NR607 PRE DIAGNOSTIC EXAM /NEWEST NR607 PRE DIAGNOSTIC TEST
2026/2027 TESTBANK AND STUDY GUIDE COMPLETE ACCURATE EXAM
1. A PMHNP is evaluating an adult client with a long history of severe major
depressive disorder who has completed adequate trials of several
antidepressants at therapeutic doses but continues to experience significant
anhedonia, hopelessness, impaired concentration, and occupational
dysfunction. The client reports adherence has been consistent and there
are no obvious medical or substance-related explanations. Which clinical
concept should the PMHNP recognize when determining the next
treatment strategy?
A) Normal variation in depressive symptoms
B) Adjustment disorder
C) Treatment-resistant depression requiring reassessment and an evidence-
based augmentation or alternative strategy
D) Somatic symptom disorder
Answer: C
2. A client with treatment-resistant depression has completed adequate
medication trials but continues to have severe symptoms and recurrent
suicidal thoughts. The PMHNP is considering a somatic treatment after
reviewing previous treatments, medical history, contraindications, and
patient preferences. Which intervention may be appropriate for severe or
treatment-resistant depression when rapid symptom reduction is clinically
necessary?
A) Electroconvulsive therapy
B) Sleep restriction alone
C) Discontinuation of all medications
D) Supportive counseling without further treatment
Answer: A
3. A client with major depressive disorder has taken an antidepressant at an
adequate therapeutic dose for an adequate duration with only partial
improvement. The client denies adverse effects and is willing to continue
1
, treatment while another intervention is considered. Which approach is
most consistent with evidence-based management of partial response?
A) Immediately discontinue every psychiatric medication
B) Evaluate adherence and diagnosis and consider an evidence-based
augmentation strategy
C) Assume the client has bipolar disorder without further assessment
D) Avoid reassessing symptoms because partial response confirms the
diagnosis
Answer: B
4. A PMHNP is evaluating a client who reports persistent depression despite
multiple medication trials. Before labeling the illness as treatment resistant,
which factor should receive careful reassessment?
A) Favorite foods
B) Preferred appointment time
C) Childhood hobbies
D) Diagnostic accuracy, adherence, adequate dose and duration,
comorbidities, substances, and psychosocial factors
Answer: D
5. A client with bipolar disorder presents with severe depressive symptoms
but reports that several previous antidepressant trials were followed by
periods of decreased need for sleep, excessive spending, and markedly
increased energy. Which treatment-planning principle is most important?
A) Consider the possibility of antidepressant-associated mood switching and
prioritize appropriate bipolar depression treatment
B) Increase antidepressant dosage without further assessment
C) Treat the depressive episode as unipolar depression
D) Avoid assessing previous manic or hypomanic symptoms
Answer: A
6. A client with bipolar I disorder presents with several days of elevated mood,
pressured speech, racing thoughts, decreased need for sleep, impulsive
spending, and increasingly impaired judgment. The client is becoming
2
, difficult to redirect during the interview. Which clinical problem should the
PMHNP prioritize?
A) Mild adjustment reaction
B) Manic episode requiring assessment of severity, psychosis, safety, and
need for urgent treatment
C) Persistent depressive disorder
D) Specific phobia
Answer: B
7. A client experiencing acute mania has become increasingly aggressive, has
slept only two hours nightly for several days, and believes the client has
supernatural powers. The family reports escalating unsafe behavior. Which
intervention should the PMHNP prioritize?
A) Encourage the client to remain home alone
B) Delay treatment until the client becomes exhausted
C) Evaluate immediate safety and initiate appropriate urgent management
of the severe manic episode
D) Focus exclusively on long-term psychotherapy
Answer: C
8. A client with bipolar disorder presents with severe depression, psychotic
symptoms, and inability to care for basic needs. The PMHNP is determining
whether outpatient management remains appropriate. Which
consideration is most important?
A) The client's favorite medication
B) Whether the client prefers morning appointments
C) Whether the client has recently changed employment
D) Severity of symptoms, psychosis, suicide risk, ability to care for self,
support system, and treatment setting
Answer: D
9. A client with bipolar disorder has a history of repeated depressive episodes
and several prior manic episodes. The client asks why the PMHNP continues
to ask about sleep, energy, impulsivity, and unusual goal-directed behavior
3
, even when the current complaint is depression. Which explanation is most
appropriate?
A) Assessment for past and current mania is essential because treatment
decisions depend on distinguishing bipolar illness from unipolar depression
B) These questions are unrelated to psychiatric diagnosis
C) Sleep and energy are only relevant to anxiety disorders
D) Bipolar disorder is diagnosed only from depressive symptoms
Answer: A
10. A PMHNP is evaluating a client who has experienced several psychotic
episodes associated with severe mood episodes. The clinician wants to
determine whether psychosis ever occurs outside the context of mood
episodes. Why is this distinction clinically important?
A) It determines whether the client has an anxiety disorder
B) The relationship between psychosis and mood episodes helps distinguish
bipolar or depressive disorders with psychotic features from schizoaffective
or primary psychotic disorders
C) Psychosis is never associated with mood disorders
D) Mood symptoms are irrelevant when evaluating psychosis
Answer: B
11. A client reports hearing voices for several months while also experiencing
prominent depressive episodes. The PMHNP carefully establishes that
hallucinations and delusions have persisted for a substantial period when
major mood symptoms were absent. Which diagnosis should be
considered?
A) Panic disorder
B) Major depressive disorder with psychotic features
C) Schizoaffective disorder
D) Generalized anxiety disorder
Answer: C
12. A client with schizophrenia continues to experience auditory hallucinations
and social withdrawal despite an adequate trial of an antipsychotic
4
2026/2027 TESTBANK AND STUDY GUIDE COMPLETE ACCURATE EXAM
1. A PMHNP is evaluating an adult client with a long history of severe major
depressive disorder who has completed adequate trials of several
antidepressants at therapeutic doses but continues to experience significant
anhedonia, hopelessness, impaired concentration, and occupational
dysfunction. The client reports adherence has been consistent and there
are no obvious medical or substance-related explanations. Which clinical
concept should the PMHNP recognize when determining the next
treatment strategy?
A) Normal variation in depressive symptoms
B) Adjustment disorder
C) Treatment-resistant depression requiring reassessment and an evidence-
based augmentation or alternative strategy
D) Somatic symptom disorder
Answer: C
2. A client with treatment-resistant depression has completed adequate
medication trials but continues to have severe symptoms and recurrent
suicidal thoughts. The PMHNP is considering a somatic treatment after
reviewing previous treatments, medical history, contraindications, and
patient preferences. Which intervention may be appropriate for severe or
treatment-resistant depression when rapid symptom reduction is clinically
necessary?
A) Electroconvulsive therapy
B) Sleep restriction alone
C) Discontinuation of all medications
D) Supportive counseling without further treatment
Answer: A
3. A client with major depressive disorder has taken an antidepressant at an
adequate therapeutic dose for an adequate duration with only partial
improvement. The client denies adverse effects and is willing to continue
1
, treatment while another intervention is considered. Which approach is
most consistent with evidence-based management of partial response?
A) Immediately discontinue every psychiatric medication
B) Evaluate adherence and diagnosis and consider an evidence-based
augmentation strategy
C) Assume the client has bipolar disorder without further assessment
D) Avoid reassessing symptoms because partial response confirms the
diagnosis
Answer: B
4. A PMHNP is evaluating a client who reports persistent depression despite
multiple medication trials. Before labeling the illness as treatment resistant,
which factor should receive careful reassessment?
A) Favorite foods
B) Preferred appointment time
C) Childhood hobbies
D) Diagnostic accuracy, adherence, adequate dose and duration,
comorbidities, substances, and psychosocial factors
Answer: D
5. A client with bipolar disorder presents with severe depressive symptoms
but reports that several previous antidepressant trials were followed by
periods of decreased need for sleep, excessive spending, and markedly
increased energy. Which treatment-planning principle is most important?
A) Consider the possibility of antidepressant-associated mood switching and
prioritize appropriate bipolar depression treatment
B) Increase antidepressant dosage without further assessment
C) Treat the depressive episode as unipolar depression
D) Avoid assessing previous manic or hypomanic symptoms
Answer: A
6. A client with bipolar I disorder presents with several days of elevated mood,
pressured speech, racing thoughts, decreased need for sleep, impulsive
spending, and increasingly impaired judgment. The client is becoming
2
, difficult to redirect during the interview. Which clinical problem should the
PMHNP prioritize?
A) Mild adjustment reaction
B) Manic episode requiring assessment of severity, psychosis, safety, and
need for urgent treatment
C) Persistent depressive disorder
D) Specific phobia
Answer: B
7. A client experiencing acute mania has become increasingly aggressive, has
slept only two hours nightly for several days, and believes the client has
supernatural powers. The family reports escalating unsafe behavior. Which
intervention should the PMHNP prioritize?
A) Encourage the client to remain home alone
B) Delay treatment until the client becomes exhausted
C) Evaluate immediate safety and initiate appropriate urgent management
of the severe manic episode
D) Focus exclusively on long-term psychotherapy
Answer: C
8. A client with bipolar disorder presents with severe depression, psychotic
symptoms, and inability to care for basic needs. The PMHNP is determining
whether outpatient management remains appropriate. Which
consideration is most important?
A) The client's favorite medication
B) Whether the client prefers morning appointments
C) Whether the client has recently changed employment
D) Severity of symptoms, psychosis, suicide risk, ability to care for self,
support system, and treatment setting
Answer: D
9. A client with bipolar disorder has a history of repeated depressive episodes
and several prior manic episodes. The client asks why the PMHNP continues
to ask about sleep, energy, impulsivity, and unusual goal-directed behavior
3
, even when the current complaint is depression. Which explanation is most
appropriate?
A) Assessment for past and current mania is essential because treatment
decisions depend on distinguishing bipolar illness from unipolar depression
B) These questions are unrelated to psychiatric diagnosis
C) Sleep and energy are only relevant to anxiety disorders
D) Bipolar disorder is diagnosed only from depressive symptoms
Answer: A
10. A PMHNP is evaluating a client who has experienced several psychotic
episodes associated with severe mood episodes. The clinician wants to
determine whether psychosis ever occurs outside the context of mood
episodes. Why is this distinction clinically important?
A) It determines whether the client has an anxiety disorder
B) The relationship between psychosis and mood episodes helps distinguish
bipolar or depressive disorders with psychotic features from schizoaffective
or primary psychotic disorders
C) Psychosis is never associated with mood disorders
D) Mood symptoms are irrelevant when evaluating psychosis
Answer: B
11. A client reports hearing voices for several months while also experiencing
prominent depressive episodes. The PMHNP carefully establishes that
hallucinations and delusions have persisted for a substantial period when
major mood symptoms were absent. Which diagnosis should be
considered?
A) Panic disorder
B) Major depressive disorder with psychotic features
C) Schizoaffective disorder
D) Generalized anxiety disorder
Answer: C
12. A client with schizophrenia continues to experience auditory hallucinations
and social withdrawal despite an adequate trial of an antipsychotic
4
