NRNP 6645 – ADVANCED PSYCHOPATHOLOGY | 2025/2026 | MIDTERM STUDY SET (100 PRACTICE QUESTIONS WITH ANSWERS & RATIONALES)

NRNP 6645 – ADVANCED PSYCHOPATHOLOGY | 2025/2026 | MIDTERM STUDY SET (100 PRACTICE QUESTIONS WITH ANSWERS & RATIONALES) 1. A 28-year-old presents with 3 weeks of depressed mood, insomnia, 10-lb weight loss, and passive suicidal ideation without plan. Which is the most appropriate immediate next step? a. Schedule outpatient psychotherapy in 2 weeks b. Begin SSRI and discharge with safety planning c. Conduct suicide risk assessment and consider urgent safety measures (hospitalize if imminent risk) d. Start benzodiazepine and follow up monthly Answer: c Rationale: Any suicidal ideation mandates immediate risk assessment and safety planning; hospitalization if imminent. 2. A patient with bipolar disorder presents with elevated mood, pressured speech, decreased need for sleep, and risky behavior for 6 days with marked impairment. Diagnosis? a. Hypomanic episode b. Manic episode c. Cyclothymic disorder d. Major depressive episode Answer: b Rationale: Mania causes marked impairment; duration ≥1 week (or any duration if hospitalization/psychosis). 3. A 45-year-old on lithium presents with nausea, coarse tremor, confusion, and a serum lithium of 2.0 mEq/L. Best immediate action? a. Increase dose of lithium b. Start haloperidol c. Stop lithium and arrange urgent medical evaluation for toxicity (IV fluids/possible dialysis) d. Switch to valproate without stopping lithium Answer: c Rationale: Lithium 1.5-2.0 with signs of toxicity requires stopping and urgent medical management; dialysis if severe. 4. A patient with major depressive disorder has persistent anhedonia despite adequate SSRI trial. Which augmentation has strongest evidence? 1 | P a g e a. Add low-dose benzodiazepine b. Add atypical antipsychotic (e.g., aripiprazole) or switch to another class; consider psychotherapy/ECT if refractory c. Add opioid analgesic d. Increase SSRI indefinitely without reassessment Answer: b Rationale: Atypical antipsychotics can augment antidepressants; ECT for resistant/severe cases. 5. A 34-year-old reports recurrent unexpected panic attacks with persistent concern for more attacks and maladaptive avoidance for 8 months. Best diagnosis? a. Specific phobia b. Panic disorder with agoraphobia c. Social anxiety disorder d. Generalized anxiety disorder Answer: b Rationale: Recurrent unexpected panic attacks plus persistent worry and avoidance = panic disorder; agoraphobia if avoidance of situations. 6. A patient with schizophrenia stabilized on haloperidol develops resting tremor, rigidity, and bradykinesia. Management? a. Continue haloperidol and add SSRI b. Reduce dose/switch to atypical antipsychotic and consider anticholinergic (benztropine) for EPS c. Increase haloperidol dose d. Add lithium Answer: b Rationale: Parkinsonism from antipsychotics treated by lowering dose/switching and using anticholinergic temporarily. 7. A 50-year-old with long history of schizophrenia now has involuntary oral-facial movements. Which is most likely? a. Akathisia b. Acute dystonia c. Tardive dyskinesia d. Serotonin syndrome Answer: c Rationale: Late-onset repetitive involuntary movements indicate tardive dyskinesia from chronic dopamine blockade. 8. A patient on clozapine presents with fever, sore throat, and absolute neutrophil count of 400/mm3. Best step? 2 | P a g e a. Continue clozapine and observe b. Stop clozapine immediately and arrange urgent hematology evaluation c. Increase clozapine dose d. Add fluvoxamine Answer: b Rationale: Clozapine can cause agranulocytosis; immediate discontinuation and workup required. 9. A 22-year-old with social anxiety fears public speaking only and has marked anxiety only in performance situations. Best immediate pharmacologic option for a single presentation? a. Long-term SSRI only b. Beta-blocker (propranolol) or short-acting benzodiazepine before performance c. Antipsychotic on the day d. Start lithium Answer: b Rationale: Beta-blocker or short-acting benzo useful for situational performance anxiety; SSRIs for generalized social anxiety. 10. A patient has PTSD symptoms for 6 weeks after assault. Diagnosis? a. Acute stress disorder b. PTSD c. Adjustment disorder d. Normal reaction Answer: a Rationale: Symptoms 1 month after trauma = acute stress disorder; PTSD requires ≥1 month. 11. A patient with bipolar disorder and renal disease cannot take lithium. Best alternative mood stabilizer for acute mania? a. Valproate (careful with hepatic disease) or atypical antipsychotics; valproate preferred if renal contraindicated b. Start lithium regardless c. Use SSRI monotherapy d. Benzodiazepines only Answer: a Rationale: Valproate is effective for mania and does not require renal clearance like lithium. 12. A patient stabilized on sertraline complains of sexual dysfunction. Best clinical change? a. Switch to bupropion or augment with bupropion b. Increase sertraline dose