NR605 Final Exam Psychiatric-Mental Health
Across Lifespan I Practicum Weeks 5-8 Official
Practice Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
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SECTION 1: MOOD DISORDERS & SUICIDE PREVENTION Q1 – Q10
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Question 1 of 50
A 34-year-old woman with a history of major depressive disorder, recurrent severe, presents
to the clinic for her fourth visit. She has been taking sertraline 100 mg daily for six weeks
with partial response; her PHQ-9 dropped from 18 to 12. She reports persistent anhedonia,
early morning awakening, and difficulty concentrating at work. Her appetite has improved
slightly, but she denies suicidal ideation. The PMHNP considers augmenting her current
regimen to achieve remission.
A. Increase sertraline to 150 mg daily and reassess in four weeks
B. Add bupropion XL 150 mg daily to the current sertraline regimen ✓ CORRECT
C. Discontinue sertraline and switch to venlafaxine XR 75 mg daily
D. Add a low-dose benzodiazepine for sleep and anxiety relief
Correct Answer: B
Rationale: Augmentation with bupropion is a well-supported STAR*D strategy for partial
responders to SSRIs, targeting residual symptoms like anhedonia and fatigue without
significantly increasing serotonergic burden. Increasing sertraline to 150 mg may help, but it
offers less robust evidence for remission when residual symptoms persist after six weeks at
a therapeutic dose. Discontinuing sertraline for venlafaxine is an unnecessary switch when
the patient has shown partial response, and benzodiazepines do not treat core depressive
symptoms and carry dependence risk.
Question 2 of 50
A 28-year-old man with bipolar I disorder, currently euthymic on lithium 900 mg daily, presents
with a creatinine of 1.4 mg/dL (baseline 0.9 mg/dL six months ago) and a lithium level of 1.3
,mEq/L. He denies polyuria, polydipsia, or tremor. His mood has been stable for eight months.
The PMHNP must determine the most appropriate next step in medication management.
A. Continue lithium at current dose and repeat labs in one month
B. Reduce lithium to 600 mg daily and recheck level and renal function in one week ✓
CORRECT
C. Discontinue lithium immediately and initiate valproic acid
D. Add lisinopril to protect renal function while maintaining lithium dose
Correct Answer: B
Rationale: A rising creatinine with a lithium level at the upper therapeutic limit signals early
nephrotoxicity, and dose reduction with close monitoring is the appropriate first intervention
to preserve renal function while maintaining mood stability. Continuing the current dose risks
progressive renal injury, and abrupt discontinuation of lithium in a stable bipolar patient is
unnecessary and risks relapse. Adding lisinopril does not address the primary issue of
lithium-induced nephrotoxicity and may complicate renal perfusion.
Question 3 of 50
A 19-year-old college student is brought to the emergency department by campus security
after roommates found a note indicating intent to overdose on acetaminophen. He admits to
planning the attempt for three days, has a specific plan, and states he would be dead now if
discovered ten minutes later. He has no prior psychiatric history. The PMHNP is consulted
for admission and safety planning.
A. Admit to a voluntary medical unit with one-to-one observation and initiate SSRI therapy
B. Place on involuntary psychiatric hold for imminent danger and admit to an inpatient
psychiatric unit ✓ CORRECT
C. Discharge with a safety contract and outpatient referral for cognitive behavioral therapy
D. Transfer to a partial hospitalization program for intensive daily monitoring
Correct Answer: B
Rationale: This patient meets criteria for imminent suicidal risk due to a specific, lethal plan
with expressed intent and a recent near-attempt, warranting involuntary psychiatric admission
for stabilization and safety. A voluntary medical unit is insufficient for acute psychiatric
stabilization, and discharge with a safety contract is contraindicated given the lethality of his
plan and lack of protective factors. Partial hospitalization does not provide the 24-hour
containment needed for this level of acute risk.
Question 4 of 50
A 52-year-old woman with treatment-resistant depression has failed trials of sertraline,
venlafaxine, and bupropion. She is currently on tranylcypromine 40 mg daily and reports
significant improvement in mood and energy after eight weeks. At today's visit, she mentions
, eating aged cheese and drinking red wine at a dinner party last night. She now has a severe
throbbing headache, neck stiffness, and a blood pressure of 188/110 mmHg.
A. Administer oral nifedipine and observe for two hours in the clinic
B. Discontinue tranylcypromine permanently and switch to electroconvulsive therapy
C. Treat as a hypertensive emergency with IV phentolamine and transfer to the emergency
department ✓ CORRECT
D. Reassure the patient that the headache is benign and will resolve with hydration
Correct Answer: C
Rationale: The combination of an MAOI with tyramine-rich foods has precipitated a
hypertensive crisis, which requires immediate emergency intervention with an alpha-blocker
such as phentolamine and transfer for hemodynamic monitoring. Oral nifedipine is no longer
recommended for hypertensive emergencies due to unpredictable hypotensive swings, and
permanent discontinuation of the MAOI is premature when the crisis is reversible with proper
management. Reassurance is dangerous given the risk of intracranial hemorrhage or stroke.
Question 5 of 50
A 41-year-old man with major depressive disorder presents for follow-up after starting
fluoxetine 20 mg daily four weeks ago. He reports improved mood and sleep but now
complains of difficulty reaching orgasm with his partner, a side effect he describes as
distressing and a reason he may stop the medication. The PMHNP discusses options to
address this adverse effect.
A. Switch to duloxetine 60 mg daily, which has a lower incidence of sexual dysfunction
B. Add bupropion XL 150 mg daily to counter SSRI-induced sexual side effects ✓ CORRECT
C. Reduce fluoxetine to 10 mg every other day and monitor for depressive relapse
D. Recommend sildenafil 50 mg as needed one hour before sexual activity
Correct Answer: B
Rationale: Augmenting with bupropion is an evidence-based strategy to mitigate SSRI-induced
sexual dysfunction, as its dopaminergic and noradrenergic activity can restore libido and
orgasmic function without compromising antidepressant efficacy. Switching to duloxetine
may not resolve the issue since SNRIs also carry a significant risk of sexual side effects, and
reducing fluoxetine to an intermittent subtherapeutic dose risks relapse. Sildenafil may
improve erectile function but does not reliably restore orgasmic capacity or libido in
SSRI-induced dysfunction.
Question 6 of 50
A 23-year-old woman presents with two weeks of elevated mood, decreased need for sleep,
excessive spending, and pressured speech following the start of an antidepressant prescribed
by her primary care provider for presumed depression. She has no prior psychiatric history.
Across Lifespan I Practicum Weeks 5-8 Official
Practice Exam Actual Exam 2026/2027 with
Detailed Rationales | Complete Exam-Style
Questions | Pass Guaranteed – A+ Graded
═════════════════════════════════════
SECTION 1: MOOD DISORDERS & SUICIDE PREVENTION Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 34-year-old woman with a history of major depressive disorder, recurrent severe, presents
to the clinic for her fourth visit. She has been taking sertraline 100 mg daily for six weeks
with partial response; her PHQ-9 dropped from 18 to 12. She reports persistent anhedonia,
early morning awakening, and difficulty concentrating at work. Her appetite has improved
slightly, but she denies suicidal ideation. The PMHNP considers augmenting her current
regimen to achieve remission.
A. Increase sertraline to 150 mg daily and reassess in four weeks
B. Add bupropion XL 150 mg daily to the current sertraline regimen ✓ CORRECT
C. Discontinue sertraline and switch to venlafaxine XR 75 mg daily
D. Add a low-dose benzodiazepine for sleep and anxiety relief
Correct Answer: B
Rationale: Augmentation with bupropion is a well-supported STAR*D strategy for partial
responders to SSRIs, targeting residual symptoms like anhedonia and fatigue without
significantly increasing serotonergic burden. Increasing sertraline to 150 mg may help, but it
offers less robust evidence for remission when residual symptoms persist after six weeks at
a therapeutic dose. Discontinuing sertraline for venlafaxine is an unnecessary switch when
the patient has shown partial response, and benzodiazepines do not treat core depressive
symptoms and carry dependence risk.
Question 2 of 50
A 28-year-old man with bipolar I disorder, currently euthymic on lithium 900 mg daily, presents
with a creatinine of 1.4 mg/dL (baseline 0.9 mg/dL six months ago) and a lithium level of 1.3
,mEq/L. He denies polyuria, polydipsia, or tremor. His mood has been stable for eight months.
The PMHNP must determine the most appropriate next step in medication management.
A. Continue lithium at current dose and repeat labs in one month
B. Reduce lithium to 600 mg daily and recheck level and renal function in one week ✓
CORRECT
C. Discontinue lithium immediately and initiate valproic acid
D. Add lisinopril to protect renal function while maintaining lithium dose
Correct Answer: B
Rationale: A rising creatinine with a lithium level at the upper therapeutic limit signals early
nephrotoxicity, and dose reduction with close monitoring is the appropriate first intervention
to preserve renal function while maintaining mood stability. Continuing the current dose risks
progressive renal injury, and abrupt discontinuation of lithium in a stable bipolar patient is
unnecessary and risks relapse. Adding lisinopril does not address the primary issue of
lithium-induced nephrotoxicity and may complicate renal perfusion.
Question 3 of 50
A 19-year-old college student is brought to the emergency department by campus security
after roommates found a note indicating intent to overdose on acetaminophen. He admits to
planning the attempt for three days, has a specific plan, and states he would be dead now if
discovered ten minutes later. He has no prior psychiatric history. The PMHNP is consulted
for admission and safety planning.
A. Admit to a voluntary medical unit with one-to-one observation and initiate SSRI therapy
B. Place on involuntary psychiatric hold for imminent danger and admit to an inpatient
psychiatric unit ✓ CORRECT
C. Discharge with a safety contract and outpatient referral for cognitive behavioral therapy
D. Transfer to a partial hospitalization program for intensive daily monitoring
Correct Answer: B
Rationale: This patient meets criteria for imminent suicidal risk due to a specific, lethal plan
with expressed intent and a recent near-attempt, warranting involuntary psychiatric admission
for stabilization and safety. A voluntary medical unit is insufficient for acute psychiatric
stabilization, and discharge with a safety contract is contraindicated given the lethality of his
plan and lack of protective factors. Partial hospitalization does not provide the 24-hour
containment needed for this level of acute risk.
Question 4 of 50
A 52-year-old woman with treatment-resistant depression has failed trials of sertraline,
venlafaxine, and bupropion. She is currently on tranylcypromine 40 mg daily and reports
significant improvement in mood and energy after eight weeks. At today's visit, she mentions
, eating aged cheese and drinking red wine at a dinner party last night. She now has a severe
throbbing headache, neck stiffness, and a blood pressure of 188/110 mmHg.
A. Administer oral nifedipine and observe for two hours in the clinic
B. Discontinue tranylcypromine permanently and switch to electroconvulsive therapy
C. Treat as a hypertensive emergency with IV phentolamine and transfer to the emergency
department ✓ CORRECT
D. Reassure the patient that the headache is benign and will resolve with hydration
Correct Answer: C
Rationale: The combination of an MAOI with tyramine-rich foods has precipitated a
hypertensive crisis, which requires immediate emergency intervention with an alpha-blocker
such as phentolamine and transfer for hemodynamic monitoring. Oral nifedipine is no longer
recommended for hypertensive emergencies due to unpredictable hypotensive swings, and
permanent discontinuation of the MAOI is premature when the crisis is reversible with proper
management. Reassurance is dangerous given the risk of intracranial hemorrhage or stroke.
Question 5 of 50
A 41-year-old man with major depressive disorder presents for follow-up after starting
fluoxetine 20 mg daily four weeks ago. He reports improved mood and sleep but now
complains of difficulty reaching orgasm with his partner, a side effect he describes as
distressing and a reason he may stop the medication. The PMHNP discusses options to
address this adverse effect.
A. Switch to duloxetine 60 mg daily, which has a lower incidence of sexual dysfunction
B. Add bupropion XL 150 mg daily to counter SSRI-induced sexual side effects ✓ CORRECT
C. Reduce fluoxetine to 10 mg every other day and monitor for depressive relapse
D. Recommend sildenafil 50 mg as needed one hour before sexual activity
Correct Answer: B
Rationale: Augmenting with bupropion is an evidence-based strategy to mitigate SSRI-induced
sexual dysfunction, as its dopaminergic and noradrenergic activity can restore libido and
orgasmic function without compromising antidepressant efficacy. Switching to duloxetine
may not resolve the issue since SNRIs also carry a significant risk of sexual side effects, and
reducing fluoxetine to an intermittent subtherapeutic dose risks relapse. Sildenafil may
improve erectile function but does not reliably restore orgasmic capacity or libido in
SSRI-induced dysfunction.
Question 6 of 50
A 23-year-old woman presents with two weeks of elevated mood, decreased need for sleep,
excessive spending, and pressured speech following the start of an antidepressant prescribed
by her primary care provider for presumed depression. She has no prior psychiatric history.
