AMERICAN INTERNATIONAL COLLEGE — NUR 6541 INTEGRATED FINAL EXAM FALL 2026
AMERICAN INTERNATIONAL COLLEGE
NUR 6541: Mental Health & Integrated Primary Care Blueprint Final Examination
Term: Fall 2026 | Course: NUR 6541 | Total Items: Exactly 150 Questions
Examination Instructions: This exam paper contains 150 multiple-choice items (A, B, C, D) covering Mental Health, Male
GU, STIs, Tick-Borne, Respiratory, Hematology, Rheumatology, Immunology, Documentation, Endocrine, Diabetes, Obesity,
and Gout. The correct answer positions are randomized throughout. Correct answers are indicated with a green checkmark
[✔ CORRECT] and accompanied by a detailed clinical rationale highlighted in yellow.
Q1. A 34-year-old patient presents with depressed mood, fatigue, anhedonia, a 10 lb weight loss,
and feelings of worthlessness for 3 weeks. According to DSM-5 criteria in the study guide, which
combination of symptoms is required for a diagnosis of Major Depressive Disorder (MDD)?
A. At least 6 symptoms for ≥1 month, including mania and anxiety
B. At least 4 symptoms for ≥6 months, including insomnia and guilt
C. At least 3 symptoms for ≥1 week, including suicidal ideation
D. At least 5 symptoms for ≥2 weeks, including either depressed mood OR anhedonia [✔ CORRECT]
Correct Answer: D
Rationale: MDD diagnosis requires ≥5 SIGECAPS symptoms for ≥2 weeks, and at least ONE must be depressed mood or
anhedonia (loss of interest/pleasure).
Q2. Which mnemonic is specified in the NUR 6541 blueprint to recall the clinical diagnostic
symptoms of Major Depressive Disorder?
A. SIGECAPS [✔ CORRECT]
B. FAT RN
C. FUN WISE
D. DIGFAST
Correct Answer: A
Rationale: SIGECAPS stands for Sleep change, Interest ↓, Guilt, Energy ↓, Concentration ↓, Appetite change, Psychomotor
change, Suicidal thoughts.
Q3. A patient with bipolar disorder has experienced one full manic episode lasting 8 days with
extreme grandiosity and flight of ideas. She has never had a major depressive episode. What is
the correct diagnosis?
A. Bipolar I Disorder [✔ CORRECT]
B. Bipolar II Disorder
C. Major Depressive Disorder with psychotic features
D. Cyclothymic Disorder
Correct Answer: A
Rationale: Bipolar ONE requires only ONE manic episode ('Bipolar ONE = ONE manic episode is enough'). Major depression
is not required for Bipolar I.
Official Examination Paper — Grounded in Course Study Guides Page 1
,AMERICAN INTERNATIONAL COLLEGE — NUR 6541 INTEGRATED FINAL EXAM FALL 2026
Q4. A 28-year-old male presents with hypomania and a history of major depressive episodes. He
has never experienced a full manic episode. What is the diagnosis?
A. Major Depressive Disorder
B. General Anxiety Disorder
C. Bipolar II Disorder [✔ CORRECT]
D. Bipolar I Disorder
Correct Answer: C
Rationale: Bipolar TWO requires TWO pieces: hypomania AND a major depressive episode, with no history of full mania.
Q5. Which mnemonic is used in the study guide to recognize manic symptoms in a patient
evaluated for bipolar disorder?
A. DABDA
B. ACID
C. SIGECAPS
D. DIGFAST [✔ CORRECT]
Correct Answer: D
Rationale: DIGFAST stands for Distractibility, Insomnia/decreased need for sleep, Grandiosity, Flight of ideas, Activity ↑,
Speech pressured, Thoughtlessness/risky behavior.
Q6. What is considered the gold standard medication for stabilizing mood in bipolar disorder?
A. Sertraline monotherapy
B. Fluoxetine monotherapy
C. Lithium [✔ CORRECT]
D. Buspirone
Correct Answer: C
Rationale: Lithium is the gold standard for bipolar disorder. The guide emphasizes never using antidepressant
monotherapy without stabilizing first.
Q7. A patient with known bipolar disorder presents with depressive symptoms. What crucial
prescribing rule must the advanced practice nurse follow regarding antidepressants?
A. Prescribe tricyclic antidepressants as first-line therapy
B. Initiate high-dose SSRI monotherapy immediately
C. Never prescribe an antidepressant alone; stabilize with a mood stabilizer first [✔ CORRECT]
D. Combine two SSRIs without a mood stabilizer
Correct Answer: C
Rationale: Bipolar + Antidepressant alone = NO. Stabilize first with a mood stabilizer (e.g., lithium, valproic acid) to
prevent precipitating mania.
Official Examination Paper — Grounded in Course Study Guides Page 2
,AMERICAN INTERNATIONAL COLLEGE — NUR 6541 INTEGRATED FINAL EXAM FALL 2026
Q8. A 45-year-old patient with no prior psychiatric history presents with new-onset acute mania.
What should the clinician suspect first?
A. An underlying medical, thyroid, neurologic, or substance-related cause [✔ CORRECT]
B. Normal age-related cognitive change
C. Primary late-onset schizophrenia
D. Unipolar major depression
Correct Answer: A
Rationale: New-onset mania after age 40 should prompt evaluation for an underlying medical, thyroid, neurologic, or
substance-related etiology.
Q9. When performing a suicide risk assessment, in what order should the clinician evaluate
thoughts and actions?
A. Means → Intent → Thoughts → Plan
B. Thoughts → Plan → Intent → Means [✔ CORRECT]
C. Plan → Means → Thoughts → Intent
D. Intent → Thoughts → Means → Plan
Correct Answer: B
Rationale: Suicide assessment progresses systematically: Thoughts → Plan → Intent → Means.
Q10. A patient states during a routine visit, 'Sometimes I wish I wouldn't wake up in the morning.'
How should the nurse practitioner interpret and manage this statement?
A. Prescribe immediate sedative hypnotics without questioning
B. This indicates active intent and requires immediate involuntary commitment
C. This is passive suicidal ideation and requires further suicide risk assessment [✔ CORRECT]
D. This is a normal finding that requires no follow-up
Correct Answer: C
Rationale: 'Sometimes I wish I wouldn't wake up' represents passive suicidal ideation, which mandates further detailed
suicide assessment.
Q11. How do Generalized Anxiety Disorder (GAD) and Panic Disorder differ regarding pattern and
duration in the blueprint?
A. GAD requires benzodiazepines; Panic Disorder is untreated
B. GAD features persistent worry lasting >6 months; Panic Disorder involves sudden, intense surges
of fear [✔ CORRECT]
C. GAD peaks within 10 minutes; Panic Disorder lasts >6 months
D. GAD involves sudden nocturnal attacks; Panic Disorder involves general worry about work
Correct Answer: B
Rationale: GAD is chronic general worry (>6 months); Panic Disorder presents with sudden, acute surges of intense fear.
Official Examination Paper — Grounded in Course Study Guides Page 3
, AMERICAN INTERNATIONAL COLLEGE — NUR 6541 INTEGRATED FINAL EXAM FALL 2026
Q12. A 30-year-old trauma survivor reports severe intrusive nightmares following a motor vehicle
collision. Which medication is specifically highlighted in the study guide for PTSD-associated
nightmares?
A. Clozapine
B. Lorazepam
C. Prazosin [✔ CORRECT]
D. Lithium
Correct Answer: C
Rationale: Prazosin is the specific high-yield medication identified for treating PTSD-associated nightmares.
Q13. Which SSRI is specifically noted in the master comparison table for having the most
prominent and distressing discontinuation symptoms ('painful to stop')?
A. Paroxetine (Paxil) [✔ CORRECT]
B. Sertraline (Zoloft)
C. Fluoxetine (Prozac)
D. Escitalopram (Lexapro)
Correct Answer: A
Rationale: Paxil (Paroxetine) = painful to stop due to prominent discontinuation symptoms and CYP450 interactions.
Q14. Which SSRI is highlighted for having a long half-life ('persists')?
A. Sertraline (Zoloft)
B. Fluvoxamine (Luvox)
C. Paroxetine (Paxil)
D. Fluoxetine (Prozac) [✔ CORRECT]
Correct Answer: D
Rationale: Prozac (Fluoxetine) = long acting and persists in the body.
Q15. A patient taking an SSRI presents with shivering, diarrhea, muscle rigidity, fever, and
agitation. What life-threatening condition is suspected?
A. Alcohol Intoxication
B. Opioid Withdrawal
C. Neuroleptic Malignant Syndrome
D. Serotonin Syndrome [✔ CORRECT]
Correct Answer: D
Rationale: Serotonin syndrome presentation: HOT + AGITATED + NEUROMUSCULAR (shivering/diarrhea → muscle rigidity
→ fever → seizures).
Q16. In Obsessive-Compulsive Disorder (OCD), what is the distinction between obsessions and
compulsions?
A. Obsessions are unwanted intrusive thoughts; compulsions are repetitive actions performed to
reduce anxiety [✔ CORRECT]
B. Obsessions are motor tics; compulsions are verbal outbursts
C. Obsessions are physical actions; compulsions are passive thoughts
D. Obsessions occur only in mania; compulsions occur only in depression
Correct Answer: A
Rationale: Obsession = thought (unwanted, intrusive). Compulsion = action (repetitive behavior to reduce anxiety).
Official Examination Paper — Grounded in Course Study Guides Page 4
AMERICAN INTERNATIONAL COLLEGE
NUR 6541: Mental Health & Integrated Primary Care Blueprint Final Examination
Term: Fall 2026 | Course: NUR 6541 | Total Items: Exactly 150 Questions
Examination Instructions: This exam paper contains 150 multiple-choice items (A, B, C, D) covering Mental Health, Male
GU, STIs, Tick-Borne, Respiratory, Hematology, Rheumatology, Immunology, Documentation, Endocrine, Diabetes, Obesity,
and Gout. The correct answer positions are randomized throughout. Correct answers are indicated with a green checkmark
[✔ CORRECT] and accompanied by a detailed clinical rationale highlighted in yellow.
Q1. A 34-year-old patient presents with depressed mood, fatigue, anhedonia, a 10 lb weight loss,
and feelings of worthlessness for 3 weeks. According to DSM-5 criteria in the study guide, which
combination of symptoms is required for a diagnosis of Major Depressive Disorder (MDD)?
A. At least 6 symptoms for ≥1 month, including mania and anxiety
B. At least 4 symptoms for ≥6 months, including insomnia and guilt
C. At least 3 symptoms for ≥1 week, including suicidal ideation
D. At least 5 symptoms for ≥2 weeks, including either depressed mood OR anhedonia [✔ CORRECT]
Correct Answer: D
Rationale: MDD diagnosis requires ≥5 SIGECAPS symptoms for ≥2 weeks, and at least ONE must be depressed mood or
anhedonia (loss of interest/pleasure).
Q2. Which mnemonic is specified in the NUR 6541 blueprint to recall the clinical diagnostic
symptoms of Major Depressive Disorder?
A. SIGECAPS [✔ CORRECT]
B. FAT RN
C. FUN WISE
D. DIGFAST
Correct Answer: A
Rationale: SIGECAPS stands for Sleep change, Interest ↓, Guilt, Energy ↓, Concentration ↓, Appetite change, Psychomotor
change, Suicidal thoughts.
Q3. A patient with bipolar disorder has experienced one full manic episode lasting 8 days with
extreme grandiosity and flight of ideas. She has never had a major depressive episode. What is
the correct diagnosis?
A. Bipolar I Disorder [✔ CORRECT]
B. Bipolar II Disorder
C. Major Depressive Disorder with psychotic features
D. Cyclothymic Disorder
Correct Answer: A
Rationale: Bipolar ONE requires only ONE manic episode ('Bipolar ONE = ONE manic episode is enough'). Major depression
is not required for Bipolar I.
Official Examination Paper — Grounded in Course Study Guides Page 1
,AMERICAN INTERNATIONAL COLLEGE — NUR 6541 INTEGRATED FINAL EXAM FALL 2026
Q4. A 28-year-old male presents with hypomania and a history of major depressive episodes. He
has never experienced a full manic episode. What is the diagnosis?
A. Major Depressive Disorder
B. General Anxiety Disorder
C. Bipolar II Disorder [✔ CORRECT]
D. Bipolar I Disorder
Correct Answer: C
Rationale: Bipolar TWO requires TWO pieces: hypomania AND a major depressive episode, with no history of full mania.
Q5. Which mnemonic is used in the study guide to recognize manic symptoms in a patient
evaluated for bipolar disorder?
A. DABDA
B. ACID
C. SIGECAPS
D. DIGFAST [✔ CORRECT]
Correct Answer: D
Rationale: DIGFAST stands for Distractibility, Insomnia/decreased need for sleep, Grandiosity, Flight of ideas, Activity ↑,
Speech pressured, Thoughtlessness/risky behavior.
Q6. What is considered the gold standard medication for stabilizing mood in bipolar disorder?
A. Sertraline monotherapy
B. Fluoxetine monotherapy
C. Lithium [✔ CORRECT]
D. Buspirone
Correct Answer: C
Rationale: Lithium is the gold standard for bipolar disorder. The guide emphasizes never using antidepressant
monotherapy without stabilizing first.
Q7. A patient with known bipolar disorder presents with depressive symptoms. What crucial
prescribing rule must the advanced practice nurse follow regarding antidepressants?
A. Prescribe tricyclic antidepressants as first-line therapy
B. Initiate high-dose SSRI monotherapy immediately
C. Never prescribe an antidepressant alone; stabilize with a mood stabilizer first [✔ CORRECT]
D. Combine two SSRIs without a mood stabilizer
Correct Answer: C
Rationale: Bipolar + Antidepressant alone = NO. Stabilize first with a mood stabilizer (e.g., lithium, valproic acid) to
prevent precipitating mania.
Official Examination Paper — Grounded in Course Study Guides Page 2
,AMERICAN INTERNATIONAL COLLEGE — NUR 6541 INTEGRATED FINAL EXAM FALL 2026
Q8. A 45-year-old patient with no prior psychiatric history presents with new-onset acute mania.
What should the clinician suspect first?
A. An underlying medical, thyroid, neurologic, or substance-related cause [✔ CORRECT]
B. Normal age-related cognitive change
C. Primary late-onset schizophrenia
D. Unipolar major depression
Correct Answer: A
Rationale: New-onset mania after age 40 should prompt evaluation for an underlying medical, thyroid, neurologic, or
substance-related etiology.
Q9. When performing a suicide risk assessment, in what order should the clinician evaluate
thoughts and actions?
A. Means → Intent → Thoughts → Plan
B. Thoughts → Plan → Intent → Means [✔ CORRECT]
C. Plan → Means → Thoughts → Intent
D. Intent → Thoughts → Means → Plan
Correct Answer: B
Rationale: Suicide assessment progresses systematically: Thoughts → Plan → Intent → Means.
Q10. A patient states during a routine visit, 'Sometimes I wish I wouldn't wake up in the morning.'
How should the nurse practitioner interpret and manage this statement?
A. Prescribe immediate sedative hypnotics without questioning
B. This indicates active intent and requires immediate involuntary commitment
C. This is passive suicidal ideation and requires further suicide risk assessment [✔ CORRECT]
D. This is a normal finding that requires no follow-up
Correct Answer: C
Rationale: 'Sometimes I wish I wouldn't wake up' represents passive suicidal ideation, which mandates further detailed
suicide assessment.
Q11. How do Generalized Anxiety Disorder (GAD) and Panic Disorder differ regarding pattern and
duration in the blueprint?
A. GAD requires benzodiazepines; Panic Disorder is untreated
B. GAD features persistent worry lasting >6 months; Panic Disorder involves sudden, intense surges
of fear [✔ CORRECT]
C. GAD peaks within 10 minutes; Panic Disorder lasts >6 months
D. GAD involves sudden nocturnal attacks; Panic Disorder involves general worry about work
Correct Answer: B
Rationale: GAD is chronic general worry (>6 months); Panic Disorder presents with sudden, acute surges of intense fear.
Official Examination Paper — Grounded in Course Study Guides Page 3
, AMERICAN INTERNATIONAL COLLEGE — NUR 6541 INTEGRATED FINAL EXAM FALL 2026
Q12. A 30-year-old trauma survivor reports severe intrusive nightmares following a motor vehicle
collision. Which medication is specifically highlighted in the study guide for PTSD-associated
nightmares?
A. Clozapine
B. Lorazepam
C. Prazosin [✔ CORRECT]
D. Lithium
Correct Answer: C
Rationale: Prazosin is the specific high-yield medication identified for treating PTSD-associated nightmares.
Q13. Which SSRI is specifically noted in the master comparison table for having the most
prominent and distressing discontinuation symptoms ('painful to stop')?
A. Paroxetine (Paxil) [✔ CORRECT]
B. Sertraline (Zoloft)
C. Fluoxetine (Prozac)
D. Escitalopram (Lexapro)
Correct Answer: A
Rationale: Paxil (Paroxetine) = painful to stop due to prominent discontinuation symptoms and CYP450 interactions.
Q14. Which SSRI is highlighted for having a long half-life ('persists')?
A. Sertraline (Zoloft)
B. Fluvoxamine (Luvox)
C. Paroxetine (Paxil)
D. Fluoxetine (Prozac) [✔ CORRECT]
Correct Answer: D
Rationale: Prozac (Fluoxetine) = long acting and persists in the body.
Q15. A patient taking an SSRI presents with shivering, diarrhea, muscle rigidity, fever, and
agitation. What life-threatening condition is suspected?
A. Alcohol Intoxication
B. Opioid Withdrawal
C. Neuroleptic Malignant Syndrome
D. Serotonin Syndrome [✔ CORRECT]
Correct Answer: D
Rationale: Serotonin syndrome presentation: HOT + AGITATED + NEUROMUSCULAR (shivering/diarrhea → muscle rigidity
→ fever → seizures).
Q16. In Obsessive-Compulsive Disorder (OCD), what is the distinction between obsessions and
compulsions?
A. Obsessions are unwanted intrusive thoughts; compulsions are repetitive actions performed to
reduce anxiety [✔ CORRECT]
B. Obsessions are motor tics; compulsions are verbal outbursts
C. Obsessions are physical actions; compulsions are passive thoughts
D. Obsessions occur only in mania; compulsions occur only in depression
Correct Answer: A
Rationale: Obsession = thought (unwanted, intrusive). Compulsion = action (repetitive behavior to reduce anxiety).
Official Examination Paper — Grounded in Course Study Guides Page 4
