NR606 MIDTERM EXAM
Latest Update | Chamberlain University
Diagnosis & Management in
Psychiatric-Mental Health II Practicum
Midterm Examination
NR606 | 100 Questions & Verified Answers | 100% Correct
Chamberlain University | College of Nursing | Advanced Practice Nursing
Curriculum Coverage (Weeks 1-4): This midterm examination covers 14 topic domains spanning
psychiatric diagnosis, psychopharmacology, special populations, and integrated clinical case scenarios.
Each question includes a comprehensive rationale explaining the correct answer and clinical reasoning
behind distractor elimination.
Cognitive Distribution: ~25% Recall | ~50% Application | ~25% Analysis. Question Style: ~70%
Scenario-based | ~20% Direct recall | ~10% Clinical judgment.
# Topic Q's
1 Mood Disorders (MDD, Bipolar Disorders, & Treatment-Resistant Depression) Q1-12
2 Anxiety, Trauma, and Stressor-Related Disorders Q13-20
3 Obsessive-Compulsive and Related Disorders Q21-25
4 Somatic Symptom and Dissociative Disorders Q26-30
5 Psychotic Disorders (Schizophrenia Spectrum, Schizoaffective, Delusional, & Brief Psychotic) Q31-38
6 Personality Disorders (Clusters A, B, C) Q39-45
7 Neurocognitive Disorders (Delirium, Dementia, Alzheimer's, Vascular, Lewy Body, Frontotemporal) Q46-52
8 Substance-Related and Addictive Disorders Q53-60
9 Psychopharmacology (Antidepressants, Mood Stabilizers, Antipsychotics, Anxiolytics, Cognitive Enhancers, & SUD
Q61-72
Medications)
10 Child and Adolescent Psychiatric Disorders Q73-78
11 Geriatric Psychiatry Q79-84
12 Women's Mental Health Q85-90
13 Forensic Psychiatry and Legal Issues Q91-94
14 Integrated Clinical Case Scenarios Q95-100
PMHNP Practicum II | Weeks 1-4 Covered | 100 Verified Questions
,NR606 Midterm Exam | Chamberlain University Diagnosis & Management in Psychiatric-Mental Health II Practicum
SECTION 1: Mood Disorders (MDD, Bipolar Disorders, &
Treatment-Resistant Depression) (Q1-Q12)
Q1. A 34-year-old female presents with depressed mood, anhedonia, weight loss of 12
pounds, insomnia (early morning awakening at 4 AM), psychomotor retardation, and
profound feelings of guilt. Symptoms have persisted daily for 6 weeks. She denies any prior
manic or hypomanic episodes. Which DSM-5-TR specifier best applies to this presentation of
Major Depressive Disorder (MDD)?
Cognitive level: Application
A. Atypical features
B. Melancholic features [CORRECT]
C. Catatonic features
D. Peripartum onset
Correct Answer: B
Rationale: Melancholic features are characterized by profound anhedonia, depression worse in the
morning, early morning awakening, significant weight loss, excessive guilt, and psychomotor changes.
Atypical features (option A) present with mood reactivity, hypersomnia, hyperphagia, leaden paralysis, and
rejection sensitivity. Catatonic features (option C) involve motor immobility or excessive movement.
Peripartum onset (option D) requires symptom onset during pregnancy or within 4 weeks postpartum. The
patient's early morning awakening, weight loss, and profound guilt are classic melancholic markers
indicating a more biologically driven depression with poorer response to placebo and better response to
TCAs/ECT.
Q2. A 28-year-old male reports depressed mood for 2 years, with periods of feeling "okay"
lasting no more than a few weeks at a time. He describes low energy, poor concentration, and
feelings of hopelessness. He continues to work but with diminished productivity. What is the
most accurate diagnosis?
Cognitive level: Application
A. Major Depressive Disorder, recurrent
B. Persistent Depressive Disorder (Dysthymia) [CORRECT]
C. Cyclothymic Disorder
D. Adjustment Disorder with depressed mood
Correct Answer: B
Rationale: Persistent Depressive Disorder (Dysthymia) requires depressed mood for most of the day,
more days than not, for at least 2 years, with no symptom-free periods exceeding 2 months. MDD (option
A) requires discrete episodes meeting full criteria for at least 2 weeks with symptom-free intervals.
Cyclothymic disorder (option C) involves fluctuating hypomanic and depressive symptoms that do not
meet full episode criteria. Adjustment disorder (option D) requires symptom onset within 3 months of a
stressor and resolution within 6 months of stressor termination. The chronic, subthreshold course over 2
years confirms dysthymia.
Weeks 1-4 | 100 Questions | Verified Answers & Rationales Page 2
,NR606 Midterm Exam | Chamberlain University Diagnosis & Management in Psychiatric-Mental Health II Practicum
Q3. A 41-year-old woman reports depressed mood, hypersomnia (sleeping 12 hours daily),
hyperphagia with 15-pound weight gain, feeling as though her arms and legs are "heavy"
(leaden paralysis), and extreme sensitivity to perceived rejection at work. Symptoms have
persisted daily for 8 weeks. Which MDD specifier best describes her presentation?
Cognitive level: Application
A. Melancholic features
B. Atypical features [CORRECT]
C. Catatonic features
D. Seasonal pattern
Correct Answer: B
Rationale: Atypical features are defined by mood reactivity (mood brightens in response to positive
events) plus two or more of: significant weight gain or hyperphagia, hypersomnia, leaden paralysis, and a
long-standing pattern of interpersonal rejection sensitivity. This patient demonstrates hyperphagia,
hypersomnia, leaden paralysis, and rejection sensitivity. Melancholic features (option A) involve
anhedonia, insomnia, and weight loss. Catatonic features (option C) involve motor disturbances. Seasonal
pattern (option D) requires a regular temporal relationship between episodes and time of year. Atypical
depression often responds preferentially to MAOIs and SSRIs.
Q4. A 19-year-old college student presents with 5 days of decreased need for sleep (sleeps 2
hours/night, feels rested), pressured speech, grandiose delusions that she has been chosen
by God to save humanity, racing thoughts, and dangerous impulsivity including spending
$15,000 on a credit card. She has required psychiatric hospitalization. What is the most
accurate diagnosis?
Cognitive level: Application
A. Bipolar II Disorder
B. Bipolar I Disorder, current episode manic [CORRECT]
C. Schizoaffective Disorder, Bipolar type
D. Cyclothymic Disorder
Correct Answer: B
Rationale: Bipolar I Disorder requires at least one manic episode lasting at least 1 week (or requiring
hospitalization), characterized by elevated/irritable mood, increased energy, and at least 3 additional
symptoms (decreased need for sleep, pressured speech, racing thoughts, grandiosity, risky behavior).
Psychosis and hospitalization are compatible with mania. Bipolar II (option A) requires hypomania (no
marked impairment, no psychosis, no hospitalization) plus a major depressive episode. Schizoaffective
disorder (option C) requires delusions/hallucinations for 2+ weeks in the absence of mood symptoms.
Cyclothymic disorder (option D) involves subthreshold symptoms over 2 years without full episodes.
Weeks 1-4 | 100 Questions | Verified Answers & Rationales Page 3
, NR606 Midterm Exam | Chamberlain University Diagnosis & Management in Psychiatric-Mental Health II Practicum
Q5. A 36-year-old female experiences 4 days of elevated mood, increased energy, decreased
need for sleep (5 hours vs. usual 8), and increased goal-directed activity at work. She denies
psychosis, hospitalization, or marked social/occupational impairment. She also has a history
of one major depressive episode lasting 6 weeks 2 years ago. What is the most accurate
diagnosis?
Cognitive level: Application
A. Bipolar I Disorder
B. Bipolar II Disorder [CORRECT]
C. Cyclothymic Disorder
D. Major Depressive Disorder with atypical features
Correct Answer: B
Rationale: Bipolar II Disorder requires at least one hypomanic episode (≥4 days, observable change in
functioning, NO marked impairment, NO psychosis, NO hospitalization) plus at least one major depressive
episode. This patient's 4-day episode meets hypomania criteria, and her prior major depressive episode
fulfills the second requirement. Bipolar I (option A) requires a full manic episode with marked impairment,
psychosis, or hospitalization. Cyclothymic disorder (option C) involves subthreshold symptoms over 2
years. MDD (option D) does not account for hypomanic episodes. Bipolar II is frequently missed, leading
to inappropriate antidepressant monotherapy that can trigger rapid cycling.
Q6. A 52-year-old male with MDD has failed adequate trials (≥6 weeks at therapeutic dose) of
two SSRIs and one SNRI. He continues to experience significant depressive symptoms.
Which of the following is the most appropriate evidence-based augmentation strategy as
first-line per current guidelines?
Cognitive level: Analysis
A. Switch to a second SNRI
B. Add aripiprazole or quetiapine as augmentation [CORRECT]
C. Discontinue all antidepressants and begin ECT immediately
D. Add phenelzine (an MAOI) without washout
Correct Answer: B
Rationale: Treatment-Resistant Depression (TRD) is defined as failure to achieve adequate response to
≥2 adequate antidepressant trials. Evidence-based augmentation strategies include atypical
antipsychotics (aripiprazole, quetiapine, olanzapine, brexpiprazole), lithium, and triiodothyronine (T3).
Atypical antipsychotic augmentation has the strongest evidence base and is FDA-approved (aripiprazole,
quetiapine XR, brexpiprazole, olanzapine-fluoxetine combination). Switching SNRIs within class (option A)
is less effective than augmentation. ECT (option C) is reserved for severe, psychotic, or catatonic
depression or after multiple augmentation failures. Adding an MAOI without washout (option D) risks fatal
serotonin syndrome - a 2-week (5-week for fluoxetine) washout is mandatory.
Weeks 1-4 | 100 Questions | Verified Answers & Rationales Page 4
Latest Update | Chamberlain University
Diagnosis & Management in
Psychiatric-Mental Health II Practicum
Midterm Examination
NR606 | 100 Questions & Verified Answers | 100% Correct
Chamberlain University | College of Nursing | Advanced Practice Nursing
Curriculum Coverage (Weeks 1-4): This midterm examination covers 14 topic domains spanning
psychiatric diagnosis, psychopharmacology, special populations, and integrated clinical case scenarios.
Each question includes a comprehensive rationale explaining the correct answer and clinical reasoning
behind distractor elimination.
Cognitive Distribution: ~25% Recall | ~50% Application | ~25% Analysis. Question Style: ~70%
Scenario-based | ~20% Direct recall | ~10% Clinical judgment.
# Topic Q's
1 Mood Disorders (MDD, Bipolar Disorders, & Treatment-Resistant Depression) Q1-12
2 Anxiety, Trauma, and Stressor-Related Disorders Q13-20
3 Obsessive-Compulsive and Related Disorders Q21-25
4 Somatic Symptom and Dissociative Disorders Q26-30
5 Psychotic Disorders (Schizophrenia Spectrum, Schizoaffective, Delusional, & Brief Psychotic) Q31-38
6 Personality Disorders (Clusters A, B, C) Q39-45
7 Neurocognitive Disorders (Delirium, Dementia, Alzheimer's, Vascular, Lewy Body, Frontotemporal) Q46-52
8 Substance-Related and Addictive Disorders Q53-60
9 Psychopharmacology (Antidepressants, Mood Stabilizers, Antipsychotics, Anxiolytics, Cognitive Enhancers, & SUD
Q61-72
Medications)
10 Child and Adolescent Psychiatric Disorders Q73-78
11 Geriatric Psychiatry Q79-84
12 Women's Mental Health Q85-90
13 Forensic Psychiatry and Legal Issues Q91-94
14 Integrated Clinical Case Scenarios Q95-100
PMHNP Practicum II | Weeks 1-4 Covered | 100 Verified Questions
,NR606 Midterm Exam | Chamberlain University Diagnosis & Management in Psychiatric-Mental Health II Practicum
SECTION 1: Mood Disorders (MDD, Bipolar Disorders, &
Treatment-Resistant Depression) (Q1-Q12)
Q1. A 34-year-old female presents with depressed mood, anhedonia, weight loss of 12
pounds, insomnia (early morning awakening at 4 AM), psychomotor retardation, and
profound feelings of guilt. Symptoms have persisted daily for 6 weeks. She denies any prior
manic or hypomanic episodes. Which DSM-5-TR specifier best applies to this presentation of
Major Depressive Disorder (MDD)?
Cognitive level: Application
A. Atypical features
B. Melancholic features [CORRECT]
C. Catatonic features
D. Peripartum onset
Correct Answer: B
Rationale: Melancholic features are characterized by profound anhedonia, depression worse in the
morning, early morning awakening, significant weight loss, excessive guilt, and psychomotor changes.
Atypical features (option A) present with mood reactivity, hypersomnia, hyperphagia, leaden paralysis, and
rejection sensitivity. Catatonic features (option C) involve motor immobility or excessive movement.
Peripartum onset (option D) requires symptom onset during pregnancy or within 4 weeks postpartum. The
patient's early morning awakening, weight loss, and profound guilt are classic melancholic markers
indicating a more biologically driven depression with poorer response to placebo and better response to
TCAs/ECT.
Q2. A 28-year-old male reports depressed mood for 2 years, with periods of feeling "okay"
lasting no more than a few weeks at a time. He describes low energy, poor concentration, and
feelings of hopelessness. He continues to work but with diminished productivity. What is the
most accurate diagnosis?
Cognitive level: Application
A. Major Depressive Disorder, recurrent
B. Persistent Depressive Disorder (Dysthymia) [CORRECT]
C. Cyclothymic Disorder
D. Adjustment Disorder with depressed mood
Correct Answer: B
Rationale: Persistent Depressive Disorder (Dysthymia) requires depressed mood for most of the day,
more days than not, for at least 2 years, with no symptom-free periods exceeding 2 months. MDD (option
A) requires discrete episodes meeting full criteria for at least 2 weeks with symptom-free intervals.
Cyclothymic disorder (option C) involves fluctuating hypomanic and depressive symptoms that do not
meet full episode criteria. Adjustment disorder (option D) requires symptom onset within 3 months of a
stressor and resolution within 6 months of stressor termination. The chronic, subthreshold course over 2
years confirms dysthymia.
Weeks 1-4 | 100 Questions | Verified Answers & Rationales Page 2
,NR606 Midterm Exam | Chamberlain University Diagnosis & Management in Psychiatric-Mental Health II Practicum
Q3. A 41-year-old woman reports depressed mood, hypersomnia (sleeping 12 hours daily),
hyperphagia with 15-pound weight gain, feeling as though her arms and legs are "heavy"
(leaden paralysis), and extreme sensitivity to perceived rejection at work. Symptoms have
persisted daily for 8 weeks. Which MDD specifier best describes her presentation?
Cognitive level: Application
A. Melancholic features
B. Atypical features [CORRECT]
C. Catatonic features
D. Seasonal pattern
Correct Answer: B
Rationale: Atypical features are defined by mood reactivity (mood brightens in response to positive
events) plus two or more of: significant weight gain or hyperphagia, hypersomnia, leaden paralysis, and a
long-standing pattern of interpersonal rejection sensitivity. This patient demonstrates hyperphagia,
hypersomnia, leaden paralysis, and rejection sensitivity. Melancholic features (option A) involve
anhedonia, insomnia, and weight loss. Catatonic features (option C) involve motor disturbances. Seasonal
pattern (option D) requires a regular temporal relationship between episodes and time of year. Atypical
depression often responds preferentially to MAOIs and SSRIs.
Q4. A 19-year-old college student presents with 5 days of decreased need for sleep (sleeps 2
hours/night, feels rested), pressured speech, grandiose delusions that she has been chosen
by God to save humanity, racing thoughts, and dangerous impulsivity including spending
$15,000 on a credit card. She has required psychiatric hospitalization. What is the most
accurate diagnosis?
Cognitive level: Application
A. Bipolar II Disorder
B. Bipolar I Disorder, current episode manic [CORRECT]
C. Schizoaffective Disorder, Bipolar type
D. Cyclothymic Disorder
Correct Answer: B
Rationale: Bipolar I Disorder requires at least one manic episode lasting at least 1 week (or requiring
hospitalization), characterized by elevated/irritable mood, increased energy, and at least 3 additional
symptoms (decreased need for sleep, pressured speech, racing thoughts, grandiosity, risky behavior).
Psychosis and hospitalization are compatible with mania. Bipolar II (option A) requires hypomania (no
marked impairment, no psychosis, no hospitalization) plus a major depressive episode. Schizoaffective
disorder (option C) requires delusions/hallucinations for 2+ weeks in the absence of mood symptoms.
Cyclothymic disorder (option D) involves subthreshold symptoms over 2 years without full episodes.
Weeks 1-4 | 100 Questions | Verified Answers & Rationales Page 3
, NR606 Midterm Exam | Chamberlain University Diagnosis & Management in Psychiatric-Mental Health II Practicum
Q5. A 36-year-old female experiences 4 days of elevated mood, increased energy, decreased
need for sleep (5 hours vs. usual 8), and increased goal-directed activity at work. She denies
psychosis, hospitalization, or marked social/occupational impairment. She also has a history
of one major depressive episode lasting 6 weeks 2 years ago. What is the most accurate
diagnosis?
Cognitive level: Application
A. Bipolar I Disorder
B. Bipolar II Disorder [CORRECT]
C. Cyclothymic Disorder
D. Major Depressive Disorder with atypical features
Correct Answer: B
Rationale: Bipolar II Disorder requires at least one hypomanic episode (≥4 days, observable change in
functioning, NO marked impairment, NO psychosis, NO hospitalization) plus at least one major depressive
episode. This patient's 4-day episode meets hypomania criteria, and her prior major depressive episode
fulfills the second requirement. Bipolar I (option A) requires a full manic episode with marked impairment,
psychosis, or hospitalization. Cyclothymic disorder (option C) involves subthreshold symptoms over 2
years. MDD (option D) does not account for hypomanic episodes. Bipolar II is frequently missed, leading
to inappropriate antidepressant monotherapy that can trigger rapid cycling.
Q6. A 52-year-old male with MDD has failed adequate trials (≥6 weeks at therapeutic dose) of
two SSRIs and one SNRI. He continues to experience significant depressive symptoms.
Which of the following is the most appropriate evidence-based augmentation strategy as
first-line per current guidelines?
Cognitive level: Analysis
A. Switch to a second SNRI
B. Add aripiprazole or quetiapine as augmentation [CORRECT]
C. Discontinue all antidepressants and begin ECT immediately
D. Add phenelzine (an MAOI) without washout
Correct Answer: B
Rationale: Treatment-Resistant Depression (TRD) is defined as failure to achieve adequate response to
≥2 adequate antidepressant trials. Evidence-based augmentation strategies include atypical
antipsychotics (aripiprazole, quetiapine, olanzapine, brexpiprazole), lithium, and triiodothyronine (T3).
Atypical antipsychotic augmentation has the strongest evidence base and is FDA-approved (aripiprazole,
quetiapine XR, brexpiprazole, olanzapine-fluoxetine combination). Switching SNRIs within class (option A)
is less effective than augmentation. ECT (option C) is reserved for severe, psychotic, or catatonic
depression or after multiple augmentation failures. Adding an MAOI without washout (option D) risks fatal
serotonin syndrome - a 2-week (5-week for fluoxetine) washout is mandatory.
Weeks 1-4 | 100 Questions | Verified Answers & Rationales Page 4
