NR548 / NR 548 Exam 4 (Week 7 - 8) Tested Qs with Ans
(Latest ): Psychiatric Assessment for PMHNP
- Chamberlain
Questions 1-20: Comprehensive Assessment & Differential Diagnosis
1. Scenario: A 24-year-old graduate student presents with complaints of
decreased sleep, poor concentration, and anhedonia for 3 weeks following a
romantic breakup. She denies suicidal ideation but reports occasional passive
thoughts like "life isn't worth living." Mental status exam shows constricted
affect, psychomotor retardation, and a depressed mood. She has no prior
psychiatric history.
Question: What is the MOST appropriate initial action?
A. Prescribe escitalopram 10 mg daily and schedule follow-up in 4 weeks
B. Start cognitive behavioral therapy and schedule weekly sessions
C. Conduct a comprehensive suicide risk assessment including access to means
D. Diagnose major depressive disorder and begin combination therapy
,Correct Answer: C
Explanation: Even with passive thoughts, any suicidal ideation requires
comprehensive risk assessment. While she meets criteria for MDD (≥2 weeks of
symptoms including depressed mood and anhedonia), safety assessment
precedes treatment planning. Option A starts medication without adequate
assessment; B delays needed assessment; D diagnoses without ruling out
adjustment disorder or other conditions.
2. Scenario: A 35-year-old man with schizophrenia, stable on risperidone 3 mg
BID for 2 years, presents with progressive cognitive decline over 6 months. His
wife reports he's become increasingly apathetic, has word-finding difficulties,
and gets lost in familiar places. Physical exam is normal. MMSE score is 22/30.
Question: What is the MOST important next step in assessment?
A. Increase risperidone dose to address negative symptoms
B. Order MRI brain with contrast and neuropsychological testing
C. Switch to clozapine for treatment-resistant symptoms
D. Assess for depression using PHQ-9
Correct Answer: B
Explanation: New cognitive deficits in schizophrenia require ruling out organic
causes. Progressive decline over months with focal findings (word-finding,
disorientation) suggests possible neurodegenerative process, stroke, or tumor.
MRI and neuropsych testing are indicated before assuming psychiatric etiology.
Option A would worsen cognitive side effects; C is premature; D doesn't address
the cognitive pattern.
3. Scenario: A 19-year-old college student presents with 3 months of fluctuating
mood, irritability, and "spacy" episodes where she feels disconnected. She
reports occasional auditory hallucinations (whispering her name) when
stressed. Collateral from roommate reveals periods of high energy with
decreased sleep and impulsive spending. No substance use. Family history of
bipolar disorder.
Question: Which diagnostic consideration is MOST urgent?
A. Schizoaffective disorder
B. Borderline personality disorder
C. Bipolar I disorder with psychotic features
,D. Substance-induced psychotic disorder
Correct Answer: C
Explanation: The presentation with mood fluctuations, psychotic symptoms,
family history, and characteristic symptoms (decreased sleep, impulsivity)
strongly suggests bipolar disorder. Psychotic symptoms in mood disorders are
typically mood-congruent and intermittent. Urgent assessment is needed due to
risk of manic escalation. Option A requires longer duration; B doesn't explain
psychotic symptoms; D is ruled out by history.
4. Scenario: A 42-year-old woman presents with anxiety, insomnia, and
hypervigilance 2 months after a car accident. She avoids driving, experiences
intrusive memories of the accident, and startles easily. She denies mood
symptoms but reports feeling "emotionally numb." PHQ-9 score: 5; GAD-7
score: 16.
Question: Which assessment tool is MOST specific for her likely condition?
A. Beck Depression Inventory (BDI)
B. PTSD Checklist for DSM-5 (PCL-5)
C. Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
D. Mood Disorder Questionnaire (MDQ)
Correct Answer: B
Explanation: The presentation with avoidance, intrusion, hyperarousal, and
emotional numbing after trauma suggests PTSD. PCL-5 is specific for PTSD
symptoms. Option A assesses depression; C assesses OCD; D screens for bipolar
disorder.
5. Scenario: A 58-year-old man with treatment-resistant depression presents
with new onset of parkinsonism (resting tremor, bradykinesia, masked facies).
He has been on fluoxetine 40 mg daily for 5 years and recently started
amitriptyline 75 mg at night for insomnia.
Question: What is the MOST likely explanation?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Medication-induced parkinsonism
D. Idiopathic Parkinson's disease
Correct Answer: C
, Explanation: Amitriptyline has significant anticholinergic properties that can
unmask or exacerbate parkinsonism. SSRIs like fluoxetine can also rarely cause
extrapyramidal symptoms. Medication-induced should be ruled out before
diagnosing Parkinson's. Option A presents with agitation, hyperthermia,
autonomic instability; B is associated with antipsychotics; D is possible but less
likely given temporal relationship to new medication.
6. Scenario: During assessment of a 30-year-old with suspected bipolar disorder,
the patient's spouse reports periods of elevated mood, decreased need for
sleep, and hypersexuality lasting 4-5 days. The patient acknowledges these
episodes but states they are "my productive times" and not problematic.
Question: According to DSM-5 criteria, what additional information is MOST
critical for diagnosis?
A. Presence of psychotic features during episodes
B. Whether episodes cause significant impairment
C. Family history of mood disorders
D. Response to previous mood stabilizers
Correct Answer: B
Explanation: For hypomanic episode (bipolar II), symptoms must cause
unequivocal change in functioning observable by others, but not cause marked
impairment. For manic episode (bipolar I), must cause marked impairment or
require hospitalization. Patient's lack of distress doesn't preclude diagnosis if
functioning is clearly altered. Options A, C, D are relevant but not diagnostic
requirements.
7. Scenario: A 25-year-old woman presents with 6-month history of social
anxiety preventing work attendance. She reports panic attacks in meetings,
avoidance of social situations, and anticipatory anxiety. She drinks 4-5 glasses of
wine nightly to "calm my nerves." AUDIT score: 14.
Question: What is the MOST appropriate initial assessment approach?
A. Begin exposure therapy for social anxiety disorder
B. Start SSRI and refer to alcohol treatment program
C. Conduct detailed assessment of alcohol use and its relationship to anxiety
D. Diagnose alcohol use disorder and prioritize abstinence
Correct Answer: C
(Latest ): Psychiatric Assessment for PMHNP
- Chamberlain
Questions 1-20: Comprehensive Assessment & Differential Diagnosis
1. Scenario: A 24-year-old graduate student presents with complaints of
decreased sleep, poor concentration, and anhedonia for 3 weeks following a
romantic breakup. She denies suicidal ideation but reports occasional passive
thoughts like "life isn't worth living." Mental status exam shows constricted
affect, psychomotor retardation, and a depressed mood. She has no prior
psychiatric history.
Question: What is the MOST appropriate initial action?
A. Prescribe escitalopram 10 mg daily and schedule follow-up in 4 weeks
B. Start cognitive behavioral therapy and schedule weekly sessions
C. Conduct a comprehensive suicide risk assessment including access to means
D. Diagnose major depressive disorder and begin combination therapy
,Correct Answer: C
Explanation: Even with passive thoughts, any suicidal ideation requires
comprehensive risk assessment. While she meets criteria for MDD (≥2 weeks of
symptoms including depressed mood and anhedonia), safety assessment
precedes treatment planning. Option A starts medication without adequate
assessment; B delays needed assessment; D diagnoses without ruling out
adjustment disorder or other conditions.
2. Scenario: A 35-year-old man with schizophrenia, stable on risperidone 3 mg
BID for 2 years, presents with progressive cognitive decline over 6 months. His
wife reports he's become increasingly apathetic, has word-finding difficulties,
and gets lost in familiar places. Physical exam is normal. MMSE score is 22/30.
Question: What is the MOST important next step in assessment?
A. Increase risperidone dose to address negative symptoms
B. Order MRI brain with contrast and neuropsychological testing
C. Switch to clozapine for treatment-resistant symptoms
D. Assess for depression using PHQ-9
Correct Answer: B
Explanation: New cognitive deficits in schizophrenia require ruling out organic
causes. Progressive decline over months with focal findings (word-finding,
disorientation) suggests possible neurodegenerative process, stroke, or tumor.
MRI and neuropsych testing are indicated before assuming psychiatric etiology.
Option A would worsen cognitive side effects; C is premature; D doesn't address
the cognitive pattern.
3. Scenario: A 19-year-old college student presents with 3 months of fluctuating
mood, irritability, and "spacy" episodes where she feels disconnected. She
reports occasional auditory hallucinations (whispering her name) when
stressed. Collateral from roommate reveals periods of high energy with
decreased sleep and impulsive spending. No substance use. Family history of
bipolar disorder.
Question: Which diagnostic consideration is MOST urgent?
A. Schizoaffective disorder
B. Borderline personality disorder
C. Bipolar I disorder with psychotic features
,D. Substance-induced psychotic disorder
Correct Answer: C
Explanation: The presentation with mood fluctuations, psychotic symptoms,
family history, and characteristic symptoms (decreased sleep, impulsivity)
strongly suggests bipolar disorder. Psychotic symptoms in mood disorders are
typically mood-congruent and intermittent. Urgent assessment is needed due to
risk of manic escalation. Option A requires longer duration; B doesn't explain
psychotic symptoms; D is ruled out by history.
4. Scenario: A 42-year-old woman presents with anxiety, insomnia, and
hypervigilance 2 months after a car accident. She avoids driving, experiences
intrusive memories of the accident, and startles easily. She denies mood
symptoms but reports feeling "emotionally numb." PHQ-9 score: 5; GAD-7
score: 16.
Question: Which assessment tool is MOST specific for her likely condition?
A. Beck Depression Inventory (BDI)
B. PTSD Checklist for DSM-5 (PCL-5)
C. Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
D. Mood Disorder Questionnaire (MDQ)
Correct Answer: B
Explanation: The presentation with avoidance, intrusion, hyperarousal, and
emotional numbing after trauma suggests PTSD. PCL-5 is specific for PTSD
symptoms. Option A assesses depression; C assesses OCD; D screens for bipolar
disorder.
5. Scenario: A 58-year-old man with treatment-resistant depression presents
with new onset of parkinsonism (resting tremor, bradykinesia, masked facies).
He has been on fluoxetine 40 mg daily for 5 years and recently started
amitriptyline 75 mg at night for insomnia.
Question: What is the MOST likely explanation?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Medication-induced parkinsonism
D. Idiopathic Parkinson's disease
Correct Answer: C
, Explanation: Amitriptyline has significant anticholinergic properties that can
unmask or exacerbate parkinsonism. SSRIs like fluoxetine can also rarely cause
extrapyramidal symptoms. Medication-induced should be ruled out before
diagnosing Parkinson's. Option A presents with agitation, hyperthermia,
autonomic instability; B is associated with antipsychotics; D is possible but less
likely given temporal relationship to new medication.
6. Scenario: During assessment of a 30-year-old with suspected bipolar disorder,
the patient's spouse reports periods of elevated mood, decreased need for
sleep, and hypersexuality lasting 4-5 days. The patient acknowledges these
episodes but states they are "my productive times" and not problematic.
Question: According to DSM-5 criteria, what additional information is MOST
critical for diagnosis?
A. Presence of psychotic features during episodes
B. Whether episodes cause significant impairment
C. Family history of mood disorders
D. Response to previous mood stabilizers
Correct Answer: B
Explanation: For hypomanic episode (bipolar II), symptoms must cause
unequivocal change in functioning observable by others, but not cause marked
impairment. For manic episode (bipolar I), must cause marked impairment or
require hospitalization. Patient's lack of distress doesn't preclude diagnosis if
functioning is clearly altered. Options A, C, D are relevant but not diagnostic
requirements.
7. Scenario: A 25-year-old woman presents with 6-month history of social
anxiety preventing work attendance. She reports panic attacks in meetings,
avoidance of social situations, and anticipatory anxiety. She drinks 4-5 glasses of
wine nightly to "calm my nerves." AUDIT score: 14.
Question: What is the MOST appropriate initial assessment approach?
A. Begin exposure therapy for social anxiety disorder
B. Start SSRI and refer to alcohol treatment program
C. Conduct detailed assessment of alcohol use and its relationship to anxiety
D. Diagnose alcohol use disorder and prioritize abstinence
Correct Answer: C
