NR 605 MIDTERM EXAM 2026/2027-EDITION
REAL EXAM QUESTIONS AND 100% VERIFIED
ANSWERS + RATIONALE
Advanced Pathophysiology & Psychopharmacology for Mental Health |Chamberlain
University
OVERVIEW
This comprehensive practice exam is designed for the NR 605 Midterm 2026 based on
Chamberlain University. It covers Advanced Assessment, Differential Diagnosis, DSM-5-TR
Criteria, Psychopharmacology, and Evidence-Based Management across lifespan. Exam
Structure: 111 multiple-choice questions (mix of recall, application, and case-based). All
questions end with a question mark (?). Correct answers are now listed in a green bold subtitle
below options, and rationales are for easy review. Key Domains: Mood Disorders, Anxiety &
Panic, Psychotic Disorders, Substance Use, Trauma/PTSD, Personality Disorders,
Neurocognitive Disorders, Pediatric & Geriatric, Psychopharm, Labs & Monitoring, Ethics/Legal.
How to Use: Time yourself for 2.5 hours, answer without notes, then review for correct answers
and rationales.
1. What is the first-line pharmacologic treatment for major depressive disorder in an adult
with no prior treatment history?
A) Amitriptyline
B) Sertraline
C) Phenelzine
D) Lithium
Answer: B) Sertraline
Rationale: SSRIs like sertraline are first-line for MDD due to efficacy, safety, and tolerability. TCAs and
MAOIs are not first-line due to side effect profile and dietary restrictions. Lithium is for bipolar.
2. Which symptom best differentiates delirium from dementia in an older adult?
A) Memory impairment
B) Acute onset with fluctuating consciousness
C) Gradual cognitive decline
D) Personality changes
Answer: B) Acute onset with fluctuating consciousness
Rationale: Delirium has acute onset, inattention, and fluctuating level of consciousness, often due to medical
cause. Dementia is gradual and chronic with clear sensorium until late stage.
,3. A patient on lithium presents with coarse tremor, polyuria, and confusion - what is the
priority action?
A) Increase fluid intake
B) Check lithium level and hold lithium
C) Add benztropine
D) Reassure and continue
Answer: B) Check lithium level and hold lithium
Rationale: Signs suggest lithium toxicity. Lithium has narrow therapeutic index (0.6-1.2). Hold drug, check
level, BMP, hydration status, and renal function immediately.
4. Which neurotransmitter is primarily associated with the positive symptoms of
schizophrenia?
A) Decreased dopamine in mesocortical pathway
B) Increased dopamine in mesolimbic pathway
C) Decreased serotonin
D) Increased GABA
Answer: B) Increased dopamine in mesolimbic pathway
Rationale: Positive symptoms (hallucinations, delusions) linked to hyperdopaminergia in mesolimbic
pathway. Negative/cognitive symptoms linked to hypodopaminergia in mesocortical pathway.
5. What is the black box warning for all antidepressants in patients under 25 years?
A) Hepatotoxicity
B) Increased risk of suicidal ideation
C) Agranulocytosis
D) Cardiac arrhythmia
Answer: B) Increased risk of suicidal ideation
Rationale: FDA black box warns increased suicidality in children, adolescents, and young adults up to 25
starting antidepressants. Requires close monitoring first weeks.
6. Which medication requires tyramine dietary restriction?
A) Fluoxetine
B) Venlafaxine
C) Tranylcypromine
D) Bupropion
Answer: C) Tranylcypromine
Rationale: Tranylcypromine is an MAOI - risk of hypertensive crisis with tyramine-rich foods (aged cheese,
cured meats, red wine). Requires 2-week washout.
7. A patient with panic disorder reports chest pain and fear of dying - what is the most
appropriate initial intervention?
, A) Order cardiac catheterization
B) Provide psychoeducation and teach diaphragmatic breathing
C) Prescribe prn haloperidol
D) Advise avoidance of all triggers
Answer: B) Provide psychoeducation and teach diaphragmatic breathing
Rationale: Panic attacks are frightening but not dangerous. Psychoeducation, CBT, and breathing
techniques are first-line non-pharm plus SSRIs. Rule out medical cause but avoid reinforcing avoidance.
8. What extrapyramidal symptom is characterized by continuous restlessness and inability
to sit still?
A) Dystonia
B) Akathisia
C) Tardive dyskinesia
D) Parkinsonism
Answer: B) Akathisia
Rationale: Akathisia is subjective restlessness and objective pacing, common with antipsychotics. Treat with
beta-blocker, benzodiazepine, or dose reduction.
9. Which screening tool is gold standard for depression in primary care?
A) GAD-7
B) PHQ-9
C) CAGE
D) MMSE
Answer: B) PHQ-9
Rationale: PHQ-9 is validated 9-item screener aligned with DSM-5 criteria for depression severity and
response to treatment. GAD-7 is for anxiety.
10. What is the mechanism of action of clozapine?
A) Selective serotonin reuptake inhibition only
B) Dopamine D2 and serotonin 5-HT2A antagonism
C) GABA enhancement
D) NMDA antagonism
Answer: B) Dopamine D2 and serotonin 5-HT2A antagonism
Rationale: Clozapine is atypical antipsychotic, most effective for treatment-resistant schizophrenia. Requires
ANC monitoring due to agranulocytosis risk.
11. Which therapeutic communication technique demonstrates empathy for a patient with
borderline personality disorder in crisis?
A) Why did you cut yourself?
B) I understand you are feeling overwhelmed right now and I am here to help you stay safe
REAL EXAM QUESTIONS AND 100% VERIFIED
ANSWERS + RATIONALE
Advanced Pathophysiology & Psychopharmacology for Mental Health |Chamberlain
University
OVERVIEW
This comprehensive practice exam is designed for the NR 605 Midterm 2026 based on
Chamberlain University. It covers Advanced Assessment, Differential Diagnosis, DSM-5-TR
Criteria, Psychopharmacology, and Evidence-Based Management across lifespan. Exam
Structure: 111 multiple-choice questions (mix of recall, application, and case-based). All
questions end with a question mark (?). Correct answers are now listed in a green bold subtitle
below options, and rationales are for easy review. Key Domains: Mood Disorders, Anxiety &
Panic, Psychotic Disorders, Substance Use, Trauma/PTSD, Personality Disorders,
Neurocognitive Disorders, Pediatric & Geriatric, Psychopharm, Labs & Monitoring, Ethics/Legal.
How to Use: Time yourself for 2.5 hours, answer without notes, then review for correct answers
and rationales.
1. What is the first-line pharmacologic treatment for major depressive disorder in an adult
with no prior treatment history?
A) Amitriptyline
B) Sertraline
C) Phenelzine
D) Lithium
Answer: B) Sertraline
Rationale: SSRIs like sertraline are first-line for MDD due to efficacy, safety, and tolerability. TCAs and
MAOIs are not first-line due to side effect profile and dietary restrictions. Lithium is for bipolar.
2. Which symptom best differentiates delirium from dementia in an older adult?
A) Memory impairment
B) Acute onset with fluctuating consciousness
C) Gradual cognitive decline
D) Personality changes
Answer: B) Acute onset with fluctuating consciousness
Rationale: Delirium has acute onset, inattention, and fluctuating level of consciousness, often due to medical
cause. Dementia is gradual and chronic with clear sensorium until late stage.
,3. A patient on lithium presents with coarse tremor, polyuria, and confusion - what is the
priority action?
A) Increase fluid intake
B) Check lithium level and hold lithium
C) Add benztropine
D) Reassure and continue
Answer: B) Check lithium level and hold lithium
Rationale: Signs suggest lithium toxicity. Lithium has narrow therapeutic index (0.6-1.2). Hold drug, check
level, BMP, hydration status, and renal function immediately.
4. Which neurotransmitter is primarily associated with the positive symptoms of
schizophrenia?
A) Decreased dopamine in mesocortical pathway
B) Increased dopamine in mesolimbic pathway
C) Decreased serotonin
D) Increased GABA
Answer: B) Increased dopamine in mesolimbic pathway
Rationale: Positive symptoms (hallucinations, delusions) linked to hyperdopaminergia in mesolimbic
pathway. Negative/cognitive symptoms linked to hypodopaminergia in mesocortical pathway.
5. What is the black box warning for all antidepressants in patients under 25 years?
A) Hepatotoxicity
B) Increased risk of suicidal ideation
C) Agranulocytosis
D) Cardiac arrhythmia
Answer: B) Increased risk of suicidal ideation
Rationale: FDA black box warns increased suicidality in children, adolescents, and young adults up to 25
starting antidepressants. Requires close monitoring first weeks.
6. Which medication requires tyramine dietary restriction?
A) Fluoxetine
B) Venlafaxine
C) Tranylcypromine
D) Bupropion
Answer: C) Tranylcypromine
Rationale: Tranylcypromine is an MAOI - risk of hypertensive crisis with tyramine-rich foods (aged cheese,
cured meats, red wine). Requires 2-week washout.
7. A patient with panic disorder reports chest pain and fear of dying - what is the most
appropriate initial intervention?
, A) Order cardiac catheterization
B) Provide psychoeducation and teach diaphragmatic breathing
C) Prescribe prn haloperidol
D) Advise avoidance of all triggers
Answer: B) Provide psychoeducation and teach diaphragmatic breathing
Rationale: Panic attacks are frightening but not dangerous. Psychoeducation, CBT, and breathing
techniques are first-line non-pharm plus SSRIs. Rule out medical cause but avoid reinforcing avoidance.
8. What extrapyramidal symptom is characterized by continuous restlessness and inability
to sit still?
A) Dystonia
B) Akathisia
C) Tardive dyskinesia
D) Parkinsonism
Answer: B) Akathisia
Rationale: Akathisia is subjective restlessness and objective pacing, common with antipsychotics. Treat with
beta-blocker, benzodiazepine, or dose reduction.
9. Which screening tool is gold standard for depression in primary care?
A) GAD-7
B) PHQ-9
C) CAGE
D) MMSE
Answer: B) PHQ-9
Rationale: PHQ-9 is validated 9-item screener aligned with DSM-5 criteria for depression severity and
response to treatment. GAD-7 is for anxiety.
10. What is the mechanism of action of clozapine?
A) Selective serotonin reuptake inhibition only
B) Dopamine D2 and serotonin 5-HT2A antagonism
C) GABA enhancement
D) NMDA antagonism
Answer: B) Dopamine D2 and serotonin 5-HT2A antagonism
Rationale: Clozapine is atypical antipsychotic, most effective for treatment-resistant schizophrenia. Requires
ANC monitoring due to agranulocytosis risk.
11. Which therapeutic communication technique demonstrates empathy for a patient with
borderline personality disorder in crisis?
A) Why did you cut yourself?
B) I understand you are feeling overwhelmed right now and I am here to help you stay safe
