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
Question 1
A 19-year-old college freshman is brought to the counseling center by her roommate,
who states the patient has not slept more than 2 hours per night for the past week, has
been "talking a mile a minute," and maxed out her credit card buying rare plants for "a
new start-up." The patient claims she has "never felt better" and denies any previous
depressive episodes. Urine drug screen is negative. Which is the primary diagnosis?
A. Bipolar I disorder, manic episode
B. Bipolar II disorder, hypomanic episode
C. Stimulant-induced mood disorder
D. Borderline personality disorder
Correct Answer: A
Rationale: The patient meets DSM-5-TR criteria for a manic episode: abnormally
elevated, expansive mood plus 3+ manic symptoms (decreased need for sleep,
pressured speech, excessive involvement in pleasurable activities with high potential for
painful consequences) lasting ≥1 week. Because this is her first manic episode and
impairment is clear (maxed credit card), Bipolar I is primary. Bipolar II requires a past
major depressive episode, which she denies. Stimulant-induced mood disorder is
excluded by negative toxicology. Borderline PD can involve impulsive spending, but the
,distinct manic constellation (decreased sleep, grandiosity, pressured speech) is not
present.
Question 2
A 35-year-old Iraq veteran reports daily intrusive combat memories, hypervigilance, and
avoiding fireworks for 8 months since returning home. He drinks 6–7 beers nightly "to
fall asleep." Which additional DSM-5-TR criterion is required to diagnose PTSD?
A. Negative alterations in cognition/mood
B. Marked physiological reactions to trauma cues
C. Duration of at least 6 months
D. Depersonalization during recollection
Correct Answer: A
Rationale: PTSD requires all symptom clusters: intrusion, avoidance, negative
alterations in cognition/mood (e.g., distorted blame, persistent negative emotional
state), and alterations in arousal/reactivity. He already endorses intrusion, avoidance,
and arousal; therefore negative cognition is the missing cluster. Physiological reactions
are part of arousal. Duration > 1 month is already met. Depersonalization is a specifier,
not required for core diagnosis.
Question 3
A 16-year-old boy with ADHD, combined presentation, has partial response to
amphetamine XR 20 mg with continued classroom disruptions. Parents refuse further
dose increases due to appetite suppression. Which non-stimulant is FDA-approved as
monotherapy for ADHD in adolescents?
,A. Atomoxetine
B. Clonidine immediate-release
C. Bupropion
D. Risperidone
Correct Answer: A
Rationale: Atomoxetine is FDA-approved for ADHD ≥6 years as monotherapy or adjunct.
Clonidine ER (not IR) is approved as adjunct, not monotherapy. Bupropion is off-label for
pediatric ADHD. Risperidone targets irritability in autism, not core ADHD symptoms.
Question 4
A 55-year-old woman with MDD and coronary artery disease is hospitalized after PCI.
She has not eaten in 3 days, states "I'm a burden," and openly hopes she "doesn't wake
up." PHQ-9 is 22. Which initial nursing/PMHNP action is priority?
A. Obtain bedside cardiac diet tray
B. Place on one-to-one observation and suicide precautions
C. Start sertraline 50 mg hs
D. Request family to bring comfort food
Correct Answer: B
Rationale: Active suicidal ideation with hopelessness and functional incapacitation
mandates immediate safety measures per Joint Commission standards. One-to-one
observation, removal of ligature points, and continuous visual contact precede
, pharmacologic interventions. Dietary measures address nutrition but not life-threat.
Starting SSRI is appropriate after safety is secured.
Question 5
A patient with schizophrenia, paranoid type, on haloperidol 10 mg BID develops fever
38.9 °C, muscle rigidity, and CK 12,000 units/L. WBC and BP are normal. Which
medication should be discontinued immediately?
A. Haloperidol
B. Acetaminophen
C. Docusate sodium
D. Aspirin
Correct Answer: A
Rationale: Neuroleptic malignant syndrome (NMS) is characterized by fever, rigidity,
elevated CK, and autonomic instability after dopamine antagonists. Haloperidol, a
high-potency typical antipsychotic, is the likely precipitant and must be stopped
immediately. Supportive care, dopamine agonists (bromocriptine), and dantrolene are
used. Other listed drugs do not cause NMS.
Question 6
A 33-year-old woman has 3-year history of picking at facial skin for "hours a day,"
causing scarring, and wears heavy makeup to work. She states, "I hate the way I look."
No body-dysmorphic beliefs are present. Which diagnosis fits?
A. Body dysmorphic disorder
Management in Psychiatric Mental Health Across the
Lifespan I | 100% Correct Practice Questions & Verified
Answers – Chamberlain
Question 1
A 19-year-old college freshman is brought to the counseling center by her roommate,
who states the patient has not slept more than 2 hours per night for the past week, has
been "talking a mile a minute," and maxed out her credit card buying rare plants for "a
new start-up." The patient claims she has "never felt better" and denies any previous
depressive episodes. Urine drug screen is negative. Which is the primary diagnosis?
A. Bipolar I disorder, manic episode
B. Bipolar II disorder, hypomanic episode
C. Stimulant-induced mood disorder
D. Borderline personality disorder
Correct Answer: A
Rationale: The patient meets DSM-5-TR criteria for a manic episode: abnormally
elevated, expansive mood plus 3+ manic symptoms (decreased need for sleep,
pressured speech, excessive involvement in pleasurable activities with high potential for
painful consequences) lasting ≥1 week. Because this is her first manic episode and
impairment is clear (maxed credit card), Bipolar I is primary. Bipolar II requires a past
major depressive episode, which she denies. Stimulant-induced mood disorder is
excluded by negative toxicology. Borderline PD can involve impulsive spending, but the
,distinct manic constellation (decreased sleep, grandiosity, pressured speech) is not
present.
Question 2
A 35-year-old Iraq veteran reports daily intrusive combat memories, hypervigilance, and
avoiding fireworks for 8 months since returning home. He drinks 6–7 beers nightly "to
fall asleep." Which additional DSM-5-TR criterion is required to diagnose PTSD?
A. Negative alterations in cognition/mood
B. Marked physiological reactions to trauma cues
C. Duration of at least 6 months
D. Depersonalization during recollection
Correct Answer: A
Rationale: PTSD requires all symptom clusters: intrusion, avoidance, negative
alterations in cognition/mood (e.g., distorted blame, persistent negative emotional
state), and alterations in arousal/reactivity. He already endorses intrusion, avoidance,
and arousal; therefore negative cognition is the missing cluster. Physiological reactions
are part of arousal. Duration > 1 month is already met. Depersonalization is a specifier,
not required for core diagnosis.
Question 3
A 16-year-old boy with ADHD, combined presentation, has partial response to
amphetamine XR 20 mg with continued classroom disruptions. Parents refuse further
dose increases due to appetite suppression. Which non-stimulant is FDA-approved as
monotherapy for ADHD in adolescents?
,A. Atomoxetine
B. Clonidine immediate-release
C. Bupropion
D. Risperidone
Correct Answer: A
Rationale: Atomoxetine is FDA-approved for ADHD ≥6 years as monotherapy or adjunct.
Clonidine ER (not IR) is approved as adjunct, not monotherapy. Bupropion is off-label for
pediatric ADHD. Risperidone targets irritability in autism, not core ADHD symptoms.
Question 4
A 55-year-old woman with MDD and coronary artery disease is hospitalized after PCI.
She has not eaten in 3 days, states "I'm a burden," and openly hopes she "doesn't wake
up." PHQ-9 is 22. Which initial nursing/PMHNP action is priority?
A. Obtain bedside cardiac diet tray
B. Place on one-to-one observation and suicide precautions
C. Start sertraline 50 mg hs
D. Request family to bring comfort food
Correct Answer: B
Rationale: Active suicidal ideation with hopelessness and functional incapacitation
mandates immediate safety measures per Joint Commission standards. One-to-one
observation, removal of ligature points, and continuous visual contact precede
, pharmacologic interventions. Dietary measures address nutrition but not life-threat.
Starting SSRI is appropriate after safety is secured.
Question 5
A patient with schizophrenia, paranoid type, on haloperidol 10 mg BID develops fever
38.9 °C, muscle rigidity, and CK 12,000 units/L. WBC and BP are normal. Which
medication should be discontinued immediately?
A. Haloperidol
B. Acetaminophen
C. Docusate sodium
D. Aspirin
Correct Answer: A
Rationale: Neuroleptic malignant syndrome (NMS) is characterized by fever, rigidity,
elevated CK, and autonomic instability after dopamine antagonists. Haloperidol, a
high-potency typical antipsychotic, is the likely precipitant and must be stopped
immediately. Supportive care, dopamine agonists (bromocriptine), and dantrolene are
used. Other listed drugs do not cause NMS.
Question 6
A 33-year-old woman has 3-year history of picking at facial skin for "hours a day,"
causing scarring, and wears heavy makeup to work. She states, "I hate the way I look."
No body-dysmorphic beliefs are present. Which diagnosis fits?
A. Body dysmorphic disorder
