NURS 663 Exam 4 V3 | NURS 663
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 4 2026)
1. A 24-year-old female presents with an intense fear of gaining weight and a body weight
that is significantly below the minimum normal range. She reports exercising for three hours
daily and severely restricting her caloric intake. Which of the following is the most
appropriate primary diagnosis?
A. Bulimia Nervosa
B. Anorexia Nervosa, Restricting Type
C. Binge-Eating Disorder
D. Avoidant/Restrictive Food Intake Disorder
Answer: B
Rationale: Anorexia Nervosa is characterized by a restriction of energy intake relative to
requirements, leading to a significantly low body weight. Patients also exhibit an intense
fear of gaining weight or becoming fat, even though they are underweight. The restricting
type specifically describes presentations where weight loss is accomplished primarily
through dieting, fasting, or excessive exercise.
,2. Which pharmacological intervention is considered first-line for the treatment of Alcohol
Use Disorder by reducing cravings through opioid receptor antagonism?
A. Disulfiram
B. Naltrexone
C. Acamprosate
D. Gabapentin
Answer: B
Rationale: Naltrexone is a competitive opioid antagonist that reduces the reinforcing
effects of alcohol. It is effective in reducing the frequency and severity of relapse to heavy
drinking by blocking the ‘high’ associated with alcohol consumption. Unlike disulfiram, it
does not cause a physical reaction to alcohol, but rather targets the neurobiological reward
system.
3. In the treatment of Opioid Use Disorder (OUD), which medication is a partial mu-opioid
agonist and requires the patient to be in mild to moderate withdrawal before the first dose?
A. Methadone
B. Naloxone
C. Buprenorphine
D. Varenicline
Answer: C
,Rationale: Buprenorphine is a partial mu-opioid agonist that has a higher affinity for the
receptor than most full agonists. Because it can displace full agonists and has lower
intrinsic activity, it can precipitate withdrawal if administered while other opioids are still
on the receptors. Therefore, patients must be in a state of mild to moderate withdrawal
(COWS score of 12 or higher) before initiation.
4. A 35-year-old male exhibits a pervasive pattern of grandiosity, a constant need for
admiration, and a lack of empathy for others. These traits are most consistent with which
Personality Disorder?
A. Antisocial Personality Disorder
B. Narcissistic Personality Disorder
C. Histrionic Personality Disorder
D. Borderline Personality Disorder
Answer: B
Rationale: Narcissistic Personality Disorder is defined by a long-term pattern of abnormal
behavior characterized by exaggerated feelings of self-importance and an excessive need
for admiration. These individuals often demonstrate a lack of understanding or concern for
the feelings of others. This disorder belongs to the Cluster B ‘dramatic, emotional, or
erratic’ group of personality disorders.
, 5. A 9-year-old child presents with symptoms of hyperactivity, impulsivity, and inattention
that occur in both school and home settings. What is the standard first-line pharmacological
treatment for this patient?
A. Atomoxetine
B. Methylphenidate
C. Guanfacine
D. Bupropion
Answer: B
Rationale: Stimulants such as Methylphenidate are recognized as the first-line
pharmacological treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) in
children. They work by increasing the levels of dopamine and norepinephrine in the
synaptic cleft. These medications have a high efficacy rate and a well-established safety
profile when used as directed.
6. A patient with Borderline Personality Disorder (BPD) is engaging in self-injurious behavior
and experiencing intense emotional dysregulation. Which evidence-based psychotherapy is
specifically designed to treat these symptoms?
A. Interpersonal Therapy (IPT)
B. Exposure and Response Prevention (ERP)
C. Dialectical Behavior Therapy (DBT)
D. Cognitive Processing Therapy (CPT)
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 4 2026)
1. A 24-year-old female presents with an intense fear of gaining weight and a body weight
that is significantly below the minimum normal range. She reports exercising for three hours
daily and severely restricting her caloric intake. Which of the following is the most
appropriate primary diagnosis?
A. Bulimia Nervosa
B. Anorexia Nervosa, Restricting Type
C. Binge-Eating Disorder
D. Avoidant/Restrictive Food Intake Disorder
Answer: B
Rationale: Anorexia Nervosa is characterized by a restriction of energy intake relative to
requirements, leading to a significantly low body weight. Patients also exhibit an intense
fear of gaining weight or becoming fat, even though they are underweight. The restricting
type specifically describes presentations where weight loss is accomplished primarily
through dieting, fasting, or excessive exercise.
,2. Which pharmacological intervention is considered first-line for the treatment of Alcohol
Use Disorder by reducing cravings through opioid receptor antagonism?
A. Disulfiram
B. Naltrexone
C. Acamprosate
D. Gabapentin
Answer: B
Rationale: Naltrexone is a competitive opioid antagonist that reduces the reinforcing
effects of alcohol. It is effective in reducing the frequency and severity of relapse to heavy
drinking by blocking the ‘high’ associated with alcohol consumption. Unlike disulfiram, it
does not cause a physical reaction to alcohol, but rather targets the neurobiological reward
system.
3. In the treatment of Opioid Use Disorder (OUD), which medication is a partial mu-opioid
agonist and requires the patient to be in mild to moderate withdrawal before the first dose?
A. Methadone
B. Naloxone
C. Buprenorphine
D. Varenicline
Answer: C
,Rationale: Buprenorphine is a partial mu-opioid agonist that has a higher affinity for the
receptor than most full agonists. Because it can displace full agonists and has lower
intrinsic activity, it can precipitate withdrawal if administered while other opioids are still
on the receptors. Therefore, patients must be in a state of mild to moderate withdrawal
(COWS score of 12 or higher) before initiation.
4. A 35-year-old male exhibits a pervasive pattern of grandiosity, a constant need for
admiration, and a lack of empathy for others. These traits are most consistent with which
Personality Disorder?
A. Antisocial Personality Disorder
B. Narcissistic Personality Disorder
C. Histrionic Personality Disorder
D. Borderline Personality Disorder
Answer: B
Rationale: Narcissistic Personality Disorder is defined by a long-term pattern of abnormal
behavior characterized by exaggerated feelings of self-importance and an excessive need
for admiration. These individuals often demonstrate a lack of understanding or concern for
the feelings of others. This disorder belongs to the Cluster B ‘dramatic, emotional, or
erratic’ group of personality disorders.
, 5. A 9-year-old child presents with symptoms of hyperactivity, impulsivity, and inattention
that occur in both school and home settings. What is the standard first-line pharmacological
treatment for this patient?
A. Atomoxetine
B. Methylphenidate
C. Guanfacine
D. Bupropion
Answer: B
Rationale: Stimulants such as Methylphenidate are recognized as the first-line
pharmacological treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) in
children. They work by increasing the levels of dopamine and norepinephrine in the
synaptic cleft. These medications have a high efficacy rate and a well-established safety
profile when used as directed.
6. A patient with Borderline Personality Disorder (BPD) is engaging in self-injurious behavior
and experiencing intense emotional dysregulation. Which evidence-based psychotherapy is
specifically designed to treat these symptoms?
A. Interpersonal Therapy (IPT)
B. Exposure and Response Prevention (ERP)
C. Dialectical Behavior Therapy (DBT)
D. Cognitive Processing Therapy (CPT)
