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 23-year-old graduate student is brought to the ED by roommates who found him
awake for 72 h, writing “the algorithm to save humanity” on the walls, and speaking so
rapidly no one can interrupt. Urine tox negative. He has no psychiatric history, but his
mother has bipolar I. Which is the PRIMARY DSM-5-TR criterion that differentiates a
manic from a hypomanic episode in this case?
A. Duration of at least 1 week
B. Presence of decreased need for sleep
C. Rapid, pressured speech
D. Family history of bipolar I disorder
Correct Answer: A
Rationale: A full manic episode requires ≥1 week of persistently
elevated/expansive/irritable mood with 3+ symptoms (or any duration if
hospitalization), whereas hypomania lasts ≥4 days and causes no marked impairment
or psychosis. Duration therefore distinguishes mania here. Decreased sleep and
pressured speech occur in both. Family history raises risk but is not a diagnostic
criterion.
2.
,A 17-year-old female reports 4-month low mood, 10-lb weight gain, hypersomnia, and
“my arms feel like lead” after school. She denies drug use. Which specifier best
captures her depressive presentation?
A. Atypical features
B. Melancholic features
C. Anxious distress
D. Catatonia
Correct Answer: A
Rationale: Mood reactivity (able to brighten to positive events) plus leaden paralysis,
hypersomnia, and weight gain define atypical features per DSM-5-TR. Melancholic
requires anhedonia, early-morning awakening, guilt. Anxious distress is comorbid
anxiety symptoms. Catatonia involves psychomotor disturbance.
3.
A 38-year-old man with schizophrenia on haloperidol 15 mg/day develops fever 39 °C,
rigidity, CK 4,800 U/L, and WBC 16 k. Which immediate medication is indicated?
A. Dantrolene 2.5 mg/kg IV
B. Lorazepam 2 mg PO
C. Bromocriptine 5 mg PO
D. Amantadine 100 mg PO
Correct Answer: A
,Rationale: Neuroleptic malignant syndrome requires rapid skeletal-muscle relaxation
with dantrolene to lower temperature and CK. Lorazepam treats catatonia but is
adjunctive. Bromocriptine (central dopamine agonist) is added after dantrolene.
Amantadine is too slow.
4.
A 6-year-old boy repeatedly bangs his head on the floor when asked to transition
activities, uses 1-word utterances, and lines up toy cars precisely. Which assessment is
FIRST priority before initiating any medication for irritability?
A. Autism-specific diagnostic tool (ADOS-2)
B. Lead level screening
C. Thyroid function panel
D. Hearing test
Correct Answer: A
Rationale: The constellation of language delay, repetitive behaviors, and low frustration
tolerance mandates confirming autism spectrum disorder with gold-standard ADOS-2.
Hearing test is routine but does not explain stereotypies. Lead and thyroid are
secondary.
5.
A 29-year-old woman 32 weeks pregnant with bipolar I has been stable on lithium for 2
years. She asks about delivery planning. Which evidence-based recommendation
minimizes neonatal risk?
A. Hold lithium 24–48 h before planned delivery or at labor onset
, B. Switch to valproate now
C. Continue lithium unchanged through delivery
D. Substitute carbamazepine now
Correct Answer: A
Rationale: Lithium can cause neonatal “floppy baby,” polyuria, and cardiac arrhythmias;
temporary discontinuation at labor prevents high fetal levels while maintaining maternal
stability. Valproate and carbamazepine are more teratogenic and not safer peripartum.
Continuing unchanged increases neonatal complications.
6.
A 45-year-old veteran reports nightly nightmares of convoy explosions, avoids fireworks,
and startles when doors slam. He drinks 8 beers nightly to “get 4 h of sleep.” Which
intervention is FIRST-LINE?
A. Prolonged exposure therapy plus naltrexone for alcohol use
B. Start prazosin 1 mg qhs and continue alcohol
C. EMDR plus sleep hygiene only
D. Risperidone 2 mg for hypervigilance
Correct Answer: A
Rationale: APA PTSD guidelines recommend trauma-focused psychotherapy (PE, EMDR)
as first-line, integrated with evidence-based treatment for comorbid alcohol use
(naltrexone). Prazosin helps nightmares but does not treat avoidance or alcohol use.
Risperidone lacks robust PTSD efficacy and adds metabolic risk.
Management in Psychiatric Mental Health Across the
Lifespan I | 100% Correct Practice Questions & Verified
Answers – Chamberlain
1.
A 23-year-old graduate student is brought to the ED by roommates who found him
awake for 72 h, writing “the algorithm to save humanity” on the walls, and speaking so
rapidly no one can interrupt. Urine tox negative. He has no psychiatric history, but his
mother has bipolar I. Which is the PRIMARY DSM-5-TR criterion that differentiates a
manic from a hypomanic episode in this case?
A. Duration of at least 1 week
B. Presence of decreased need for sleep
C. Rapid, pressured speech
D. Family history of bipolar I disorder
Correct Answer: A
Rationale: A full manic episode requires ≥1 week of persistently
elevated/expansive/irritable mood with 3+ symptoms (or any duration if
hospitalization), whereas hypomania lasts ≥4 days and causes no marked impairment
or psychosis. Duration therefore distinguishes mania here. Decreased sleep and
pressured speech occur in both. Family history raises risk but is not a diagnostic
criterion.
2.
,A 17-year-old female reports 4-month low mood, 10-lb weight gain, hypersomnia, and
“my arms feel like lead” after school. She denies drug use. Which specifier best
captures her depressive presentation?
A. Atypical features
B. Melancholic features
C. Anxious distress
D. Catatonia
Correct Answer: A
Rationale: Mood reactivity (able to brighten to positive events) plus leaden paralysis,
hypersomnia, and weight gain define atypical features per DSM-5-TR. Melancholic
requires anhedonia, early-morning awakening, guilt. Anxious distress is comorbid
anxiety symptoms. Catatonia involves psychomotor disturbance.
3.
A 38-year-old man with schizophrenia on haloperidol 15 mg/day develops fever 39 °C,
rigidity, CK 4,800 U/L, and WBC 16 k. Which immediate medication is indicated?
A. Dantrolene 2.5 mg/kg IV
B. Lorazepam 2 mg PO
C. Bromocriptine 5 mg PO
D. Amantadine 100 mg PO
Correct Answer: A
,Rationale: Neuroleptic malignant syndrome requires rapid skeletal-muscle relaxation
with dantrolene to lower temperature and CK. Lorazepam treats catatonia but is
adjunctive. Bromocriptine (central dopamine agonist) is added after dantrolene.
Amantadine is too slow.
4.
A 6-year-old boy repeatedly bangs his head on the floor when asked to transition
activities, uses 1-word utterances, and lines up toy cars precisely. Which assessment is
FIRST priority before initiating any medication for irritability?
A. Autism-specific diagnostic tool (ADOS-2)
B. Lead level screening
C. Thyroid function panel
D. Hearing test
Correct Answer: A
Rationale: The constellation of language delay, repetitive behaviors, and low frustration
tolerance mandates confirming autism spectrum disorder with gold-standard ADOS-2.
Hearing test is routine but does not explain stereotypies. Lead and thyroid are
secondary.
5.
A 29-year-old woman 32 weeks pregnant with bipolar I has been stable on lithium for 2
years. She asks about delivery planning. Which evidence-based recommendation
minimizes neonatal risk?
A. Hold lithium 24–48 h before planned delivery or at labor onset
, B. Switch to valproate now
C. Continue lithium unchanged through delivery
D. Substitute carbamazepine now
Correct Answer: A
Rationale: Lithium can cause neonatal “floppy baby,” polyuria, and cardiac arrhythmias;
temporary discontinuation at labor prevents high fetal levels while maintaining maternal
stability. Valproate and carbamazepine are more teratogenic and not safer peripartum.
Continuing unchanged increases neonatal complications.
6.
A 45-year-old veteran reports nightly nightmares of convoy explosions, avoids fireworks,
and startles when doors slam. He drinks 8 beers nightly to “get 4 h of sleep.” Which
intervention is FIRST-LINE?
A. Prolonged exposure therapy plus naltrexone for alcohol use
B. Start prazosin 1 mg qhs and continue alcohol
C. EMDR plus sleep hygiene only
D. Risperidone 2 mg for hypervigilance
Correct Answer: A
Rationale: APA PTSD guidelines recommend trauma-focused psychotherapy (PE, EMDR)
as first-line, integrated with evidence-based treatment for comorbid alcohol use
(naltrexone). Prazosin helps nightmares but does not treat avoidance or alcohol use.
Risperidone lacks robust PTSD efficacy and adds metabolic risk.
