR607 Pre-Diagnostic Exam
Chamberlain 2026/2027 –
Complete Practice Test Bank with
Detailed Rationales | PMHNP III
Prepare for the NR607 Pre-Diagnostic Exam at
Chamberlain with this complete practice test bank.
Includes exam-style questions covering advanced health
assessment, pathophysiology, pharmacology, diagnostic
reasoning, and PMHNP clinical management. Each
question features verified answers with detailed
rationales to strengthen clinical judgment. Organized by
topic for efficient review. Updated for the 2026/2027
academic year. Ideal for PMHNP students preparing for
practicum III evaluations and competency assessments.
Question 1
A 52-year-old obese man with type 2 diabetes reports dozing off while driving,
watching TV, or reading, with increased apathy and fatigue. A sleep study reveals 10
episodes of apnea lasting 15-20 seconds each per hour of sleep. What should the
PMHNP prescribe?
A. Referral to otolaryngology for rhinoplasty
B. Antidepressant medications
C. Referral to otolaryngology for uvuloplasty
D. Continuous positive airway pressure
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D
This presentation is consistent with obstructive sleep apnea (OSA), confirmed by
10 apneic episodes per hour (moderate OSA). First-line treatment for moderate
to severe OSA is CPAP, which provides pneumatic splinting of the airway.
Surgical referrals are not the initial treatment of choice .
Question 2
Which of the following is an indication for monitoring of serum drug levels?
A. Smoking cessation
B. New diagnosis of hyperlipidemia
C. Resolution of symptoms
D. New diagnosis of diabetes
A
Smoking cessation is a critical indication for monitoring serum drug levels
because tobacco smoke induces the CYP1A2 enzyme system. When a patient
stops smoking, metabolism of certain drugs (e.g., clozapine, olanzapine)
decreases, leading to potentially toxic serum levels. Dose adjustments and
serum level monitoring are necessary .
Question 3
A 21-year-old man had his first drink at a birthday party. The next morning he
presents with psychomotor agitation, cognitive impairment, depressed mood, flat
affect, and anhedonia. HR 110, BP 90/60, abdominal pain. After 2L normal saline IV,
he is referred to psychiatry. Which test should the consulting PMHNP order?
A. Urinalysis
B. Acetaminophen level
C. Urinary porphobilinogen
D. Blood alcohol level
C
The patient's neuropsychiatric disturbances, tachycardia, hypotension, and
abdominal pain following alcohol ingestion suggest acute intermittent
porphyria (AIP), a rare inherited disorder of heme synthesis. Urinary
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porphobilinogen is the diagnostic test of choice during acute attacks. AIP can
mimic psychiatric disorders, making recognition critical .
Question 4
A 24-year-old male with schizophrenia has been started on clozapine after failing
two other antipsychotic trials. What is the mandatory monitoring frequency for
absolute neutrophil count (ANC) during the first 6 months?
A. Weekly
B. Every 2 weeks
C. Monthly
D. Every 6 months
A
Clozapine requires weekly ANC monitoring for the first 6 months due to the risk
of agranulocytosis. After 6 months, monitoring can be extended to every 2
weeks if ANC remains stable .
Question 5
A client who is having active visual hallucinations currently has a lighter and a
pocketknife in his possession. What is the priority nursing intervention?
A. Ask the client about the items
B. Remove the items and ensure safety
C. Document the findings
D. Notify the provider
B
Safety is the priority. A client experiencing active hallucinations with access to
potentially dangerous items requires immediate removal of the items to prevent
harm to self or others .
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Question 6
A patient with bipolar I disorder is prescribed lithium. Which lab finding at 3 months
requires immediate intervention?
A. TSH 4.5 mIU/L
B. Serum creatinine 1.6 mg/dL (baseline 0.9)
C. Lithium level 0.8 mEq/L
D. Calcium 9.2 mg/dL
B
Creatinine rise >0.5 mg/dL from baseline suggests lithium-induced
nephropathy. TSH elevation (mild) is expected. Lithium level 0.8 is therapeutic.
Calcium 9.2 is within normal limits .
Question 7
A 45-year-old woman with major depressive disorder has not responded to two
adequate trials of SSRIs. Which pharmacologic intervention is most appropriate as
the next step?
A. Switch to a different SSRI
B. Augment with lithium carbonate
C. Initiate electroconvulsive therapy immediately
D. Prescribe a benzodiazepine for anxiety symptoms
B
For treatment-resistant depression (failure of two adequate antidepressant
trials), augmentation strategies are evidence-based next steps. Lithium
augmentation has strong empirical support. Switching to another SSRI after two
SSRI failures is less likely to yield benefit. ECT is reserved for severe or highly
treatment-resistant cases .
Question 8
A patient on clozapine reports flu-like symptoms and sore throat. What should the
PMHNP do first?
A. Reassure the patient that this is normal
B. Discontinue clozapine immediately and check WBC count
NR607 Pre-Diagnostic Exam
Chamberlain 2026/2027 –
Complete Practice Test Bank with
Detailed Rationales | PMHNP III
Prepare for the NR607 Pre-Diagnostic Exam at
Chamberlain with this complete practice test bank.
Includes exam-style questions covering advanced health
assessment, pathophysiology, pharmacology, diagnostic
reasoning, and PMHNP clinical management. Each
question features verified answers with detailed
rationales to strengthen clinical judgment. Organized by
topic for efficient review. Updated for the 2026/2027
academic year. Ideal for PMHNP students preparing for
practicum III evaluations and competency assessments.
Question 1
A 52-year-old obese man with type 2 diabetes reports dozing off while driving,
watching TV, or reading, with increased apathy and fatigue. A sleep study reveals 10
episodes of apnea lasting 15-20 seconds each per hour of sleep. What should the
PMHNP prescribe?
A. Referral to otolaryngology for rhinoplasty
B. Antidepressant medications
C. Referral to otolaryngology for uvuloplasty
D. Continuous positive airway pressure
,2|Page
D
This presentation is consistent with obstructive sleep apnea (OSA), confirmed by
10 apneic episodes per hour (moderate OSA). First-line treatment for moderate
to severe OSA is CPAP, which provides pneumatic splinting of the airway.
Surgical referrals are not the initial treatment of choice .
Question 2
Which of the following is an indication for monitoring of serum drug levels?
A. Smoking cessation
B. New diagnosis of hyperlipidemia
C. Resolution of symptoms
D. New diagnosis of diabetes
A
Smoking cessation is a critical indication for monitoring serum drug levels
because tobacco smoke induces the CYP1A2 enzyme system. When a patient
stops smoking, metabolism of certain drugs (e.g., clozapine, olanzapine)
decreases, leading to potentially toxic serum levels. Dose adjustments and
serum level monitoring are necessary .
Question 3
A 21-year-old man had his first drink at a birthday party. The next morning he
presents with psychomotor agitation, cognitive impairment, depressed mood, flat
affect, and anhedonia. HR 110, BP 90/60, abdominal pain. After 2L normal saline IV,
he is referred to psychiatry. Which test should the consulting PMHNP order?
A. Urinalysis
B. Acetaminophen level
C. Urinary porphobilinogen
D. Blood alcohol level
C
The patient's neuropsychiatric disturbances, tachycardia, hypotension, and
abdominal pain following alcohol ingestion suggest acute intermittent
porphyria (AIP), a rare inherited disorder of heme synthesis. Urinary
,3|Page
porphobilinogen is the diagnostic test of choice during acute attacks. AIP can
mimic psychiatric disorders, making recognition critical .
Question 4
A 24-year-old male with schizophrenia has been started on clozapine after failing
two other antipsychotic trials. What is the mandatory monitoring frequency for
absolute neutrophil count (ANC) during the first 6 months?
A. Weekly
B. Every 2 weeks
C. Monthly
D. Every 6 months
A
Clozapine requires weekly ANC monitoring for the first 6 months due to the risk
of agranulocytosis. After 6 months, monitoring can be extended to every 2
weeks if ANC remains stable .
Question 5
A client who is having active visual hallucinations currently has a lighter and a
pocketknife in his possession. What is the priority nursing intervention?
A. Ask the client about the items
B. Remove the items and ensure safety
C. Document the findings
D. Notify the provider
B
Safety is the priority. A client experiencing active hallucinations with access to
potentially dangerous items requires immediate removal of the items to prevent
harm to self or others .
, 4|Page
Question 6
A patient with bipolar I disorder is prescribed lithium. Which lab finding at 3 months
requires immediate intervention?
A. TSH 4.5 mIU/L
B. Serum creatinine 1.6 mg/dL (baseline 0.9)
C. Lithium level 0.8 mEq/L
D. Calcium 9.2 mg/dL
B
Creatinine rise >0.5 mg/dL from baseline suggests lithium-induced
nephropathy. TSH elevation (mild) is expected. Lithium level 0.8 is therapeutic.
Calcium 9.2 is within normal limits .
Question 7
A 45-year-old woman with major depressive disorder has not responded to two
adequate trials of SSRIs. Which pharmacologic intervention is most appropriate as
the next step?
A. Switch to a different SSRI
B. Augment with lithium carbonate
C. Initiate electroconvulsive therapy immediately
D. Prescribe a benzodiazepine for anxiety symptoms
B
For treatment-resistant depression (failure of two adequate antidepressant
trials), augmentation strategies are evidence-based next steps. Lithium
augmentation has strong empirical support. Switching to another SSRI after two
SSRI failures is less likely to yield benefit. ECT is reserved for severe or highly
treatment-resistant cases .
Question 8
A patient on clozapine reports flu-like symptoms and sore throat. What should the
PMHNP do first?
A. Reassure the patient that this is normal
B. Discontinue clozapine immediately and check WBC count
