CHAMBERLAIN UNIVERSITY
NR606 / NR 606
Week 2
Diagnosis & Management
in Psychiatric-Mental
Health II
Practicum Examination
Comprehensive examination covering mood disorders,
anxiety and trauma-related disorders, obsessive-compulsive
and related disorders, somatic symptom and dissociative
disorders, psychopharmacology, non-pharmacological
interventions, special populations, suicide risk assessment,
and integrated clinical case scenarios. Aligned with 2026-
2027 PMHNP competencies and advanced psychiatric
diagnostic guidelines.
QUESTIONS FOR M AT U P D ATE
75 Verified Multiple Choice
P M HNP AD VANC ED P R AC T I C E NUR S I NG | C OM P LET E GUI D E W I T H QUES T I ONS AND
VER I FI ED R AT I ONALES
, NR606 / NR 606 Week 2 (Latest Update 2026/2027)
Diagnosis & Management in Psychiatric-Mental Health II Practicum
Complete Guide with Questions and Verified Rationales | 75 Questions
Section 1: Mood Disorders (Major Depressive Disorder, Bipolar Disorders, &
Treatment-Resistant Depression)
Q1: A 34-year-old patient presents with a 3-week history of depressed mood, anhedonia, significant weight loss,
insomnia, fatigue, difficulty concentrating, and recurrent thoughts of death. Which DSM-5-TR criterion must be
present to meet the diagnosis of Major Depressive Disorder (MDD)?
A. At least five total symptoms including depressed mood or anhedonia for at least 2 weeks [CORRECT]
B. At least five total symptoms including depressed mood or anhedonia for at least 4 weeks
C. Depressed mood alone for at least 2 weeks with no additional symptoms required
D. Anhedonia alone for at least 1 week with three additional symptoms
Correct Answer: A
Rationale: The DSM-5-TR requires at least five of nine symptoms, with at least one being either depressed mood or anhedonia, present
during the same 2-week period. This patient meets criteria with seven symptoms including the required cardinal symptom. A 4-week
duration (B) is incorrect as MDD requires only 2 weeks. Options C and D are incorrect because MDD requires five total symptoms, not
just one cardinal symptom alone.
Q2: A 28-year-old woman reports mood swings that occur predictably during the luteal phase of her menstrual cycle,
with symptoms resolving within a few days after menses onset. She experiences marked irritability, mood lability,
anxiety, and a sense of being overwhelmed. What is the most likely diagnosis?
A. Persistent Depressive Disorder (Dysthymia)
B. Premenstrual Dysphoric Disorder (PMDD) [CORRECT]
C. Bipolar II Disorder
D. Adjustment Disorder with Depressed Mood
Correct Answer: B
Rationale: PMDD is characterized by mood symptoms occurring in the luteal phase that remit with menses onset. The patient exhibits the
core affective symptoms (irritability, mood lability, anxiety) and functional impairment consistent with PMDD. Dysthymia (A) requires
chronic depressed mood for 2 years. Bipolar II (C) requires a hypomanic episode plus depressive episodes. Adjustment Disorder (D) is
tied to an identifiable stressor within 3 months, not cyclical hormonal changes.
Q3: A 42-year-old patient with a history of MDD has failed to achieve adequate response after trials of sertraline 200
mg/day and escitalopram 20 mg/day, each for 8 weeks at therapeutic doses. Which of the following defines this
patient's condition according to evidence-based guidelines?
A. Refractory depression
B. Treatment-Resistant Depression (TRD) defined as inadequate response to two or more antidepressants at
adequate dose and duration [CORRECT]
C. Pseudoresistant depression due to nonadherence
D. Partial response requiring only dose escalation
Correct Answer: B
Rationale: TRD is specifically defined as inadequate response to at least two antidepressant trials at adequate doses and durations. This
patient has had two adequate trials, meeting the definition. Refractory depression (A) is not a standard DSM-5-TR or clinical term.
Pseudoresistance (C) implies nonadherence, which is not stated. Simply escalating the dose (D) has already been done and is insufficient
to classify the response as adequate.
, Q4: A 31-year-old male presents with a 10-day period of persistently elevated, euphoric mood, decreased need for
sleep (sleeping 3 hours per night), grandiosity, rapid speech, distractibility, and excessive involvement in risky business
investments. He states he feels "on top of the world" and has been spending excessively. What is the most appropriate
diagnosis?
A. Bipolar II Disorder
B. Cyclothymic Disorder
C. Bipolar I Disorder, current episode manic, severe without psychotic features [CORRECT]
D. Substance/Medication-Induced Bipolar Disorder
Correct Answer: C
Rationale: Bipolar I Disorder requires at least one manic episode lasting at least 7 days. This patient's 10-day euphoric mood with classic
manic symptoms (decreased sleep need, grandiosity, pressured speech, distractibility, risky behavior) meets full criteria for a manic
episode. Bipolar II (A) requires hypomania (not full mania) plus a major depressive episode. Cyclothymic Disorder (B) involves
subthreshold symptoms for 2+ years. There is no indication of substance use causing symptoms (D).
Q5: A PMHNP is treating a 45-year-old woman with Bipolar I Disorder who is currently in a depressive episode.
Which of the following medications is FDA-approved and most appropriate as first-line treatment for bipolar
depression?
A. Sertraline (Zoloft)
B. Lamotrigine (Lamictal) [CORRECT]
C. Fluoxetine (Prozac) monotherapy
D. Citalopram (Celexa)
Correct Answer: B
Rationale: Lamotrigine is FDA-approved for the maintenance treatment of bipolar I disorder and is the first-line mood stabilizer
specifically effective for bipolar depression. Unlike the other options, lamotrigine treats the depressive phase of bipolar disorder without
inducing mania or rapid cycling. SSRIs such as sertraline (A), fluoxetine (C), and citalopram (D) are not first-line for bipolar
depression; they carry the risk of inducing manic/hypomanic episodes or rapid cycling when used as monotherapy in bipolar disorder.
Q6: A 25-year-old woman presents with depressed mood that has persisted for 3 years. She reports poor appetite, low
energy, low self-esteem, and difficulty concentrating, but she continues to work and maintains social relationships. She
has never had a symptom-free period lasting more than 2 months during this time. What is the most likely diagnosis?
A. Major Depressive Disorder, recurrent, moderate
B. Persistent Depressive Disorder (Dysthymia) [CORRECT]
C. Adjustment Disorder with Depressed Mood
D. Bipolar II Disorder
Correct Answer: B
Rationale: Persistent Depressive Disorder (Dysthymia) requires a depressed mood lasting for at least 2 years in adults, with at least two
additional depressive symptoms. This patient meets the 2-year duration criterion, has associated symptoms (poor appetite, low energy,
low self-esteem, concentration difficulties), and has not been symptom-free for more than 2 months. MDD (A) is episodic, not chronic.
Adjustment Disorder (C) is time-limited to 6 months after a stressor. Bipolar II (D) requires a hypomanic episode.
Q7: A patient diagnosed with MDD has prominent psychomotor retardation, profound anhedonia, depression worse in
the morning, early morning awakening (3 AM), and significant weight loss. Which MDD specifier best describes this
presentation?
A. With atypical features
B. With melancholic features [CORRECT]
C. With seasonal pattern
D. With catatonia
Correct Answer: B
NR606 Week 2 Examination | Page 2
NR606 / NR 606
Week 2
Diagnosis & Management
in Psychiatric-Mental
Health II
Practicum Examination
Comprehensive examination covering mood disorders,
anxiety and trauma-related disorders, obsessive-compulsive
and related disorders, somatic symptom and dissociative
disorders, psychopharmacology, non-pharmacological
interventions, special populations, suicide risk assessment,
and integrated clinical case scenarios. Aligned with 2026-
2027 PMHNP competencies and advanced psychiatric
diagnostic guidelines.
QUESTIONS FOR M AT U P D ATE
75 Verified Multiple Choice
P M HNP AD VANC ED P R AC T I C E NUR S I NG | C OM P LET E GUI D E W I T H QUES T I ONS AND
VER I FI ED R AT I ONALES
, NR606 / NR 606 Week 2 (Latest Update 2026/2027)
Diagnosis & Management in Psychiatric-Mental Health II Practicum
Complete Guide with Questions and Verified Rationales | 75 Questions
Section 1: Mood Disorders (Major Depressive Disorder, Bipolar Disorders, &
Treatment-Resistant Depression)
Q1: A 34-year-old patient presents with a 3-week history of depressed mood, anhedonia, significant weight loss,
insomnia, fatigue, difficulty concentrating, and recurrent thoughts of death. Which DSM-5-TR criterion must be
present to meet the diagnosis of Major Depressive Disorder (MDD)?
A. At least five total symptoms including depressed mood or anhedonia for at least 2 weeks [CORRECT]
B. At least five total symptoms including depressed mood or anhedonia for at least 4 weeks
C. Depressed mood alone for at least 2 weeks with no additional symptoms required
D. Anhedonia alone for at least 1 week with three additional symptoms
Correct Answer: A
Rationale: The DSM-5-TR requires at least five of nine symptoms, with at least one being either depressed mood or anhedonia, present
during the same 2-week period. This patient meets criteria with seven symptoms including the required cardinal symptom. A 4-week
duration (B) is incorrect as MDD requires only 2 weeks. Options C and D are incorrect because MDD requires five total symptoms, not
just one cardinal symptom alone.
Q2: A 28-year-old woman reports mood swings that occur predictably during the luteal phase of her menstrual cycle,
with symptoms resolving within a few days after menses onset. She experiences marked irritability, mood lability,
anxiety, and a sense of being overwhelmed. What is the most likely diagnosis?
A. Persistent Depressive Disorder (Dysthymia)
B. Premenstrual Dysphoric Disorder (PMDD) [CORRECT]
C. Bipolar II Disorder
D. Adjustment Disorder with Depressed Mood
Correct Answer: B
Rationale: PMDD is characterized by mood symptoms occurring in the luteal phase that remit with menses onset. The patient exhibits the
core affective symptoms (irritability, mood lability, anxiety) and functional impairment consistent with PMDD. Dysthymia (A) requires
chronic depressed mood for 2 years. Bipolar II (C) requires a hypomanic episode plus depressive episodes. Adjustment Disorder (D) is
tied to an identifiable stressor within 3 months, not cyclical hormonal changes.
Q3: A 42-year-old patient with a history of MDD has failed to achieve adequate response after trials of sertraline 200
mg/day and escitalopram 20 mg/day, each for 8 weeks at therapeutic doses. Which of the following defines this
patient's condition according to evidence-based guidelines?
A. Refractory depression
B. Treatment-Resistant Depression (TRD) defined as inadequate response to two or more antidepressants at
adequate dose and duration [CORRECT]
C. Pseudoresistant depression due to nonadherence
D. Partial response requiring only dose escalation
Correct Answer: B
Rationale: TRD is specifically defined as inadequate response to at least two antidepressant trials at adequate doses and durations. This
patient has had two adequate trials, meeting the definition. Refractory depression (A) is not a standard DSM-5-TR or clinical term.
Pseudoresistance (C) implies nonadherence, which is not stated. Simply escalating the dose (D) has already been done and is insufficient
to classify the response as adequate.
, Q4: A 31-year-old male presents with a 10-day period of persistently elevated, euphoric mood, decreased need for
sleep (sleeping 3 hours per night), grandiosity, rapid speech, distractibility, and excessive involvement in risky business
investments. He states he feels "on top of the world" and has been spending excessively. What is the most appropriate
diagnosis?
A. Bipolar II Disorder
B. Cyclothymic Disorder
C. Bipolar I Disorder, current episode manic, severe without psychotic features [CORRECT]
D. Substance/Medication-Induced Bipolar Disorder
Correct Answer: C
Rationale: Bipolar I Disorder requires at least one manic episode lasting at least 7 days. This patient's 10-day euphoric mood with classic
manic symptoms (decreased sleep need, grandiosity, pressured speech, distractibility, risky behavior) meets full criteria for a manic
episode. Bipolar II (A) requires hypomania (not full mania) plus a major depressive episode. Cyclothymic Disorder (B) involves
subthreshold symptoms for 2+ years. There is no indication of substance use causing symptoms (D).
Q5: A PMHNP is treating a 45-year-old woman with Bipolar I Disorder who is currently in a depressive episode.
Which of the following medications is FDA-approved and most appropriate as first-line treatment for bipolar
depression?
A. Sertraline (Zoloft)
B. Lamotrigine (Lamictal) [CORRECT]
C. Fluoxetine (Prozac) monotherapy
D. Citalopram (Celexa)
Correct Answer: B
Rationale: Lamotrigine is FDA-approved for the maintenance treatment of bipolar I disorder and is the first-line mood stabilizer
specifically effective for bipolar depression. Unlike the other options, lamotrigine treats the depressive phase of bipolar disorder without
inducing mania or rapid cycling. SSRIs such as sertraline (A), fluoxetine (C), and citalopram (D) are not first-line for bipolar
depression; they carry the risk of inducing manic/hypomanic episodes or rapid cycling when used as monotherapy in bipolar disorder.
Q6: A 25-year-old woman presents with depressed mood that has persisted for 3 years. She reports poor appetite, low
energy, low self-esteem, and difficulty concentrating, but she continues to work and maintains social relationships. She
has never had a symptom-free period lasting more than 2 months during this time. What is the most likely diagnosis?
A. Major Depressive Disorder, recurrent, moderate
B. Persistent Depressive Disorder (Dysthymia) [CORRECT]
C. Adjustment Disorder with Depressed Mood
D. Bipolar II Disorder
Correct Answer: B
Rationale: Persistent Depressive Disorder (Dysthymia) requires a depressed mood lasting for at least 2 years in adults, with at least two
additional depressive symptoms. This patient meets the 2-year duration criterion, has associated symptoms (poor appetite, low energy,
low self-esteem, concentration difficulties), and has not been symptom-free for more than 2 months. MDD (A) is episodic, not chronic.
Adjustment Disorder (C) is time-limited to 6 months after a stressor. Bipolar II (D) requires a hypomanic episode.
Q7: A patient diagnosed with MDD has prominent psychomotor retardation, profound anhedonia, depression worse in
the morning, early morning awakening (3 AM), and significant weight loss. Which MDD specifier best describes this
presentation?
A. With atypical features
B. With melancholic features [CORRECT]
C. With seasonal pattern
D. With catatonia
Correct Answer: B
NR606 Week 2 Examination | Page 2
