NR 605 Final Exam (New 2025/2026 Update) — Diagnosis &
Management in Psychiatric Mental Health Across the
Lifespan I | 100% Correct Practice Questions & Verified
Answers – Chamberlain
1.
A 23-year-old graduate student is brought to the ER after roommate found him counting
“spy devices” in ceiling tiles. He has not slept for 4 days, talks rapidly about “quantum
algorithms,” and spent his semester tuition on cryptocurrency. He denies substance use;
urine tox is negative. One year ago he had a 3-week period of similar symptoms after
final exams. Which diagnosis is most accurate?
A. Brief psychotic disorder
B. Bipolar I disorder, manic episode
C. Schizophreniform disorder
D. Stimulant-induced psychotic disorder
Correct Answer: B
Rationale: The patient meets DSM-5-TR criteria for a manic episode (≥1 week
abnormally elevated mood, decreased need for sleep, grandiosity, excessive
involvement in pleasurable activities with painful consequences) that is not attributable
to substances. A prior similar episode supports bipolar I rather than a brief or
substance-induced psychosis. Schizophreniform disorder requires ≥1 month of
psychotic symptoms without sufficient affective component.
2.
,A 7-year-old boy is evaluated for “constant movement.” Teachers report he climbs on
windowsills, blurts answers, and cannot line up. At home he finishes chores but forgets
steps. Birth weight 2,100 g, no lead exposure. Which additional finding is required to
confirm ADHD combined presentation?
A. Symptoms present in two or more settings
B. Onset before age 3
C. Full-scale IQ ≥90
D. Evidence of gross neurologic deficit
Correct Answer: A
Rationale: DSM-5-TR requires several inattentive and hyperactive-impulsive symptoms
present for ≥6 months, maladaptive and inconsistent with developmental level, present
in ≥2 settings (e.g., school and home), and causing impairment before age 12. IQ and
neurologic signs are not diagnostic criteria.
3.
A 34-year-old woman with bipolar II has been euthymic on lamotrigine 200 mg for 2
years. She plans pregnancy and asks about risk. Which evidence-based counseling is
correct?
A. Discontinue lamotrigine immediately to avoid teratogenicity
B. Continue current dose; risk of fetal malformation is ≤2%
C. Switch to valproate for better mood stability in pregnancy
D. Taper over 1 week to prevent cleft palate
,Correct Answer: B
Rationale: Lamotrigine has the largest pregnancy registry among mood stabilizers;
major-malformation risk is ~2% (similar to baseline) and lower than valproate (10%).
Guidelines recommend continuing effective therapy to prevent maternal relapse, which
carries greater fetal risk. Rapid taper risks rebound depression.
4.
A 68-year-old man with major NCD due to Alzheimer disease becomes agitated every
evening, striking staff during hygiene care. He is on donepezil 10 mg and memantine 10
mg BID. Which medication is FDA-approved for this indication?
A. Quetiapine 25 mg qHS
B. Risperidone 0.5 mg qAM
C. Haloperidol 0.5 mg qHS
D. Brexpiprazole 1 mg daily
Correct Answer: D
Rationale: Brexpiprazole (2023) is the only agent FDA-approved for agitation in
Alzheimer dementia. All other antipsychotics carry black-box warnings for increased
mortality in elderly with dementia-related psychosis.
5.
A 29-year-old veteran reports nightly nightmares of an IED blast 18 months ago. He
avoids fireworks, sleeps with lights on, and startles when trash trucks backfire. He
drinks 6 beers nightly to “knock myself out.” Which medication has the strongest
evidence for both PTSD nightmares and alcohol-use reduction?
, A. Prazosin
B. Topiramate
C. Sertraline
D. Gabapentin
Correct Answer: B
Rationale: Topiramate is supported by RCTs for both PTSD nightmares and alcohol-use
disorder (reduces heavy-drinking days). Prazosin helps nightmares but not drinking.
Sertraline is first-line for global PTSD but lacks anti-craving data. Gabapentin aids
alcohol relapse but is weaker for nightmares.
6.
A 15-year-old girl is caught vaping THC at school. Her mother demands random urine
drug screens. The girl admits weekly use but no withdrawal or academic failure. Which
APA recommendation aligns with harm-reduction?
A. Weekly observed UDAs to maintain accountability
B. Motivational enhancement therapy plus psychoeducation
C. Immediate residential treatment
D. Suspend her until she tests negative
Correct Answer: B
Rationale: APA/AAP endorse brief motivational interventions for non-dependent
adolescent cannabis use, emphasizing change talk and education. Random UDAs
Management in Psychiatric Mental Health Across the
Lifespan I | 100% Correct Practice Questions & Verified
Answers – Chamberlain
1.
A 23-year-old graduate student is brought to the ER after roommate found him counting
“spy devices” in ceiling tiles. He has not slept for 4 days, talks rapidly about “quantum
algorithms,” and spent his semester tuition on cryptocurrency. He denies substance use;
urine tox is negative. One year ago he had a 3-week period of similar symptoms after
final exams. Which diagnosis is most accurate?
A. Brief psychotic disorder
B. Bipolar I disorder, manic episode
C. Schizophreniform disorder
D. Stimulant-induced psychotic disorder
Correct Answer: B
Rationale: The patient meets DSM-5-TR criteria for a manic episode (≥1 week
abnormally elevated mood, decreased need for sleep, grandiosity, excessive
involvement in pleasurable activities with painful consequences) that is not attributable
to substances. A prior similar episode supports bipolar I rather than a brief or
substance-induced psychosis. Schizophreniform disorder requires ≥1 month of
psychotic symptoms without sufficient affective component.
2.
,A 7-year-old boy is evaluated for “constant movement.” Teachers report he climbs on
windowsills, blurts answers, and cannot line up. At home he finishes chores but forgets
steps. Birth weight 2,100 g, no lead exposure. Which additional finding is required to
confirm ADHD combined presentation?
A. Symptoms present in two or more settings
B. Onset before age 3
C. Full-scale IQ ≥90
D. Evidence of gross neurologic deficit
Correct Answer: A
Rationale: DSM-5-TR requires several inattentive and hyperactive-impulsive symptoms
present for ≥6 months, maladaptive and inconsistent with developmental level, present
in ≥2 settings (e.g., school and home), and causing impairment before age 12. IQ and
neurologic signs are not diagnostic criteria.
3.
A 34-year-old woman with bipolar II has been euthymic on lamotrigine 200 mg for 2
years. She plans pregnancy and asks about risk. Which evidence-based counseling is
correct?
A. Discontinue lamotrigine immediately to avoid teratogenicity
B. Continue current dose; risk of fetal malformation is ≤2%
C. Switch to valproate for better mood stability in pregnancy
D. Taper over 1 week to prevent cleft palate
,Correct Answer: B
Rationale: Lamotrigine has the largest pregnancy registry among mood stabilizers;
major-malformation risk is ~2% (similar to baseline) and lower than valproate (10%).
Guidelines recommend continuing effective therapy to prevent maternal relapse, which
carries greater fetal risk. Rapid taper risks rebound depression.
4.
A 68-year-old man with major NCD due to Alzheimer disease becomes agitated every
evening, striking staff during hygiene care. He is on donepezil 10 mg and memantine 10
mg BID. Which medication is FDA-approved for this indication?
A. Quetiapine 25 mg qHS
B. Risperidone 0.5 mg qAM
C. Haloperidol 0.5 mg qHS
D. Brexpiprazole 1 mg daily
Correct Answer: D
Rationale: Brexpiprazole (2023) is the only agent FDA-approved for agitation in
Alzheimer dementia. All other antipsychotics carry black-box warnings for increased
mortality in elderly with dementia-related psychosis.
5.
A 29-year-old veteran reports nightly nightmares of an IED blast 18 months ago. He
avoids fireworks, sleeps with lights on, and startles when trash trucks backfire. He
drinks 6 beers nightly to “knock myself out.” Which medication has the strongest
evidence for both PTSD nightmares and alcohol-use reduction?
, A. Prazosin
B. Topiramate
C. Sertraline
D. Gabapentin
Correct Answer: B
Rationale: Topiramate is supported by RCTs for both PTSD nightmares and alcohol-use
disorder (reduces heavy-drinking days). Prazosin helps nightmares but not drinking.
Sertraline is first-line for global PTSD but lacks anti-craving data. Gabapentin aids
alcohol relapse but is weaker for nightmares.
6.
A 15-year-old girl is caught vaping THC at school. Her mother demands random urine
drug screens. The girl admits weekly use but no withdrawal or academic failure. Which
APA recommendation aligns with harm-reduction?
A. Weekly observed UDAs to maintain accountability
B. Motivational enhancement therapy plus psychoeducation
C. Immediate residential treatment
D. Suspend her until she tests negative
Correct Answer: B
Rationale: APA/AAP endorse brief motivational interventions for non-dependent
adolescent cannabis use, emphasizing change talk and education. Random UDAs
