NR 605 EXAM 2 2026/2027-EDITION
REAL EXAM QUESTIONS AND 100% VERIFIED
ANSWERS + RATIONALE
Comprehensive Review for Psychiatric-Mental Health Nurse Practitioner:
Diagnosis, Psychopharmacology, Psychotherapy & Clinical Decision-Making
Overview:
This practice exam is meticulously built to reflect the Chamberlain NR 605 Exam 2 (2026). It is not a
brain dump, but a learning tool designed to help you understand why an answer is right.
1. Content Domains (138 Questions Mixed Format):
• Mood Disorders: Major Depressive Disorder (including atypical, melancholic, peripartum), Bipolar I/II,
Cyclothymia, PDD - DSM-5-TR criteria & differential.
• Anxiety, Trauma & OCD Related: GAD, Panic, Social Anxiety, PTSD, Acute Stress, OCD, Body
Dysmorphic Disorder.
• Psychotic Disorders: Schizophrenia, Schizoaffective, Brief Psychotic, Delusional disorders.
• Neurodevelopmental & Other: ADHD across lifespan, Eating Disorders, Personality Disorders
(Cluster A/B/C), Substance Use & Withdrawal syndromes, Delirium vs Dementia.
• Psychopharmacology Core: SSRIs, SNRIs, NDRIs, MAOIs, TCAs, Lithium, Anticonvulsant mood
stabilizers, First & Second Generation Antipsychotics, Benzodiazepines, Non-stimulants, Clozapine
REMS, Stimulants.
• Safety & Monitoring: Serotonin Syndrome, Neuroleptic Malignant Syndrome, EPS (dystonia,
akathisia, parkinsonism, tardive dyskinesia), Agranulocytosis, Hyponatremia, Hypertensive Crisis, QTc
prolongation.
• Practice & Ethics: Psychotherapy integration (CBT, DBT, ERP, Motivational Interviewing), Informed
consent, Involuntary hold, Cultural considerations.
2. Format: Every question ends with a question mark (?). Four options A-D. The correct answer is
bolded in green for easy visual recall. Immediately below is the rationale that explains
pathophysiology, drug mechanism, and why distractors are wrong.
3. Study Strategy: Do 30-40 questions per sitting, then review blue rationales even for items you got
right. Focus on nursing implications: what to assess, what labs to order, what to teach patients.
1. A 28-year-old female presents with 3 weeks of anhedonia, hypersomnia, increased
appetite, and feelings of worthlessness. She denies any history of mania or hypomania.
What is the most likely DSM-5-TR diagnosis?
A) Bipolar II disorder
B) Major Depressive Disorder, with atypical features
C) Persistent Depressive Disorder
D) Adjustment disorder with depressed mood
, Rationale: Atypical depression requires mood reactivity plus 2 of: hyperphagia, hypersomnia, leaden
paralysis, rejection sensitivity. Bipolar II requires hypomania. PDD is chronic >2 years. Adjustment disorder
is response to identifiable stressor within 3 months and resolves within 6 months.
2. Which medication requires routine monitoring of renal function, thyroid function, and
serum levels drawn 8-12 hours post-dose due to narrow therapeutic index?
A) Lamotrigine
B) Lithium
C) Valproate
D) Aripiprazole
Rationale: Lithium therapeutic range 0.6-1.2 mEq/L for acute mania, 0.6-1.0 for maintenance. Causes
hypothyroidism, polyuria leading to interstitial nephritis, and toxicity. Levels must be 8-12 hrs after dose, at
steady state after 5 days.
3. A patient on fluoxetine and tramadol presents with agitation, inducible clonus,
hyperthermia, diaphoresis, and hyperreflexia. What syndrome should the PMHNP suspect?
A) Neuroleptic Malignant Syndrome
B) Serotonin Syndrome
C) Anticholinergic toxicity
D) Malignant hyperthermia
Rationale: Hunter Criteria for Serotonin Syndrome: serotonergic agent + clonus/hyperreflexia +
agitation/diaphoresis/temperature >38C. NMS shows lead-pipe rigidity, bradyreflexia, from dopamine
antagonists. Requires cyproheptadine and stopping offending agents.
4. What is the first-line pharmacologic treatment for acute mania with psychotic features in
a treatment-naive patient?
A) Lithium monotherapy
B) Second-generation antipsychotic such as quetiapine, olanzapine, or risperidone
C) Lorazepam monotherapy
D) Lamotrigine
Rationale: SGAs have rapid antimanic and antipsychotic effects. Lithium takes 5-7 days. Lamotrigine is not
effective for acute mania, it is for bipolar depression maintenance. Benzos are adjunctive only for agitation.
5. A patient with schizophrenia on haloperidol develops acute torticollis and tongue
protrusion 2 hours after injection. What is the best immediate intervention?
A) Administer benztropine or diphenhydramine IM
B) Administer lorazepam 2 mg
C) Start propranolol
D) Decrease haloperidol dose
Rationale: Acute dystonia is a D2-blockade EPS emergency occurring hours to days after exposure. Treat
immediately with anticholinergic benztropine 1-2 mg IM or diphenhydramine 50 mg IM/IV. Do not just lower
dose, airway can be compromised.
,6. A patient taking phenelzine reports severe headache and hypertension after eating aged
cheese and red wine. What is occurring?
A) Serotonin syndrome
B) Hypertensive crisis from tyramine interaction with MAOI
C) Allergic reaction
D) Panic attack
Rationale: MAOIs inhibit tyramine metabolism. Tyramine-rich foods cause massive NE release leading to
hypertensive crisis. Teach low-tyramine diet, avoid sympathomimetics. Treat with phentolamine.
7. A 28-year-old female presents with 3 weeks of anhedonia, hypersomnia, increased
appetite, and feelings of worthlessness. She denies any history of mania or hypomania.
What is the most likely DSM-5-TR diagnosis?
A) Bipolar II disorder
B) Major Depressive Disorder, with atypical features
C) Persistent Depressive Disorder
D) Adjustment disorder with depressed mood
Rationale: Atypical depression requires mood reactivity plus 2 of: hyperphagia, hypersomnia, leaden
paralysis, rejection sensitivity. Bipolar II requires hypomania. PDD is chronic >2 years. Adjustment disorder
is response to identifiable stressor within 3 months and resolves within 6 months.
8. Which medication requires routine monitoring of renal function, thyroid function, and
serum levels drawn 8-12 hours post-dose due to narrow therapeutic index?
A) Lamotrigine
B) Lithium
C) Valproate
D) Aripiprazole
Rationale: Lithium therapeutic range 0.6-1.2 mEq/L for acute mania, 0.6-1.0 for maintenance. Causes
hypothyroidism, polyuria leading to interstitial nephritis, and toxicity. Levels must be 8-12 hrs after dose, at
steady state after 5 days.
9. A patient on fluoxetine and tramadol presents with agitation, inducible clonus,
hyperthermia, diaphoresis, and hyperreflexia. What syndrome should the PMHNP suspect?
A) Neuroleptic Malignant Syndrome
B) Serotonin Syndrome
C) Anticholinergic toxicity
D) Malignant hyperthermia
Rationale: Hunter Criteria for Serotonin Syndrome: serotonergic agent + clonus/hyperreflexia +
agitation/diaphoresis/temperature >38C. NMS shows lead-pipe rigidity, bradyreflexia, from dopamine
antagonists. Requires cyproheptadine and stopping offending agents.
10. What is the first-line pharmacologic treatment for acute mania with psychotic features in
a treatment-naive patient?
A) Lithium monotherapy
, B) Second-generation antipsychotic such as quetiapine, olanzapine, or risperidone
C) Lorazepam monotherapy
D) Lamotrigine
Rationale: SGAs have rapid antimanic and antipsychotic effects. Lithium takes 5-7 days. Lamotrigine is not
effective for acute mania, it is for bipolar depression maintenance. Benzos are adjunctive only for agitation.
11. A patient with schizophrenia on haloperidol develops acute torticollis and tongue
protrusion 2 hours after injection. What is the best immediate intervention?
A) Administer benztropine or diphenhydramine IM
B) Administer lorazepam 2 mg
C) Start propranolol
D) Decrease haloperidol dose
Rationale: Acute dystonia is a D2-blockade EPS emergency occurring hours to days after exposure. Treat
immediately with anticholinergic benztropine 1-2 mg IM or diphenhydramine 50 mg IM/IV. Do not just lower
dose, airway can be compromised.
12. A patient on clozapine for treatment-resistant schizophrenia presents with fever and
sore throat. What lab should be checked immediately?
A) Liver function tests
B) Absolute neutrophil count (ANC)
C) Serum creatinine
D) Prolactin level
Rationale: Clozapine carries black box for agranulocytosis. Mandatory ANC monitoring per REMS.
Fever/sore throat may signal neutropenia. If ANC <1000, hold and evaluate.
13. A 28-year-old female presents with 3 weeks of anhedonia, hypersomnia, increased
appetite, and feelings of worthlessness. She denies any history of mania or hypomania.
What is the most likely DSM-5-TR diagnosis?
A) Bipolar II disorder
B) Major Depressive Disorder, with atypical features
C) Persistent Depressive Disorder
D) Adjustment disorder with depressed mood
Rationale: Atypical depression requires mood reactivity plus 2 of: hyperphagia, hypersomnia, leaden
paralysis, rejection sensitivity. Bipolar II requires hypomania. PDD is chronic >2 years. Adjustment disorder
is response to identifiable stressor within 3 months and resolves within 6 months.
14. Which medication requires routine monitoring of renal function, thyroid function, and
serum levels drawn 8-12 hours post-dose due to narrow therapeutic index?
A) Lamotrigine
B) Lithium
C) Valproate
D) Aripiprazole
REAL EXAM QUESTIONS AND 100% VERIFIED
ANSWERS + RATIONALE
Comprehensive Review for Psychiatric-Mental Health Nurse Practitioner:
Diagnosis, Psychopharmacology, Psychotherapy & Clinical Decision-Making
Overview:
This practice exam is meticulously built to reflect the Chamberlain NR 605 Exam 2 (2026). It is not a
brain dump, but a learning tool designed to help you understand why an answer is right.
1. Content Domains (138 Questions Mixed Format):
• Mood Disorders: Major Depressive Disorder (including atypical, melancholic, peripartum), Bipolar I/II,
Cyclothymia, PDD - DSM-5-TR criteria & differential.
• Anxiety, Trauma & OCD Related: GAD, Panic, Social Anxiety, PTSD, Acute Stress, OCD, Body
Dysmorphic Disorder.
• Psychotic Disorders: Schizophrenia, Schizoaffective, Brief Psychotic, Delusional disorders.
• Neurodevelopmental & Other: ADHD across lifespan, Eating Disorders, Personality Disorders
(Cluster A/B/C), Substance Use & Withdrawal syndromes, Delirium vs Dementia.
• Psychopharmacology Core: SSRIs, SNRIs, NDRIs, MAOIs, TCAs, Lithium, Anticonvulsant mood
stabilizers, First & Second Generation Antipsychotics, Benzodiazepines, Non-stimulants, Clozapine
REMS, Stimulants.
• Safety & Monitoring: Serotonin Syndrome, Neuroleptic Malignant Syndrome, EPS (dystonia,
akathisia, parkinsonism, tardive dyskinesia), Agranulocytosis, Hyponatremia, Hypertensive Crisis, QTc
prolongation.
• Practice & Ethics: Psychotherapy integration (CBT, DBT, ERP, Motivational Interviewing), Informed
consent, Involuntary hold, Cultural considerations.
2. Format: Every question ends with a question mark (?). Four options A-D. The correct answer is
bolded in green for easy visual recall. Immediately below is the rationale that explains
pathophysiology, drug mechanism, and why distractors are wrong.
3. Study Strategy: Do 30-40 questions per sitting, then review blue rationales even for items you got
right. Focus on nursing implications: what to assess, what labs to order, what to teach patients.
1. A 28-year-old female presents with 3 weeks of anhedonia, hypersomnia, increased
appetite, and feelings of worthlessness. She denies any history of mania or hypomania.
What is the most likely DSM-5-TR diagnosis?
A) Bipolar II disorder
B) Major Depressive Disorder, with atypical features
C) Persistent Depressive Disorder
D) Adjustment disorder with depressed mood
, Rationale: Atypical depression requires mood reactivity plus 2 of: hyperphagia, hypersomnia, leaden
paralysis, rejection sensitivity. Bipolar II requires hypomania. PDD is chronic >2 years. Adjustment disorder
is response to identifiable stressor within 3 months and resolves within 6 months.
2. Which medication requires routine monitoring of renal function, thyroid function, and
serum levels drawn 8-12 hours post-dose due to narrow therapeutic index?
A) Lamotrigine
B) Lithium
C) Valproate
D) Aripiprazole
Rationale: Lithium therapeutic range 0.6-1.2 mEq/L for acute mania, 0.6-1.0 for maintenance. Causes
hypothyroidism, polyuria leading to interstitial nephritis, and toxicity. Levels must be 8-12 hrs after dose, at
steady state after 5 days.
3. A patient on fluoxetine and tramadol presents with agitation, inducible clonus,
hyperthermia, diaphoresis, and hyperreflexia. What syndrome should the PMHNP suspect?
A) Neuroleptic Malignant Syndrome
B) Serotonin Syndrome
C) Anticholinergic toxicity
D) Malignant hyperthermia
Rationale: Hunter Criteria for Serotonin Syndrome: serotonergic agent + clonus/hyperreflexia +
agitation/diaphoresis/temperature >38C. NMS shows lead-pipe rigidity, bradyreflexia, from dopamine
antagonists. Requires cyproheptadine and stopping offending agents.
4. What is the first-line pharmacologic treatment for acute mania with psychotic features in
a treatment-naive patient?
A) Lithium monotherapy
B) Second-generation antipsychotic such as quetiapine, olanzapine, or risperidone
C) Lorazepam monotherapy
D) Lamotrigine
Rationale: SGAs have rapid antimanic and antipsychotic effects. Lithium takes 5-7 days. Lamotrigine is not
effective for acute mania, it is for bipolar depression maintenance. Benzos are adjunctive only for agitation.
5. A patient with schizophrenia on haloperidol develops acute torticollis and tongue
protrusion 2 hours after injection. What is the best immediate intervention?
A) Administer benztropine or diphenhydramine IM
B) Administer lorazepam 2 mg
C) Start propranolol
D) Decrease haloperidol dose
Rationale: Acute dystonia is a D2-blockade EPS emergency occurring hours to days after exposure. Treat
immediately with anticholinergic benztropine 1-2 mg IM or diphenhydramine 50 mg IM/IV. Do not just lower
dose, airway can be compromised.
,6. A patient taking phenelzine reports severe headache and hypertension after eating aged
cheese and red wine. What is occurring?
A) Serotonin syndrome
B) Hypertensive crisis from tyramine interaction with MAOI
C) Allergic reaction
D) Panic attack
Rationale: MAOIs inhibit tyramine metabolism. Tyramine-rich foods cause massive NE release leading to
hypertensive crisis. Teach low-tyramine diet, avoid sympathomimetics. Treat with phentolamine.
7. A 28-year-old female presents with 3 weeks of anhedonia, hypersomnia, increased
appetite, and feelings of worthlessness. She denies any history of mania or hypomania.
What is the most likely DSM-5-TR diagnosis?
A) Bipolar II disorder
B) Major Depressive Disorder, with atypical features
C) Persistent Depressive Disorder
D) Adjustment disorder with depressed mood
Rationale: Atypical depression requires mood reactivity plus 2 of: hyperphagia, hypersomnia, leaden
paralysis, rejection sensitivity. Bipolar II requires hypomania. PDD is chronic >2 years. Adjustment disorder
is response to identifiable stressor within 3 months and resolves within 6 months.
8. Which medication requires routine monitoring of renal function, thyroid function, and
serum levels drawn 8-12 hours post-dose due to narrow therapeutic index?
A) Lamotrigine
B) Lithium
C) Valproate
D) Aripiprazole
Rationale: Lithium therapeutic range 0.6-1.2 mEq/L for acute mania, 0.6-1.0 for maintenance. Causes
hypothyroidism, polyuria leading to interstitial nephritis, and toxicity. Levels must be 8-12 hrs after dose, at
steady state after 5 days.
9. A patient on fluoxetine and tramadol presents with agitation, inducible clonus,
hyperthermia, diaphoresis, and hyperreflexia. What syndrome should the PMHNP suspect?
A) Neuroleptic Malignant Syndrome
B) Serotonin Syndrome
C) Anticholinergic toxicity
D) Malignant hyperthermia
Rationale: Hunter Criteria for Serotonin Syndrome: serotonergic agent + clonus/hyperreflexia +
agitation/diaphoresis/temperature >38C. NMS shows lead-pipe rigidity, bradyreflexia, from dopamine
antagonists. Requires cyproheptadine and stopping offending agents.
10. What is the first-line pharmacologic treatment for acute mania with psychotic features in
a treatment-naive patient?
A) Lithium monotherapy
, B) Second-generation antipsychotic such as quetiapine, olanzapine, or risperidone
C) Lorazepam monotherapy
D) Lamotrigine
Rationale: SGAs have rapid antimanic and antipsychotic effects. Lithium takes 5-7 days. Lamotrigine is not
effective for acute mania, it is for bipolar depression maintenance. Benzos are adjunctive only for agitation.
11. A patient with schizophrenia on haloperidol develops acute torticollis and tongue
protrusion 2 hours after injection. What is the best immediate intervention?
A) Administer benztropine or diphenhydramine IM
B) Administer lorazepam 2 mg
C) Start propranolol
D) Decrease haloperidol dose
Rationale: Acute dystonia is a D2-blockade EPS emergency occurring hours to days after exposure. Treat
immediately with anticholinergic benztropine 1-2 mg IM or diphenhydramine 50 mg IM/IV. Do not just lower
dose, airway can be compromised.
12. A patient on clozapine for treatment-resistant schizophrenia presents with fever and
sore throat. What lab should be checked immediately?
A) Liver function tests
B) Absolute neutrophil count (ANC)
C) Serum creatinine
D) Prolactin level
Rationale: Clozapine carries black box for agranulocytosis. Mandatory ANC monitoring per REMS.
Fever/sore throat may signal neutropenia. If ANC <1000, hold and evaluate.
13. A 28-year-old female presents with 3 weeks of anhedonia, hypersomnia, increased
appetite, and feelings of worthlessness. She denies any history of mania or hypomania.
What is the most likely DSM-5-TR diagnosis?
A) Bipolar II disorder
B) Major Depressive Disorder, with atypical features
C) Persistent Depressive Disorder
D) Adjustment disorder with depressed mood
Rationale: Atypical depression requires mood reactivity plus 2 of: hyperphagia, hypersomnia, leaden
paralysis, rejection sensitivity. Bipolar II requires hypomania. PDD is chronic >2 years. Adjustment disorder
is response to identifiable stressor within 3 months and resolves within 6 months.
14. Which medication requires routine monitoring of renal function, thyroid function, and
serum levels drawn 8-12 hours post-dose due to narrow therapeutic index?
A) Lamotrigine
B) Lithium
C) Valproate
D) Aripiprazole
