1
NRNP 6635 FINAL EXAM (V2) - ACTUAL EXAM 2026/2027 |
COMPLETE COURSE REVIEW | EXPERT VERIFIED | 100
VERIFIED Q&A | COMPLETE RATIONALES | PASS
GUARANTEED - A+ GRADED
QUESTION 1
A 55-year-old male presents with a 6-week history of depressed mood, anhedonia, significant weight loss,
insomnia, psychomotor retardation, fatigue, feelings of worthlessness, and diminished ability to concentrate.
He reports these symptoms cause clinically significant distress and impair his occupational functioning. He
has a history of three prior depressive episodes in the past 12 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 three 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 42-year-old female presents with a 5-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 clonazepam 0.5 mg TID by her primary care
provider. Which of the following is the most appropriate next step in her management?
A) Continue clonazepam and add fluoxetine
B) Taper clonazepam and initiate sertraline
C) Increase clonazepam to 1 mg TID
D) Continue clonazepam and add cognitive behavioral therapy
,2
Correct Answer: B
Rationale: Tapering clonazepam and initiating sertraline (SSRI) is the most appropriate next step.
Benzodiazepines like clonazepam 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. The patient's 5-year history of
benzodiazepine use requires careful tapering.
QUESTION 3
A 26-year-old male presents with a 5-month history of auditory hallucinations, delusions of persecution,
disorganized speech, and negative symptoms including flat affect and avolition. Symptoms have persisted for
6 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: A
Rationale: Schizophrenia requires at least 2 core symptoms (delusions, hallucinations, disorganized speech,
grossly disorganized/catatonic behavior, negative symptoms) for a significant portion of time during a 1-
month period, with continuous signs of disturbance for at least 6 months. The patient has a 6-month total
duration with active symptoms for 5 months, meeting the 6-month criterion. Schizophreniform Disorder
requires 1-6 months duration but the patient has reached 6 months. Brief Psychotic Disorder requires 1 day to
1 month. Schizoaffective Disorder requires concurrent mood episodes.
QUESTION 4
A 52-year-old female presents with episodes of elevated mood, decreased need for sleep, racing thoughts,
distractibility, and increased goal-directed activity lasting 7 days. She reports these episodes alternate with
periods of depression lasting 3 weeks. During the current episode, she has no psychotic features but has been
hospitalized in the past for similar episodes. 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: A
Rationale: Bipolar I Disorder, Manic Episode requires a distinct period of abnormally and persistently
elevated, expansive, or irritable mood and increased goal-directed activity/energy lasting at least 1 week (or
any duration if hospitalization is required). The patient has 7 days of elevated mood with 5 associated
symptoms, meeting full manic episode criteria. The history of hospitalization further supports Bipolar I.
Bipolar II requires hypomania (4+ days) plus major depressive episodes. Cyclothymic requires 2+ years of
hypomanic and depressive symptoms not meeting full criteria.
QUESTION 5
A 70-year-old male presents with progressive memory loss, difficulty with executive functioning, and
behavioral changes over the past 5 years. Brain imaging reveals hippocampal atrophy. He has difficulty with
instrumental activities of daily living including managing finances and cooking. His MoCA score is 15/30.
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 5 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 38-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 24
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 24
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. The patient's history of childhood sexual abuse and persistent symptoms indicate
chronic PTSD.
QUESTION 7
A 48-year-old male with a 30-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 and what is the most appropriate treatment?
A) Vitamin B12 deficiency; Oral vitamin B12 supplementation
B) Thiamine (Vitamin B1) deficiency; Intravenous thiamine
C) Folate deficiency; Oral folic acid
D) Vitamin D deficiency; Oral vitamin D supplementation
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. IV thiamine is the most appropriate treatment to prevent progression to Korsakoff's syndrome.
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
NRNP 6635 FINAL EXAM (V2) - ACTUAL EXAM 2026/2027 |
COMPLETE COURSE REVIEW | EXPERT VERIFIED | 100
VERIFIED Q&A | COMPLETE RATIONALES | PASS
GUARANTEED - A+ GRADED
QUESTION 1
A 55-year-old male presents with a 6-week history of depressed mood, anhedonia, significant weight loss,
insomnia, psychomotor retardation, fatigue, feelings of worthlessness, and diminished ability to concentrate.
He reports these symptoms cause clinically significant distress and impair his occupational functioning. He
has a history of three prior depressive episodes in the past 12 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 three 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 42-year-old female presents with a 5-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 clonazepam 0.5 mg TID by her primary care
provider. Which of the following is the most appropriate next step in her management?
A) Continue clonazepam and add fluoxetine
B) Taper clonazepam and initiate sertraline
C) Increase clonazepam to 1 mg TID
D) Continue clonazepam and add cognitive behavioral therapy
,2
Correct Answer: B
Rationale: Tapering clonazepam and initiating sertraline (SSRI) is the most appropriate next step.
Benzodiazepines like clonazepam 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. The patient's 5-year history of
benzodiazepine use requires careful tapering.
QUESTION 3
A 26-year-old male presents with a 5-month history of auditory hallucinations, delusions of persecution,
disorganized speech, and negative symptoms including flat affect and avolition. Symptoms have persisted for
6 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: A
Rationale: Schizophrenia requires at least 2 core symptoms (delusions, hallucinations, disorganized speech,
grossly disorganized/catatonic behavior, negative symptoms) for a significant portion of time during a 1-
month period, with continuous signs of disturbance for at least 6 months. The patient has a 6-month total
duration with active symptoms for 5 months, meeting the 6-month criterion. Schizophreniform Disorder
requires 1-6 months duration but the patient has reached 6 months. Brief Psychotic Disorder requires 1 day to
1 month. Schizoaffective Disorder requires concurrent mood episodes.
QUESTION 4
A 52-year-old female presents with episodes of elevated mood, decreased need for sleep, racing thoughts,
distractibility, and increased goal-directed activity lasting 7 days. She reports these episodes alternate with
periods of depression lasting 3 weeks. During the current episode, she has no psychotic features but has been
hospitalized in the past for similar episodes. 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: A
Rationale: Bipolar I Disorder, Manic Episode requires a distinct period of abnormally and persistently
elevated, expansive, or irritable mood and increased goal-directed activity/energy lasting at least 1 week (or
any duration if hospitalization is required). The patient has 7 days of elevated mood with 5 associated
symptoms, meeting full manic episode criteria. The history of hospitalization further supports Bipolar I.
Bipolar II requires hypomania (4+ days) plus major depressive episodes. Cyclothymic requires 2+ years of
hypomanic and depressive symptoms not meeting full criteria.
QUESTION 5
A 70-year-old male presents with progressive memory loss, difficulty with executive functioning, and
behavioral changes over the past 5 years. Brain imaging reveals hippocampal atrophy. He has difficulty with
instrumental activities of daily living including managing finances and cooking. His MoCA score is 15/30.
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 5 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 38-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 24
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 24
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. The patient's history of childhood sexual abuse and persistent symptoms indicate
chronic PTSD.
QUESTION 7
A 48-year-old male with a 30-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 and what is the most appropriate treatment?
A) Vitamin B12 deficiency; Oral vitamin B12 supplementation
B) Thiamine (Vitamin B1) deficiency; Intravenous thiamine
C) Folate deficiency; Oral folic acid
D) Vitamin D deficiency; Oral vitamin D supplementation
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. IV thiamine is the most appropriate treatment to prevent progression to Korsakoff's syndrome.
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
