WGU D345 Comprehensive Quiz Bank with
Dr Cole | Questions and Answers | 2026
Updated | 100% Correct - OA Remediation .
SECTION 1: Mood Disorders & Depressive Disorders (Questions 1-12)
Q1: A 42-year-old female presents with depressed mood, anhedonia, insomnia,
fatigue, poor concentration, feelings of worthlessness, and a 12-pound weight loss
over 3 weeks. She denies manic/hypomanic history. Which diagnosis is most
appropriate?
A. Persistent Depressive Disorder
B. Major Depressive Disorder, single episode, severe
C. Bipolar II Disorder
D. Adjustment Disorder with Depressed Mood
Correct Answer: B
Rationale: Correct because the patient meets ≥5 of 9 DSM-5-TR symptoms for MDD
present during the same 2-week period with depressed mood and anhedonia,
representing a change from previous functioning with clinically significant distress.
Per DSM-5-TR diagnostic criteria, the symptom count and severity support MDD,
single episode, severe without psychotic features.
Q2: A 28-year-old male with MDD reports early morning awakening, anhedonia, non-
reactivity to pleasurable stimuli, psychomotor retardation, significant weight loss,
and excessive guilt. Which specifier best applies?
A. With atypical features
B. With mixed features
C. With melancholic features
D. With peripartum onset
Correct Answer: C
Rationale: Correct because melancholic features require anhedonia, non-reactivity to
usually pleasurable stimuli, and at least three of the following: distinct quality of
depressed mood, depression worse in the morning, early morning awakening,
,psychomotor retardation, significant weight loss, or excessive guilt. Standard PMHNP
practice requires recognizing melancholic features as they predict better response to
biological treatments like antidepressants and ECT.
Q3: A 35-year-old female with MDD reports mood reactivity, leaden paralysis,
interpersonal rejection sensitivity, hypersomnia, and weight gain. Which treatment is
most appropriate first-line?
A. Phenelzine (MAOI)
B. Fluoxetine (SSRI)
C. Bupropion
D. Mirtazapine
Correct Answer: A
Rationale: Correct because the atypical features specifier (mood reactivity, leaden
paralysis, interpersonal rejection sensitivity, increased
appetite/hypersomnia/weight gain) is associated with a preferential response to
MAOIs per historical and clinical evidence, though SSRIs remain commonly used
first-line in practice. APA guidelines indicate MAOIs may be considered when atypical
features are prominent and SSRIs are ineffective.
Q4: A patient with MDD is started on escitalopram 10mg daily. After 4 weeks, partial
response is noted. The PMHNP considers augmentation. Which agent is FDA-
approved for adjunctive treatment of MDD?
A. Lithium carbonate
B. Aripiprazole
C. T3 (liothyronine)
D. Lamotrigine
Correct Answer: B
Rationale: Correct because aripiprazole is FDA-approved as an adjunctive treatment
for MDD when there is inadequate response to antidepressant monotherapy.
Standard PMHNP practice requires knowing FDA-approved augmentation strategies,
with aripiprazole, brexpiprazole, and quetiapine XR being the antipsychotics with
this specific indication.
Q5: A 30-year-old female presents 2 weeks postpartum with depressed mood,
anhedonia, insomnia despite exhaustion, excessive guilt about parenting, and
, recurrent thoughts that her baby would be better off without her. She has no
psychotic symptoms. Which is the most appropriate diagnosis?
A. Postpartum blues
B. Major Depressive Disorder with peripartum onset
C. Brief Psychotic Disorder
D. Bipolar I Disorder
Correct Answer: B
Rationale: Correct because the onset during the postpartum period (within 4 weeks
postpartum) with full MDD criteria including depressed mood, anhedonia, and
significant distress meets criteria for MDD with peripartum onset specifier. Per DSM-
5-TR diagnostic criteria, postpartum blues last <2 weeks and do not meet full MDD
criteria, while this patient has symptom duration and severity consistent with MDD.
Q6: A patient with severe, psychotic MDD has failed two adequate trials of
antidepressants. The patient is catatonic and refuses oral intake. Which intervention
is most appropriate?
A. Add an atypical antipsychotic to current antidepressant
B. Initiate electroconvulsive therapy (ECT)
C. Switch to a different SSRI
D. Begin transcranial magnetic stimulation (TMS)
Correct Answer: B
Rationale: Correct because ECT is indicated for severe MDD with psychotic features,
catatonia, and medication resistance. Standard PMHNP practice requires recognizing
ECT as the treatment of choice for severe, life-threatening depression with psychotic
features or catatonia, particularly when rapid response is needed and oral
medication adherence is compromised.
Q7: A 22-year-old college student presents after a breakup with depressed mood,
anhedonia, insomnia, fatigue, poor concentration, feelings of worthlessness, and
passive suicidal ideation without plan or intent. On the PHQ-9, the patient scores
"nearly every day" on item 9. What is the most appropriate next step?
A. Initiate SSRI monotherapy and schedule follow-up in 4 weeks
B. Conduct a comprehensive suicide risk assessment including ideation, intent, plan,
means, and protective factors
Dr Cole | Questions and Answers | 2026
Updated | 100% Correct - OA Remediation .
SECTION 1: Mood Disorders & Depressive Disorders (Questions 1-12)
Q1: A 42-year-old female presents with depressed mood, anhedonia, insomnia,
fatigue, poor concentration, feelings of worthlessness, and a 12-pound weight loss
over 3 weeks. She denies manic/hypomanic history. Which diagnosis is most
appropriate?
A. Persistent Depressive Disorder
B. Major Depressive Disorder, single episode, severe
C. Bipolar II Disorder
D. Adjustment Disorder with Depressed Mood
Correct Answer: B
Rationale: Correct because the patient meets ≥5 of 9 DSM-5-TR symptoms for MDD
present during the same 2-week period with depressed mood and anhedonia,
representing a change from previous functioning with clinically significant distress.
Per DSM-5-TR diagnostic criteria, the symptom count and severity support MDD,
single episode, severe without psychotic features.
Q2: A 28-year-old male with MDD reports early morning awakening, anhedonia, non-
reactivity to pleasurable stimuli, psychomotor retardation, significant weight loss,
and excessive guilt. Which specifier best applies?
A. With atypical features
B. With mixed features
C. With melancholic features
D. With peripartum onset
Correct Answer: C
Rationale: Correct because melancholic features require anhedonia, non-reactivity to
usually pleasurable stimuli, and at least three of the following: distinct quality of
depressed mood, depression worse in the morning, early morning awakening,
,psychomotor retardation, significant weight loss, or excessive guilt. Standard PMHNP
practice requires recognizing melancholic features as they predict better response to
biological treatments like antidepressants and ECT.
Q3: A 35-year-old female with MDD reports mood reactivity, leaden paralysis,
interpersonal rejection sensitivity, hypersomnia, and weight gain. Which treatment is
most appropriate first-line?
A. Phenelzine (MAOI)
B. Fluoxetine (SSRI)
C. Bupropion
D. Mirtazapine
Correct Answer: A
Rationale: Correct because the atypical features specifier (mood reactivity, leaden
paralysis, interpersonal rejection sensitivity, increased
appetite/hypersomnia/weight gain) is associated with a preferential response to
MAOIs per historical and clinical evidence, though SSRIs remain commonly used
first-line in practice. APA guidelines indicate MAOIs may be considered when atypical
features are prominent and SSRIs are ineffective.
Q4: A patient with MDD is started on escitalopram 10mg daily. After 4 weeks, partial
response is noted. The PMHNP considers augmentation. Which agent is FDA-
approved for adjunctive treatment of MDD?
A. Lithium carbonate
B. Aripiprazole
C. T3 (liothyronine)
D. Lamotrigine
Correct Answer: B
Rationale: Correct because aripiprazole is FDA-approved as an adjunctive treatment
for MDD when there is inadequate response to antidepressant monotherapy.
Standard PMHNP practice requires knowing FDA-approved augmentation strategies,
with aripiprazole, brexpiprazole, and quetiapine XR being the antipsychotics with
this specific indication.
Q5: A 30-year-old female presents 2 weeks postpartum with depressed mood,
anhedonia, insomnia despite exhaustion, excessive guilt about parenting, and
, recurrent thoughts that her baby would be better off without her. She has no
psychotic symptoms. Which is the most appropriate diagnosis?
A. Postpartum blues
B. Major Depressive Disorder with peripartum onset
C. Brief Psychotic Disorder
D. Bipolar I Disorder
Correct Answer: B
Rationale: Correct because the onset during the postpartum period (within 4 weeks
postpartum) with full MDD criteria including depressed mood, anhedonia, and
significant distress meets criteria for MDD with peripartum onset specifier. Per DSM-
5-TR diagnostic criteria, postpartum blues last <2 weeks and do not meet full MDD
criteria, while this patient has symptom duration and severity consistent with MDD.
Q6: A patient with severe, psychotic MDD has failed two adequate trials of
antidepressants. The patient is catatonic and refuses oral intake. Which intervention
is most appropriate?
A. Add an atypical antipsychotic to current antidepressant
B. Initiate electroconvulsive therapy (ECT)
C. Switch to a different SSRI
D. Begin transcranial magnetic stimulation (TMS)
Correct Answer: B
Rationale: Correct because ECT is indicated for severe MDD with psychotic features,
catatonia, and medication resistance. Standard PMHNP practice requires recognizing
ECT as the treatment of choice for severe, life-threatening depression with psychotic
features or catatonia, particularly when rapid response is needed and oral
medication adherence is compromised.
Q7: A 22-year-old college student presents after a breakup with depressed mood,
anhedonia, insomnia, fatigue, poor concentration, feelings of worthlessness, and
passive suicidal ideation without plan or intent. On the PHQ-9, the patient scores
"nearly every day" on item 9. What is the most appropriate next step?
A. Initiate SSRI monotherapy and schedule follow-up in 4 weeks
B. Conduct a comprehensive suicide risk assessment including ideation, intent, plan,
means, and protective factors
