NSG 526 Exam 3 | Exam Guide with Correct Answers and
Rationales – Latest Update 2026/2027 | Already Graded A+
Question 1. A patient with major depressive disorder reports feeling hopeless
and says, “My family would be better off without me.” The patient denies
having a suicide plan. Which action should the PMHNP take first?
A. Document that the patient is not suicidal because there is no plan
B. Conduct a comprehensive suicide-risk assessment
C. Recommend outpatient psychotherapy without further assessment
D. Ask the patient to promise not to attempt suicide
Correct Answer: B
Rationale: Passive death wishes and statements about being a burden are
clinically significant suicide-risk indicators. The absence of a specific plan
does not eliminate risk. The PMHNP should assess suicidal thoughts, intent,
planning, access to means, previous attempts, protective factors, substance
use, and other risk factors.
Question 2. A patient states, “I have decided exactly how I will kill myself, and
I have the means available at home.” Which finding is most concerning?
A. Passive sadness
B. Specific suicide plan with access to means
C. Mild insomnia
D. Reduced appetite
Correct Answer: B
Rationale: A specific suicide plan combined with access to the intended
means substantially increases immediate safety concerns. The clinician must
determine imminence and take appropriate protective measures rather than
relying solely on outpatient follow-up.
1
,Question 3. A patient with depression suddenly becomes cheerful and begins
giving away possessions after previously expressing suicidal thoughts. Which
interpretation is most appropriate?
A. The depression has definitely resolved
B. The behavioral change warrants immediate reassessment of suicide risk
C. The patient is demonstrating improved insight
D. The patient no longer requires monitoring
Correct Answer: B
Rationale: A sudden behavioral change after suicidal thinking can represent
increased risk rather than recovery. Giving away possessions and making final
arrangements can be warning signs of suicidal preparation. The clinician
should reassess risk immediately.
Question 4. A patient reports depressed mood, anhedonia, fatigue, impaired
concentration, appetite changes, and recurrent thoughts of death. Which
assessment is most important before finalizing a diagnosis?
A. Determine whether symptoms could be explained by substances,
medications, medical conditions, or bipolar disorder
B. Ask only about childhood experiences
C. Assume the patient has unipolar depression
D. Diagnose persistent depressive disorder immediately
Correct Answer: A
Rationale: A comprehensive differential diagnosis is essential. Depressive
symptoms can occur in major depressive disorder, bipolar disorder,
substance-induced conditions, medication effects, and medical illnesses.
Missing bipolar disorder can significantly affect treatment planning.
Question 5. A patient with depression reports a previous period lasting
several weeks during which the patient slept only three hours nightly, had
unusually high energy, spent large amounts of money, and believed they could
accomplish anything. What diagnosis should be carefully considered?
2
,A. Bipolar disorder
B. Specific phobia
C. Somatic symptom disorder
D. Dissociative amnesia
Correct Answer: A
Rationale: A history of sustained elevated or expansive mood, decreased
need for sleep, increased energy, grandiosity, and risky behavior suggests a
possible manic or hypomanic episode. This history is critical when
differentiating bipolar depression from unipolar depression.
Question 6. A patient experiencing mania says, “I have discovered a business
strategy that will make me the richest person in the world,” while
simultaneously spending thousands of dollars impulsively. Which
combination is most characteristic?
A. Grandiosity and impaired judgment
B. Obsession and compulsion
C. Depersonalization and derealization
D. Avolition and alogia
Correct Answer: A
Rationale: Grandiose beliefs or inflated self-confidence are common during
mania. Impulsive spending represents impaired judgment and potentially
dangerous goal-directed behavior.
Question 7. A patient with bipolar disorder has pressured speech, racing
thoughts, distractibility, and increased goal-directed activity. Which MSE
finding would further support mania?
A. Decreased need for sleep
B. Flat affect only
C. Psychomotor retardation
D. Social withdrawal
3
, Correct Answer: A
Rationale: Decreased need for sleep is a classic feature of mania. The patient
may sleep very little without experiencing the fatigue expected from ordinary
sleep deprivation.
Question 8. A patient with bipolar disorder states, “I don't need medication
because I have never felt better in my life.” What should the PMHNP
recognize?
A. The statement may reflect impaired insight associated with mania
B. The patient has demonstrated complete insight
C. The patient is necessarily malingering
D. The patient is experiencing delirium
Correct Answer: A
Rationale: During mania, patients may perceive their elevated energy and
confidence as desirable and may not recognize the associated impairment or
risk. This can reduce treatment adherence and complicate decision-making.
Question 9. A patient reports recurrent unexpected episodes of intense fear
accompanied by palpitations, sweating, trembling, and shortness of breath.
The patient now avoids leaving home because of fear of another episode.
Which assessment is most important?
A. Assess for panic disorder and agoraphobic avoidance
B. Diagnose schizophrenia
C. Assess only for obsessive-compulsive disorder
D. Diagnose a personality disorder
Correct Answer: A
Rationale: Recurrent panic attacks followed by persistent concern or
avoidance may indicate panic disorder. Avoidance of situations because
escape or assistance may be difficult should also prompt assessment for
agoraphobia.
4
Rationales – Latest Update 2026/2027 | Already Graded A+
Question 1. A patient with major depressive disorder reports feeling hopeless
and says, “My family would be better off without me.” The patient denies
having a suicide plan. Which action should the PMHNP take first?
A. Document that the patient is not suicidal because there is no plan
B. Conduct a comprehensive suicide-risk assessment
C. Recommend outpatient psychotherapy without further assessment
D. Ask the patient to promise not to attempt suicide
Correct Answer: B
Rationale: Passive death wishes and statements about being a burden are
clinically significant suicide-risk indicators. The absence of a specific plan
does not eliminate risk. The PMHNP should assess suicidal thoughts, intent,
planning, access to means, previous attempts, protective factors, substance
use, and other risk factors.
Question 2. A patient states, “I have decided exactly how I will kill myself, and
I have the means available at home.” Which finding is most concerning?
A. Passive sadness
B. Specific suicide plan with access to means
C. Mild insomnia
D. Reduced appetite
Correct Answer: B
Rationale: A specific suicide plan combined with access to the intended
means substantially increases immediate safety concerns. The clinician must
determine imminence and take appropriate protective measures rather than
relying solely on outpatient follow-up.
1
,Question 3. A patient with depression suddenly becomes cheerful and begins
giving away possessions after previously expressing suicidal thoughts. Which
interpretation is most appropriate?
A. The depression has definitely resolved
B. The behavioral change warrants immediate reassessment of suicide risk
C. The patient is demonstrating improved insight
D. The patient no longer requires monitoring
Correct Answer: B
Rationale: A sudden behavioral change after suicidal thinking can represent
increased risk rather than recovery. Giving away possessions and making final
arrangements can be warning signs of suicidal preparation. The clinician
should reassess risk immediately.
Question 4. A patient reports depressed mood, anhedonia, fatigue, impaired
concentration, appetite changes, and recurrent thoughts of death. Which
assessment is most important before finalizing a diagnosis?
A. Determine whether symptoms could be explained by substances,
medications, medical conditions, or bipolar disorder
B. Ask only about childhood experiences
C. Assume the patient has unipolar depression
D. Diagnose persistent depressive disorder immediately
Correct Answer: A
Rationale: A comprehensive differential diagnosis is essential. Depressive
symptoms can occur in major depressive disorder, bipolar disorder,
substance-induced conditions, medication effects, and medical illnesses.
Missing bipolar disorder can significantly affect treatment planning.
Question 5. A patient with depression reports a previous period lasting
several weeks during which the patient slept only three hours nightly, had
unusually high energy, spent large amounts of money, and believed they could
accomplish anything. What diagnosis should be carefully considered?
2
,A. Bipolar disorder
B. Specific phobia
C. Somatic symptom disorder
D. Dissociative amnesia
Correct Answer: A
Rationale: A history of sustained elevated or expansive mood, decreased
need for sleep, increased energy, grandiosity, and risky behavior suggests a
possible manic or hypomanic episode. This history is critical when
differentiating bipolar depression from unipolar depression.
Question 6. A patient experiencing mania says, “I have discovered a business
strategy that will make me the richest person in the world,” while
simultaneously spending thousands of dollars impulsively. Which
combination is most characteristic?
A. Grandiosity and impaired judgment
B. Obsession and compulsion
C. Depersonalization and derealization
D. Avolition and alogia
Correct Answer: A
Rationale: Grandiose beliefs or inflated self-confidence are common during
mania. Impulsive spending represents impaired judgment and potentially
dangerous goal-directed behavior.
Question 7. A patient with bipolar disorder has pressured speech, racing
thoughts, distractibility, and increased goal-directed activity. Which MSE
finding would further support mania?
A. Decreased need for sleep
B. Flat affect only
C. Psychomotor retardation
D. Social withdrawal
3
, Correct Answer: A
Rationale: Decreased need for sleep is a classic feature of mania. The patient
may sleep very little without experiencing the fatigue expected from ordinary
sleep deprivation.
Question 8. A patient with bipolar disorder states, “I don't need medication
because I have never felt better in my life.” What should the PMHNP
recognize?
A. The statement may reflect impaired insight associated with mania
B. The patient has demonstrated complete insight
C. The patient is necessarily malingering
D. The patient is experiencing delirium
Correct Answer: A
Rationale: During mania, patients may perceive their elevated energy and
confidence as desirable and may not recognize the associated impairment or
risk. This can reduce treatment adherence and complicate decision-making.
Question 9. A patient reports recurrent unexpected episodes of intense fear
accompanied by palpitations, sweating, trembling, and shortness of breath.
The patient now avoids leaving home because of fear of another episode.
Which assessment is most important?
A. Assess for panic disorder and agoraphobic avoidance
B. Diagnose schizophrenia
C. Assess only for obsessive-compulsive disorder
D. Diagnose a personality disorder
Correct Answer: A
Rationale: Recurrent panic attacks followed by persistent concern or
avoidance may indicate panic disorder. Avoidance of situations because
escape or assistance may be difficult should also prompt assessment for
agoraphobia.
4
