NURSING 527 CERTIFICATION PAPER 2026
FULL SOLUTION GRADED A+
● Borderline personality disorder is not considered a differential
diagnosis for conduct disorder, as indicated by the patient's truancy,
defiance of authority figures, fights with family members, poor
academic performance, sexual promiscuity, running away from home,
and "tough guy" demeanor. Oppositional defiant disorder, bipolar
disorders, and adjustment disorders are all considered potential
differential diagnoses for conduct disorder, as are depressive disorders,
attention-deficit/hyperactivity disorder, and intermittent explosive
disorder. Answer: Tony, a 16-year-old male, has been sent to your clinic
for counseling. He has a long record of skipping school, talking back to
his teachers, and getting poor grades. His parents say he has often gotten
in fights with them, has frequently been caught sneaking girls into his
room, and has run away from home on two occasions. During the
session, you notice Tony acts tough and aloof, not deigning to speak
much. If you suspect conduct disorder, which of the following
conditions would you be least likely to include in your differential
diagnosis?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder
,● Depressive symptoms are associated with decreased, not increased,
levels of somatostatin in cerebrospinal fluid. Patients with depression
may exhibit a decreased thyroid-stimulating hormone response to
thyrotropin-releasing hormone, as well as hypersecretion of cortisol.
Depressive symptoms are also associated with irregularities in growth
hormone release, such as reduced nocturnal secretion and diurnal
hypersecretion. Answer: Which of these lab findings would be least
expected in a patient with depression?
1. Decreased nocturnal growth hormone secretion
2. Decreased thyroid-stimulating hormone response
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol
● Although ambivalence regarding suicidal intent should be taken into
account when considering level of observation in a patient, it indicates a
moderate risk, not a severe risk. Close observation should be employed
with patients who profess suicidal thoughts, are unable to commit to a
"No Harm" contract, or experience withdrawal. Answer: Jeremy, a
suicidal inpatient, is under close observation. He is able to be observed
at all times by hospital staff during waking hours and when he sleeps,
and is checked on every 15-30 minutes. Which of these reasons would
least indicate the need for this level of supervision?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract.
,● The patient's recent involvement in risky pleasurable activity (e.g.,
unprotected sex), increase in goal-driven activity at work, decreased
need for sleep, and subjective experience of racing thoughts all suggest a
manic episode; as such, bupropion, an antidepressant, would not be
considered because the patient has not displayed the diagnostic criteria
for a major depressive episode. Pharmacologic options for the treatment
of manic episodes include anticonvulsants (carbamazepine),
antipsychotics (haloperidol), and benzodiazepines (lorazepam). Answer:
Adam, a 23-year-old male, is undergoing an STD test at your clinic.
When you ask him why he is here, he says, "I'm here because I've had
this increased craving for sex. I've been picking up strangers in bars, not
caring about using protection ... I don't know what it is. For the last
week, I've just felt really driven. Keep throwing myself into my work,
don't feel much need for sleep, feel like my thoughts are running a
marathon in my head." The patient lives a "clean life," clarifying that he
does not abuse any substance, "not even coffee or cigarettes." He also
does not have a history of mental disorders. Given the most likely
diagnosis, which of these medications would you least likely
recommend for Adam?
Lorazepam
Haloperidol
Carbamazepine
Bupropion
● Lorazepam would not be the first choice to treat delirium in a
dehydrated patient because benzodiazepines may cause respiratory
, depression, especially in debilitated patients. Antipsychotics such as
haloperidol, quetiapine, and risperidone are considered the mainstay in
managing agitation in delirium patients; haloperidol is considered the
standard of care, but newer agents such as quetiapine and risperidone
may be preferred due to reduced chance of side effects. Answer: You
have determined that a patient's delirium stems from dehydration. As
you begin treatment, you realize the patient will require pharmacologic
management for his agitation. Which of these agents would be least
appropriate in this situation?
Risperidone
Haloperidol
Quetiapine
Lorazepam
● Most inpatients who develop a suicide plan and follow it have agreed
to a "No Harm" contract. The most common method of suicide among
inpatients is hanging, not self-inflicted wounds. When "unsolvable"
problems at work, school, or home motivate the ideation, inpatients are
most likely to attempt suicide either within the first 5 days at the hospital
or shortly after discharge, not after a month. The rate of suicide among
bipolar patients is relatively low, about 10%-15%, and risk would be
higher in patients with schizophrenia or an untreated anxiety disorder.
Answer: Which of the following is true about suicide among inpatients?
Most patients who develop a suicide plan and follow it have agreed to a
"No Harm" contract.
Self-inflicted wounds are the most common means of suicide.
Inpatients with bipolar disorder are most likely to commit suicide.
FULL SOLUTION GRADED A+
● Borderline personality disorder is not considered a differential
diagnosis for conduct disorder, as indicated by the patient's truancy,
defiance of authority figures, fights with family members, poor
academic performance, sexual promiscuity, running away from home,
and "tough guy" demeanor. Oppositional defiant disorder, bipolar
disorders, and adjustment disorders are all considered potential
differential diagnoses for conduct disorder, as are depressive disorders,
attention-deficit/hyperactivity disorder, and intermittent explosive
disorder. Answer: Tony, a 16-year-old male, has been sent to your clinic
for counseling. He has a long record of skipping school, talking back to
his teachers, and getting poor grades. His parents say he has often gotten
in fights with them, has frequently been caught sneaking girls into his
room, and has run away from home on two occasions. During the
session, you notice Tony acts tough and aloof, not deigning to speak
much. If you suspect conduct disorder, which of the following
conditions would you be least likely to include in your differential
diagnosis?
1. Borderline personality disorder
2. Oppositional defiant disorder
3. Adjustment disorder with disturbance of conduct
4. Bipolar disorder
,● Depressive symptoms are associated with decreased, not increased,
levels of somatostatin in cerebrospinal fluid. Patients with depression
may exhibit a decreased thyroid-stimulating hormone response to
thyrotropin-releasing hormone, as well as hypersecretion of cortisol.
Depressive symptoms are also associated with irregularities in growth
hormone release, such as reduced nocturnal secretion and diurnal
hypersecretion. Answer: Which of these lab findings would be least
expected in a patient with depression?
1. Decreased nocturnal growth hormone secretion
2. Decreased thyroid-stimulating hormone response
3. Increased somatostatin in cerebrospinal fluid
4. Increased secretion of cortisol
● Although ambivalence regarding suicidal intent should be taken into
account when considering level of observation in a patient, it indicates a
moderate risk, not a severe risk. Close observation should be employed
with patients who profess suicidal thoughts, are unable to commit to a
"No Harm" contract, or experience withdrawal. Answer: Jeremy, a
suicidal inpatient, is under close observation. He is able to be observed
at all times by hospital staff during waking hours and when he sleeps,
and is checked on every 15-30 minutes. Which of these reasons would
least indicate the need for this level of supervision?
1. Jeremy has expressed suicidal thoughts.
2. Jeremy experiences withdrawal from alcohol and cocaine.
3. Jeremy is ambivalent about his intent to commit suicide.
4. Jeremy was unable to commit to a "No Harm" contract.
,● The patient's recent involvement in risky pleasurable activity (e.g.,
unprotected sex), increase in goal-driven activity at work, decreased
need for sleep, and subjective experience of racing thoughts all suggest a
manic episode; as such, bupropion, an antidepressant, would not be
considered because the patient has not displayed the diagnostic criteria
for a major depressive episode. Pharmacologic options for the treatment
of manic episodes include anticonvulsants (carbamazepine),
antipsychotics (haloperidol), and benzodiazepines (lorazepam). Answer:
Adam, a 23-year-old male, is undergoing an STD test at your clinic.
When you ask him why he is here, he says, "I'm here because I've had
this increased craving for sex. I've been picking up strangers in bars, not
caring about using protection ... I don't know what it is. For the last
week, I've just felt really driven. Keep throwing myself into my work,
don't feel much need for sleep, feel like my thoughts are running a
marathon in my head." The patient lives a "clean life," clarifying that he
does not abuse any substance, "not even coffee or cigarettes." He also
does not have a history of mental disorders. Given the most likely
diagnosis, which of these medications would you least likely
recommend for Adam?
Lorazepam
Haloperidol
Carbamazepine
Bupropion
● Lorazepam would not be the first choice to treat delirium in a
dehydrated patient because benzodiazepines may cause respiratory
, depression, especially in debilitated patients. Antipsychotics such as
haloperidol, quetiapine, and risperidone are considered the mainstay in
managing agitation in delirium patients; haloperidol is considered the
standard of care, but newer agents such as quetiapine and risperidone
may be preferred due to reduced chance of side effects. Answer: You
have determined that a patient's delirium stems from dehydration. As
you begin treatment, you realize the patient will require pharmacologic
management for his agitation. Which of these agents would be least
appropriate in this situation?
Risperidone
Haloperidol
Quetiapine
Lorazepam
● Most inpatients who develop a suicide plan and follow it have agreed
to a "No Harm" contract. The most common method of suicide among
inpatients is hanging, not self-inflicted wounds. When "unsolvable"
problems at work, school, or home motivate the ideation, inpatients are
most likely to attempt suicide either within the first 5 days at the hospital
or shortly after discharge, not after a month. The rate of suicide among
bipolar patients is relatively low, about 10%-15%, and risk would be
higher in patients with schizophrenia or an untreated anxiety disorder.
Answer: Which of the following is true about suicide among inpatients?
Most patients who develop a suicide plan and follow it have agreed to a
"No Harm" contract.
Self-inflicted wounds are the most common means of suicide.
Inpatients with bipolar disorder are most likely to commit suicide.
