1|Page
NRNP 6635 MIDTERM COMPREHENSIVE
ACTUAL EXAM ALL 150 QUESTIONS AND
CORRECT DETAILED ANSWERS | LATEST
2026-2027 VERSION | RATED A + | NEW AND
REVISED
1. A 24-year-old patient presents with a 2-week history of
depressed mood, anhedonia, insomnia, and feelings of
worthlessness following job loss. There is no history of
mania or hypomania. Which diagnosis is most appropriate?
A. Adjustment disorder with depressed mood
B. Major depressive disorder
C. Persistent depressive disorder
D. Bipolar II disorder
Italicized rationale: The patient meets DSM-5-TR criteria
for MDD with ≥2 weeks of depressive symptoms causing
impairment and no history of mania or hypomania.
2. A patient with schizophrenia reports hearing voices
commenting on his behavior. This symptom is best
classified as:
A. Negative symptom
B. Cognitive symptom
C. Positive symptom
D. Affective symptom
Italicized rationale: Hallucinations are positive
,2|Page
symptoms, reflecting an excess or distortion of normal
functioning.
3. Which neurotransmitter is most strongly associated with
the pathophysiology of depression?
A. Dopamine
B. Serotonin
C. GABA
D. Acetylcholine
Italicized rationale: Serotonin dysregulation is central to
mood disorders and is the primary target of many
antidepressants.
4. A PMHNP is initiating sertraline for a patient with major
depressive disorder. Which side effect should be discussed
as most common early in treatment?
A. Agranulocytosis
B. Gastrointestinal upset
C. Hypertensive crisis
D. Stevens-Johnson syndrome
Italicized rationale: SSRIs commonly cause nausea and
diarrhea early, which often resolve with time.
5. A 35-year-old patient presents with excessive worry for
more than 6 months, muscle tension, restlessness, and
difficulty concentrating. Which diagnosis is most
appropriate?
A. Panic disorder
B. Social anxiety disorder
C. Generalized anxiety disorder
D. Acute stress disorder
Italicized rationale: Persistent, excessive worry for ≥6
months with somatic symptoms is diagnostic of GAD.
,3|Page
6. The primary mechanism of action of benzodiazepines is:
A. Blocking serotonin reuptake
B. Enhancing GABA-A receptor activity
C. Inhibiting monoamine oxidase
D. Blocking dopamine receptors
Italicized rationale: Benzodiazepines potentiate GABA-A,
increasing inhibitory neurotransmission.
7. A patient taking clozapine requires regular monitoring of:
A. Liver enzymes
B. Serum sodium
C. Absolute neutrophil count
D. Serum lithium level
Italicized rationale: Clozapine carries a risk of
agranulocytosis, requiring ANC monitoring.
8. Which symptom best differentiates bipolar I disorder from
bipolar II disorder?
A. Hypomanic episodes
B. Major depressive episodes
C. Full manic episodes
D. Cyclothymic mood changes
Italicized rationale: Bipolar I is defined by at least one
full manic episode.
9. A 70-year-old patient presents with gradual memory
decline and impaired executive function over several years.
Which diagnosis is most likely?
A. Delirium
B. Mild neurocognitive disorder
C. Major neurocognitive disorder due to Alzheimer’s
disease
D. Vascular dementia
Italicized rationale: Progressive memory loss and
, 4|Page
executive dysfunction are hallmark features of
Alzheimer’s disease.
10. Which screening tool is most appropriate for assessing
depression severity in primary psychiatric care?
A. MMSE
B. PHQ-9
C. GAD-7
D. MoCA
Italicized rationale: PHQ-9 is validated for screening and
monitoring depression severity.
11. A patient presents with recurrent panic attacks and
fear of future attacks. The most appropriate first-line long-
term treatment is:
A. PRN benzodiazepines only
B. SSRI therapy
C. Beta-blockers
D. Antipsychotics
Italicized rationale: SSRIs are first-line for panic disorder
due to efficacy and safety.
12. Which therapy focuses on identifying and
restructuring maladaptive thoughts?
A. Psychodynamic therapy
B. Cognitive behavioral therapy
C. Interpersonal therapy
D. Humanistic therapy
Italicized rationale: CBT targets cognitive distortions and
behaviors.
13. A patient with PTSD experiences recurrent nightmares
and hypervigilance. Which medication may specifically
help reduce nightmares?
A. Fluoxetine
NRNP 6635 MIDTERM COMPREHENSIVE
ACTUAL EXAM ALL 150 QUESTIONS AND
CORRECT DETAILED ANSWERS | LATEST
2026-2027 VERSION | RATED A + | NEW AND
REVISED
1. A 24-year-old patient presents with a 2-week history of
depressed mood, anhedonia, insomnia, and feelings of
worthlessness following job loss. There is no history of
mania or hypomania. Which diagnosis is most appropriate?
A. Adjustment disorder with depressed mood
B. Major depressive disorder
C. Persistent depressive disorder
D. Bipolar II disorder
Italicized rationale: The patient meets DSM-5-TR criteria
for MDD with ≥2 weeks of depressive symptoms causing
impairment and no history of mania or hypomania.
2. A patient with schizophrenia reports hearing voices
commenting on his behavior. This symptom is best
classified as:
A. Negative symptom
B. Cognitive symptom
C. Positive symptom
D. Affective symptom
Italicized rationale: Hallucinations are positive
,2|Page
symptoms, reflecting an excess or distortion of normal
functioning.
3. Which neurotransmitter is most strongly associated with
the pathophysiology of depression?
A. Dopamine
B. Serotonin
C. GABA
D. Acetylcholine
Italicized rationale: Serotonin dysregulation is central to
mood disorders and is the primary target of many
antidepressants.
4. A PMHNP is initiating sertraline for a patient with major
depressive disorder. Which side effect should be discussed
as most common early in treatment?
A. Agranulocytosis
B. Gastrointestinal upset
C. Hypertensive crisis
D. Stevens-Johnson syndrome
Italicized rationale: SSRIs commonly cause nausea and
diarrhea early, which often resolve with time.
5. A 35-year-old patient presents with excessive worry for
more than 6 months, muscle tension, restlessness, and
difficulty concentrating. Which diagnosis is most
appropriate?
A. Panic disorder
B. Social anxiety disorder
C. Generalized anxiety disorder
D. Acute stress disorder
Italicized rationale: Persistent, excessive worry for ≥6
months with somatic symptoms is diagnostic of GAD.
,3|Page
6. The primary mechanism of action of benzodiazepines is:
A. Blocking serotonin reuptake
B. Enhancing GABA-A receptor activity
C. Inhibiting monoamine oxidase
D. Blocking dopamine receptors
Italicized rationale: Benzodiazepines potentiate GABA-A,
increasing inhibitory neurotransmission.
7. A patient taking clozapine requires regular monitoring of:
A. Liver enzymes
B. Serum sodium
C. Absolute neutrophil count
D. Serum lithium level
Italicized rationale: Clozapine carries a risk of
agranulocytosis, requiring ANC monitoring.
8. Which symptom best differentiates bipolar I disorder from
bipolar II disorder?
A. Hypomanic episodes
B. Major depressive episodes
C. Full manic episodes
D. Cyclothymic mood changes
Italicized rationale: Bipolar I is defined by at least one
full manic episode.
9. A 70-year-old patient presents with gradual memory
decline and impaired executive function over several years.
Which diagnosis is most likely?
A. Delirium
B. Mild neurocognitive disorder
C. Major neurocognitive disorder due to Alzheimer’s
disease
D. Vascular dementia
Italicized rationale: Progressive memory loss and
, 4|Page
executive dysfunction are hallmark features of
Alzheimer’s disease.
10. Which screening tool is most appropriate for assessing
depression severity in primary psychiatric care?
A. MMSE
B. PHQ-9
C. GAD-7
D. MoCA
Italicized rationale: PHQ-9 is validated for screening and
monitoring depression severity.
11. A patient presents with recurrent panic attacks and
fear of future attacks. The most appropriate first-line long-
term treatment is:
A. PRN benzodiazepines only
B. SSRI therapy
C. Beta-blockers
D. Antipsychotics
Italicized rationale: SSRIs are first-line for panic disorder
due to efficacy and safety.
12. Which therapy focuses on identifying and
restructuring maladaptive thoughts?
A. Psychodynamic therapy
B. Cognitive behavioral therapy
C. Interpersonal therapy
D. Humanistic therapy
Italicized rationale: CBT targets cognitive distortions and
behaviors.
13. A patient with PTSD experiences recurrent nightmares
and hypervigilance. Which medication may specifically
help reduce nightmares?
A. Fluoxetine
