NR 605 Final Exam (New 2025/2026 Update) — Diagnosis &
Management in Psychiatric Mental Health Across the
Lifespan I | 100% Correct actual Questions & Verified
Answers – Chamberlain
1.
A 27-year-old woman presents with 4 days of decreased need for sleep, pressured speech,
and excessive spending on crypto-currency. She has no previous psychiatric history and
denies substance use. Urine toxicology is negative. Which diagnosis is PRIMARY?
A. Bipolar I disorder, manic episode
B. Bipolar II disorder, hypomanic episode
C. Cyclothymic disorder
D. Substance/medication-induced bipolar disorder
Correct Answer: A
Rationale:
The patient meets DSM-5-TR criteria for a manic episode: ≥3 symptoms (decreased
sleep, pressured speech, excessive involvement in pleasurable activities) lasting ≥1 week
,and causing marked impairment. Because this is her first episode and no substances are
implicated, bipolar I is primary. Hypomania (bipolar II) does not cause severe impairment
or require hospitalization. Cyclothymia requires 2 years of subthreshold mood swings.
Negative toxicology rules out substance-induced etiology.
2.
A 19-year-old college freshman reports 6 months of picking at “imperfections” on her
face for 2–3 hours daily, leaving scars. She is distressed but cannot stop. She denies
body-dysmorphic beliefs. Which FIRST-LINE medication is best supported?
A. Sertraline 100 mg daily
B. N-acetylcysteine 1.2 g BID
C. Lamotrigine 200 mg daily
D. Risperidone 1 mg daily
Correct Answer: B
Rationale:
The vignette describes excoriation (skin-picking) disorder, an OCRD. N-acetylcysteine
(NAC) has two positive RCTs reducing picking urges via glutamate modulation. SSRIs
are second-line and require higher doses. Lamotrigine lacks evidence. Antipsychotics are
reserved for comorbid tics or psychosis.
, 3.
A 77-year-old widower is brought to clinic after wandering outside in 30 °F weather
without a coat. He believes it is July and asks when his deceased wife will return. MMSE
is 18/30, decline from 24 six months ago. Which neurocognitive domain is MOST
affected?
A. Complex attention
B. Executive function
C. Orientation
D. Language
Correct Answer: C
Rationale:
Disorientation to time and person, plus confabulation, indicates predominant impairment
in orientation, typical of major NCD due to Alzheimer disease. Executive dysfunction
would manifest in poor planning or abstraction. Attention deficits occur in delirium but
are fluctuating. Language is preserved (fluent speech).
4.
, A 35-year-old veteran with PTSD on prazosin 6 mg at bedtime reports continued
nightmares and new daytime flashbacks. He adheres to therapy. Which augmentation has
the strongest evidence?
A. Risperidone 1 mg daily
B. Topiramate 50 mg BID
C. D-cycloserine 50 mg before exposure
D. Sertraline uptitrated to 200 mg
Correct Answer: B
Rationale:
Topiramate reduces noradrenergic drive and intrusive symptoms in two RCTs.
Risperidone augmentation lacks FDA approval and increases mortality risk.
D-cycloserine facilitates exposure but does not target nightmares. SSRI dose is already
optimal; further titration yields diminishing returns.
5.
A 42-year-old woman with bipolar I disorder delivers a healthy infant vaginally. She was
stable on lithium throughout pregnancy (level 0.8 mEq/L). Which peripartum plan
minimizes neonatal toxicity while preventing maternal relapse?
Management in Psychiatric Mental Health Across the
Lifespan I | 100% Correct actual Questions & Verified
Answers – Chamberlain
1.
A 27-year-old woman presents with 4 days of decreased need for sleep, pressured speech,
and excessive spending on crypto-currency. She has no previous psychiatric history and
denies substance use. Urine toxicology is negative. Which diagnosis is PRIMARY?
A. Bipolar I disorder, manic episode
B. Bipolar II disorder, hypomanic episode
C. Cyclothymic disorder
D. Substance/medication-induced bipolar disorder
Correct Answer: A
Rationale:
The patient meets DSM-5-TR criteria for a manic episode: ≥3 symptoms (decreased
sleep, pressured speech, excessive involvement in pleasurable activities) lasting ≥1 week
,and causing marked impairment. Because this is her first episode and no substances are
implicated, bipolar I is primary. Hypomania (bipolar II) does not cause severe impairment
or require hospitalization. Cyclothymia requires 2 years of subthreshold mood swings.
Negative toxicology rules out substance-induced etiology.
2.
A 19-year-old college freshman reports 6 months of picking at “imperfections” on her
face for 2–3 hours daily, leaving scars. She is distressed but cannot stop. She denies
body-dysmorphic beliefs. Which FIRST-LINE medication is best supported?
A. Sertraline 100 mg daily
B. N-acetylcysteine 1.2 g BID
C. Lamotrigine 200 mg daily
D. Risperidone 1 mg daily
Correct Answer: B
Rationale:
The vignette describes excoriation (skin-picking) disorder, an OCRD. N-acetylcysteine
(NAC) has two positive RCTs reducing picking urges via glutamate modulation. SSRIs
are second-line and require higher doses. Lamotrigine lacks evidence. Antipsychotics are
reserved for comorbid tics or psychosis.
, 3.
A 77-year-old widower is brought to clinic after wandering outside in 30 °F weather
without a coat. He believes it is July and asks when his deceased wife will return. MMSE
is 18/30, decline from 24 six months ago. Which neurocognitive domain is MOST
affected?
A. Complex attention
B. Executive function
C. Orientation
D. Language
Correct Answer: C
Rationale:
Disorientation to time and person, plus confabulation, indicates predominant impairment
in orientation, typical of major NCD due to Alzheimer disease. Executive dysfunction
would manifest in poor planning or abstraction. Attention deficits occur in delirium but
are fluctuating. Language is preserved (fluent speech).
4.
, A 35-year-old veteran with PTSD on prazosin 6 mg at bedtime reports continued
nightmares and new daytime flashbacks. He adheres to therapy. Which augmentation has
the strongest evidence?
A. Risperidone 1 mg daily
B. Topiramate 50 mg BID
C. D-cycloserine 50 mg before exposure
D. Sertraline uptitrated to 200 mg
Correct Answer: B
Rationale:
Topiramate reduces noradrenergic drive and intrusive symptoms in two RCTs.
Risperidone augmentation lacks FDA approval and increases mortality risk.
D-cycloserine facilitates exposure but does not target nightmares. SSRI dose is already
optimal; further titration yields diminishing returns.
5.
A 42-year-old woman with bipolar I disorder delivers a healthy infant vaginally. She was
stable on lithium throughout pregnancy (level 0.8 mEq/L). Which peripartum plan
minimizes neonatal toxicity while preventing maternal relapse?
