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 19-year-old college sophomore is brought to the ER by campus police after
barricading himself in the library restroom, claiming “the government implanted a
micro-chip in my molar.” He has not slept in 72 h, is wearing three winter coats, and
speaks in rapid, rhyming sentences. Vital signs are normal; urine tox screen negative.
Which is the MOST likely DSM-5-TR diagnosis?
A. Bipolar I disorder, manic episode with psychotic features
B. Brief psychotic disorder
C. Schizoaffective disorder, bipolar type
D. Substance-induced psychotic disorder
Correct Answer: A
Rationale: The patient meets criteria for a manic episode (≥3 days of decreased sleep,
pressured speech, grandiosity, excessive involvement in goal-directed activity)
accompanied by mood-congruent psychotic features (micro-chip delusion). Because
the psychosis occurs in the context of frank mania, bipolar I is primary. Brief psychotic
disorder (B) lasts <1 month without mood syndrome. Schizoaffective disorder (C)
,requires ≥2 weeks of psychosis in the absence of mood symptoms, not described here.
Negative tox screen rules out substance-induced (D).
2
A 31-year-old woman with borderline personality disorder is hospitalized after
self-inflicted superficial forearm cuts. On day 2 she screams that staff are “poisoning
my food” and refuses meals. Which nursing action is PRIORITY?
A. Place patient on one-to-one observation
B. Administer PRN haloperidol 5 mg IM
C. Offer finger foods with sealed beverages
D. Obtain serum ammonia level
Correct Answer: C
Rationale: Transient stress-related psychosis in BPD is best managed by reducing
arousal and offering choices that preserve autonomy while ensuring nutrition. Finger
foods bypass the “poisoned tray” delusion and build therapeutic alliance. One-to-one (A)
may escalate paranoia. Antipsychotic (B) is premature without risk of harm. Serum
ammonia (D) is unrelated unless hepatic encephalopathy suspected.
3
A 77-year-old widower is evaluated for 10-month cognitive decline. MoCA is 19/30;
clock-draw shows missing numbers. He scores 6/10 on PHQ-9, stating “I’m no use to
anyone.” He still enjoys watching baseball. Which diagnosis is PRIMARY?
A. Major neurocognitive disorder with behavioral disturbance
,B. Major depressive disorder with cognitive features
C. Mild neurocognitive disorder due to Alzheimer disease
D. Adjustment disorder with depressed mood
Correct Answer: B
Rationale: Depressive pseudodementia presents with cognitive complaints exceeding
deficits, preserved interest in remote pleasures, and mood congruent self-deprecation.
MoCA >17 and subjective uselessness favor depression. Neurocognitive disorder (A)
requires preserved insight into mood. Mild NCD (C) does not explain functional decline
to this degree. Adjustment disorder (D) lasts <6 months.
4
A 6-year-old boy with autism spectrum disorder (ASD) and global developmental delay
repeatedly slaps his ears, resulting in excoriation. ABC data reveal behavior peaks when
ceiling fan is activated. Which FIRST-LINE medication class is indicated?
A. Second-generation antipsychotic
B. Alpha-2 agonist
C. SSRI
D. Benzodiazepine
Correct Answer: A
Rationale: Self-injurious behavior (SIB) in ASD that is refractory to behavioral
intervention responds best to risperidone or aripiprazole, both FDA-approved for
, irritability. Alpha-2 agonists (B) target hyperactivity. SSRIs (C) lack evidence for SIB.
Benzodiazepines (D) risk paradoxical agitation.
5
A 42-year-old man with bipolar I disorder, maintained euthymic on lithium 1200 mg hs
(level 0.8 mEq/L), develops new-onset polyuria and polydipsia. Sodium is 148 mEq/L,
creatinine 1.4 mg/dL (baseline 1.0). Which adjustment is BEST?
A. Split lithium dose to 600 mg bid
B. Add amiloride 5 mg daily
C. Switch to extended-release lithium carbonate
D. Discontinue lithium and start valproate
Correct Answer: B
Rationale: Nephrogenic diabetes insipidus (NDI) is evidenced by hypernatremia and
rising creatinine; amiloride blocks lithium entry into collecting-duct cells and reduces
polyuria. Split dosing (A) does not correct tubular defect. Extended-release (C) does not
change pharmacokinetics. Discontinuation (D) is unnecessary if renal function
stabilizes with amiloride.
6
A 28-year-old woman reports 8-year history of picking “bumps” on face and arms,
spending 2 h nightly with magnifying mirror. She applies antibiotic ointment and
makeup to conceal lesions. She is embarrassed but feels “compelled.” Which treatment
has STRONGEST evidence?
A. Fluoxetine 60 mg daily
& Management in Psychiatric Mental Health Across the
Lifespan I | 100% Correct Practice Questions & Verified
Answers – Chamberlain
1
A 19-year-old college sophomore is brought to the ER by campus police after
barricading himself in the library restroom, claiming “the government implanted a
micro-chip in my molar.” He has not slept in 72 h, is wearing three winter coats, and
speaks in rapid, rhyming sentences. Vital signs are normal; urine tox screen negative.
Which is the MOST likely DSM-5-TR diagnosis?
A. Bipolar I disorder, manic episode with psychotic features
B. Brief psychotic disorder
C. Schizoaffective disorder, bipolar type
D. Substance-induced psychotic disorder
Correct Answer: A
Rationale: The patient meets criteria for a manic episode (≥3 days of decreased sleep,
pressured speech, grandiosity, excessive involvement in goal-directed activity)
accompanied by mood-congruent psychotic features (micro-chip delusion). Because
the psychosis occurs in the context of frank mania, bipolar I is primary. Brief psychotic
disorder (B) lasts <1 month without mood syndrome. Schizoaffective disorder (C)
,requires ≥2 weeks of psychosis in the absence of mood symptoms, not described here.
Negative tox screen rules out substance-induced (D).
2
A 31-year-old woman with borderline personality disorder is hospitalized after
self-inflicted superficial forearm cuts. On day 2 she screams that staff are “poisoning
my food” and refuses meals. Which nursing action is PRIORITY?
A. Place patient on one-to-one observation
B. Administer PRN haloperidol 5 mg IM
C. Offer finger foods with sealed beverages
D. Obtain serum ammonia level
Correct Answer: C
Rationale: Transient stress-related psychosis in BPD is best managed by reducing
arousal and offering choices that preserve autonomy while ensuring nutrition. Finger
foods bypass the “poisoned tray” delusion and build therapeutic alliance. One-to-one (A)
may escalate paranoia. Antipsychotic (B) is premature without risk of harm. Serum
ammonia (D) is unrelated unless hepatic encephalopathy suspected.
3
A 77-year-old widower is evaluated for 10-month cognitive decline. MoCA is 19/30;
clock-draw shows missing numbers. He scores 6/10 on PHQ-9, stating “I’m no use to
anyone.” He still enjoys watching baseball. Which diagnosis is PRIMARY?
A. Major neurocognitive disorder with behavioral disturbance
,B. Major depressive disorder with cognitive features
C. Mild neurocognitive disorder due to Alzheimer disease
D. Adjustment disorder with depressed mood
Correct Answer: B
Rationale: Depressive pseudodementia presents with cognitive complaints exceeding
deficits, preserved interest in remote pleasures, and mood congruent self-deprecation.
MoCA >17 and subjective uselessness favor depression. Neurocognitive disorder (A)
requires preserved insight into mood. Mild NCD (C) does not explain functional decline
to this degree. Adjustment disorder (D) lasts <6 months.
4
A 6-year-old boy with autism spectrum disorder (ASD) and global developmental delay
repeatedly slaps his ears, resulting in excoriation. ABC data reveal behavior peaks when
ceiling fan is activated. Which FIRST-LINE medication class is indicated?
A. Second-generation antipsychotic
B. Alpha-2 agonist
C. SSRI
D. Benzodiazepine
Correct Answer: A
Rationale: Self-injurious behavior (SIB) in ASD that is refractory to behavioral
intervention responds best to risperidone or aripiprazole, both FDA-approved for
, irritability. Alpha-2 agonists (B) target hyperactivity. SSRIs (C) lack evidence for SIB.
Benzodiazepines (D) risk paradoxical agitation.
5
A 42-year-old man with bipolar I disorder, maintained euthymic on lithium 1200 mg hs
(level 0.8 mEq/L), develops new-onset polyuria and polydipsia. Sodium is 148 mEq/L,
creatinine 1.4 mg/dL (baseline 1.0). Which adjustment is BEST?
A. Split lithium dose to 600 mg bid
B. Add amiloride 5 mg daily
C. Switch to extended-release lithium carbonate
D. Discontinue lithium and start valproate
Correct Answer: B
Rationale: Nephrogenic diabetes insipidus (NDI) is evidenced by hypernatremia and
rising creatinine; amiloride blocks lithium entry into collecting-duct cells and reduces
polyuria. Split dosing (A) does not correct tubular defect. Extended-release (C) does not
change pharmacokinetics. Discontinuation (D) is unnecessary if renal function
stabilizes with amiloride.
6
A 28-year-old woman reports 8-year history of picking “bumps” on face and arms,
spending 2 h nightly with magnifying mirror. She applies antibiotic ointment and
makeup to conceal lesions. She is embarrassed but feels “compelled.” Which treatment
has STRONGEST evidence?
A. Fluoxetine 60 mg daily
