NR 605 FINAL EXAM 2026/2027-EDITION
REAL EXAM QUESTIONS AND 100% VERIFIED
ANSWERS + RATIONALE
Comprehensive Practice Review for PMHNP Students | 161 Q&A; with Rationales
OVERVIEW
This practice exam aligns with the Chamberlain NR 605 Final for Advanced
Psychopharmacology. It is designed to strengthen clinical judgment in prescribing,
monitoring, and managing psychiatric disorders across the lifespan.
Coverage: Major Depressive Disorder including treatment-resistant depression, Bipolar I and
II, Generalized Anxiety, Panic, PTSD, Schizophrenia spectrum, ADHD, Substance Use
Disorders (alcohol, opioid, stimulant), insomnia, and special populations (geriatric and
pediatric). Focus areas include mechanisms of action, black box warnings, major drug
interactions, required lab monitoring for lithium, valproate, carbamazepine, and clozapine,
and PMHNP ethical prescribing.
Format: 161 exam-style questions, each ending with a question mark. Correct answers are
bolded in green. Rationales are with concise clinical pearls explaining why the answer is
correct.
Disclaimer: Independent study aid only, the actual NR 605 exam.
PRACTICE QUESTIONS - 161 Items
1. A 32-year-old female with MDD is started on sertraline 50 mg daily and reports significant
nausea and agitation after 3 days. What is the best initial intervention?
A. Discontinue sertraline and switch to venlafaxine immediately
B. Reduce dose to 25 mg and titrate slowly with food
C. Add bupropion to counteract side effects
D. Order liver function tests
Rationale: GI activation and agitation are common early SSRI side effects. Starting low, taking with food,
and slow titration improves tolerance. Nausea often resolves within 1-2 weeks.
2. Which medication requires routine monitoring of thyroid function, renal function, and
serum drug levels?
A. Lamotrigine
B. Lithium
C. Quetiapine
D. Lurasidone
Rationale: Lithium has narrow therapeutic index (0.6-1.2 mEq/L). It can cause hypothyroidism and renal
insufficiency. Requires baseline and ongoing TSH, BMP, and lithium level.
3. A patient on phenelzine presents with hypertensive crisis after eating aged cheese. What is
the underlying mechanism?
, A. Serotonin syndrome
B. Inhibition of tyramine metabolism leading to norepinephrine release
C. Dopamine excess
D. Histamine reaction
Rationale: MAOIs block metabolism of tyramine. Tyramine-rich foods cause massive NE release, leading
to hypertensive emergency.
4. A 45-year-old with psychosis is prescribed a medication that prolongs QTc interval. Which
baseline test is essential before initiation?
A. Baseline ECG and electrolytes
B. Chest X-ray only
C. No baseline testing needed
D. Only weight check
Rationale: Second-generation antipsychotics and citalopram prolong QTc. Baseline ECG, K+, Mg2+, and
cardiac history prevent torsades.
5. Which neurotransmitter system is primarily targeted by bupropion in the treatment of
depression?
A. Serotonin only
B. Dopamine and norepinephrine
C. GABA only
D. Histamine
Rationale: Bupropion is an NDRI with no serotonergic activity, so lower sexual dysfunction but higher
seizure risk.
6. A patient with bipolar depression asks about lamotrigine. What serious rash should you
warn about?
A. Contact dermatitis
B. Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis
C. Urticaria only
D. Acneiform rash
Rationale: Lamotrigine requires slow titration to reduce SJS/TEN risk. Risk increases with valproate.
7. Patient on clozapine for treatment-resistant schizophrenia develops fever and sore throat.
What is your priority action?
A. Reassure and continue clozapine
B. Obtain urgent CBC with differential for agranulocytosis and hold clozapine
C. Add acetaminophen
D. Switch to haloperidol
Rationale: Clozapine has black box for agranulocytosis. Weekly to monthly ANC via REMS is required.
8. Which medication is FDA-approved for opioid use disorder and is a partial mu-opioid
agonist?
A. Buprenorphine/naloxone
, B. Alprazolam
C. Disulfiram only
D. Lorazepam
Rationale: Buprenorphine is partial agonist for OUD; naloxone deters IV misuse.
9. A 28-year-old with GAD and MDD reports sexual dysfunction on paroxetine. Which switch
would be most appropriate?
A. Continue same dose
B. Switch to bupropion or add bupropion augmentation
C. Switch to higher dose paroxetine
D. Add benztropine
Rationale: SSRIs cause sexual dysfunction. Bupropion has lowest sexual side effects.
10. What is the recommended washout period when switching from fluoxetine to an MAOI?
A. 24 hours
B. 3 days
C. At least 5 weeks due to long half-life of fluoxetine and norfluoxetine
D. No washout needed
Rationale: Fluoxetine half-life 4-6 days, norfluoxetine 7-15 days. Need 5 weeks washout before MAOI.
11. Which antipsychotic has the highest risk for metabolic syndrome?
A. Haloperidol
B. Ziprasidone
C. Olanzapine and clozapine
D. Lurasidone
Rationale: Olanzapine and clozapine have highest metabolic risk. Monitor BMI, A1c, lipids at baseline, 12
weeks, then annually.
12. A 45-year-old with psychosis is prescribed a medication that prolongs QTc interval. Which
baseline test is essential before initiation?
A. Baseline ECG and electrolytes
B. Chest X-ray only
C. No baseline testing needed
D. Only weight check
Rationale: Second-generation antipsychotics and citalopram prolong QTc. Baseline ECG, K+, Mg2+, and
cardiac history prevent torsades.
13. Which neurotransmitter system is primarily targeted by bupropion in the treatment of
depression?
A. Serotonin only
B. Dopamine and norepinephrine
C. GABA only
D. Histamine
, Rationale: Bupropion is an NDRI with no serotonergic activity, so lower sexual dysfunction but higher
seizure risk.
14. A patient with bipolar depression asks about lamotrigine. What serious rash should you
warn about?
A. Contact dermatitis
B. Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis
C. Urticaria only
D. Acneiform rash
Rationale: Lamotrigine requires slow titration to reduce SJS/TEN risk. Risk increases with valproate.
15. Patient on clozapine for treatment-resistant schizophrenia develops fever and sore throat.
What is your priority action?
A. Reassure and continue clozapine
B. Obtain urgent CBC with differential for agranulocytosis and hold clozapine
C. Add acetaminophen
D. Switch to haloperidol
Rationale: Clozapine has black box for agranulocytosis. Weekly to monthly ANC via REMS is required.
16. Which medication is FDA-approved for opioid use disorder and is a partial mu-opioid
agonist?
A. Buprenorphine/naloxone
B. Alprazolam
C. Disulfiram only
D. Lorazepam
Rationale: Buprenorphine is partial agonist for OUD; naloxone deters IV misuse.
17. A 28-year-old with GAD and MDD reports sexual dysfunction on paroxetine. Which switch
would be most appropriate?
A. Continue same dose
B. Switch to bupropion or add bupropion augmentation
C. Switch to higher dose paroxetine
D. Add benztropine
Rationale: SSRIs cause sexual dysfunction. Bupropion has lowest sexual side effects.
18. What is the recommended washout period when switching from fluoxetine to an MAOI?
A. 24 hours
B. 3 days
C. At least 5 weeks due to long half-life of fluoxetine and norfluoxetine
D. No washout needed
Rationale: Fluoxetine half-life 4-6 days, norfluoxetine 7-15 days. Need 5 weeks washout before MAOI.
19. Which antipsychotic has the highest risk for metabolic syndrome?
A. Haloperidol
REAL EXAM QUESTIONS AND 100% VERIFIED
ANSWERS + RATIONALE
Comprehensive Practice Review for PMHNP Students | 161 Q&A; with Rationales
OVERVIEW
This practice exam aligns with the Chamberlain NR 605 Final for Advanced
Psychopharmacology. It is designed to strengthen clinical judgment in prescribing,
monitoring, and managing psychiatric disorders across the lifespan.
Coverage: Major Depressive Disorder including treatment-resistant depression, Bipolar I and
II, Generalized Anxiety, Panic, PTSD, Schizophrenia spectrum, ADHD, Substance Use
Disorders (alcohol, opioid, stimulant), insomnia, and special populations (geriatric and
pediatric). Focus areas include mechanisms of action, black box warnings, major drug
interactions, required lab monitoring for lithium, valproate, carbamazepine, and clozapine,
and PMHNP ethical prescribing.
Format: 161 exam-style questions, each ending with a question mark. Correct answers are
bolded in green. Rationales are with concise clinical pearls explaining why the answer is
correct.
Disclaimer: Independent study aid only, the actual NR 605 exam.
PRACTICE QUESTIONS - 161 Items
1. A 32-year-old female with MDD is started on sertraline 50 mg daily and reports significant
nausea and agitation after 3 days. What is the best initial intervention?
A. Discontinue sertraline and switch to venlafaxine immediately
B. Reduce dose to 25 mg and titrate slowly with food
C. Add bupropion to counteract side effects
D. Order liver function tests
Rationale: GI activation and agitation are common early SSRI side effects. Starting low, taking with food,
and slow titration improves tolerance. Nausea often resolves within 1-2 weeks.
2. Which medication requires routine monitoring of thyroid function, renal function, and
serum drug levels?
A. Lamotrigine
B. Lithium
C. Quetiapine
D. Lurasidone
Rationale: Lithium has narrow therapeutic index (0.6-1.2 mEq/L). It can cause hypothyroidism and renal
insufficiency. Requires baseline and ongoing TSH, BMP, and lithium level.
3. A patient on phenelzine presents with hypertensive crisis after eating aged cheese. What is
the underlying mechanism?
, A. Serotonin syndrome
B. Inhibition of tyramine metabolism leading to norepinephrine release
C. Dopamine excess
D. Histamine reaction
Rationale: MAOIs block metabolism of tyramine. Tyramine-rich foods cause massive NE release, leading
to hypertensive emergency.
4. A 45-year-old with psychosis is prescribed a medication that prolongs QTc interval. Which
baseline test is essential before initiation?
A. Baseline ECG and electrolytes
B. Chest X-ray only
C. No baseline testing needed
D. Only weight check
Rationale: Second-generation antipsychotics and citalopram prolong QTc. Baseline ECG, K+, Mg2+, and
cardiac history prevent torsades.
5. Which neurotransmitter system is primarily targeted by bupropion in the treatment of
depression?
A. Serotonin only
B. Dopamine and norepinephrine
C. GABA only
D. Histamine
Rationale: Bupropion is an NDRI with no serotonergic activity, so lower sexual dysfunction but higher
seizure risk.
6. A patient with bipolar depression asks about lamotrigine. What serious rash should you
warn about?
A. Contact dermatitis
B. Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis
C. Urticaria only
D. Acneiform rash
Rationale: Lamotrigine requires slow titration to reduce SJS/TEN risk. Risk increases with valproate.
7. Patient on clozapine for treatment-resistant schizophrenia develops fever and sore throat.
What is your priority action?
A. Reassure and continue clozapine
B. Obtain urgent CBC with differential for agranulocytosis and hold clozapine
C. Add acetaminophen
D. Switch to haloperidol
Rationale: Clozapine has black box for agranulocytosis. Weekly to monthly ANC via REMS is required.
8. Which medication is FDA-approved for opioid use disorder and is a partial mu-opioid
agonist?
A. Buprenorphine/naloxone
, B. Alprazolam
C. Disulfiram only
D. Lorazepam
Rationale: Buprenorphine is partial agonist for OUD; naloxone deters IV misuse.
9. A 28-year-old with GAD and MDD reports sexual dysfunction on paroxetine. Which switch
would be most appropriate?
A. Continue same dose
B. Switch to bupropion or add bupropion augmentation
C. Switch to higher dose paroxetine
D. Add benztropine
Rationale: SSRIs cause sexual dysfunction. Bupropion has lowest sexual side effects.
10. What is the recommended washout period when switching from fluoxetine to an MAOI?
A. 24 hours
B. 3 days
C. At least 5 weeks due to long half-life of fluoxetine and norfluoxetine
D. No washout needed
Rationale: Fluoxetine half-life 4-6 days, norfluoxetine 7-15 days. Need 5 weeks washout before MAOI.
11. Which antipsychotic has the highest risk for metabolic syndrome?
A. Haloperidol
B. Ziprasidone
C. Olanzapine and clozapine
D. Lurasidone
Rationale: Olanzapine and clozapine have highest metabolic risk. Monitor BMI, A1c, lipids at baseline, 12
weeks, then annually.
12. A 45-year-old with psychosis is prescribed a medication that prolongs QTc interval. Which
baseline test is essential before initiation?
A. Baseline ECG and electrolytes
B. Chest X-ray only
C. No baseline testing needed
D. Only weight check
Rationale: Second-generation antipsychotics and citalopram prolong QTc. Baseline ECG, K+, Mg2+, and
cardiac history prevent torsades.
13. Which neurotransmitter system is primarily targeted by bupropion in the treatment of
depression?
A. Serotonin only
B. Dopamine and norepinephrine
C. GABA only
D. Histamine
, Rationale: Bupropion is an NDRI with no serotonergic activity, so lower sexual dysfunction but higher
seizure risk.
14. A patient with bipolar depression asks about lamotrigine. What serious rash should you
warn about?
A. Contact dermatitis
B. Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis
C. Urticaria only
D. Acneiform rash
Rationale: Lamotrigine requires slow titration to reduce SJS/TEN risk. Risk increases with valproate.
15. Patient on clozapine for treatment-resistant schizophrenia develops fever and sore throat.
What is your priority action?
A. Reassure and continue clozapine
B. Obtain urgent CBC with differential for agranulocytosis and hold clozapine
C. Add acetaminophen
D. Switch to haloperidol
Rationale: Clozapine has black box for agranulocytosis. Weekly to monthly ANC via REMS is required.
16. Which medication is FDA-approved for opioid use disorder and is a partial mu-opioid
agonist?
A. Buprenorphine/naloxone
B. Alprazolam
C. Disulfiram only
D. Lorazepam
Rationale: Buprenorphine is partial agonist for OUD; naloxone deters IV misuse.
17. A 28-year-old with GAD and MDD reports sexual dysfunction on paroxetine. Which switch
would be most appropriate?
A. Continue same dose
B. Switch to bupropion or add bupropion augmentation
C. Switch to higher dose paroxetine
D. Add benztropine
Rationale: SSRIs cause sexual dysfunction. Bupropion has lowest sexual side effects.
18. What is the recommended washout period when switching from fluoxetine to an MAOI?
A. 24 hours
B. 3 days
C. At least 5 weeks due to long half-life of fluoxetine and norfluoxetine
D. No washout needed
Rationale: Fluoxetine half-life 4-6 days, norfluoxetine 7-15 days. Need 5 weeks washout before MAOI.
19. Which antipsychotic has the highest risk for metabolic syndrome?
A. Haloperidol
