NR 605 Psychiatric Mental Health Newest Exam
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Question 1
A 34-year-old patient presents with a persistent depressed mood,
anhedonia, significant weight loss, insomnia, psychomotor agitation,
fatigue, feelings of worthlessness, and diminished ability to
concentrate. These symptoms have been present for over two years
with no symptom-free period exceeding two months. Which of the
following is the most accurate diagnosis?
A) Major Depressive Disorder, recurrent
B) Dysthymic Disorder (Persistent Depressive Disorder)
C) Bipolar II Disorder, current episode depressed
D) Adjustment Disorder with depressed mood
Answer: B) Dysthymic Disorder (Persistent Depressive Disorder)
Explanation: The DSM-5 criteria for Persistent Depressive Disorder
(Dysthymia) require a depressed mood for most of the day, for more
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days than not, for at least two years in adults. The patient must have at
least two of the specified symptoms (e.g., appetite changes, sleep
disturbances, fatigue, low self-esteem, poor concentration, or
hopelessness) and no symptom-free period longer than two months.
The presentation matches this chronic, low-grade depressive picture.
Major Depressive Disorder is characterized by discrete episodes, not a
chronic unremitting course over two years. Bipolar II requires a history
of hypomania. Adjustment disorder is tied to a specific identifiable
stressor and does not persist for two years.
Question 2
Which neurotransmitter system is most directly implicated in the
pathophysiology of schizophrenia, particularly regarding positive
symptoms such as hallucinations and delusions?
A) Norepinephrine
B) Serotonin
C) Dopamine
D) Gamma-aminobutyric acid (GABA)
Answer: C) Dopamine
Explanation: The dopamine hypothesis of schizophrenia posits that
hyperactivity of dopamine transmission in the mesolimbic pathway is
responsible for the positive symptoms of schizophrenia. This is
supported by the fact that antipsychotic medications that block D2
dopamine receptors are effective in reducing these symptoms. While
other neurotransmitter systems, such as glutamate, serotonin, and
GABA, are also involved in the complex pathophysiology, dopamine
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dysregulation remains the most direct and historically significant link to
the positive symptom cluster.
Question 3
A patient with a history of alcohol use disorder is brought to the
emergency department in a state of severe confusion, tremors,
diaphoresis, tachycardia, and hypertension. He reports seeing "bugs
crawling on the walls." Which of the following conditions is the patient
most likely experiencing?
A) Wernicke's encephalopathy
B) Delirium tremens
C) Alcoholic hallucinosis
D) Korsakoff's syndrome
Answer: B) Delirium tremens
Explanation: Delirium tremens (DTs) is a severe form of alcohol
withdrawal that typically occurs 48 to 72 hours after the last drink. It is
characterized by a triad of autonomic hyperactivity (tachycardia,
hypertension, diaphoresis), severe confusion/disorientation, and visual
hallucinations. The presence of visual hallucinations in the context of
autonomic instability and confusion is classic for DTs. Wernicke's
encephalopathy is an acute neurological emergency caused by thiamine
deficiency, characterized by the triad of confusion, ataxia, and
ophthalmoplegia. Alcoholic hallucinosis occurs in clear consciousness,
without the autonomic and cognitive features of DTs. Korsakoff's
syndrome is a chronic condition characterized by profound anterograde
and retrograde amnesia.
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Question 4
In the context of psychiatric mental health nursing, the concept of
"therapeutic use of self" is best defined as:
A) The ability of the nurse to form a social friendship with the patient.
B) The use of the nurse's personality, experiences, values, feelings, and
intelligence to assist the patient to grow and develop.
C) The process of the nurse self-disclosing personal information to build
a trusting relationship.
D) A set of technical skills used to administer medications and provide
psychoeducation.
Answer: B) The use of the nurse's personality, experiences, values,
feelings, and intelligence to assist the patient to grow and develop.
Explanation: Therapeutic use of self is the foundational concept in
psychiatric nursing. It involves the nurse's conscious, deliberate use of
her or his own personality, experiences, values, feelings, and intelligence
to establish a therapeutic relationship and facilitate the patient's
growth and healing. It is not about social friendship (A) or self-
disclosure (C) for personal reasons, but rather a professional,
purposeful, and artful application of one's self to meet the patient's
needs. While technical skills are important, they are not the defining
feature of therapeutic use of self.
Question 5