NR 607 WEEK 4 | DIAGNOSIS & MANAGEMENT IN PSYCHIATRIC
MENTAL HEALTH III STUDY QUESTIONS | CORRECTLY
ANSWERED AND RATED A+ | CHAMBERLAIN
Core Domains
Psychopharmacology & Medication Management
Mood Disorders & Bipolar Spectrum
Anxiety, OCD & Trauma-Related Disorders
Psychotic Disorders & Antipsychotics
Ethical & Legal Principles in PMHNP Practice
Therapeutic Modalities & Evidence-Based Practice
Neurobiology & Pathophysiology
Assessment Tools & Clinical Decision-Making
Introduction
The NR 607 Week 4 Examination assesses the psychiatric mental
health nurse practitioner's ability to diagnose and manage complex
mental health conditions. This examination evaluates knowledge of
psychopharmacology, mood disorders, anxiety spectrum disorders,
psychotic disorders, ethical decision-making, and evidence-based
therapeutic interventions. Items include multiple-choice and
scenario-based questions that require clinical reasoning, differential
diagnosis, and treatment planning. The examination emphasizes
real-world application, including medication monitoring,
therapeutic communication, legal standards, and culturally
competent care. Successful performance demonstrates readiness for
advanced psychiatric practice and the capacity to deliver safe,
effective, person-centered mental health care.
Section One: Questions 1–70
,1. A 27-year-old female with major depressive disorder is
prescribed fluoxetine 20 mg daily. The patient should be
counseled about which most common side effect?
A. Orthostatic hypotension
B. Sexual dysfunction
C. Jaundice
D. Agranulocytosis
🟢 B. Sexual dysfunction
🔴 RATIONALE: Sexual dysfunction is the most common side
effect of SSRIs, occurring in approximately 20-40% of patients.
This includes decreased libido, difficulty achieving orgasm, and
erectile dysfunction. It results from serotonergic effects on sexual
functioning. Patients should be counseled about this possibility
and may benefit from dose adjustment or augmentation
strategies if problematic .
2. A 48-year-old male with bipolar I disorder is being managed
with lithium monotherapy. He presents with polydipsia,
polyuria, and nocturia. What is the most appropriate nursing
action?
A. Increase lithium dosage for better mood control
B. Check serum lithium level and assess for nephrogenic diabetes
insipidus
C. Discontinue lithium immediately
D. Encourage fluid restriction
🟢 B. Check serum lithium level and assess for nephrogenic
diabetes insipidus
🔴 RATIONALE: The patient's symptoms of polydipsia, polyuria,
and nocturia suggest possible nephrogenic diabetes insipidus
(NDI), a known complication of chronic lithium therapy. The first
step is to check serum lithium levels to ensure they are
,therapeutic (0.6-1.2 mEq/L) and assess renal function. If lithium-
induced NDI is confirmed, management may include adequate
hydration, thiazide diuretics, or switching to an alternative mood
stabilizer .
3. A 36-year-old female with generalized anxiety disorder (GAD)
reports persistent worry, muscle tension, sleep disturbance, and
difficulty concentrating for 7 months. Which medication
represents first-line pharmacotherapy for GAD?
A. Alprazolam
B. Buspirone
C. Sertraline
D. Hydroxyzine
🟢 C. Sertraline
🔴 RATIONALE: SSRIs such as sertraline are first-line
pharmacotherapy for generalized anxiety disorder. They have a
favorable safety profile and address both anxiety and depressive
symptoms. Benzodiazepines are reserved for short-term use due
to dependence risk .
4. A 31-year-old female with borderline personality disorder
presents with affective instability, identity disturbance, and
recurrent self-injurious behaviors. Which evidence-based
psychotherapeutic intervention is specifically designed for BPD?
A. Dialectical Behavior Therapy (DBT)
B. Exposure therapy
C. Psychoanalysis
D. Motivational interviewing
🟢 A. Dialectical Behavior Therapy (DBT)
🔴 RATIONALE: DBT was specifically developed by Marsha
Linehan for borderline personality disorder. It combines cognitive-
, behavioral techniques with mindfulness and acceptance
strategies. DBT targets emotional dysregulation, interpersonal
difficulties, and self-harm behaviors .
5. A 38-year-old male with obsessive-compulsive disorder (OCD)
has been treated with fluoxetine 60 mg daily for six months with
partial response. Which augmentation strategy is most
appropriate?
A. Augment with buspirone
B. Augment with clomipramine
C. Augment with aripiprazole
D. Augment with hydroxyzine
🟢 C. Augment with aripiprazole
🔴 RATIONALE: For OCD with partial response to SSRI therapy,
augmentation with a second-generation antipsychotic such as
aripiprazole is supported by evidence. Clomipramine is a TCA with
significant side effects and is not first-line for augmentation .
6. A 72-year-old female with Alzheimer's dementia is started on
donepezil. After four weeks, her family reports she is having
vivid nightmares, muscle cramps, and frequent loose stools.
Which mechanism best describes these adverse effects?
A. Antagonism of nicotinic receptors in autonomic ganglia
B. Excessive stimulation of muscarinic receptors in the
gastrointestinal tract and CNS
C. Inhibition of norepinephrine reuptake
D. Overstimulation of NMDA receptors
🟢 B. Excessive stimulation of muscarinic receptors in the
gastrointestinal tract and CNS
🔴 RATIONALE: Donepezil is a cholinesterase inhibitor that
increases acetylcholine at the synaptic cleft. Gastrointestinal
MENTAL HEALTH III STUDY QUESTIONS | CORRECTLY
ANSWERED AND RATED A+ | CHAMBERLAIN
Core Domains
Psychopharmacology & Medication Management
Mood Disorders & Bipolar Spectrum
Anxiety, OCD & Trauma-Related Disorders
Psychotic Disorders & Antipsychotics
Ethical & Legal Principles in PMHNP Practice
Therapeutic Modalities & Evidence-Based Practice
Neurobiology & Pathophysiology
Assessment Tools & Clinical Decision-Making
Introduction
The NR 607 Week 4 Examination assesses the psychiatric mental
health nurse practitioner's ability to diagnose and manage complex
mental health conditions. This examination evaluates knowledge of
psychopharmacology, mood disorders, anxiety spectrum disorders,
psychotic disorders, ethical decision-making, and evidence-based
therapeutic interventions. Items include multiple-choice and
scenario-based questions that require clinical reasoning, differential
diagnosis, and treatment planning. The examination emphasizes
real-world application, including medication monitoring,
therapeutic communication, legal standards, and culturally
competent care. Successful performance demonstrates readiness for
advanced psychiatric practice and the capacity to deliver safe,
effective, person-centered mental health care.
Section One: Questions 1–70
,1. A 27-year-old female with major depressive disorder is
prescribed fluoxetine 20 mg daily. The patient should be
counseled about which most common side effect?
A. Orthostatic hypotension
B. Sexual dysfunction
C. Jaundice
D. Agranulocytosis
🟢 B. Sexual dysfunction
🔴 RATIONALE: Sexual dysfunction is the most common side
effect of SSRIs, occurring in approximately 20-40% of patients.
This includes decreased libido, difficulty achieving orgasm, and
erectile dysfunction. It results from serotonergic effects on sexual
functioning. Patients should be counseled about this possibility
and may benefit from dose adjustment or augmentation
strategies if problematic .
2. A 48-year-old male with bipolar I disorder is being managed
with lithium monotherapy. He presents with polydipsia,
polyuria, and nocturia. What is the most appropriate nursing
action?
A. Increase lithium dosage for better mood control
B. Check serum lithium level and assess for nephrogenic diabetes
insipidus
C. Discontinue lithium immediately
D. Encourage fluid restriction
🟢 B. Check serum lithium level and assess for nephrogenic
diabetes insipidus
🔴 RATIONALE: The patient's symptoms of polydipsia, polyuria,
and nocturia suggest possible nephrogenic diabetes insipidus
(NDI), a known complication of chronic lithium therapy. The first
step is to check serum lithium levels to ensure they are
,therapeutic (0.6-1.2 mEq/L) and assess renal function. If lithium-
induced NDI is confirmed, management may include adequate
hydration, thiazide diuretics, or switching to an alternative mood
stabilizer .
3. A 36-year-old female with generalized anxiety disorder (GAD)
reports persistent worry, muscle tension, sleep disturbance, and
difficulty concentrating for 7 months. Which medication
represents first-line pharmacotherapy for GAD?
A. Alprazolam
B. Buspirone
C. Sertraline
D. Hydroxyzine
🟢 C. Sertraline
🔴 RATIONALE: SSRIs such as sertraline are first-line
pharmacotherapy for generalized anxiety disorder. They have a
favorable safety profile and address both anxiety and depressive
symptoms. Benzodiazepines are reserved for short-term use due
to dependence risk .
4. A 31-year-old female with borderline personality disorder
presents with affective instability, identity disturbance, and
recurrent self-injurious behaviors. Which evidence-based
psychotherapeutic intervention is specifically designed for BPD?
A. Dialectical Behavior Therapy (DBT)
B. Exposure therapy
C. Psychoanalysis
D. Motivational interviewing
🟢 A. Dialectical Behavior Therapy (DBT)
🔴 RATIONALE: DBT was specifically developed by Marsha
Linehan for borderline personality disorder. It combines cognitive-
, behavioral techniques with mindfulness and acceptance
strategies. DBT targets emotional dysregulation, interpersonal
difficulties, and self-harm behaviors .
5. A 38-year-old male with obsessive-compulsive disorder (OCD)
has been treated with fluoxetine 60 mg daily for six months with
partial response. Which augmentation strategy is most
appropriate?
A. Augment with buspirone
B. Augment with clomipramine
C. Augment with aripiprazole
D. Augment with hydroxyzine
🟢 C. Augment with aripiprazole
🔴 RATIONALE: For OCD with partial response to SSRI therapy,
augmentation with a second-generation antipsychotic such as
aripiprazole is supported by evidence. Clomipramine is a TCA with
significant side effects and is not first-line for augmentation .
6. A 72-year-old female with Alzheimer's dementia is started on
donepezil. After four weeks, her family reports she is having
vivid nightmares, muscle cramps, and frequent loose stools.
Which mechanism best describes these adverse effects?
A. Antagonism of nicotinic receptors in autonomic ganglia
B. Excessive stimulation of muscarinic receptors in the
gastrointestinal tract and CNS
C. Inhibition of norepinephrine reuptake
D. Overstimulation of NMDA receptors
🟢 B. Excessive stimulation of muscarinic receptors in the
gastrointestinal tract and CNS
🔴 RATIONALE: Donepezil is a cholinesterase inhibitor that
increases acetylcholine at the synaptic cleft. Gastrointestinal
