NR 607 FINAL EXAM (CHAMBERLAIN)
COMPREHENSIVE TEST BANK - 500
QUESTIONS WITH ANSWERS AND
RATIONALES Chamberlain University | 2025-
2026 Academic Year | Most Recent Edition
EXAM OVERVIEW
The NR 607 Diagnosis & Management in Psychiatric Mental Health III Practicum final
examination assesses the advanced practice nursing student's ability to synthesize clinical
management skills for complex psychiatric mental health populations. This
comprehensive test bank covers all major content areas including complex psychiatric
disorders, psychopharmacology, psychotherapy interventions, trauma-informed care,
crisis intervention, legal and ethical considerations, and evidence-based treatment
planning .
The exam is designed for PMHNP students in their third practicum course, building upon
prior knowledge to include complex mental health diagnoses and psychiatric
emergencies. Students must demonstrate skills related to health promotion, prevention
of illness, diagnosis, and management of complex psychiatric mental health problems
across the lifespan . Care strategies include psychopharmacological prescribing,
psychotherapy, patient education, follow-up, and referral in a precepted psychiatric
mental health care setting .
A passing score of 80% is typically required to demonstrate competency in advanced
psychiatric assessment and management. The exam aligns with Chamberlain University's
PMHNP curriculum and ANCC certification requirements .
SECTION 1: PSYCHIATRIC ASSESSMENT AND DIAGNOSIS (Questions 1-100)
1. A client who is having active visual hallucinations currently has a lighter and a
pocketknife in his possession. Which AEIO risk assessment category is correctly assigned
for this client?
,A) Objects-high risk
B) Environment-moderate risk
C) Intent-high risk
D) Agitation-moderate risk
Answer: A) Objects-high risk
Rationale: The AEIO (Agitation, Environment, Intent, Objects) risk assessment
framework evaluates immediate safety concerns . The presence of a lighter and
pocketknife during active hallucinations represents an object-related high risk, as these
items could be used to harm self or others. Objects that can be used as weapons warrant
the highest risk classification .
2. A client who experienced significant childhood trauma is seeking alternative
treatments to help ease symptoms associated with complex trauma. Which approach
might the PMHNP recommend?
A) Acupuncture
B) Structured walking programs
C) Passionflower extract
D) Reiki
Answer: A) Acupuncture
Rationale: Acupuncture is an evidence-based complementary and alternative medicine
(CAM) treatment for trauma-related symptoms . It has shown benefit for anxiety,
depression, and PTSD symptoms. Other CAM treatments for CPTSD include mindfulness,
yoga, relaxation techniques, and equine-assisted therapy .
3. A client being treated for schizophrenia presents with fever and chills, hypotension,
and mouth ulcers. After stabilization, which is the most appropriate next step?
A) Discontinue medications that alter serotonin
B) Order stat serum medication level
C) Order complete blood count
D) Discontinue antipsychotic medications
Answer: A) Discontinue medications that alter serotonin
,Rationale: Fever, hypotension, and mouth ulcers in a patient on antipsychotic medication
suggest neutropenia or agranulocytosis, which can be caused by clozapine . Discontinuing
medications that alter serotonin (including clozapine) is the priority to prevent further
bone marrow suppression. Complete blood count should be ordered to assess white blood
cell count .
4. The PMHNP receives a consult to see a client with a known history of alcohol use
disorder in the emergency department. The client displays symptoms of delirium and is
shaky and combative. What medical cause of delirium should the PMHNP initially
suspect?
A) Hypoxia
B) Uremia
C) Hypercalcemia
D) Hypoglycemia
Answer: D) Hypoglycemia
Rationale: In a client with alcohol use disorder presenting with delirium, shakiness, and
combativeness, hypoglycemia should be initially suspected. Alcohol impairs
gluconeogenesis and can deplete glycogen stores, leading to hypoglycemia. This is a
medical emergency requiring immediate glucose assessment and correction before
psychiatric evaluation.
5. A client continues to have frequent hallucinations despite serial treatment with two
different antipsychotic medications over the past six months. Which is the most
appropriate treatment strategy?
A) Add a second antipsychotic medication
B) Confirm that the client has been taking medications as prescribed
C) Add valbenazine
D) Increase the dose of the current antipsychotic medication
Answer: B) Confirm that the client has been taking medications as prescribed
Rationale: Before declaring treatment resistance, medication adherence must be
confirmed. Non-adherence is a common cause of apparent treatment failure. Valbenazine
is for tardive dyskinesia, not hallucinations. Adding a second antipsychotic or increasing
the dose would be premature without adherence confirmation.
, 6. The caregiver of an 82-year-old client with dementia is concerned about the client's
symptoms of anxiety. Which is the best treatment option?
A) Add risperidone
B) Switch to olanzapine long acting injection
C) Increase olanzapine to 20mg daily
D) Switch to clozapine
Answer: C) Increase olanzapine to 20mg daily
Rationale: In elderly patients with dementia and anxiety, non-pharmacological
interventions should be tried first. When medication is needed, low-dose antipsychotics
may be used cautiously. The question implies the client is already on olanzapine and
requires dose adjustment.
7. Four days ago, a client admitted to a surgical unit following a colon resection has
suddenly begun hallucinating. The PMHNP should suspect which of the following?
A) Neurocognitive disorder
B) Opioid withdrawal
C) Schizoaffective disorder
D) Delirium
Answer: D) Delirium
Rationale: Acute onset of hallucinations in a hospitalized post-surgical patient is classic
for delirium. Delirium is characterized by acute onset, fluctuating course, and underlying
medical cause. Post-operative delirium is common in older adults and requires
identification and treatment of the underlying cause.
8. Which physical symptom would help differentiate lithium toxicity from other
emergency psychiatric conditions?
A) Dysrhythmias
B) Muscle spasms
C) Confusion
D) Vision changes
Answer: D) Vision changes
COMPREHENSIVE TEST BANK - 500
QUESTIONS WITH ANSWERS AND
RATIONALES Chamberlain University | 2025-
2026 Academic Year | Most Recent Edition
EXAM OVERVIEW
The NR 607 Diagnosis & Management in Psychiatric Mental Health III Practicum final
examination assesses the advanced practice nursing student's ability to synthesize clinical
management skills for complex psychiatric mental health populations. This
comprehensive test bank covers all major content areas including complex psychiatric
disorders, psychopharmacology, psychotherapy interventions, trauma-informed care,
crisis intervention, legal and ethical considerations, and evidence-based treatment
planning .
The exam is designed for PMHNP students in their third practicum course, building upon
prior knowledge to include complex mental health diagnoses and psychiatric
emergencies. Students must demonstrate skills related to health promotion, prevention
of illness, diagnosis, and management of complex psychiatric mental health problems
across the lifespan . Care strategies include psychopharmacological prescribing,
psychotherapy, patient education, follow-up, and referral in a precepted psychiatric
mental health care setting .
A passing score of 80% is typically required to demonstrate competency in advanced
psychiatric assessment and management. The exam aligns with Chamberlain University's
PMHNP curriculum and ANCC certification requirements .
SECTION 1: PSYCHIATRIC ASSESSMENT AND DIAGNOSIS (Questions 1-100)
1. A client who is having active visual hallucinations currently has a lighter and a
pocketknife in his possession. Which AEIO risk assessment category is correctly assigned
for this client?
,A) Objects-high risk
B) Environment-moderate risk
C) Intent-high risk
D) Agitation-moderate risk
Answer: A) Objects-high risk
Rationale: The AEIO (Agitation, Environment, Intent, Objects) risk assessment
framework evaluates immediate safety concerns . The presence of a lighter and
pocketknife during active hallucinations represents an object-related high risk, as these
items could be used to harm self or others. Objects that can be used as weapons warrant
the highest risk classification .
2. A client who experienced significant childhood trauma is seeking alternative
treatments to help ease symptoms associated with complex trauma. Which approach
might the PMHNP recommend?
A) Acupuncture
B) Structured walking programs
C) Passionflower extract
D) Reiki
Answer: A) Acupuncture
Rationale: Acupuncture is an evidence-based complementary and alternative medicine
(CAM) treatment for trauma-related symptoms . It has shown benefit for anxiety,
depression, and PTSD symptoms. Other CAM treatments for CPTSD include mindfulness,
yoga, relaxation techniques, and equine-assisted therapy .
3. A client being treated for schizophrenia presents with fever and chills, hypotension,
and mouth ulcers. After stabilization, which is the most appropriate next step?
A) Discontinue medications that alter serotonin
B) Order stat serum medication level
C) Order complete blood count
D) Discontinue antipsychotic medications
Answer: A) Discontinue medications that alter serotonin
,Rationale: Fever, hypotension, and mouth ulcers in a patient on antipsychotic medication
suggest neutropenia or agranulocytosis, which can be caused by clozapine . Discontinuing
medications that alter serotonin (including clozapine) is the priority to prevent further
bone marrow suppression. Complete blood count should be ordered to assess white blood
cell count .
4. The PMHNP receives a consult to see a client with a known history of alcohol use
disorder in the emergency department. The client displays symptoms of delirium and is
shaky and combative. What medical cause of delirium should the PMHNP initially
suspect?
A) Hypoxia
B) Uremia
C) Hypercalcemia
D) Hypoglycemia
Answer: D) Hypoglycemia
Rationale: In a client with alcohol use disorder presenting with delirium, shakiness, and
combativeness, hypoglycemia should be initially suspected. Alcohol impairs
gluconeogenesis and can deplete glycogen stores, leading to hypoglycemia. This is a
medical emergency requiring immediate glucose assessment and correction before
psychiatric evaluation.
5. A client continues to have frequent hallucinations despite serial treatment with two
different antipsychotic medications over the past six months. Which is the most
appropriate treatment strategy?
A) Add a second antipsychotic medication
B) Confirm that the client has been taking medications as prescribed
C) Add valbenazine
D) Increase the dose of the current antipsychotic medication
Answer: B) Confirm that the client has been taking medications as prescribed
Rationale: Before declaring treatment resistance, medication adherence must be
confirmed. Non-adherence is a common cause of apparent treatment failure. Valbenazine
is for tardive dyskinesia, not hallucinations. Adding a second antipsychotic or increasing
the dose would be premature without adherence confirmation.
, 6. The caregiver of an 82-year-old client with dementia is concerned about the client's
symptoms of anxiety. Which is the best treatment option?
A) Add risperidone
B) Switch to olanzapine long acting injection
C) Increase olanzapine to 20mg daily
D) Switch to clozapine
Answer: C) Increase olanzapine to 20mg daily
Rationale: In elderly patients with dementia and anxiety, non-pharmacological
interventions should be tried first. When medication is needed, low-dose antipsychotics
may be used cautiously. The question implies the client is already on olanzapine and
requires dose adjustment.
7. Four days ago, a client admitted to a surgical unit following a colon resection has
suddenly begun hallucinating. The PMHNP should suspect which of the following?
A) Neurocognitive disorder
B) Opioid withdrawal
C) Schizoaffective disorder
D) Delirium
Answer: D) Delirium
Rationale: Acute onset of hallucinations in a hospitalized post-surgical patient is classic
for delirium. Delirium is characterized by acute onset, fluctuating course, and underlying
medical cause. Post-operative delirium is common in older adults and requires
identification and treatment of the underlying cause.
8. Which physical symptom would help differentiate lithium toxicity from other
emergency psychiatric conditions?
A) Dysrhythmias
B) Muscle spasms
C) Confusion
D) Vision changes
Answer: D) Vision changes
