SECTION 1: PSYCHIATRIC AND MENTAL HEALTH CONDITIONS
1. A 28-year-old female patient presents with symptoms of excessive worry, restlessness,
fatigue, and difficulty concentrating for the past 6 months. She reports that her worry is
difficult to control and interferes with her work and social life. Which of the following is the
most likely diagnosis?
A) Major depressive disorder
B) Generalized anxiety disorder
C) Panic disorder
D) Social anxiety disorder
Correct Answer: B - Generalized anxiety disorder
Rationale: Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable
worry about various events or activities occurring more days than not for at least 6
months. The worry is associated with at least three of the following symptoms:
restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep
disturbance. The patient's presentation of excessive worry with associated symptoms that
interfere with function meets the diagnostic criteria for GAD. Major depressive disorder
would require depressed mood or anhedonia as primary symptoms. Panic disorder
involves recurrent unexpected panic attacks. Social anxiety disorder involves fear of social
scrutiny and embarrassment.
2. A 32-year-old male patient with bipolar I disorder is currently in a depressive episode.
He reports feeling hopeless and has had thoughts of death but denies a specific plan. Which
medication class should be avoided as monotherapy in this patient?
A) SSRIs
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,B) Mood stabilizers
C) Atypical antipsychotics
D) Lithium
Correct Answer: A - SSRIs
Rationale: Antidepressant monotherapy, including SSRIs, is contraindicated in bipolar
depression because it can precipitate a manic or hypomanic episode, induce rapid cycling,
or worsen the overall course of the illness. The risk of antidepressant-induced mood
switching is particularly high in bipolar I disorder. Guidelines recommend using mood
stabilizers (such as lithium or valproate) or atypical antipsychotics (such as quetiapine or
lurasidone) as first-line treatment for bipolar depression. If an antidepressant is used, it
should be co-administered with a mood stabilizer to mitigate the risk of switching. Lithium
is a first-line mood stabilizer for bipolar disorder and has demonstrated efficacy in
reducing suicide risk.
3. A 45-year-old female patient with a history of major depressive disorder presents for a
routine follow-up. She reports that her symptoms have worsened over the past month,
including early morning awakening, decreased appetite, and suicidal ideation without a
specific plan. What is the most appropriate initial action?
A) Prescribe an SSRI and schedule a follow-up in 4 weeks
B) Hospitalize the patient involuntarily
C) Conduct a thorough suicide risk assessment and develop a safety plan
D) Refer to psychiatry and tell the patient to call if symptoms worsen
Correct Answer: C - Conduct a thorough suicide risk assessment and develop a safety plan
Rationale: Any patient presenting with suicidal ideation requires an immediate and
comprehensive suicide risk assessment to determine the level of acuity and need for
intervention. This includes assessing for plan, intent, means, and protective factors. While
the patient does not have a specific plan, the presence of suicidal ideation with worsening
depressive symptoms warrants immediate intervention. Developing a safety plan with the
patient, which includes identifying warning signs, coping strategies, and emergency
contacts, is essential. Involuntary hospitalization is only indicated if there is imminent
danger to self or others. Delaying treatment or simply referring without immediate
intervention is inappropriate given the acuity of the presentation.
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,4. You are assessing a 26-year-old male patient who complains that his arm hurts. When
assessing ROM of the shoulder, you ask him to touch the opposite scapula by placing his
arm up and over the back of his neck, but the patient reports tremendous pain when
attempting to do this. Which one of the following would you suspect?
A) Humeral malignancy
B) Rotator cuff injury
C) Ulnar nerve injury
D) Biceps brachii injury
Correct Answer: B - Rotator cuff injury
Rationale: The maneuver described is the Apley scratch test, which assesses shoulder range
of motion and specifically tests for rotator cuff pathology. When a patient experiences
severe pain when attempting to reach behind the neck to touch the opposite scapula, this
suggests impingement or tearing of the rotator cuff tendons, most commonly the
supraspinatus. This movement requires internal rotation and adduction, which places
stress on the rotator cuff mechanism. Humeral malignancy would present with night pain
and bony tenderness. Ulnar nerve injury would cause sensory changes in the fourth and
fifth digits. Biceps brachii injury would cause pain with elbow flexion and supination.
5. Your patient has made an attempt on their own life, and has survived. In assessing them,
it is important the nurse practitioner recognize that patients with a history of self-harm
need to be evaluated for which of the following underlying disease states, which is the most
common co-diagnosis in patients who have made attempts of self-harm?
A) Depression
B) Anxiety
C) Schizophrenia
D) Bipolar Disorder
Correct Answer: A - Depression
Rationale: Depression is the most common psychiatric diagnosis associated with suicide
attempts and self-harm behaviors. Studies consistently demonstrate that major depressive
disorder is present in up to 60-70% of patients who attempt suicide. The feelings of
hopelessness, worthlessness, and profound sadness characteristic of depression
significantly increase suicidal ideation and attempts. While anxiety, schizophrenia, and
bipolar disorder are also associated with increased suicide risk, depression remains the
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, most frequently co-occurring diagnosis in this patient population. It is essential for the
nurse practitioner to screen all self-harm patients for depressive disorders and initiate
appropriate treatment and safety planning.
SECTION 2: MUSCULOSKELETAL CONDITIONS
6. You are assessing a 26-year-old male patient who complains that his arm hurts. When
assessing ROM of the shoulder, you ask him to touch the opposite scapula by placing his
arm up and over the back of his neck, but the patient reports tremendous pain when
attempting to do this. Which one of the following would you suspect?
A) Humeral malignancy
B) Rotator cuff injury
C) Ulnar nerve injury
D) Biceps brachii injury
Correct Answer: B - Rotator cuff injury
Rationale: The maneuver described is the Apley scratch test, which assesses shoulder range
of motion and specifically tests for rotator cuff pathology. When a patient experiences
severe pain when attempting to reach behind the neck to touch the opposite scapula, this
suggests impingement or tearing of the rotator cuff tendons, most commonly the
supraspinatus. This movement requires internal rotation and adduction, which places
stress on the rotator cuff mechanism. Humeral malignancy would present with night pain
and bony tenderness. Ulnar nerve injury would cause sensory changes in the fourth and
fifth digits. Biceps brachii injury would cause pain with elbow flexion and supination.
7. A 55-year-old female patient presents with gradual onset of bilateral knee pain that is
worse with activity and improves with rest. On examination, you note crepitus with
movement and mild swelling. There is no erythema or warmth. Which of the following is
the most likely diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Septic arthritis
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1. A 28-year-old female patient presents with symptoms of excessive worry, restlessness,
fatigue, and difficulty concentrating for the past 6 months. She reports that her worry is
difficult to control and interferes with her work and social life. Which of the following is the
most likely diagnosis?
A) Major depressive disorder
B) Generalized anxiety disorder
C) Panic disorder
D) Social anxiety disorder
Correct Answer: B - Generalized anxiety disorder
Rationale: Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable
worry about various events or activities occurring more days than not for at least 6
months. The worry is associated with at least three of the following symptoms:
restlessness, fatigue, difficulty concentrating, irritability, muscle tension, or sleep
disturbance. The patient's presentation of excessive worry with associated symptoms that
interfere with function meets the diagnostic criteria for GAD. Major depressive disorder
would require depressed mood or anhedonia as primary symptoms. Panic disorder
involves recurrent unexpected panic attacks. Social anxiety disorder involves fear of social
scrutiny and embarrassment.
2. A 32-year-old male patient with bipolar I disorder is currently in a depressive episode.
He reports feeling hopeless and has had thoughts of death but denies a specific plan. Which
medication class should be avoided as monotherapy in this patient?
A) SSRIs
SCHOLARSOURCE 1
,B) Mood stabilizers
C) Atypical antipsychotics
D) Lithium
Correct Answer: A - SSRIs
Rationale: Antidepressant monotherapy, including SSRIs, is contraindicated in bipolar
depression because it can precipitate a manic or hypomanic episode, induce rapid cycling,
or worsen the overall course of the illness. The risk of antidepressant-induced mood
switching is particularly high in bipolar I disorder. Guidelines recommend using mood
stabilizers (such as lithium or valproate) or atypical antipsychotics (such as quetiapine or
lurasidone) as first-line treatment for bipolar depression. If an antidepressant is used, it
should be co-administered with a mood stabilizer to mitigate the risk of switching. Lithium
is a first-line mood stabilizer for bipolar disorder and has demonstrated efficacy in
reducing suicide risk.
3. A 45-year-old female patient with a history of major depressive disorder presents for a
routine follow-up. She reports that her symptoms have worsened over the past month,
including early morning awakening, decreased appetite, and suicidal ideation without a
specific plan. What is the most appropriate initial action?
A) Prescribe an SSRI and schedule a follow-up in 4 weeks
B) Hospitalize the patient involuntarily
C) Conduct a thorough suicide risk assessment and develop a safety plan
D) Refer to psychiatry and tell the patient to call if symptoms worsen
Correct Answer: C - Conduct a thorough suicide risk assessment and develop a safety plan
Rationale: Any patient presenting with suicidal ideation requires an immediate and
comprehensive suicide risk assessment to determine the level of acuity and need for
intervention. This includes assessing for plan, intent, means, and protective factors. While
the patient does not have a specific plan, the presence of suicidal ideation with worsening
depressive symptoms warrants immediate intervention. Developing a safety plan with the
patient, which includes identifying warning signs, coping strategies, and emergency
contacts, is essential. Involuntary hospitalization is only indicated if there is imminent
danger to self or others. Delaying treatment or simply referring without immediate
intervention is inappropriate given the acuity of the presentation.
SCHOLARSOURCE 2
,4. You are assessing a 26-year-old male patient who complains that his arm hurts. When
assessing ROM of the shoulder, you ask him to touch the opposite scapula by placing his
arm up and over the back of his neck, but the patient reports tremendous pain when
attempting to do this. Which one of the following would you suspect?
A) Humeral malignancy
B) Rotator cuff injury
C) Ulnar nerve injury
D) Biceps brachii injury
Correct Answer: B - Rotator cuff injury
Rationale: The maneuver described is the Apley scratch test, which assesses shoulder range
of motion and specifically tests for rotator cuff pathology. When a patient experiences
severe pain when attempting to reach behind the neck to touch the opposite scapula, this
suggests impingement or tearing of the rotator cuff tendons, most commonly the
supraspinatus. This movement requires internal rotation and adduction, which places
stress on the rotator cuff mechanism. Humeral malignancy would present with night pain
and bony tenderness. Ulnar nerve injury would cause sensory changes in the fourth and
fifth digits. Biceps brachii injury would cause pain with elbow flexion and supination.
5. Your patient has made an attempt on their own life, and has survived. In assessing them,
it is important the nurse practitioner recognize that patients with a history of self-harm
need to be evaluated for which of the following underlying disease states, which is the most
common co-diagnosis in patients who have made attempts of self-harm?
A) Depression
B) Anxiety
C) Schizophrenia
D) Bipolar Disorder
Correct Answer: A - Depression
Rationale: Depression is the most common psychiatric diagnosis associated with suicide
attempts and self-harm behaviors. Studies consistently demonstrate that major depressive
disorder is present in up to 60-70% of patients who attempt suicide. The feelings of
hopelessness, worthlessness, and profound sadness characteristic of depression
significantly increase suicidal ideation and attempts. While anxiety, schizophrenia, and
bipolar disorder are also associated with increased suicide risk, depression remains the
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, most frequently co-occurring diagnosis in this patient population. It is essential for the
nurse practitioner to screen all self-harm patients for depressive disorders and initiate
appropriate treatment and safety planning.
SECTION 2: MUSCULOSKELETAL CONDITIONS
6. You are assessing a 26-year-old male patient who complains that his arm hurts. When
assessing ROM of the shoulder, you ask him to touch the opposite scapula by placing his
arm up and over the back of his neck, but the patient reports tremendous pain when
attempting to do this. Which one of the following would you suspect?
A) Humeral malignancy
B) Rotator cuff injury
C) Ulnar nerve injury
D) Biceps brachii injury
Correct Answer: B - Rotator cuff injury
Rationale: The maneuver described is the Apley scratch test, which assesses shoulder range
of motion and specifically tests for rotator cuff pathology. When a patient experiences
severe pain when attempting to reach behind the neck to touch the opposite scapula, this
suggests impingement or tearing of the rotator cuff tendons, most commonly the
supraspinatus. This movement requires internal rotation and adduction, which places
stress on the rotator cuff mechanism. Humeral malignancy would present with night pain
and bony tenderness. Ulnar nerve injury would cause sensory changes in the fourth and
fifth digits. Biceps brachii injury would cause pain with elbow flexion and supination.
7. A 55-year-old female patient presents with gradual onset of bilateral knee pain that is
worse with activity and improves with rest. On examination, you note crepitus with
movement and mild swelling. There is no erythema or warmth. Which of the following is
the most likely diagnosis?
A) Rheumatoid arthritis
B) Osteoarthritis
C) Gout
D) Septic arthritis
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