Nr 607 Final Exam 2026/2027 – Psychiatric Disorders, Medications & Emergency
Management Study Guide, 300 Practice Questions & Answers
100 Practice Questions & Answers
Below are 100 exam-style questions organized by topic area, with verified answers and
clinical rationales drawn from the study guide content.
Section 1: Psychopharmacology & Medication Management (Questions 1–35)
1. A 45-year-old male with schizophrenia has been on haloperidol for 8 years. He presents
with repetitive, involuntary movements of the tongue, lips, and jaw. What is the most
likely diagnosis?
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Pseudoparkinsonism
Answer: C. Tardive dyskinesia is a late-onset movement disorder caused by long-term D2
receptor blockade in the nigrostriatal pathway, characterized by involuntary choreoathetoid
movements of the tongue, lips, face, and extremities .
2. A 28-year-old female reports mood changes during the week before her menstrual
period, including irritability, anger, difficulty concentrating, and increased sleep.
Symptoms resolve shortly after her period begins. What is the most likely diagnosis?
A. Premenstrual syndrome
B. Premenstrual dysphoric disorder
C. Major depressive disorder
D. Persistent depressive disorder
Answer: B. PMDD is characterized by mood lability, irritability, dysphoria, and functional
impairment during the luteal phase that remit shortly after menstruation begins .
3. A patient on fluoxetine for 3 weeks reports nausea, headache, and insomnia. What is
the most appropriate initial response?
A. Discontinue fluoxetine immediately
B. Reassure that these are common and often resolve within 2–4 weeks
C. Increase the fluoxetine dose
D. Switch to a different SSRI
Answer: B. Nausea, headache, and insomnia are common initial SSRI side effects that are
typically transient and resolve within 2–4 weeks .
4. A 70-year-old male develops acute confusion, disorientation, and hallucinations over 24
hours after starting a new medication for insomnia. Which class is most concerning?
,A. SSRIs
B. Benzodiazepines
C. Anticholinergic medications
D. Beta-blockers
Answer: C. Anticholinergic medications are strongly associated with delirium in older adults
due to age-related changes in drug metabolism and blood-brain barrier permeability .
5. A 52-year-old with treatment-resistant schizophrenia continues to experience auditory
hallucinations despite adequate trials of two antipsychotics. What is the most appropriate
first step?
A. Add a second antipsychotic
B. Increase the current antipsychotic dose
C. Confirm medication adherence
D. Initiate clozapine therapy
Answer: C. Before declaring treatment resistance, medication non-adherence must be ruled
out .
6. A patient on clozapine develops fever, chills, and a WBC of 800 cells/mm³. What is the
most likely cause?
A. Haloperidol
B. Risperidone
C. Clozapine
D. Thioridazine
Answer: C. Clozapine is associated with agranulocytosis, requiring regular ANC monitoring .
7. A 58-year-old male on lithium presents with excessive thirst and urination. What is the
most likely diagnosis?
A. Bipolar disorder
B. Major depression
C. Panic disorder
D. Schizophrenia
Answer: A. Lithium-induced nephrogenic diabetes insipidus presents with polyuria and
polydipsia .
8. A 34-year-old male presents with headache, dizziness, and BP 210/150. He reports a
recent meal with wine. Which medication is he most likely taking?
A. Bupropion
B. Lithium
C. Amitriptyline
D. Phenelzine
, Answer: D. Phenelzine is an MAOI; tyramine-rich foods (wine, aged cheese) can precipitate
hypertensive crisis .
9. A patient on donepezil develops vivid nightmares, muscle cramps, and loose stools.
What mechanism explains these effects?
A. Antagonism of nicotinic receptors
B. Excessive stimulation of muscarinic receptors
C. Inhibition of norepinephrine reuptake
D. Overstimulation of NMDA receptors
Answer: B. Donepezil is a cholinesterase inhibitor; cholinergic excess causes GI and CNS
effects mediated by muscarinic receptors .
10. Which medication requires monitoring of serum levels after smoking cessation?
A. Fluoxetine
B. Clozapine
C. Sertraline
D. Bupropion
Answer: B. Tobacco smoke induces CYP1A2; smoking cessation decreases clozapine
metabolism, potentially leading to toxic levels .
11. A 19-year-old on an antidepressant develops muscle spasms, confusion, fever,
tachycardia, and hypertension. What is the most likely cause?
A. Serotonin syndrome
B. Cocaine intoxication
C. Meningitis
D. Alcohol withdrawal
Answer: A. Serotonin syndrome presents with autonomic instability, neuromuscular
abnormalities (clonus, hyperreflexia), and altered mental status .
12. Which medication should be avoided in a patient with bulimia nervosa due to seizure
risk?
A. Fluoxetine
B. Trazodone
C. Imipramine
D. Bupropion
Answer: D. Bupropion lowers seizure threshold and is contraindicated in eating disorders .
13. A 35-year-old African American woman with bipolar disorder delivers a newborn with
spina bifida. Which medication is most likely responsible?
A. Lithium
B. Valproate
Management Study Guide, 300 Practice Questions & Answers
100 Practice Questions & Answers
Below are 100 exam-style questions organized by topic area, with verified answers and
clinical rationales drawn from the study guide content.
Section 1: Psychopharmacology & Medication Management (Questions 1–35)
1. A 45-year-old male with schizophrenia has been on haloperidol for 8 years. He presents
with repetitive, involuntary movements of the tongue, lips, and jaw. What is the most
likely diagnosis?
A. Acute dystonia
B. Akathisia
C. Tardive dyskinesia
D. Pseudoparkinsonism
Answer: C. Tardive dyskinesia is a late-onset movement disorder caused by long-term D2
receptor blockade in the nigrostriatal pathway, characterized by involuntary choreoathetoid
movements of the tongue, lips, face, and extremities .
2. A 28-year-old female reports mood changes during the week before her menstrual
period, including irritability, anger, difficulty concentrating, and increased sleep.
Symptoms resolve shortly after her period begins. What is the most likely diagnosis?
A. Premenstrual syndrome
B. Premenstrual dysphoric disorder
C. Major depressive disorder
D. Persistent depressive disorder
Answer: B. PMDD is characterized by mood lability, irritability, dysphoria, and functional
impairment during the luteal phase that remit shortly after menstruation begins .
3. A patient on fluoxetine for 3 weeks reports nausea, headache, and insomnia. What is
the most appropriate initial response?
A. Discontinue fluoxetine immediately
B. Reassure that these are common and often resolve within 2–4 weeks
C. Increase the fluoxetine dose
D. Switch to a different SSRI
Answer: B. Nausea, headache, and insomnia are common initial SSRI side effects that are
typically transient and resolve within 2–4 weeks .
4. A 70-year-old male develops acute confusion, disorientation, and hallucinations over 24
hours after starting a new medication for insomnia. Which class is most concerning?
,A. SSRIs
B. Benzodiazepines
C. Anticholinergic medications
D. Beta-blockers
Answer: C. Anticholinergic medications are strongly associated with delirium in older adults
due to age-related changes in drug metabolism and blood-brain barrier permeability .
5. A 52-year-old with treatment-resistant schizophrenia continues to experience auditory
hallucinations despite adequate trials of two antipsychotics. What is the most appropriate
first step?
A. Add a second antipsychotic
B. Increase the current antipsychotic dose
C. Confirm medication adherence
D. Initiate clozapine therapy
Answer: C. Before declaring treatment resistance, medication non-adherence must be ruled
out .
6. A patient on clozapine develops fever, chills, and a WBC of 800 cells/mm³. What is the
most likely cause?
A. Haloperidol
B. Risperidone
C. Clozapine
D. Thioridazine
Answer: C. Clozapine is associated with agranulocytosis, requiring regular ANC monitoring .
7. A 58-year-old male on lithium presents with excessive thirst and urination. What is the
most likely diagnosis?
A. Bipolar disorder
B. Major depression
C. Panic disorder
D. Schizophrenia
Answer: A. Lithium-induced nephrogenic diabetes insipidus presents with polyuria and
polydipsia .
8. A 34-year-old male presents with headache, dizziness, and BP 210/150. He reports a
recent meal with wine. Which medication is he most likely taking?
A. Bupropion
B. Lithium
C. Amitriptyline
D. Phenelzine
, Answer: D. Phenelzine is an MAOI; tyramine-rich foods (wine, aged cheese) can precipitate
hypertensive crisis .
9. A patient on donepezil develops vivid nightmares, muscle cramps, and loose stools.
What mechanism explains these effects?
A. Antagonism of nicotinic receptors
B. Excessive stimulation of muscarinic receptors
C. Inhibition of norepinephrine reuptake
D. Overstimulation of NMDA receptors
Answer: B. Donepezil is a cholinesterase inhibitor; cholinergic excess causes GI and CNS
effects mediated by muscarinic receptors .
10. Which medication requires monitoring of serum levels after smoking cessation?
A. Fluoxetine
B. Clozapine
C. Sertraline
D. Bupropion
Answer: B. Tobacco smoke induces CYP1A2; smoking cessation decreases clozapine
metabolism, potentially leading to toxic levels .
11. A 19-year-old on an antidepressant develops muscle spasms, confusion, fever,
tachycardia, and hypertension. What is the most likely cause?
A. Serotonin syndrome
B. Cocaine intoxication
C. Meningitis
D. Alcohol withdrawal
Answer: A. Serotonin syndrome presents with autonomic instability, neuromuscular
abnormalities (clonus, hyperreflexia), and altered mental status .
12. Which medication should be avoided in a patient with bulimia nervosa due to seizure
risk?
A. Fluoxetine
B. Trazodone
C. Imipramine
D. Bupropion
Answer: D. Bupropion lowers seizure threshold and is contraindicated in eating disorders .
13. A 35-year-old African American woman with bipolar disorder delivers a newborn with
spina bifida. Which medication is most likely responsible?
A. Lithium
B. Valproate
