NR 607 Final Exam Chamberlain PMHNP
(2026/2027) – Actual Exam Questions and
Answers (Guaranteed Pass)
A patient with major depressive disorder reports, “I have been thinking about
killing myself, and I bought a gun yesterday.” What is the PMHNP's priority
intervention?
A. Schedule a follow-up appointment in one week
B. Develop a written safety plan and discharge the patient
C. Arrange immediate safety measures and psychiatric evaluation
D. Begin an SSRI and reassess in 4 weeks
Answer: _C. Arrange immediate safety measures and psychiatric evaluation_
Rationale: A specific suicidal plan combined with access to a lethal means
indicates high acute risk. Immediate safety, restriction of lethal means, and
comprehensive psychiatric evaluation take priority over routine outpatient
treatment.
Which finding most strongly suggests imminent suicide risk?
A. Passive thoughts that life is difficult
B. History of depression
C. Specific plan, intent, and access to lethal means
D. Feelings of sadness after a breakup
Answer: _C. Specific plan, intent, and access to lethal means_
Rationale: A specific plan, intent, and available means substantially increase acute
suicide risk and require immediate intervention.
A patient experiencing severe agitation begins shouting and pacing. Which
intervention should the PMHNP use first?
,A. Confront the patient about the behavior
B. Use calm verbal de-escalation
C. Apply four-point restraints immediately
D. Leave the patient alone without observation
Answer: _B. Use calm verbal de-escalation_
Rationale: Early verbal de-escalation is preferred when clinically feasible. The
goal is to reduce stimulation, establish safety, and prevent escalation to restraint
or seclusion.
Which behavior is an early warning sign of escalating aggression?
A. Quiet participation in group therapy
B. Relaxed posture
C. Clenched fists and increasing volume of speech
D. Appropriate eye contact
Answer: _C. Clenched fists and increasing volume of speech_
Rationale: Clenched fists, threatening posture, pacing, loud speech, and increasing
agitation can signal escalating aggression and should prompt early intervention.
A patient in acute psychosis states, “The government implanted a tracking device
in my brain.” What is the most therapeutic response?
A. “That is completely impossible.”
B. “Why would the government do that?”
C. “I understand that this feels frightening. I do not have evidence that a device
was implanted.”
D. “Yes, I think the government may be monitoring you.”
Answer: _C. “I understand that this feels frightening. I do not have evidence that a
device was implanted.”_
Rationale: The PMHNP should validate the patient's emotional experience without
validating the delusional belief and should gently present reality.
Which medication is associated with a potentially life-threatening agranulocytosis
risk?
,A. Sertraline
B. Clozapine
C. Buspirone
D. Lamotrigine
Answer: _B. Clozapine_
Rationale: Clozapine can cause severe neutropenia/agranulocytosis. Appropriate
blood-count monitoring and prompt evaluation of infection symptoms are
essential.
A patient taking clozapine reports fever and sore throat. What should the PMHNP
do?
A. Reassure the patient that this is expected
B. Increase the clozapine dose
C. Obtain urgent evaluation for possible neutropenia
D. Add another antipsychotic
Answer: _C. Obtain urgent evaluation for possible neutropenia_
Rationale: Fever and sore throat may indicate infection associated with
neutropenia. Prompt evaluation is required.
A patient taking lithium develops coarse tremor, vomiting, diarrhea, confusion, and
marked ataxia. What is the priority action?
A. Give the next lithium dose
B. Hold lithium and obtain urgent medical evaluation
C. Add an SSRI
D. Encourage vigorous exercise
Answer: _B. Hold lithium and obtain urgent medical evaluation_
Rationale: Gastrointestinal symptoms, neurologic changes, coarse tremor, and
ataxia are concerning for lithium toxicity. Lithium should be withheld and the
patient urgently evaluated.
Which laboratory test is particularly important when monitoring lithium therapy?
, A. Serum lithium concentration and renal function
B. Serum amylase only
C. Troponin only
D. Hemoglobin A1c only
Answer: _A. Serum lithium concentration and renal function_
Rationale: Lithium has a narrow therapeutic index and is eliminated renally.
Serum levels and kidney function are important components of safe monitoring.
Which medication interaction can increase lithium toxicity risk?
A. Acetaminophen
B. NSAIDs
C. Topical moisturizer
D. Calcium carbonate in usual doses
Answer: _B. NSAIDs_
Rationale: NSAIDs can reduce renal lithium clearance and increase serum lithium
concentrations, potentially causing toxicity.
A patient taking an SSRI develops agitation, diaphoresis, hyperreflexia, clonus,
and fever. Which condition should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Lithium withdrawal
Answer: _B. Serotonin syndrome_
Rationale: Serotonin syndrome commonly presents with autonomic instability and
neuromuscular hyperactivity such as hyperreflexia and clonus.
Which finding is most characteristic of neuroleptic malignant syndrome?
A. Lead-pipe rigidity and hyperthermia
B. Diarrhea and hyperreflexia
C. Pinpoint pupils and respiratory depression
D. Excessive salivation and diarrhea
(2026/2027) – Actual Exam Questions and
Answers (Guaranteed Pass)
A patient with major depressive disorder reports, “I have been thinking about
killing myself, and I bought a gun yesterday.” What is the PMHNP's priority
intervention?
A. Schedule a follow-up appointment in one week
B. Develop a written safety plan and discharge the patient
C. Arrange immediate safety measures and psychiatric evaluation
D. Begin an SSRI and reassess in 4 weeks
Answer: _C. Arrange immediate safety measures and psychiatric evaluation_
Rationale: A specific suicidal plan combined with access to a lethal means
indicates high acute risk. Immediate safety, restriction of lethal means, and
comprehensive psychiatric evaluation take priority over routine outpatient
treatment.
Which finding most strongly suggests imminent suicide risk?
A. Passive thoughts that life is difficult
B. History of depression
C. Specific plan, intent, and access to lethal means
D. Feelings of sadness after a breakup
Answer: _C. Specific plan, intent, and access to lethal means_
Rationale: A specific plan, intent, and available means substantially increase acute
suicide risk and require immediate intervention.
A patient experiencing severe agitation begins shouting and pacing. Which
intervention should the PMHNP use first?
,A. Confront the patient about the behavior
B. Use calm verbal de-escalation
C. Apply four-point restraints immediately
D. Leave the patient alone without observation
Answer: _B. Use calm verbal de-escalation_
Rationale: Early verbal de-escalation is preferred when clinically feasible. The
goal is to reduce stimulation, establish safety, and prevent escalation to restraint
or seclusion.
Which behavior is an early warning sign of escalating aggression?
A. Quiet participation in group therapy
B. Relaxed posture
C. Clenched fists and increasing volume of speech
D. Appropriate eye contact
Answer: _C. Clenched fists and increasing volume of speech_
Rationale: Clenched fists, threatening posture, pacing, loud speech, and increasing
agitation can signal escalating aggression and should prompt early intervention.
A patient in acute psychosis states, “The government implanted a tracking device
in my brain.” What is the most therapeutic response?
A. “That is completely impossible.”
B. “Why would the government do that?”
C. “I understand that this feels frightening. I do not have evidence that a device
was implanted.”
D. “Yes, I think the government may be monitoring you.”
Answer: _C. “I understand that this feels frightening. I do not have evidence that a
device was implanted.”_
Rationale: The PMHNP should validate the patient's emotional experience without
validating the delusional belief and should gently present reality.
Which medication is associated with a potentially life-threatening agranulocytosis
risk?
,A. Sertraline
B. Clozapine
C. Buspirone
D. Lamotrigine
Answer: _B. Clozapine_
Rationale: Clozapine can cause severe neutropenia/agranulocytosis. Appropriate
blood-count monitoring and prompt evaluation of infection symptoms are
essential.
A patient taking clozapine reports fever and sore throat. What should the PMHNP
do?
A. Reassure the patient that this is expected
B. Increase the clozapine dose
C. Obtain urgent evaluation for possible neutropenia
D. Add another antipsychotic
Answer: _C. Obtain urgent evaluation for possible neutropenia_
Rationale: Fever and sore throat may indicate infection associated with
neutropenia. Prompt evaluation is required.
A patient taking lithium develops coarse tremor, vomiting, diarrhea, confusion, and
marked ataxia. What is the priority action?
A. Give the next lithium dose
B. Hold lithium and obtain urgent medical evaluation
C. Add an SSRI
D. Encourage vigorous exercise
Answer: _B. Hold lithium and obtain urgent medical evaluation_
Rationale: Gastrointestinal symptoms, neurologic changes, coarse tremor, and
ataxia are concerning for lithium toxicity. Lithium should be withheld and the
patient urgently evaluated.
Which laboratory test is particularly important when monitoring lithium therapy?
, A. Serum lithium concentration and renal function
B. Serum amylase only
C. Troponin only
D. Hemoglobin A1c only
Answer: _A. Serum lithium concentration and renal function_
Rationale: Lithium has a narrow therapeutic index and is eliminated renally.
Serum levels and kidney function are important components of safe monitoring.
Which medication interaction can increase lithium toxicity risk?
A. Acetaminophen
B. NSAIDs
C. Topical moisturizer
D. Calcium carbonate in usual doses
Answer: _B. NSAIDs_
Rationale: NSAIDs can reduce renal lithium clearance and increase serum lithium
concentrations, potentially causing toxicity.
A patient taking an SSRI develops agitation, diaphoresis, hyperreflexia, clonus,
and fever. Which condition should the PMHNP suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Anticholinergic toxicity
D. Lithium withdrawal
Answer: _B. Serotonin syndrome_
Rationale: Serotonin syndrome commonly presents with autonomic instability and
neuromuscular hyperactivity such as hyperreflexia and clonus.
Which finding is most characteristic of neuroleptic malignant syndrome?
A. Lead-pipe rigidity and hyperthermia
B. Diarrhea and hyperreflexia
C. Pinpoint pupils and respiratory depression
D. Excessive salivation and diarrhea
