1|Page
NR 607| NR 607 FINAL ACTUAL EXAM PREP
2026 ALL QUESTIONS AND CORRECT
DETAILED ANWERS |ALREADY A GRADED
|HIGHLY RECOMMENDED BY EXPERTS
|BRAND NEW!!|REVISED
1. A PMHNP is meeting a new client who has never engaged in
mental health treatment before. Which intervention best establishes
a therapeutic alliance at the first visit?
A. Use open-ended, nonjudgmental questions and reflect the
client’s feelings
B. Ask the client to complete a medication consent form before
speaking
C. Focus immediately on diagnosis and medication options
D. Reassure the client that all symptoms will resolve quickly
Rationale: Therapeutic alliance begins with rapport, active
listening, and respect for autonomy. These behaviors support
trust and improve engagement in care.
2. A client says, “I have a gun at home, and I have been thinking
seriously about ending my life tonight.” What is the nurse’s
priority action?
A. Schedule outpatient therapy for the next available appointment
B. Ask the client to sign a no-suicide contract
C. Initiate immediate safety measures and a high-acuity suicide
risk assessment
D. Teach relaxation techniques and discharge home
Rationale: A stated plan, access to a firearm, and intent indicate
high suicide risk and require immediate safety intervention.
,2|Page
Current suicide-assessment guidance emphasizes rapid
evaluation of risk factors, inquiry, and appropriate triage.
3. Which action is included in the SAMHSA SAFE-T framework for
suicide assessment?
A. Ordering a brain MRI before any interview
B. Identifying risk factors, protective factors, and level of risk,
then documenting the plan
C. Telling the client that suicidal thoughts are only attention-
seeking
D. Requiring family permission before any suicide inquiry
Rationale: SAFE-T uses a structured five-step approach that
includes risk factors, protective factors, suicide inquiry, risk level,
interventions, and documentation.
4. A client with moderate major depressive disorder asks about
treatment options. Which plan is most evidence-based?
A. Hospitalization is always required before treatment begins
B. Psychotherapy, pharmacotherapy, or both depending on
severity and preference
C. Antipsychotic monotherapy as first-line treatment
D. No treatment is needed unless the client has psychosis
Rationale: Evidence-based depression care includes
psychotherapy and/or medication, tailored to severity,
preferences, and functional impairment.
5. Which assessment finding most strongly suggests mania rather
than unipolar depression?
A. Low self-esteem and guilt
B. Increased appetite and hypersomnia
C. Decreased need for sleep with grandiosity and pressured
speech
D. Slow movement and psychomotor retardation
,3|Page
Rationale: Manic episodes commonly include decreased need for
sleep, grandiosity, pressured speech, and increased energy.
6. A client with suspected bipolar disorder is prescribed sertraline
alone for depressive symptoms. What is the main concern?
A. Sertraline causes immediate serotonin syndrome in all clients
B. Antidepressant monotherapy can precipitate mania or rapid
cycling in bipolar illness
C. Sertraline is contraindicated in every client with depression
D. Sertraline is ineffective for anxiety symptoms
Rationale: In bipolar disorder, antidepressants should not be
used alone when mania risk is present because they may
destabilize mood. Mood-stabilizing treatment is the foundation of
care.
7. A client taking sertraline and linezolid develops agitation, tremor,
fever, and hyperreflexia. Which complication should the PMHNP
suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Acute dystonia
D. Tardive dyskinesia
Rationale: SSRIs can precipitate serotonin syndrome, especially
with other serotonergic agents. Fever, agitation, tremor, and
hyperreflexia are classic warning signs.
8. A client is prescribed olanzapine for schizophrenia. Which
baseline teaching is most important?
A. Weight gain is rare and does not require monitoring
B. Regular monitoring of weight and metabolic effects is
needed
C. The medication should be stopped as soon as symptoms
improve
D. This drug has no long-term adverse effects
, 4|Page
Rationale: Olanzapine is associated with significant weight gain
and metabolic risk, so ongoing monitoring is required.
9. A client taking lithium reports vomiting, diarrhea, coarse tremor,
and unsteady gait. What is the best next action?
A. Encourage the client to double the next dose
B. Hold lithium and assess for toxicity immediately
C. Reassure the client that these are expected effects
D. Add an SSRI to reduce tremor
Rationale: Gastrointestinal upset, tremor, and ataxia are
concerning for lithium toxicity and require urgent evaluation.
Lithium labeling emphasizes monitoring for toxicity and
dehydration risk.
10. Which client statement shows correct understanding of
lithium safety?
A. “I should restrict my fluid intake to prevent edema.”
B. “I can stop drinking water when I feel well.”
C. “I need to maintain adequate fluids and avoid dehydration.”
D. “I should take lithium only when I feel manic.”
Rationale: Dehydration and sodium changes can increase
lithium levels and toxicity risk, so fluid balance is essential.
11. A client with PTSD asks what treatment works best as first-
line care. What should the PMHNP recommend?
A. Antipsychotic monotherapy
B. Trauma-focused psychotherapy
C. Long-term benzodiazepine therapy
D. Electroconvulsive therapy for all clients
Rationale: Trauma-focused psychotherapy is a core evidence-
based intervention for PTSD, with medications used when
indicated.
12. A client in a panic attack arrives in the clinic
hyperventilating, frightened, and convinced they are dying. What
NR 607| NR 607 FINAL ACTUAL EXAM PREP
2026 ALL QUESTIONS AND CORRECT
DETAILED ANWERS |ALREADY A GRADED
|HIGHLY RECOMMENDED BY EXPERTS
|BRAND NEW!!|REVISED
1. A PMHNP is meeting a new client who has never engaged in
mental health treatment before. Which intervention best establishes
a therapeutic alliance at the first visit?
A. Use open-ended, nonjudgmental questions and reflect the
client’s feelings
B. Ask the client to complete a medication consent form before
speaking
C. Focus immediately on diagnosis and medication options
D. Reassure the client that all symptoms will resolve quickly
Rationale: Therapeutic alliance begins with rapport, active
listening, and respect for autonomy. These behaviors support
trust and improve engagement in care.
2. A client says, “I have a gun at home, and I have been thinking
seriously about ending my life tonight.” What is the nurse’s
priority action?
A. Schedule outpatient therapy for the next available appointment
B. Ask the client to sign a no-suicide contract
C. Initiate immediate safety measures and a high-acuity suicide
risk assessment
D. Teach relaxation techniques and discharge home
Rationale: A stated plan, access to a firearm, and intent indicate
high suicide risk and require immediate safety intervention.
,2|Page
Current suicide-assessment guidance emphasizes rapid
evaluation of risk factors, inquiry, and appropriate triage.
3. Which action is included in the SAMHSA SAFE-T framework for
suicide assessment?
A. Ordering a brain MRI before any interview
B. Identifying risk factors, protective factors, and level of risk,
then documenting the plan
C. Telling the client that suicidal thoughts are only attention-
seeking
D. Requiring family permission before any suicide inquiry
Rationale: SAFE-T uses a structured five-step approach that
includes risk factors, protective factors, suicide inquiry, risk level,
interventions, and documentation.
4. A client with moderate major depressive disorder asks about
treatment options. Which plan is most evidence-based?
A. Hospitalization is always required before treatment begins
B. Psychotherapy, pharmacotherapy, or both depending on
severity and preference
C. Antipsychotic monotherapy as first-line treatment
D. No treatment is needed unless the client has psychosis
Rationale: Evidence-based depression care includes
psychotherapy and/or medication, tailored to severity,
preferences, and functional impairment.
5. Which assessment finding most strongly suggests mania rather
than unipolar depression?
A. Low self-esteem and guilt
B. Increased appetite and hypersomnia
C. Decreased need for sleep with grandiosity and pressured
speech
D. Slow movement and psychomotor retardation
,3|Page
Rationale: Manic episodes commonly include decreased need for
sleep, grandiosity, pressured speech, and increased energy.
6. A client with suspected bipolar disorder is prescribed sertraline
alone for depressive symptoms. What is the main concern?
A. Sertraline causes immediate serotonin syndrome in all clients
B. Antidepressant monotherapy can precipitate mania or rapid
cycling in bipolar illness
C. Sertraline is contraindicated in every client with depression
D. Sertraline is ineffective for anxiety symptoms
Rationale: In bipolar disorder, antidepressants should not be
used alone when mania risk is present because they may
destabilize mood. Mood-stabilizing treatment is the foundation of
care.
7. A client taking sertraline and linezolid develops agitation, tremor,
fever, and hyperreflexia. Which complication should the PMHNP
suspect?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Acute dystonia
D. Tardive dyskinesia
Rationale: SSRIs can precipitate serotonin syndrome, especially
with other serotonergic agents. Fever, agitation, tremor, and
hyperreflexia are classic warning signs.
8. A client is prescribed olanzapine for schizophrenia. Which
baseline teaching is most important?
A. Weight gain is rare and does not require monitoring
B. Regular monitoring of weight and metabolic effects is
needed
C. The medication should be stopped as soon as symptoms
improve
D. This drug has no long-term adverse effects
, 4|Page
Rationale: Olanzapine is associated with significant weight gain
and metabolic risk, so ongoing monitoring is required.
9. A client taking lithium reports vomiting, diarrhea, coarse tremor,
and unsteady gait. What is the best next action?
A. Encourage the client to double the next dose
B. Hold lithium and assess for toxicity immediately
C. Reassure the client that these are expected effects
D. Add an SSRI to reduce tremor
Rationale: Gastrointestinal upset, tremor, and ataxia are
concerning for lithium toxicity and require urgent evaluation.
Lithium labeling emphasizes monitoring for toxicity and
dehydration risk.
10. Which client statement shows correct understanding of
lithium safety?
A. “I should restrict my fluid intake to prevent edema.”
B. “I can stop drinking water when I feel well.”
C. “I need to maintain adequate fluids and avoid dehydration.”
D. “I should take lithium only when I feel manic.”
Rationale: Dehydration and sodium changes can increase
lithium levels and toxicity risk, so fluid balance is essential.
11. A client with PTSD asks what treatment works best as first-
line care. What should the PMHNP recommend?
A. Antipsychotic monotherapy
B. Trauma-focused psychotherapy
C. Long-term benzodiazepine therapy
D. Electroconvulsive therapy for all clients
Rationale: Trauma-focused psychotherapy is a core evidence-
based intervention for PTSD, with medications used when
indicated.
12. A client in a panic attack arrives in the clinic
hyperventilating, frightened, and convinced they are dying. What
