NR 605 Final Exam (New 2025/2026 Update) — Diagnosis
& Management in Psychiatric Mental Health Across the
Lifespan I | 100% Correct Questions & Verified Answers –
Chamberlain
1
A 27-year-old woman 8 weeks postpartum describes daily crying spells, intrusive
thoughts of dropping her infant, and guilt over “being a bad mom.” She denies
hallucinations or suicidal intent. She breastfeeds exclusively. Which DSM-5-TR
diagnosis and first-line treatment align best?
A. Major depressive episode, sertraline 25 mg daily
B. Postpartum blues, continue support group only
C. Bipolar depression, lithium 300 mg BID
D. Postpartum psychosis, brexpiprazole 1 mg daily
Correct Answer: A
Rationale: The patient meets criteria for a major depressive episode with peripartum
onset (within 4 weeks postpartum but can extend to 12). Sertraline is the SSRI of choice
during breastfeeding because of low milk levels and extensive safety data. Postpartum
blues remit within 2 weeks and do not include intrusive thoughts or functional
impairment. Bipolar depression is unlikely without history of mania/hypomania, and
lithium has higher milk transfer. Postpartum psychosis presents with delusions,
disorganized behavior, or frank hallucinations—none reported here.
,2
A 72-year-old man with vascular neurocognitive disorder becomes agitated each
evening, accusing staff of poisoning his food. Vital signs and CBC are normal. Which
medication is FDA-approved for this indication?
A. Brexpiprazole
B. Haloperidol 1 mg PO
C. Lorazepam 0.5 mg PO
D. Quetiapine 25 mg PO
Correct Answer: A
Rationale: Brexpiprazole is the only agent currently FDA-approved specifically for
dementia-related agitation, supported by 2023 phase-III data showing modest efficacy
and acceptable tolerability. Haloperidol and quetiapine are used off-label and carry
black-box warnings for increased cerebrovascular events and mortality in elders.
Benzodiazepines worsen confusion and falls.
3
A 16-year-old autistic boy repeatedly slaps his ears when classroom fluorescent lights
flicker. Functional analysis confirms sensory escape behavior. Which evidence-based
intervention should the PMHNP prioritize?
A. Applied behavior analysis with sensory extinction
B. Risperidone 0.5 mg BID
C. Valproate 250 mg BID
,D. Fluoxetine 10 mg daily
Correct Answer: A
Rationale: ABA incorporating sensory extinction (e.g., non-contingent access to
noise-blocking headphones) is first-line for autism-related stereotypy maintained by
sensory reinforcement. Antipsychotics (risperidone) are reserved for severe irritability,
not isolated sensory behaviors. Valproate and fluoxetine lack evidence for
sensory-based stereotypies.
4
A 34-year-old woman with borderline personality disorder presents after superficial
forearm cuts following partner abandonment. She reports chronic emptiness but denies
active suicidal intent. Vital signs stable. Which nursing action is most appropriate in the
first 2 hours?
A. One-to-one observation while completing risk assessment
B. Apply restraints and obtain haloperidol order
C. Discharge with outpatient DBT referral within 24 h
D. Encourage expression of anger via punching pillow
Correct Answer: A
Rationale: NAPSI guidelines mandate continuous observation until a structured suicide
risk stratification (e.g., Columbia, STAMP) is completed, even when intent is denied,
because BPD carries high impulsivity. Restraints are over-restrictive without imminent
danger. Immediate discharge bypasses safety evaluation; pillow punching lacks
evidence and may reinforce dysregulation.
, 5
A 55-year-old man with cirrhosis (Child–Pugh B) develops depressive episode. Which
antidepressant requires no hepatic metabolism and is safest?
A. Desvenlafaxine
B. Duloxetine
C. Mirtazapine
D. Nefazodone
Correct Answer: A
Rationale: Desvenlafaxine is the major active metabolite of venlafaxine and undergoes
direct glucuronidation with minimal CYP450 involvement, making it the preferred SNRIs
in hepatic impairment. Duloxetine and nefazodone are contraindicated in
moderate–severe hepatic disease; mirtazapine requires 50% dose reduction but still
relies on CYP metabolism.
6
A 23-year-old woman reports 4 days of decreased sleep, racing thoughts, and spending
$2000 on crypto-currency after starting sertraline 2 weeks ago for MDD. She denies
prior mood episodes. Which action is most appropriate?
A. Discontinue sertraline and monitor weekly
B. Add lithium 300 mg BID immediately
C. Increase sertraline to 100 mg for better antidepressant effect
D. Start quetiapine 300 mg XR for bipolar depression
& Management in Psychiatric Mental Health Across the
Lifespan I | 100% Correct Questions & Verified Answers –
Chamberlain
1
A 27-year-old woman 8 weeks postpartum describes daily crying spells, intrusive
thoughts of dropping her infant, and guilt over “being a bad mom.” She denies
hallucinations or suicidal intent. She breastfeeds exclusively. Which DSM-5-TR
diagnosis and first-line treatment align best?
A. Major depressive episode, sertraline 25 mg daily
B. Postpartum blues, continue support group only
C. Bipolar depression, lithium 300 mg BID
D. Postpartum psychosis, brexpiprazole 1 mg daily
Correct Answer: A
Rationale: The patient meets criteria for a major depressive episode with peripartum
onset (within 4 weeks postpartum but can extend to 12). Sertraline is the SSRI of choice
during breastfeeding because of low milk levels and extensive safety data. Postpartum
blues remit within 2 weeks and do not include intrusive thoughts or functional
impairment. Bipolar depression is unlikely without history of mania/hypomania, and
lithium has higher milk transfer. Postpartum psychosis presents with delusions,
disorganized behavior, or frank hallucinations—none reported here.
,2
A 72-year-old man with vascular neurocognitive disorder becomes agitated each
evening, accusing staff of poisoning his food. Vital signs and CBC are normal. Which
medication is FDA-approved for this indication?
A. Brexpiprazole
B. Haloperidol 1 mg PO
C. Lorazepam 0.5 mg PO
D. Quetiapine 25 mg PO
Correct Answer: A
Rationale: Brexpiprazole is the only agent currently FDA-approved specifically for
dementia-related agitation, supported by 2023 phase-III data showing modest efficacy
and acceptable tolerability. Haloperidol and quetiapine are used off-label and carry
black-box warnings for increased cerebrovascular events and mortality in elders.
Benzodiazepines worsen confusion and falls.
3
A 16-year-old autistic boy repeatedly slaps his ears when classroom fluorescent lights
flicker. Functional analysis confirms sensory escape behavior. Which evidence-based
intervention should the PMHNP prioritize?
A. Applied behavior analysis with sensory extinction
B. Risperidone 0.5 mg BID
C. Valproate 250 mg BID
,D. Fluoxetine 10 mg daily
Correct Answer: A
Rationale: ABA incorporating sensory extinction (e.g., non-contingent access to
noise-blocking headphones) is first-line for autism-related stereotypy maintained by
sensory reinforcement. Antipsychotics (risperidone) are reserved for severe irritability,
not isolated sensory behaviors. Valproate and fluoxetine lack evidence for
sensory-based stereotypies.
4
A 34-year-old woman with borderline personality disorder presents after superficial
forearm cuts following partner abandonment. She reports chronic emptiness but denies
active suicidal intent. Vital signs stable. Which nursing action is most appropriate in the
first 2 hours?
A. One-to-one observation while completing risk assessment
B. Apply restraints and obtain haloperidol order
C. Discharge with outpatient DBT referral within 24 h
D. Encourage expression of anger via punching pillow
Correct Answer: A
Rationale: NAPSI guidelines mandate continuous observation until a structured suicide
risk stratification (e.g., Columbia, STAMP) is completed, even when intent is denied,
because BPD carries high impulsivity. Restraints are over-restrictive without imminent
danger. Immediate discharge bypasses safety evaluation; pillow punching lacks
evidence and may reinforce dysregulation.
, 5
A 55-year-old man with cirrhosis (Child–Pugh B) develops depressive episode. Which
antidepressant requires no hepatic metabolism and is safest?
A. Desvenlafaxine
B. Duloxetine
C. Mirtazapine
D. Nefazodone
Correct Answer: A
Rationale: Desvenlafaxine is the major active metabolite of venlafaxine and undergoes
direct glucuronidation with minimal CYP450 involvement, making it the preferred SNRIs
in hepatic impairment. Duloxetine and nefazodone are contraindicated in
moderate–severe hepatic disease; mirtazapine requires 50% dose reduction but still
relies on CYP metabolism.
6
A 23-year-old woman reports 4 days of decreased sleep, racing thoughts, and spending
$2000 on crypto-currency after starting sertraline 2 weeks ago for MDD. She denies
prior mood episodes. Which action is most appropriate?
A. Discontinue sertraline and monitor weekly
B. Add lithium 300 mg BID immediately
C. Increase sertraline to 100 mg for better antidepressant effect
D. Start quetiapine 300 mg XR for bipolar depression
