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 23-year-old graduate student presents with 4 weeks of “too much energy,”
sleeping 3 h nightly, spending $8,000 on crypto-currencies, and writing 40-page
manifestos. He is unconcerned, denies medical problems, and urine tox is
negative. Which DSM-5-TR specifier best applies to his current episode?
A. Bipolar I, manic episode with psychotic features
B. Bipolar I, manic episode without psychotic features
C. Bipolar II, hypomanic episode
D. Schizoaffective disorder, bipolar type
Correct Answer: A
Rationale: The patient meets criteria for mania: ≥1-week abnormally elevated
mood, decreased sleep, excessive goal-directed activity, and excessive
involvement in pleasurable activities with potential for painful consequences. His
expansive grandiose manifestos imply psychotic features (delusional ideation),
making “with psychotic features” the correct specifier. Bipolar II is ruled out by
,severity and psychosis. Schizoaffective disorder requires ≥2 weeks of psychosis
in the absence of mood symptoms, not described here.
2
A 34-year-old woman with borderline personality disorder is started on
lamotrigine for mood lability. Which counseling point is MOST critical during the
first 8 weeks?
A. Report any new rash immediately
B. Take with high-fat meal to enhance absorption
C. Expect therapeutic benefit within 3 days
D. Discontinue if mild tremor develops
Correct Answer: A
Rationale: Lamotrigine carries a black-box warning for potentially life-threatening
rash (Stevens-Johnson syndrome, TEN). Risk is highest during the slow titration
phase (weeks 1-8) and can be mitigated by adhering to starter packs and
reporting rash early. Absorption is unaffected by fat; therapeutic lag is 4-6 weeks;
mild tremor is not an indication to stop.
3
A 16-year-old transgender male (on intramuscular testosterone for 6 months)
reports 3 weeks of fatigue, anhedonia, irritability, and suicidal ideation without
plan. PHQ-A 16. Which INITIAL antidepressant minimizes interaction with
testosterone?
,A. Sertraline
B. Carbamazepine
C. Fluvoxamine
D. St. John’s wort
Correct Answer: A
Rationale: Testosterone is metabolized partly via CYP3A4; carbamazepine and
St. John’s wort are strong inducers that could lower hormone levels. Fluvoxamine
is a potent 2D6/1A2 inhibitor with more side-effects. Sertraline is a mild inhibitor,
generally neutral on testosterone levels, and first-line in adolescents.
4
A 77-year-old man with major NCD due to Alzheimer’s becomes physically
aggressive during bathing. He has QTc 490 ms, BP 130/82, and creatinine 1.4.
Which oral antipsychical is LOWEST risk for QTc prolongation?
A. Haloperidol 0.5 mg
B. Risperidone 0.5 mg
C. Quetiapine 25 mg
D. Olanzapine 2.5 mg
Correct Answer: D
, Rationale: Olanzapine has modest QTc liability compared with haloperidol,
risperidone, and quetiapine. Low doses reduce overall risk while providing
sedation and anti-agitation effects. Haloperidol carries a black-box QTc warning.
5
A 29-year-old veteran reports nightly combat nightmares, hypervigilance, and
survivor guilt. He drinks 12 beers nightly “to sleep.” Which medication is
FIRST-LINE for PTSD nightmares?
A. Prazosin
B. Trazodone
C. Risperidone
D. Gabapentin
Correct Answer: A
Rationale: Although not FDA-labeled, prazosin has the strongest RCT evidence for
reducing PTSD trauma nightmares and is endorsed by VA/DoD guidelines. It
must be titrated and BP monitored. Trazodone aids sleep onset but does not
target nightmare content. Risperidone lacks monotherapy data for PTSD.
6
A 7-year-old girl with ADHD, combined type, on methylphenidate 10 mg BID
develops new-onset echolalia, shoulder jerks, and eye-blinking 4 weeks after
dose increase. Which action is BEST?
& Management in Psychiatric Mental Health Across the
Lifespan I | 100% Correct actual Questions & Verified
Answers – Chamberlain
1
A 23-year-old graduate student presents with 4 weeks of “too much energy,”
sleeping 3 h nightly, spending $8,000 on crypto-currencies, and writing 40-page
manifestos. He is unconcerned, denies medical problems, and urine tox is
negative. Which DSM-5-TR specifier best applies to his current episode?
A. Bipolar I, manic episode with psychotic features
B. Bipolar I, manic episode without psychotic features
C. Bipolar II, hypomanic episode
D. Schizoaffective disorder, bipolar type
Correct Answer: A
Rationale: The patient meets criteria for mania: ≥1-week abnormally elevated
mood, decreased sleep, excessive goal-directed activity, and excessive
involvement in pleasurable activities with potential for painful consequences. His
expansive grandiose manifestos imply psychotic features (delusional ideation),
making “with psychotic features” the correct specifier. Bipolar II is ruled out by
,severity and psychosis. Schizoaffective disorder requires ≥2 weeks of psychosis
in the absence of mood symptoms, not described here.
2
A 34-year-old woman with borderline personality disorder is started on
lamotrigine for mood lability. Which counseling point is MOST critical during the
first 8 weeks?
A. Report any new rash immediately
B. Take with high-fat meal to enhance absorption
C. Expect therapeutic benefit within 3 days
D. Discontinue if mild tremor develops
Correct Answer: A
Rationale: Lamotrigine carries a black-box warning for potentially life-threatening
rash (Stevens-Johnson syndrome, TEN). Risk is highest during the slow titration
phase (weeks 1-8) and can be mitigated by adhering to starter packs and
reporting rash early. Absorption is unaffected by fat; therapeutic lag is 4-6 weeks;
mild tremor is not an indication to stop.
3
A 16-year-old transgender male (on intramuscular testosterone for 6 months)
reports 3 weeks of fatigue, anhedonia, irritability, and suicidal ideation without
plan. PHQ-A 16. Which INITIAL antidepressant minimizes interaction with
testosterone?
,A. Sertraline
B. Carbamazepine
C. Fluvoxamine
D. St. John’s wort
Correct Answer: A
Rationale: Testosterone is metabolized partly via CYP3A4; carbamazepine and
St. John’s wort are strong inducers that could lower hormone levels. Fluvoxamine
is a potent 2D6/1A2 inhibitor with more side-effects. Sertraline is a mild inhibitor,
generally neutral on testosterone levels, and first-line in adolescents.
4
A 77-year-old man with major NCD due to Alzheimer’s becomes physically
aggressive during bathing. He has QTc 490 ms, BP 130/82, and creatinine 1.4.
Which oral antipsychical is LOWEST risk for QTc prolongation?
A. Haloperidol 0.5 mg
B. Risperidone 0.5 mg
C. Quetiapine 25 mg
D. Olanzapine 2.5 mg
Correct Answer: D
, Rationale: Olanzapine has modest QTc liability compared with haloperidol,
risperidone, and quetiapine. Low doses reduce overall risk while providing
sedation and anti-agitation effects. Haloperidol carries a black-box QTc warning.
5
A 29-year-old veteran reports nightly combat nightmares, hypervigilance, and
survivor guilt. He drinks 12 beers nightly “to sleep.” Which medication is
FIRST-LINE for PTSD nightmares?
A. Prazosin
B. Trazodone
C. Risperidone
D. Gabapentin
Correct Answer: A
Rationale: Although not FDA-labeled, prazosin has the strongest RCT evidence for
reducing PTSD trauma nightmares and is endorsed by VA/DoD guidelines. It
must be titrated and BP monitored. Trazodone aids sleep onset but does not
target nightmare content. Risperidone lacks monotherapy data for PTSD.
6
A 7-year-old girl with ADHD, combined type, on methylphenidate 10 mg BID
develops new-onset echolalia, shoulder jerks, and eye-blinking 4 weeks after
dose increase. Which action is BEST?
