1
NRNP 6635 FINAL EXAM (V1) - ACTUAL EXAM 2026/2027 |
COMPLETE COURSE REVIEW | EXPERT VERIFIED | 100
VERIFIED Q&A | COMPLETE RATIONALES | PASS
GUARANTEED - A+ GRADED
QUESTION 1
A 52-year-old male presents with a 4-week history of depressed mood, anhedonia, significant weight loss,
insomnia, psychomotor agitation, fatigue, feelings of worthlessness, and diminished ability to think or
concentrate. He reports these symptoms cause clinically significant distress and impair his occupational
functioning. He has a history of two prior depressive episodes in the past 10 years. Which DSM-5-TR
diagnosis is most appropriate?
A) Major Depressive Disorder, Single Episode, Moderate
B) Major Depressive Disorder, Recurrent Episode, Moderate
C) Major Depressive Disorder, Recurrent Episode, Severe
D) Persistent Depressive Disorder (Dysthymia)
Correct Answer: B
Rationale: The patient meets criteria for Major Depressive Disorder with at least 5 symptoms present for a
minimum of 2 weeks, including depressed mood or anhedonia. The presence of 8 symptoms indicates
moderate severity. "Recurrent" is specified because the patient has a history of two prior depressive episodes.
"Single Episode" would be used for first occurrence. "Severe" would require psychotic features or significant
functional impairment. "Persistent Depressive Disorder" requires symptoms for at least 2 years.
QUESTION 2
A 38-year-old female presents with a 2-year history of excessive anxiety and worry about work, health, and
family. She reports difficulty controlling the worry, restlessness, fatigue, difficulty concentrating, irritability,
muscle tension, and sleep disturbance. She has been prescribed lorazepam 1 mg TID by her primary care
provider. Which of the following is the most appropriate next step in her management?
A) Continue lorazepam and add fluoxetine
B) Taper lorazepam and initiate sertraline
C) Increase lorazepam to 2 mg TID
D) Continue lorazepam and add cognitive behavioral therapy
,2
Correct Answer: B
Rationale: Tapering lorazepam and initiating sertraline (SSRI) is the most appropriate next step.
Benzodiazepines like lorazepam are not recommended as long-term monotherapy for Generalized Anxiety
Disorder due to risk of tolerance, dependence, and withdrawal. SSRIs are first-line treatment for GAD with
strong evidence for efficacy. Benzodiazepines should be tapered gradually to avoid withdrawal symptoms, and
an SSRI should be started to provide effective long-term treatment.
QUESTION 3
A 24-year-old male presents with a 4-month history of auditory hallucinations, delusions of persecution,
disorganized speech, and negative symptoms including flat affect and avolition. Symptoms have persisted for
5 months total. He has no history of depressive or manic episodes. Which diagnosis is most appropriate?
A) Schizophrenia
B) Schizophreniform Disorder
C) Brief Psychotic Disorder
D) Schizoaffective Disorder
Correct Answer: B
Rationale: Schizophreniform Disorder is diagnosed when the patient meets criteria for schizophrenia
including 2 or more core symptoms (delusions, hallucinations, disorganized speech, grossly
disorganized/catatonic behavior, negative symptoms) for a significant portion of time during a 1-month
period, but the total duration of illness is between 1 and 6 months. The patient has a 5-month duration,
meeting criteria for Schizophreniform Disorder. Schizophrenia requires at least 6 months. Brief Psychotic
Disorder requires 1 day to 1 month. Schizoaffective Disorder requires concurrent mood episodes.
QUESTION 4
A 55-year-old female presents with episodes of elevated mood, decreased need for sleep, racing thoughts,
distractibility, and increased goal-directed activity lasting 6 days. She reports these episodes alternate with
periods of depression lasting 2 weeks. During the current episode, she has no psychotic features and does not
require hospitalization. Which diagnosis is most appropriate?
A) Bipolar I Disorder, Current Episode Manic
B) Bipolar II Disorder, Current Episode Hypomanic
C) Cyclothymic Disorder
D) Bipolar I Disorder, Current Episode Hypomanic
,3
Correct Answer: B
Rationale: Bipolar II Disorder requires at least one hypomanic episode and one major depressive episode.
Hypomanic episodes last at least 4 consecutive days (the patient reports 6 days) and include elevated mood
plus 3 or more associated symptoms. The absence of psychotic features and no need for hospitalization
distinguishes hypomania from mania, which requires at least 7 days and causes marked impairment or
requires hospitalization. Cyclothymic Disorder requires 2+ years of hypomanic and depressive symptoms not
meeting full criteria.
QUESTION 5
A 68-year-old male presents with progressive memory loss, difficulty with executive functioning, and
behavioral changes over the past 4 years. Brain imaging reveals hippocampal atrophy. He has difficulty with
instrumental activities of daily living including managing finances and cooking. Which of the following is the
most likely diagnosis?
A) Mild Cognitive Impairment
B) Major Neurocognitive Disorder due to Alzheimer's Disease
C) Delirium
D) Pseudodementia due to Depression
Correct Answer: B
Rationale: Major Neurocognitive Disorder due to Alzheimer's Disease requires significant cognitive decline
from previous level of functioning in one or more cognitive domains (memory, language, executive function)
and interference with independence in daily activities. The patient has progressive decline over 4 years with
deficits in multiple domains and difficulty with instrumental activities of daily living. Mild Cognitive
Impairment would involve modest cognitive decline without significant interference with daily activities.
Delirium has acute onset with fluctuating course. Pseudodementia from depression typically has prominent
mood symptoms.
QUESTION 6
A 35-year-old female with a history of childhood sexual abuse presents with recurrent, involuntary,
distressing memories of the event, recurrent nightmares, flashbacks, and intense psychological distress at
exposure to cues resembling the trauma. She reports avoiding thoughts, feelings, and external reminders of
the event. She has persistent negative beliefs about herself and the world. Symptoms have been present for 18
months. Which of the following is the most appropriate diagnosis?
, 4
A) Acute Stress Disorder
B) Posttraumatic Stress Disorder, Chronic
C) Adjustment Disorder
D) Posttraumatic Stress Disorder, with Dissociative Symptoms
Correct Answer: B
Rationale: PTSD requires exposure to actual or threatened death, serious injury, or sexual violence, with
symptoms from all 4 clusters (intrusion, avoidance, negative alterations in cognition/mood, alterations in
arousal/reactivity) persisting for more than 1 month. The patient's symptoms have been present for 18
months, meeting the chronic PTSD criteria (symptoms > 3 months). Acute Stress Disorder is diagnosed when
symptoms last 3 days to 1 month. Adjustment Disorder involves emotional/behavioral symptoms in response
to identifiable stressors.
QUESTION 7
A 50-year-old male with a 25-year history of alcohol use disorder presents with memory impairment,
confabulation, ataxia, and ophthalmoplegia. Which of the following vitamin deficiencies is most likely
responsible for his symptoms?
A) Vitamin B12
B) Thiamine (Vitamin B1)
C) Folate
D) Vitamin D
Correct Answer: B
Rationale: Thiamine (Vitamin B1) deficiency is the cause of Wernicke-Korsakoff Syndrome, commonly seen
in patients with chronic alcohol dependence. The classic Wernicke's triad consists of confusion,
ophthalmoplegia, and ataxia. Korsakoff's syndrome presents with anterograde/retrograde amnesia and
confabulation. Vitamin B12 deficiency can cause neuropathy and cognitive impairment but not the classic
triad. Folate deficiency can cause megaloblastic anemia. Vitamin D deficiency is associated with bone disease
and mood disorders.
QUESTION 8
A 16-year-old female presents with restriction of energy intake leading to significantly low body weight (BMI
16.2), intense fear of gaining weight, and disturbance in self-perceived weight/shape. She denies binge eating
NRNP 6635 FINAL EXAM (V1) - ACTUAL EXAM 2026/2027 |
COMPLETE COURSE REVIEW | EXPERT VERIFIED | 100
VERIFIED Q&A | COMPLETE RATIONALES | PASS
GUARANTEED - A+ GRADED
QUESTION 1
A 52-year-old male presents with a 4-week history of depressed mood, anhedonia, significant weight loss,
insomnia, psychomotor agitation, fatigue, feelings of worthlessness, and diminished ability to think or
concentrate. He reports these symptoms cause clinically significant distress and impair his occupational
functioning. He has a history of two prior depressive episodes in the past 10 years. Which DSM-5-TR
diagnosis is most appropriate?
A) Major Depressive Disorder, Single Episode, Moderate
B) Major Depressive Disorder, Recurrent Episode, Moderate
C) Major Depressive Disorder, Recurrent Episode, Severe
D) Persistent Depressive Disorder (Dysthymia)
Correct Answer: B
Rationale: The patient meets criteria for Major Depressive Disorder with at least 5 symptoms present for a
minimum of 2 weeks, including depressed mood or anhedonia. The presence of 8 symptoms indicates
moderate severity. "Recurrent" is specified because the patient has a history of two prior depressive episodes.
"Single Episode" would be used for first occurrence. "Severe" would require psychotic features or significant
functional impairment. "Persistent Depressive Disorder" requires symptoms for at least 2 years.
QUESTION 2
A 38-year-old female presents with a 2-year history of excessive anxiety and worry about work, health, and
family. She reports difficulty controlling the worry, restlessness, fatigue, difficulty concentrating, irritability,
muscle tension, and sleep disturbance. She has been prescribed lorazepam 1 mg TID by her primary care
provider. Which of the following is the most appropriate next step in her management?
A) Continue lorazepam and add fluoxetine
B) Taper lorazepam and initiate sertraline
C) Increase lorazepam to 2 mg TID
D) Continue lorazepam and add cognitive behavioral therapy
,2
Correct Answer: B
Rationale: Tapering lorazepam and initiating sertraline (SSRI) is the most appropriate next step.
Benzodiazepines like lorazepam are not recommended as long-term monotherapy for Generalized Anxiety
Disorder due to risk of tolerance, dependence, and withdrawal. SSRIs are first-line treatment for GAD with
strong evidence for efficacy. Benzodiazepines should be tapered gradually to avoid withdrawal symptoms, and
an SSRI should be started to provide effective long-term treatment.
QUESTION 3
A 24-year-old male presents with a 4-month history of auditory hallucinations, delusions of persecution,
disorganized speech, and negative symptoms including flat affect and avolition. Symptoms have persisted for
5 months total. He has no history of depressive or manic episodes. Which diagnosis is most appropriate?
A) Schizophrenia
B) Schizophreniform Disorder
C) Brief Psychotic Disorder
D) Schizoaffective Disorder
Correct Answer: B
Rationale: Schizophreniform Disorder is diagnosed when the patient meets criteria for schizophrenia
including 2 or more core symptoms (delusions, hallucinations, disorganized speech, grossly
disorganized/catatonic behavior, negative symptoms) for a significant portion of time during a 1-month
period, but the total duration of illness is between 1 and 6 months. The patient has a 5-month duration,
meeting criteria for Schizophreniform Disorder. Schizophrenia requires at least 6 months. Brief Psychotic
Disorder requires 1 day to 1 month. Schizoaffective Disorder requires concurrent mood episodes.
QUESTION 4
A 55-year-old female presents with episodes of elevated mood, decreased need for sleep, racing thoughts,
distractibility, and increased goal-directed activity lasting 6 days. She reports these episodes alternate with
periods of depression lasting 2 weeks. During the current episode, she has no psychotic features and does not
require hospitalization. Which diagnosis is most appropriate?
A) Bipolar I Disorder, Current Episode Manic
B) Bipolar II Disorder, Current Episode Hypomanic
C) Cyclothymic Disorder
D) Bipolar I Disorder, Current Episode Hypomanic
,3
Correct Answer: B
Rationale: Bipolar II Disorder requires at least one hypomanic episode and one major depressive episode.
Hypomanic episodes last at least 4 consecutive days (the patient reports 6 days) and include elevated mood
plus 3 or more associated symptoms. The absence of psychotic features and no need for hospitalization
distinguishes hypomania from mania, which requires at least 7 days and causes marked impairment or
requires hospitalization. Cyclothymic Disorder requires 2+ years of hypomanic and depressive symptoms not
meeting full criteria.
QUESTION 5
A 68-year-old male presents with progressive memory loss, difficulty with executive functioning, and
behavioral changes over the past 4 years. Brain imaging reveals hippocampal atrophy. He has difficulty with
instrumental activities of daily living including managing finances and cooking. Which of the following is the
most likely diagnosis?
A) Mild Cognitive Impairment
B) Major Neurocognitive Disorder due to Alzheimer's Disease
C) Delirium
D) Pseudodementia due to Depression
Correct Answer: B
Rationale: Major Neurocognitive Disorder due to Alzheimer's Disease requires significant cognitive decline
from previous level of functioning in one or more cognitive domains (memory, language, executive function)
and interference with independence in daily activities. The patient has progressive decline over 4 years with
deficits in multiple domains and difficulty with instrumental activities of daily living. Mild Cognitive
Impairment would involve modest cognitive decline without significant interference with daily activities.
Delirium has acute onset with fluctuating course. Pseudodementia from depression typically has prominent
mood symptoms.
QUESTION 6
A 35-year-old female with a history of childhood sexual abuse presents with recurrent, involuntary,
distressing memories of the event, recurrent nightmares, flashbacks, and intense psychological distress at
exposure to cues resembling the trauma. She reports avoiding thoughts, feelings, and external reminders of
the event. She has persistent negative beliefs about herself and the world. Symptoms have been present for 18
months. Which of the following is the most appropriate diagnosis?
, 4
A) Acute Stress Disorder
B) Posttraumatic Stress Disorder, Chronic
C) Adjustment Disorder
D) Posttraumatic Stress Disorder, with Dissociative Symptoms
Correct Answer: B
Rationale: PTSD requires exposure to actual or threatened death, serious injury, or sexual violence, with
symptoms from all 4 clusters (intrusion, avoidance, negative alterations in cognition/mood, alterations in
arousal/reactivity) persisting for more than 1 month. The patient's symptoms have been present for 18
months, meeting the chronic PTSD criteria (symptoms > 3 months). Acute Stress Disorder is diagnosed when
symptoms last 3 days to 1 month. Adjustment Disorder involves emotional/behavioral symptoms in response
to identifiable stressors.
QUESTION 7
A 50-year-old male with a 25-year history of alcohol use disorder presents with memory impairment,
confabulation, ataxia, and ophthalmoplegia. Which of the following vitamin deficiencies is most likely
responsible for his symptoms?
A) Vitamin B12
B) Thiamine (Vitamin B1)
C) Folate
D) Vitamin D
Correct Answer: B
Rationale: Thiamine (Vitamin B1) deficiency is the cause of Wernicke-Korsakoff Syndrome, commonly seen
in patients with chronic alcohol dependence. The classic Wernicke's triad consists of confusion,
ophthalmoplegia, and ataxia. Korsakoff's syndrome presents with anterograde/retrograde amnesia and
confabulation. Vitamin B12 deficiency can cause neuropathy and cognitive impairment but not the classic
triad. Folate deficiency can cause megaloblastic anemia. Vitamin D deficiency is associated with bone disease
and mood disorders.
QUESTION 8
A 16-year-old female presents with restriction of energy intake leading to significantly low body weight (BMI
16.2), intense fear of gaining weight, and disturbance in self-perceived weight/shape. She denies binge eating
