1|Page
NR605 / NR 605 FINAL EXAM (LATEST UPDATE 2026),
DIAGNOSIS & MANAGEMENT IN PSYCHIATRIC-MENTAL
HEALTH ACROSS THE LIFESPAN I PRACTICUM
1.
A 34-year-old client with generalized anxiety disorder reports constant
worry and difficulty concentrating at work. The provider prescribes
buspirone. Which statement best explains the action of this medication?
A. It acts as a benzodiazepine with sedative effects
B. It works as a serotonin receptor agonist without sedation
C. It increases GABA activity similar to alcohol
D. It produces rapid relief within 30 minutes
Rationale: Buspirone is a non-benzodiazepine anxiolytic that acts on
serotonin receptors and reduces anxiety without sedation or dependency. It
takes 2–4 weeks for therapeutic effect, unlike benzodiazepines which act
quickly.
2.
A 52-year-old client with major depressive disorder started fluoxetine 3
weeks ago. The client reports improved mood but is experiencing insomnia.
What is the most appropriate nursing recommendation?
A. Take the medication at bedtime with a snack
B. Take the medication in the morning to reduce insomnia
C. Skip doses when insomnia is severe
D. Switch to a tricyclic antidepressant immediately
Rationale: Fluoxetine (an SSRI) is activating and can cause insomnia, so it
should be taken in the morning. It should not be skipped or abruptly
switched to a TCA, and taking it at bedtime worsens insomnia.
,2|Page
3.
A client with bipolar I disorder is prescribed lithium. Which serum lithium
level should prompt the nurse to notify the provider immediately?
A. 0.8 mEq/L
B. 1.0 mEq/L
C. 2.0 mEq/L
D. 1.2 mEq/L
Rationale: The therapeutic range for lithium is 0.6–1.2 mEq/L. A level of
2.0 mEq/L indicates toxicity, which can cause tremors, confusion, seizures,
and even death.
4.
A college student with ADHD is prescribed methylphenidate. Which finding
would require the nurse’s intervention?
A. Reports improved concentration in class
B. Blood pressure 160/95 mmHg after 2 weeks of therapy
C. Slight decrease in appetite
D. Reports difficulty falling asleep
Rationale: Methylphenidate, a stimulant, can cause hypertension,
tachycardia, decreased appetite, and insomnia. A blood pressure of 160/95 is
unsafe and requires immediate intervention. Appetite suppression and
insomnia are common but less urgent.
5.
A nurse is assessing a client with schizophrenia who states, “I hear voices
telling me I am worthless.” What is the nurse’s priority action?
A. Distract the client with another activity
B. Ask the client if they feel like acting on the voices
C. Tell the client the voices are not real
D. Increase the client’s daily medication dose
,3|Page
Rationale: When a client reports command hallucinations, the priority is to
assess the risk of self-harm or harm to others. Asking about intent ensures
safety. Dismissing or distracting without assessment does not address
potential danger.
6.
A 41-year-old client is being tapered off alprazolam after long-term use.
Which symptom requires immediate medical attention?
A. Irritability and restlessness
B. Seizure activity
C. Mild insomnia
D. Increased anxiety
Rationale: Benzodiazepine withdrawal can be life-threatening and may
result in seizures. Increased anxiety, irritability, and insomnia are common
but less urgent compared to seizures.
7.
The nurse evaluates a client on clozapine. Which assessment finding
requires urgent intervention?
A. Constipation and sedation
B. Weight gain of 10 pounds
C. Sore throat and fever
D. Hypersalivation
Rationale: Clozapine can cause agranulocytosis, a dangerous drop in
WBCs. Sore throat and fever may indicate infection and require immediate
reporting. Weight gain, constipation, and hypersalivation are common but
less dangerous.
8.
A 27-year-old pregnant client is diagnosed with depression. Which
antidepressant is generally considered the safest first-line choice during
, 4|Page
pregnancy?
A. Paroxetine
B. Sertraline
C. Doxepin
D. Phenelzine
Rationale: Sertraline (SSRI) is often preferred in pregnancy due to its safety
profile. Paroxetine is linked to fetal cardiac defects, TCAs (like doxepin) and
MAOIs (like phenelzine) are generally avoided.
9.
A client with alcohol withdrawal is being treated with lorazepam. Which
assessment finding indicates the medication is effective?
A. Elevated blood pressure and tachycardia
B. Increasing anxiety and tremors
C. Decreased agitation and stable vital signs
D. Persistent hallucinations
Rationale: Benzodiazepines such as lorazepam are the drug of choice in
alcohol withdrawal to reduce agitation, anxiety, tremors, and prevent
seizures. Stable vitals and reduced agitation show effectiveness.
10.
A client with PTSD tells the nurse, “I can’t sleep because I keep reliving the
trauma.” Which medication is most appropriate to address this symptom?
A. Lithium
B. Fluoxetine
C. Prazosin
D. Valproic acid
Rationale: Prazosin, an alpha-1 blocker, is effective in reducing trauma-
related nightmares in PTSD. SSRIs like fluoxetine treat depression/anxiety
but are less effective for nightmares. Lithium and valproic acid are mood
stabilizers, not first-line for PTSD.
NR605 / NR 605 FINAL EXAM (LATEST UPDATE 2026),
DIAGNOSIS & MANAGEMENT IN PSYCHIATRIC-MENTAL
HEALTH ACROSS THE LIFESPAN I PRACTICUM
1.
A 34-year-old client with generalized anxiety disorder reports constant
worry and difficulty concentrating at work. The provider prescribes
buspirone. Which statement best explains the action of this medication?
A. It acts as a benzodiazepine with sedative effects
B. It works as a serotonin receptor agonist without sedation
C. It increases GABA activity similar to alcohol
D. It produces rapid relief within 30 minutes
Rationale: Buspirone is a non-benzodiazepine anxiolytic that acts on
serotonin receptors and reduces anxiety without sedation or dependency. It
takes 2–4 weeks for therapeutic effect, unlike benzodiazepines which act
quickly.
2.
A 52-year-old client with major depressive disorder started fluoxetine 3
weeks ago. The client reports improved mood but is experiencing insomnia.
What is the most appropriate nursing recommendation?
A. Take the medication at bedtime with a snack
B. Take the medication in the morning to reduce insomnia
C. Skip doses when insomnia is severe
D. Switch to a tricyclic antidepressant immediately
Rationale: Fluoxetine (an SSRI) is activating and can cause insomnia, so it
should be taken in the morning. It should not be skipped or abruptly
switched to a TCA, and taking it at bedtime worsens insomnia.
,2|Page
3.
A client with bipolar I disorder is prescribed lithium. Which serum lithium
level should prompt the nurse to notify the provider immediately?
A. 0.8 mEq/L
B. 1.0 mEq/L
C. 2.0 mEq/L
D. 1.2 mEq/L
Rationale: The therapeutic range for lithium is 0.6–1.2 mEq/L. A level of
2.0 mEq/L indicates toxicity, which can cause tremors, confusion, seizures,
and even death.
4.
A college student with ADHD is prescribed methylphenidate. Which finding
would require the nurse’s intervention?
A. Reports improved concentration in class
B. Blood pressure 160/95 mmHg after 2 weeks of therapy
C. Slight decrease in appetite
D. Reports difficulty falling asleep
Rationale: Methylphenidate, a stimulant, can cause hypertension,
tachycardia, decreased appetite, and insomnia. A blood pressure of 160/95 is
unsafe and requires immediate intervention. Appetite suppression and
insomnia are common but less urgent.
5.
A nurse is assessing a client with schizophrenia who states, “I hear voices
telling me I am worthless.” What is the nurse’s priority action?
A. Distract the client with another activity
B. Ask the client if they feel like acting on the voices
C. Tell the client the voices are not real
D. Increase the client’s daily medication dose
,3|Page
Rationale: When a client reports command hallucinations, the priority is to
assess the risk of self-harm or harm to others. Asking about intent ensures
safety. Dismissing or distracting without assessment does not address
potential danger.
6.
A 41-year-old client is being tapered off alprazolam after long-term use.
Which symptom requires immediate medical attention?
A. Irritability and restlessness
B. Seizure activity
C. Mild insomnia
D. Increased anxiety
Rationale: Benzodiazepine withdrawal can be life-threatening and may
result in seizures. Increased anxiety, irritability, and insomnia are common
but less urgent compared to seizures.
7.
The nurse evaluates a client on clozapine. Which assessment finding
requires urgent intervention?
A. Constipation and sedation
B. Weight gain of 10 pounds
C. Sore throat and fever
D. Hypersalivation
Rationale: Clozapine can cause agranulocytosis, a dangerous drop in
WBCs. Sore throat and fever may indicate infection and require immediate
reporting. Weight gain, constipation, and hypersalivation are common but
less dangerous.
8.
A 27-year-old pregnant client is diagnosed with depression. Which
antidepressant is generally considered the safest first-line choice during
, 4|Page
pregnancy?
A. Paroxetine
B. Sertraline
C. Doxepin
D. Phenelzine
Rationale: Sertraline (SSRI) is often preferred in pregnancy due to its safety
profile. Paroxetine is linked to fetal cardiac defects, TCAs (like doxepin) and
MAOIs (like phenelzine) are generally avoided.
9.
A client with alcohol withdrawal is being treated with lorazepam. Which
assessment finding indicates the medication is effective?
A. Elevated blood pressure and tachycardia
B. Increasing anxiety and tremors
C. Decreased agitation and stable vital signs
D. Persistent hallucinations
Rationale: Benzodiazepines such as lorazepam are the drug of choice in
alcohol withdrawal to reduce agitation, anxiety, tremors, and prevent
seizures. Stable vitals and reduced agitation show effectiveness.
10.
A client with PTSD tells the nurse, “I can’t sleep because I keep reliving the
trauma.” Which medication is most appropriate to address this symptom?
A. Lithium
B. Fluoxetine
C. Prazosin
D. Valproic acid
Rationale: Prazosin, an alpha-1 blocker, is effective in reducing trauma-
related nightmares in PTSD. SSRIs like fluoxetine treat depression/anxiety
but are less effective for nightmares. Lithium and valproic acid are mood
stabilizers, not first-line for PTSD.
