NRNP 6675 WEEK 9 PATIENT SCENARIOS
| 2026/2027 UPDATED | COMPLETE
PRACTICE QUESTIONS, SOLUTIONS &
DETAILED RATIONALES
Study-use note: This is an original practice question bank based on the subject area
indicated by the title. It is not an official course assessment, confidential question set,
or official answer key, and no grade or exam outcome can be guaranteed.
INTRODUCTION
NRNP 6675 Week 9 Patient Scenarios practice is designed to help advanced-practice
nursing students apply psychiatric assessment, diagnostic reasoning, treatment
planning, medication management, safety assessment, and clinical decision-making to
realistic patient presentations. Scenario-based questions are particularly valuable
because psychiatric cases rarely present as a single textbook diagnosis; instead,
clinicians must integrate symptoms, duration, functional impairment, substance use,
medical conditions, medications, risk factors, mental-status findings, and psychosocial
context. This practice bank emphasizes clinical reasoning rather than simple
memorization. Each question presents a challenging patient situation requiring
selection of the most appropriate diagnosis, assessment step, intervention, medication
strategy, monitoring plan, or patient education response. The accompanying rationales
explain the reasoning behind the best answer and distinguish it from plausible
alternatives. Use the questions to identify gaps in diagnostic reasoning and
pharmacologic knowledge, then review the rationale after attempting each item
independently.
CORE DOMAINS TESTED
1.
Psychiatric Assessment — Comprehensive history, mental-status
examination, differential diagnosis, and clinical formulation.
2.
3.
Diagnostic Reasoning — Distinguishing psychiatric disorders with
overlapping symptoms.
4.
5.
1
, Risk Assessment — Suicide, self-harm, violence, psychosis, and acute safety
concerns.
6.
7.
Psychopharmacology — Medication selection, adverse effects, interactions,
contraindications, and monitoring.
8.
9.
Mood Disorders — Recognition and management of depressive and bipolar
presentations.
10.
11.
Anxiety & Trauma-Related Disorders — Differential diagnosis and
evidence-based treatment.
12.
13.
Psychotic Disorders — Assessment of psychosis and antipsychotic
management.
14.
15.
Substance-Related Presentations — Intoxication, withdrawal, comorbidity,
and treatment considerations.
16.
17.
Medical/Psychiatric Differentials — Identifying medical or medication-
induced causes of psychiatric symptoms.
18.
19.
Clinical Follow-Up — Treatment response, adherence, safety planning, and
longitudinal management.
20.
QUESTIONS 1-100
2
, Q1: A 32-year-old patient presents with depressed mood, anhedonia, insomnia,
decreased appetite, poor concentration, and feelings of worthlessness for 3 weeks. The
patient denies psychosis or mania. Symptoms have significantly impaired
occupational functioning. Which diagnostic formulation is most appropriate?
A) Adjustment disorder with depressed mood
B) Major depressive disorder, current episode without psychotic features
C) Persistent depressive disorder
D) Bipolar II disorder
Rationale: B is correct because the patient has a sustained cluster of depressive
symptoms lasting at least 2 weeks with clinically significant impairment and no
evidence of mania or hypomania. A is less appropriate when full criteria for a major
depressive episode are met. C requires a chronic depressed mood pattern lasting at
least 2 years in adults. D requires a history of hypomania and a major depressive
episode.
Q2: A patient with recurrent depression reports that previous antidepressant trials
caused agitation, decreased need for sleep, and unusually elevated energy lasting
several days. What is the most important next step?
A) Increase the antidepressant dose
B) Clarify whether the patient has experienced prior hypomanic or manic
episodes
C) Discontinue all psychiatric treatment permanently
D) Diagnose generalized anxiety disorder
Rationale: B is correct because antidepressant-associated activation may reflect an
underlying bipolar-spectrum illness, although medication effects must be
distinguished from spontaneous episodes. A could worsen mood instability if bipolar
disorder is present. C is unnecessarily absolute. D does not explain the episodic
elevated-energy symptoms.
Q3: A patient reports four days of decreased need for sleep, increased goal-directed
activity, pressured speech, and impulsive spending but no marked functional
impairment, hospitalization, or psychosis. Which feature is most important when
distinguishing hypomania from mania?
A) Presence of anxiety
B) Degree of functional impairment and severity
C) Whether the patient has a college degree
D) Presence of appetite changes
Rationale: B is correct because mania is characterized by more severe impairment,
possible hospitalization, or psychosis, whereas hypomania is a distinct period of
elevated or irritable mood and increased activity without marked functional
impairment or psychosis. The other characteristics do not establish the distinction.
Q4: A patient taking lithium develops coarse tremor, vomiting, diarrhea, ataxia, and
confusion. What is the priority?
3
| 2026/2027 UPDATED | COMPLETE
PRACTICE QUESTIONS, SOLUTIONS &
DETAILED RATIONALES
Study-use note: This is an original practice question bank based on the subject area
indicated by the title. It is not an official course assessment, confidential question set,
or official answer key, and no grade or exam outcome can be guaranteed.
INTRODUCTION
NRNP 6675 Week 9 Patient Scenarios practice is designed to help advanced-practice
nursing students apply psychiatric assessment, diagnostic reasoning, treatment
planning, medication management, safety assessment, and clinical decision-making to
realistic patient presentations. Scenario-based questions are particularly valuable
because psychiatric cases rarely present as a single textbook diagnosis; instead,
clinicians must integrate symptoms, duration, functional impairment, substance use,
medical conditions, medications, risk factors, mental-status findings, and psychosocial
context. This practice bank emphasizes clinical reasoning rather than simple
memorization. Each question presents a challenging patient situation requiring
selection of the most appropriate diagnosis, assessment step, intervention, medication
strategy, monitoring plan, or patient education response. The accompanying rationales
explain the reasoning behind the best answer and distinguish it from plausible
alternatives. Use the questions to identify gaps in diagnostic reasoning and
pharmacologic knowledge, then review the rationale after attempting each item
independently.
CORE DOMAINS TESTED
1.
Psychiatric Assessment — Comprehensive history, mental-status
examination, differential diagnosis, and clinical formulation.
2.
3.
Diagnostic Reasoning — Distinguishing psychiatric disorders with
overlapping symptoms.
4.
5.
1
, Risk Assessment — Suicide, self-harm, violence, psychosis, and acute safety
concerns.
6.
7.
Psychopharmacology — Medication selection, adverse effects, interactions,
contraindications, and monitoring.
8.
9.
Mood Disorders — Recognition and management of depressive and bipolar
presentations.
10.
11.
Anxiety & Trauma-Related Disorders — Differential diagnosis and
evidence-based treatment.
12.
13.
Psychotic Disorders — Assessment of psychosis and antipsychotic
management.
14.
15.
Substance-Related Presentations — Intoxication, withdrawal, comorbidity,
and treatment considerations.
16.
17.
Medical/Psychiatric Differentials — Identifying medical or medication-
induced causes of psychiatric symptoms.
18.
19.
Clinical Follow-Up — Treatment response, adherence, safety planning, and
longitudinal management.
20.
QUESTIONS 1-100
2
, Q1: A 32-year-old patient presents with depressed mood, anhedonia, insomnia,
decreased appetite, poor concentration, and feelings of worthlessness for 3 weeks. The
patient denies psychosis or mania. Symptoms have significantly impaired
occupational functioning. Which diagnostic formulation is most appropriate?
A) Adjustment disorder with depressed mood
B) Major depressive disorder, current episode without psychotic features
C) Persistent depressive disorder
D) Bipolar II disorder
Rationale: B is correct because the patient has a sustained cluster of depressive
symptoms lasting at least 2 weeks with clinically significant impairment and no
evidence of mania or hypomania. A is less appropriate when full criteria for a major
depressive episode are met. C requires a chronic depressed mood pattern lasting at
least 2 years in adults. D requires a history of hypomania and a major depressive
episode.
Q2: A patient with recurrent depression reports that previous antidepressant trials
caused agitation, decreased need for sleep, and unusually elevated energy lasting
several days. What is the most important next step?
A) Increase the antidepressant dose
B) Clarify whether the patient has experienced prior hypomanic or manic
episodes
C) Discontinue all psychiatric treatment permanently
D) Diagnose generalized anxiety disorder
Rationale: B is correct because antidepressant-associated activation may reflect an
underlying bipolar-spectrum illness, although medication effects must be
distinguished from spontaneous episodes. A could worsen mood instability if bipolar
disorder is present. C is unnecessarily absolute. D does not explain the episodic
elevated-energy symptoms.
Q3: A patient reports four days of decreased need for sleep, increased goal-directed
activity, pressured speech, and impulsive spending but no marked functional
impairment, hospitalization, or psychosis. Which feature is most important when
distinguishing hypomania from mania?
A) Presence of anxiety
B) Degree of functional impairment and severity
C) Whether the patient has a college degree
D) Presence of appetite changes
Rationale: B is correct because mania is characterized by more severe impairment,
possible hospitalization, or psychosis, whereas hypomania is a distinct period of
elevated or irritable mood and increased activity without marked functional
impairment or psychosis. The other characteristics do not establish the distinction.
Q4: A patient taking lithium develops coarse tremor, vomiting, diarrhea, ataxia, and
confusion. What is the priority?
3
