NR605 Diagnosis Management in Psychiatric
Mental Health EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Psychiatric Diagnostic Interviewing and Comprehensive Assessment
2. Psychopharmacology and Pharmacokinetics Across the Lifespan
3. Depressive and Bipolar Spectrum Disorders Management
4. Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders
5. Schizophrenia Spectrum and Other Psychotic Disorders
6. Neurodevelopmental and Neurocognitive Disorders
7. Personality Disorders and Substance-Related Conditions
8. Legal, Ethical, and Professional Standards in Mental Health Practice
1. A 34-year-old female presents with persistent, pervasive worry about multiple life domains for
the past 9 years, accompanied by muscle tension, irritability, and chronic insomnia. She reports
her symptoms are refractory to a 12-week trial of escitalopram at therapeutic doses. Which of the
following is the most appropriate next pharmacotherapeutic step based on evidence-based
guidelines?
A. Switch to duloxetine 60 mg PO daily
B. Increase escitalopram to twice the maximum FDA-approved dose
C. Initiate alprazolam 1 mg PO TID long-term maintenance
, D. Add bupropion SR 150 mg PO daily immediately
CORRECT ANSWER : A
Rationale: When generalized anxiety disorder fails to respond to an adequate trial of a first-line
selective serotonin reuptake inhibitor (SSRI) like escitalopram, switching to a serotonin-
norepinephrine reuptake inhibitor (SNRI) such as duloxetine or venlafaxine is an evidence-based
recommendation. Doubling escitalopram beyond maximum dosing increases side effects without
demonstrated efficacy benefits. Long-term benzodiazepines like alprazolam are discouraged due
to dependence, tolerance, and withdrawal risks, while bupropion can exacerbate anxiety
symptoms.
2. A 28-year-old male with a history of bipolar I disorder, currently maintained on lithium
carbonate 900 mg daily, presents with acute onset coarse hand tremors, ataxia, vomiting, and
lethargy. His serum lithium level is 1.8 mEq/L. Which immediate intervention should the
psychiatric-mental health nurse practitioner prioritize?
A. Administer oral sodium polystyrene sulfonate and repeat lithium dose
B. Discontinue lithium immediately, initiate aggressive intravenous normal saline
rehydration, and obtain a stat basic metabolic panel
C. Reduce the lithium dose by half and reassess serum levels in one week
D. Prescribe propranolol 20 mg PO TID to manage the tremor while continuing current lithium
CORRECT ANSWER : B
Rationale: A serum lithium level of 1.8 mEq/L combined with acute symptoms of toxicity (coarse
tremor, ataxia, GI distress, lethargy) indicates moderate-to-severe lithium toxicity. Immediate
cessation of lithium and aggressive volume resuscitation with IV normal saline are critical to
enhance renal excretion and prevent neurological sequelae. Continuing lithium or merely
reducing the dose would be dangerous given acute toxicity levels, and propranolol does not
address acute overdose.
3. A 45-year-old male is brought to the clinic by his spouse due to a 3-week history of grandiose
delusions, decreased need for sleep, pressured speech, and reckless financial spending. He has no
prior psychiatric history and denies substance use. Which initial diagnostic action is most
critical?
A. Immediately prescribe olanzapine 10 mg PO daily and schedule follow-up in 4 weeks
B. Order a comprehensive metabolic panel, thyroid-stimulating hormone (TSH), complete
blood count, and urine drug screen to rule out secondary organic etiologies
, C. Administer the Patient Health Questionnaire-9 (PHQ-9) to screen for major depressive
episodes
D. Refer the patient directly for electroconvulsive therapy (ECT) evaluation
CORRECT ANSWER : B
Rationale: Manic symptoms appearing for the first time in middle adulthood require a thorough
medical workup to rule out secondary mania caused by medical conditions (e.g.,
hyperthyroidism), central nervous system pathology, or substance-induced states before
assigning a primary psychiatric diagnosis. Antipsychotic initiation is premature without
stabilization context, and PHQ-9 targets depression rather than mania.
4. A 62-year-old female with major depressive disorder is scheduled to start phenelzine, a
monoamine oxidase inhibitor (MAOI), after failing trials of multiple SSRIs and an SNRI. What
crucial dietary and medication safety education must the provider deliver?
A. Avoid foods high in vitamin K such as spinach and kale to prevent bleeding complications
B. Strictly avoid tyramine-rich foods (e.g., aged cheeses, cured meats, tap beers) and
consult the provider before taking any over-the-counter cold or decongestant medications
C. Eliminate all citrus fruits and grapefruit juice to prevent hepatic enzyme inhibition
D. Restrict daily fluid intake to less than 1,000 mL to prevent severe water intoxication
CORRECT ANSWER : B
Rationale: MAOIs like phenelzine irreversibly inhibit monoamine oxidase in the gut and brain,
preventing the breakdown of dietary tyramine. Accumulation of tyramine displaces
norepinephrine, precipitating a life-threatening hypertensive crisis. Patients must also avoid
sympathomimetic decongestants (e.g., pseudoephedrine) which similarly trigger dangerous
blood pressure spikes.
5. A 22-year-old college student presents with recurrent, unexpected panic attacks accompanied by
intense fear of dying and agoraphobia restricting her class attendance. She requests immediate
relief. Which combined treatment approach yields the highest long-term remission rates?
A. High-potency benzodiazepine monotherapy indefinitely
B. Cognitive Behavioral Therapy (CBT) combined with an SSRI (e.g., sertraline)
C. Psychodynamic psychotherapy alone without pharmacotherapy
D. First-generation antipsychotic monotherapy
, CORRECT ANSWER : B
Rationale: Clinical practice guidelines recommend a combination of Cognitive Behavioral
Therapy (CBT) and an SSRI as the gold-standard treatment for panic disorder with
agoraphobia, providing rapid symptom reduction and durable long-term remission.
Benzodiazepines should be avoided as primary long-term therapy due to dependence and
tolerance risks, while psychodynamic therapy and antipsychotics lack primary evidence for
panic disorder.
6. A psychiatric-mental health nurse practitioner is evaluating a 50-year-old male with
schizophrenia who has experienced persistent, disabling tardive dyskinesia after years of
treatment with haloperidol. Which FDA-approved medication class is specifically indicated to
treat tardive dyskinesia?
A. Anticholinergics such as benztropine
B. Vesicular monoamine transporter 2 (VMAT2) inhibitors (e.g., deutetrabenazine or
valbenazine)
C. Dopamine agonists such as bromocriptine
D. Selective serotonin reuptake inhibitors
CORRECT ANSWER : B
Rationale: VMAT2 inhibitors (valbenazine, deutetrabenazine) are FDA-approved specifically for
treating tardive dyskinesia by reducing dopamine vesicle packaging in striatal neurons.
Anticholinergics like benztropine are effective for acute extrapyramidal symptoms (EPS) or
parkinsonism but can worsen tardive dyskinesia. Dopamine agonists would exacerbate psychotic
symptoms.
7. A 70-year-old male with mild cognitive impairment is brought in by his daughter, who notes
progressive memory loss, apathy, and difficulty managing finances over the past year.
Neuropsychological testing confirms amnestic mild cognitive impairment. Which medication is
strongly indicated to slow cognitive decline?
A. Haloperidol 1 mg PO daily
B. Donepezil 5 mg PO daily (acetylcholinesterase inhibitor)
C. Diazepam 5 mg PO BID
D. Lithium carbonate 300 mg PO BID
CORRECT ANSWER : B
Mental Health EXAM with Questions and
Answers/Plus a Rationale Updated 2026 A+/Instant
Download PDF
EXAM COVERAGE
1. Psychiatric Diagnostic Interviewing and Comprehensive Assessment
2. Psychopharmacology and Pharmacokinetics Across the Lifespan
3. Depressive and Bipolar Spectrum Disorders Management
4. Anxiety, Obsessive-Compulsive, and Trauma-Related Disorders
5. Schizophrenia Spectrum and Other Psychotic Disorders
6. Neurodevelopmental and Neurocognitive Disorders
7. Personality Disorders and Substance-Related Conditions
8. Legal, Ethical, and Professional Standards in Mental Health Practice
1. A 34-year-old female presents with persistent, pervasive worry about multiple life domains for
the past 9 years, accompanied by muscle tension, irritability, and chronic insomnia. She reports
her symptoms are refractory to a 12-week trial of escitalopram at therapeutic doses. Which of the
following is the most appropriate next pharmacotherapeutic step based on evidence-based
guidelines?
A. Switch to duloxetine 60 mg PO daily
B. Increase escitalopram to twice the maximum FDA-approved dose
C. Initiate alprazolam 1 mg PO TID long-term maintenance
, D. Add bupropion SR 150 mg PO daily immediately
CORRECT ANSWER : A
Rationale: When generalized anxiety disorder fails to respond to an adequate trial of a first-line
selective serotonin reuptake inhibitor (SSRI) like escitalopram, switching to a serotonin-
norepinephrine reuptake inhibitor (SNRI) such as duloxetine or venlafaxine is an evidence-based
recommendation. Doubling escitalopram beyond maximum dosing increases side effects without
demonstrated efficacy benefits. Long-term benzodiazepines like alprazolam are discouraged due
to dependence, tolerance, and withdrawal risks, while bupropion can exacerbate anxiety
symptoms.
2. A 28-year-old male with a history of bipolar I disorder, currently maintained on lithium
carbonate 900 mg daily, presents with acute onset coarse hand tremors, ataxia, vomiting, and
lethargy. His serum lithium level is 1.8 mEq/L. Which immediate intervention should the
psychiatric-mental health nurse practitioner prioritize?
A. Administer oral sodium polystyrene sulfonate and repeat lithium dose
B. Discontinue lithium immediately, initiate aggressive intravenous normal saline
rehydration, and obtain a stat basic metabolic panel
C. Reduce the lithium dose by half and reassess serum levels in one week
D. Prescribe propranolol 20 mg PO TID to manage the tremor while continuing current lithium
CORRECT ANSWER : B
Rationale: A serum lithium level of 1.8 mEq/L combined with acute symptoms of toxicity (coarse
tremor, ataxia, GI distress, lethargy) indicates moderate-to-severe lithium toxicity. Immediate
cessation of lithium and aggressive volume resuscitation with IV normal saline are critical to
enhance renal excretion and prevent neurological sequelae. Continuing lithium or merely
reducing the dose would be dangerous given acute toxicity levels, and propranolol does not
address acute overdose.
3. A 45-year-old male is brought to the clinic by his spouse due to a 3-week history of grandiose
delusions, decreased need for sleep, pressured speech, and reckless financial spending. He has no
prior psychiatric history and denies substance use. Which initial diagnostic action is most
critical?
A. Immediately prescribe olanzapine 10 mg PO daily and schedule follow-up in 4 weeks
B. Order a comprehensive metabolic panel, thyroid-stimulating hormone (TSH), complete
blood count, and urine drug screen to rule out secondary organic etiologies
, C. Administer the Patient Health Questionnaire-9 (PHQ-9) to screen for major depressive
episodes
D. Refer the patient directly for electroconvulsive therapy (ECT) evaluation
CORRECT ANSWER : B
Rationale: Manic symptoms appearing for the first time in middle adulthood require a thorough
medical workup to rule out secondary mania caused by medical conditions (e.g.,
hyperthyroidism), central nervous system pathology, or substance-induced states before
assigning a primary psychiatric diagnosis. Antipsychotic initiation is premature without
stabilization context, and PHQ-9 targets depression rather than mania.
4. A 62-year-old female with major depressive disorder is scheduled to start phenelzine, a
monoamine oxidase inhibitor (MAOI), after failing trials of multiple SSRIs and an SNRI. What
crucial dietary and medication safety education must the provider deliver?
A. Avoid foods high in vitamin K such as spinach and kale to prevent bleeding complications
B. Strictly avoid tyramine-rich foods (e.g., aged cheeses, cured meats, tap beers) and
consult the provider before taking any over-the-counter cold or decongestant medications
C. Eliminate all citrus fruits and grapefruit juice to prevent hepatic enzyme inhibition
D. Restrict daily fluid intake to less than 1,000 mL to prevent severe water intoxication
CORRECT ANSWER : B
Rationale: MAOIs like phenelzine irreversibly inhibit monoamine oxidase in the gut and brain,
preventing the breakdown of dietary tyramine. Accumulation of tyramine displaces
norepinephrine, precipitating a life-threatening hypertensive crisis. Patients must also avoid
sympathomimetic decongestants (e.g., pseudoephedrine) which similarly trigger dangerous
blood pressure spikes.
5. A 22-year-old college student presents with recurrent, unexpected panic attacks accompanied by
intense fear of dying and agoraphobia restricting her class attendance. She requests immediate
relief. Which combined treatment approach yields the highest long-term remission rates?
A. High-potency benzodiazepine monotherapy indefinitely
B. Cognitive Behavioral Therapy (CBT) combined with an SSRI (e.g., sertraline)
C. Psychodynamic psychotherapy alone without pharmacotherapy
D. First-generation antipsychotic monotherapy
, CORRECT ANSWER : B
Rationale: Clinical practice guidelines recommend a combination of Cognitive Behavioral
Therapy (CBT) and an SSRI as the gold-standard treatment for panic disorder with
agoraphobia, providing rapid symptom reduction and durable long-term remission.
Benzodiazepines should be avoided as primary long-term therapy due to dependence and
tolerance risks, while psychodynamic therapy and antipsychotics lack primary evidence for
panic disorder.
6. A psychiatric-mental health nurse practitioner is evaluating a 50-year-old male with
schizophrenia who has experienced persistent, disabling tardive dyskinesia after years of
treatment with haloperidol. Which FDA-approved medication class is specifically indicated to
treat tardive dyskinesia?
A. Anticholinergics such as benztropine
B. Vesicular monoamine transporter 2 (VMAT2) inhibitors (e.g., deutetrabenazine or
valbenazine)
C. Dopamine agonists such as bromocriptine
D. Selective serotonin reuptake inhibitors
CORRECT ANSWER : B
Rationale: VMAT2 inhibitors (valbenazine, deutetrabenazine) are FDA-approved specifically for
treating tardive dyskinesia by reducing dopamine vesicle packaging in striatal neurons.
Anticholinergics like benztropine are effective for acute extrapyramidal symptoms (EPS) or
parkinsonism but can worsen tardive dyskinesia. Dopamine agonists would exacerbate psychotic
symptoms.
7. A 70-year-old male with mild cognitive impairment is brought in by his daughter, who notes
progressive memory loss, apathy, and difficulty managing finances over the past year.
Neuropsychological testing confirms amnestic mild cognitive impairment. Which medication is
strongly indicated to slow cognitive decline?
A. Haloperidol 1 mg PO daily
B. Donepezil 5 mg PO daily (acetylcholinesterase inhibitor)
C. Diazepam 5 mg PO BID
D. Lithium carbonate 300 mg PO BID
CORRECT ANSWER : B
