NR 607 FINAL EXAM 2026/2027 – PSYCHIATRIC DISORDERS, MEDICATIONS & EMERGENCY
MANAGEMENT STUDY GUIDE | 300 PRACTICE QUESTIONS & ANSWERS
Core Domains
Psychiatric Assessment and Differential Diagnosis
Neurobiology and Psychopharmacology
Schizophrenia Spectrum and Psychotic Disorders
Mood Disorders and Suicide Risk Assessment
Anxiety, Trauma, and Stressor-Related Disorders
Substance Use and Addictive Disorders
Child and Adolescent Psychiatry
Geriatric Psychiatry and Special Populations
Psychiatric Emergencies and Crisis Management
Legal and Ethical Issues in Psychiatric Practice
Introduction
This comprehensive examination is designed to simulate the NR 607 Final Exam for Diagnosis and
Management in Psychiatric-Mental Health Practicum III. The assessment covers advanced diagnostic
reasoning, psychopharmacology, evidence-based treatment planning, and emergency management
across the lifespan. You will encounter multiple-choice questions and scenario-based problems
emphasizing real-world application, clinical decision-making, and patient safety. Mastery of these
domains is essential for any Psychiatric-Mental Health Nurse Practitioner seeking to deliver safe,
effective, and evidence-based care to individuals with psychiatric disorders.
SECTION ONE: QUESTIONS 1–150
1. A 24-year-old male with schizophrenia has been started on clozapine after failing two other
antipsychotic trials. What is the mandatory monitoring frequency for the absolute neutrophil count
(ANC) during the first 6 months of treatment?
A. Every 2 weeks
🟢 B. Weekly
C. Monthly
D. Every 6 months
🔴 RATIONALE: Clozapine requires weekly ANC monitoring for the first 6 months due to the risk of
agranulocytosis. After 6 months, monitoring can be extended to every 2 weeks if ANC remains stable.
2. A 32-year-old woman reports depressed mood, anhedonia, fatigue, and poor concentration for 3
weeks. She also has increased appetite and sleeps 11 hours per night. What is the most likely
diagnosis?
A. Major Depressive Disorder, melancholic features
🟢 B. Major Depressive Disorder, atypical features
C. Persistent Depressive Disorder (Dysthymia)
D. Bipolar II Disorder, depressive episode
,🔴 RATIONALE: Atypical features of depression include hypersomnia, increased appetite/weight gain,
leaden paralysis, and mood reactivity. The patient's symptoms of increased sleep (11 hours) and
increased appetite are characteristic of atypical depression.
3. A patient experiences recurrent panic attacks followed by 4 months of persistent worry about
having another attack. He avoids the gym where the first attack occurred. What diagnosis best fits?
A. Panic Disorder without Agoraphobia
🟢 B. Panic Disorder with Agoraphobia
C. Agoraphobia without Panic Disorder
D. Generalized Anxiety Disorder
🔴 RATIONALE: Panic Disorder requires recurrent unexpected panic attacks followed by at least 1
month of persistent concern about additional attacks or a significant maladaptive change in behavior
related to the attacks. This patient has 4 months of worry and avoids the location where the attack
occurred, meeting criteria for agoraphobia.
4. A 45-year-old patient on lithium for Bipolar I Disorder presents with coarse tremors, ataxia, and a
serum lithium level of 1.8 mEq/L. What is the most appropriate action?
A. Increase the Lithium dose
🟢 B. Hold Lithium, assess for signs of toxicity, and consider IV fluids if indicated
C. Add a beta-blocker for tremor control
D. Continue current dose and monitor
🔴 RATIONALE: A lithium level of 1.8 mEq/L with coarse tremors and ataxia indicates lithium toxicity.
The therapeutic range is 0.6-1.2 mEq/L. The lithium should be held, and the patient should be assessed
for signs of toxicity.
5. A PMHNP is evaluating a 10-year-old boy referred by the school nurse because of persistent
stomachache every morning before school. The boy does not like to go to school and insists on
coming home immediately after arrival. What is the most likely diagnosis?
A. Illness Anxiety Disorder
🟢 B. Separation Anxiety Disorder
C. Social Anxiety Disorder
D. Somatic Symptom Disorder
🔴 RATIONALE: Separation anxiety disorder involves developmentally inappropriate and excessive
fear/anxiety concerning separation from attachment figures. Physical symptoms (stomachaches) are
common, especially on school days.
6. A client who is having active visual hallucinations currently has a lighter and a pocketknife in his
possession. What is the priority nursing intervention?
A. Ask the client about the items
🟢 B. Remove the items and ensure safety
C. Document the findings
D. Notify the provider
, 🔴 RATIONALE: Safety is the priority. A client experiencing active hallucinations with access to
potentially dangerous items requires immediate removal of the items to prevent harm to self or others.
7. When should restraints be used?
A. As a first-line intervention for agitation
🟢 B. Only when alternatives have failed and the patient or others are at risk of harm
C. For staff convenience
D. As a punishment for non-compliance
🔴 RATIONALE: Restraints should only be used as a last resort when less restrictive alternatives have
failed and there is an immediate risk of harm to the patient or others. They should never be used for
discipline, coercion, or staff convenience.
8. Who is in control of restraint and seclusion laws?
A. The federal government
🟢 B. The state
C. The Joint Commission
D. The hospital administrator
🔴 RATIONALE: Restraint and seclusion laws are controlled by individual states, and laws differ from
state to state. Providers must abide by their state's regulations.
9. What is the primary goal of inpatient psychiatric treatment?
A. Long-term rehabilitation
🟢 B. Stabilization
C. Permanent housing
D. Medication management only
🔴 RATIONALE: The primary goal of inpatient psychiatric treatment is stabilization. This includes
safety, crisis intervention, and initiation or adjustment of treatment.
10. Which client most likely meets the criteria for an emergency psychiatric hold in most states?
A. A client who is homeless but not dangerous
🟢 B. A client with a history of mental illness, poor treatment adherence, and is gravely disabled
C. A client who refuses medication but is not dangerous
D. A client who is eccentric but not impaired
🔴 RATIONALE: Gravely disabled individuals who cannot meet basic needs qualify for a hold. Danger
to self, danger to others, or grave disability are the criteria for an emergency psychiatric hold.
11. Which statement best distinguishes voluntary from involuntary admission?
A. Voluntary admission requires a court order
🟢 B. Voluntary admission requires a signed consent form; involuntary admission does not require
consent
, C. Involuntary admission requires the patient's signature
D. There is no difference between the two
🔴 RATIONALE: Voluntary admission requires the patient's signed consent. Involuntary admission does
not require the patient's consent but requires documented risk assessment and legal criteria.
12. What are exemptions to informed consent?
A. Only when the patient is unconscious
🟢 B. Incapacitation, life-threatening emergencies, and client's voluntary waiver
C. When the family requests treatment
D. When the provider deems it unnecessary
🔴 RATIONALE: Exemptions to informed consent include incapacitation, life-threatening emergencies
with no time for consent, and the client's voluntary waiver of informed consent.
13. What is civil commitment?
A. Voluntary admission to a psychiatric hospital
🟢 B. Legal intervention directed by a judge to order a person with serious symptoms to remain in
psychiatric hospital or attend supervised outpatient treatment
C. Arrest for criminal behavior
D. Transfer to a nursing home
🔴 RATIONALE: Civil commitment is a legal intervention directed by a judge to order a person with
serious symptoms of continued danger to self/others, grave disability, or serious deterioration to
either remain in psychiatric hospital or attend supervised outpatient treatment for a period of time.
14. What are common psychiatric emergencies?
A. Only suicide attempts
🟢 B. Suicidality, acute psychosis, agitation and aggression, mania, substance-related concerns,
decompensation, severe anxiety
C. Only medication side effects
D. Only violent behavior
🔴 RATIONALE: Common psychiatric emergencies include suicidality, acute psychosis, agitation and
aggression, mania, substance-related concerns, decompensation related to personality disorders, and
severe anxiety.
15. When a client presents with aggressive behavior, where should the APRN position themselves?
A. Directly in front of the client
🟢 B. Between the client and the door
C. With their back to the door
D. In a corner of the room
🔴 RATIONALE: When a client presents with aggressive behavior, the APRN should leave the door
open and position themselves between the client and the door to ensure a safe exit route.
MANAGEMENT STUDY GUIDE | 300 PRACTICE QUESTIONS & ANSWERS
Core Domains
Psychiatric Assessment and Differential Diagnosis
Neurobiology and Psychopharmacology
Schizophrenia Spectrum and Psychotic Disorders
Mood Disorders and Suicide Risk Assessment
Anxiety, Trauma, and Stressor-Related Disorders
Substance Use and Addictive Disorders
Child and Adolescent Psychiatry
Geriatric Psychiatry and Special Populations
Psychiatric Emergencies and Crisis Management
Legal and Ethical Issues in Psychiatric Practice
Introduction
This comprehensive examination is designed to simulate the NR 607 Final Exam for Diagnosis and
Management in Psychiatric-Mental Health Practicum III. The assessment covers advanced diagnostic
reasoning, psychopharmacology, evidence-based treatment planning, and emergency management
across the lifespan. You will encounter multiple-choice questions and scenario-based problems
emphasizing real-world application, clinical decision-making, and patient safety. Mastery of these
domains is essential for any Psychiatric-Mental Health Nurse Practitioner seeking to deliver safe,
effective, and evidence-based care to individuals with psychiatric disorders.
SECTION ONE: QUESTIONS 1–150
1. A 24-year-old male with schizophrenia has been started on clozapine after failing two other
antipsychotic trials. What is the mandatory monitoring frequency for the absolute neutrophil count
(ANC) during the first 6 months of treatment?
A. Every 2 weeks
🟢 B. Weekly
C. Monthly
D. Every 6 months
🔴 RATIONALE: Clozapine requires weekly ANC monitoring for the first 6 months due to the risk of
agranulocytosis. After 6 months, monitoring can be extended to every 2 weeks if ANC remains stable.
2. A 32-year-old woman reports depressed mood, anhedonia, fatigue, and poor concentration for 3
weeks. She also has increased appetite and sleeps 11 hours per night. What is the most likely
diagnosis?
A. Major Depressive Disorder, melancholic features
🟢 B. Major Depressive Disorder, atypical features
C. Persistent Depressive Disorder (Dysthymia)
D. Bipolar II Disorder, depressive episode
,🔴 RATIONALE: Atypical features of depression include hypersomnia, increased appetite/weight gain,
leaden paralysis, and mood reactivity. The patient's symptoms of increased sleep (11 hours) and
increased appetite are characteristic of atypical depression.
3. A patient experiences recurrent panic attacks followed by 4 months of persistent worry about
having another attack. He avoids the gym where the first attack occurred. What diagnosis best fits?
A. Panic Disorder without Agoraphobia
🟢 B. Panic Disorder with Agoraphobia
C. Agoraphobia without Panic Disorder
D. Generalized Anxiety Disorder
🔴 RATIONALE: Panic Disorder requires recurrent unexpected panic attacks followed by at least 1
month of persistent concern about additional attacks or a significant maladaptive change in behavior
related to the attacks. This patient has 4 months of worry and avoids the location where the attack
occurred, meeting criteria for agoraphobia.
4. A 45-year-old patient on lithium for Bipolar I Disorder presents with coarse tremors, ataxia, and a
serum lithium level of 1.8 mEq/L. What is the most appropriate action?
A. Increase the Lithium dose
🟢 B. Hold Lithium, assess for signs of toxicity, and consider IV fluids if indicated
C. Add a beta-blocker for tremor control
D. Continue current dose and monitor
🔴 RATIONALE: A lithium level of 1.8 mEq/L with coarse tremors and ataxia indicates lithium toxicity.
The therapeutic range is 0.6-1.2 mEq/L. The lithium should be held, and the patient should be assessed
for signs of toxicity.
5. A PMHNP is evaluating a 10-year-old boy referred by the school nurse because of persistent
stomachache every morning before school. The boy does not like to go to school and insists on
coming home immediately after arrival. What is the most likely diagnosis?
A. Illness Anxiety Disorder
🟢 B. Separation Anxiety Disorder
C. Social Anxiety Disorder
D. Somatic Symptom Disorder
🔴 RATIONALE: Separation anxiety disorder involves developmentally inappropriate and excessive
fear/anxiety concerning separation from attachment figures. Physical symptoms (stomachaches) are
common, especially on school days.
6. A client who is having active visual hallucinations currently has a lighter and a pocketknife in his
possession. What is the priority nursing intervention?
A. Ask the client about the items
🟢 B. Remove the items and ensure safety
C. Document the findings
D. Notify the provider
, 🔴 RATIONALE: Safety is the priority. A client experiencing active hallucinations with access to
potentially dangerous items requires immediate removal of the items to prevent harm to self or others.
7. When should restraints be used?
A. As a first-line intervention for agitation
🟢 B. Only when alternatives have failed and the patient or others are at risk of harm
C. For staff convenience
D. As a punishment for non-compliance
🔴 RATIONALE: Restraints should only be used as a last resort when less restrictive alternatives have
failed and there is an immediate risk of harm to the patient or others. They should never be used for
discipline, coercion, or staff convenience.
8. Who is in control of restraint and seclusion laws?
A. The federal government
🟢 B. The state
C. The Joint Commission
D. The hospital administrator
🔴 RATIONALE: Restraint and seclusion laws are controlled by individual states, and laws differ from
state to state. Providers must abide by their state's regulations.
9. What is the primary goal of inpatient psychiatric treatment?
A. Long-term rehabilitation
🟢 B. Stabilization
C. Permanent housing
D. Medication management only
🔴 RATIONALE: The primary goal of inpatient psychiatric treatment is stabilization. This includes
safety, crisis intervention, and initiation or adjustment of treatment.
10. Which client most likely meets the criteria for an emergency psychiatric hold in most states?
A. A client who is homeless but not dangerous
🟢 B. A client with a history of mental illness, poor treatment adherence, and is gravely disabled
C. A client who refuses medication but is not dangerous
D. A client who is eccentric but not impaired
🔴 RATIONALE: Gravely disabled individuals who cannot meet basic needs qualify for a hold. Danger
to self, danger to others, or grave disability are the criteria for an emergency psychiatric hold.
11. Which statement best distinguishes voluntary from involuntary admission?
A. Voluntary admission requires a court order
🟢 B. Voluntary admission requires a signed consent form; involuntary admission does not require
consent
, C. Involuntary admission requires the patient's signature
D. There is no difference between the two
🔴 RATIONALE: Voluntary admission requires the patient's signed consent. Involuntary admission does
not require the patient's consent but requires documented risk assessment and legal criteria.
12. What are exemptions to informed consent?
A. Only when the patient is unconscious
🟢 B. Incapacitation, life-threatening emergencies, and client's voluntary waiver
C. When the family requests treatment
D. When the provider deems it unnecessary
🔴 RATIONALE: Exemptions to informed consent include incapacitation, life-threatening emergencies
with no time for consent, and the client's voluntary waiver of informed consent.
13. What is civil commitment?
A. Voluntary admission to a psychiatric hospital
🟢 B. Legal intervention directed by a judge to order a person with serious symptoms to remain in
psychiatric hospital or attend supervised outpatient treatment
C. Arrest for criminal behavior
D. Transfer to a nursing home
🔴 RATIONALE: Civil commitment is a legal intervention directed by a judge to order a person with
serious symptoms of continued danger to self/others, grave disability, or serious deterioration to
either remain in psychiatric hospital or attend supervised outpatient treatment for a period of time.
14. What are common psychiatric emergencies?
A. Only suicide attempts
🟢 B. Suicidality, acute psychosis, agitation and aggression, mania, substance-related concerns,
decompensation, severe anxiety
C. Only medication side effects
D. Only violent behavior
🔴 RATIONALE: Common psychiatric emergencies include suicidality, acute psychosis, agitation and
aggression, mania, substance-related concerns, decompensation related to personality disorders, and
severe anxiety.
15. When a client presents with aggressive behavior, where should the APRN position themselves?
A. Directly in front of the client
🟢 B. Between the client and the door
C. With their back to the door
D. In a corner of the room
🔴 RATIONALE: When a client presents with aggressive behavior, the APRN should leave the door
open and position themselves between the client and the door to ensure a safe exit route.
