NR-668: Psychiatric-Mental Health Capstone
Practicum – Advanced Clinical Integration, Evidence-
Based Mental Health Assessment, and Therapeutic
Intervention with detailed answers and rationales
2025-2026
1. A 28-year-old female presents with persistent sadness,
loss of interest in activities, and fatigue for the past 8
weeks. Which is the most likely diagnosis?
A. Bipolar I Disorder
B. Persistent Depressive Disorder
C. Major Depressive Disorder
D. Cyclothymic Disorder
Rationale: Symptoms lasting more than 2 weeks, including
low mood and anhedonia, are consistent with Major
Depressive Disorder.
2. A patient with schizophrenia reports auditory
hallucinations. Which intervention is most appropriate
first-line?
A. Cognitive behavioral therapy
B. Initiate antipsychotic medication
C. Electroconvulsive therapy
D. Hospital discharge without intervention
Rationale: Antipsychotic medications are first-line
treatment for hallucinations in schizophrenia.
,3. A patient on lithium presents with nausea, tremor, and
confusion. Which is the most concerning possibility?
A. Dehydration
B. Anxiety
C. Lithium toxicity
D. Serotonin syndrome
Rationale: Lithium toxicity is characterized by GI
symptoms, tremor, and neurological changes, requiring
immediate evaluation.
4. When assessing suicide risk, which factor is most
significant?
A. Gender
B. Employment status
C. Marital status
D. Previous suicide attempts
Rationale: Previous suicide attempts are the strongest
predictor of future suicidal behavior.
5. A patient with generalized anxiety disorder is started on
sertraline. Which teaching point is most important?
A. Expect symptom improvement immediately
B. Full effect may take 4–6 weeks
C. Avoid all social interactions
D. Stop the medication if anxiety worsens after 2 days
Rationale: SSRIs may take several weeks for maximal
therapeutic effect.
,6. A patient presents with acute mania. Which medication
class is preferred for stabilization?
A. SSRI
B. Mood stabilizer
C. Benzodiazepine
D. Antidepressant
Rationale: Mood stabilizers (e.g., lithium, valproate) are
first-line for acute mania.
7. A patient reports auditory hallucinations and paranoia.
What legal consideration should the clinician prioritize?
A. Documenting the hallucinations
B. Assessing for risk of harm to self or others
C. Prescribing any requested medication
D. Encouraging social isolation
Rationale: Safety assessment is a legal and ethical
obligation in psychiatric care.
8. A patient with major depressive disorder has not
responded to two different SSRIs. What is the next best
step?
A. Increase the dose of the first SSRI indefinitely
B. Consider switching to an SNRI or augmentation
therapy
C. Stop all medications
D. Initiate benzodiazepine monotherapy
Rationale: Nonresponse to SSRIs warrants switching or
augmentation strategies.
, 9. A patient with PTSD reports nightmares and
hypervigilance. Which therapy is most evidence-based?
A. Supportive counseling
B. Trauma-focused cognitive behavioral therapy (CBT)
C. Psychoanalysis
D. Electroconvulsive therapy
Rationale: Trauma-focused CBT is first-line evidence-based
therapy for PTSD.
10. A patient taking clozapine must be monitored for
which serious adverse effect?
A. Weight loss
B. Hypertension
C. Agranulocytosis
D. Hair loss
Rationale: Clozapine carries a risk of agranulocytosis,
requiring regular CBC monitoring.
11. Which of the following is a primary ethical principle
in psychiatric practice?
A. Profit
B. Beneficence
C. Compliance with peers only
D. Personal beliefs over patient autonomy
Rationale: Beneficence involves acting in the best interest
of the patient.
12. A patient with bipolar disorder is nonadherent with
lithium due to side effects. Which approach is best?
Practicum – Advanced Clinical Integration, Evidence-
Based Mental Health Assessment, and Therapeutic
Intervention with detailed answers and rationales
2025-2026
1. A 28-year-old female presents with persistent sadness,
loss of interest in activities, and fatigue for the past 8
weeks. Which is the most likely diagnosis?
A. Bipolar I Disorder
B. Persistent Depressive Disorder
C. Major Depressive Disorder
D. Cyclothymic Disorder
Rationale: Symptoms lasting more than 2 weeks, including
low mood and anhedonia, are consistent with Major
Depressive Disorder.
2. A patient with schizophrenia reports auditory
hallucinations. Which intervention is most appropriate
first-line?
A. Cognitive behavioral therapy
B. Initiate antipsychotic medication
C. Electroconvulsive therapy
D. Hospital discharge without intervention
Rationale: Antipsychotic medications are first-line
treatment for hallucinations in schizophrenia.
,3. A patient on lithium presents with nausea, tremor, and
confusion. Which is the most concerning possibility?
A. Dehydration
B. Anxiety
C. Lithium toxicity
D. Serotonin syndrome
Rationale: Lithium toxicity is characterized by GI
symptoms, tremor, and neurological changes, requiring
immediate evaluation.
4. When assessing suicide risk, which factor is most
significant?
A. Gender
B. Employment status
C. Marital status
D. Previous suicide attempts
Rationale: Previous suicide attempts are the strongest
predictor of future suicidal behavior.
5. A patient with generalized anxiety disorder is started on
sertraline. Which teaching point is most important?
A. Expect symptom improvement immediately
B. Full effect may take 4–6 weeks
C. Avoid all social interactions
D. Stop the medication if anxiety worsens after 2 days
Rationale: SSRIs may take several weeks for maximal
therapeutic effect.
,6. A patient presents with acute mania. Which medication
class is preferred for stabilization?
A. SSRI
B. Mood stabilizer
C. Benzodiazepine
D. Antidepressant
Rationale: Mood stabilizers (e.g., lithium, valproate) are
first-line for acute mania.
7. A patient reports auditory hallucinations and paranoia.
What legal consideration should the clinician prioritize?
A. Documenting the hallucinations
B. Assessing for risk of harm to self or others
C. Prescribing any requested medication
D. Encouraging social isolation
Rationale: Safety assessment is a legal and ethical
obligation in psychiatric care.
8. A patient with major depressive disorder has not
responded to two different SSRIs. What is the next best
step?
A. Increase the dose of the first SSRI indefinitely
B. Consider switching to an SNRI or augmentation
therapy
C. Stop all medications
D. Initiate benzodiazepine monotherapy
Rationale: Nonresponse to SSRIs warrants switching or
augmentation strategies.
, 9. A patient with PTSD reports nightmares and
hypervigilance. Which therapy is most evidence-based?
A. Supportive counseling
B. Trauma-focused cognitive behavioral therapy (CBT)
C. Psychoanalysis
D. Electroconvulsive therapy
Rationale: Trauma-focused CBT is first-line evidence-based
therapy for PTSD.
10. A patient taking clozapine must be monitored for
which serious adverse effect?
A. Weight loss
B. Hypertension
C. Agranulocytosis
D. Hair loss
Rationale: Clozapine carries a risk of agranulocytosis,
requiring regular CBC monitoring.
11. Which of the following is a primary ethical principle
in psychiatric practice?
A. Profit
B. Beneficence
C. Compliance with peers only
D. Personal beliefs over patient autonomy
Rationale: Beneficence involves acting in the best interest
of the patient.
12. A patient with bipolar disorder is nonadherent with
lithium due to side effects. Which approach is best?
