NR605 / NR 605 Final Exam (Latest Update 2025 /
2026): Diagnosis & Management in Psychiatric-
Mental Health across the Lifespan I Practicum |
Weeks 5 - 8 Covered | Questions and Verified Answers
| 100% Correct - Chamberlain
WEEK 5: MOOD DISORDERS
Question 1
A 28-year-old female reports 3 weeks of depressed mood, anhedonia, insomnia, fatigue, and
suicidal ideation. No manic symptoms. Diagnosis?
Answer: Major Depressive Disorder (MDD), Severe with Suicidal Ideation
Rationale: DSM-5-TR: ≥5 symptoms ≥2 weeks, including depressed mood/anhedonia. Clinical
Implication: Immediate safety assessment; SSRI + psychotherapy.
Question 2
A 35-year-old male has 5 days of elevated mood, grandiosity, decreased need for sleep, and risky
behavior. Past depressive episode. Diagnosis?
Answer: Bipolar I Disorder, Current Manic Episode
Rationale: DSM-5-TR: Manic episode ≥1 week + impairment. Clinical Implication: Mood
stabilizer (lithium/valproate) + antipsychotic.
Question 3
A 22-year-old female has mood swings, irritability, and bloating 1 week before menses,
resolving with menstruation. Diagnosis?
Answer: Premenstrual Dysphoric Disorder (PMDD)
Rationale: DSM-5-TR: ≥5 symptoms in luteal phase, remit post-menses. Clinical Implication:
SSRI (fluoxetine) or OCPs.
Question 4
First-line pharmacologic treatment for MDD in a 40-year-old with no prior treatment?
Answer: Sertraline 50 mg daily
Rationale: APA: SSRIs first-line; sertraline favorable side effect profile. Clinical Implication:
Titrate to 100–200 mg.
,Question 5
A 60-year-old male with MDD fails sertraline. Next step?
Answer: Augment with bupropion
Rationale: STAR*D: Augmentation improves response. Clinical Implication: Monitor BP with
bupropion.
Question 6
A 30-year-old female with bipolar I is pregnant. Safest mood stabilizer?
Answer: Lamotrigine
Rationale: Lowest teratogenic risk (Category C). Clinical Implication: Monitor for rash.
Question 7
A 45-year-old with MDD has sexual dysfunction on escitalopram. Next agent?
Answer: Bupropion
Rationale: Minimal sexual side effects. Clinical Implication: Avoid in seizure history.
Question 8
A 25-year-old with bipolar II has hypomania and depression. Best long-term agent?
Answer: Quetiapine
Rationale: FDA-approved for bipolar depression and maintenance. Clinical Implication:
Monitor metabolic parameters.
Question 9
A 50-year-old with MDD and insomnia. Best initial medication?
Answer: Mirtazapine 15 mg HS
Rationale: Sedating antidepressant. Clinical Implication: Weight gain risk.
Question 10
A 19-year-old with first manic episode. Acute treatment?
Answer: Lithium + risperidone
Rationale: Rapid control of mania. Clinical Implication: Monitor lithium levels (0.8–1.2
mEq/L).
, Question 11
A 70-year-old with MDD and cognitive impairment. Best agent?
Answer: Vortioxetine
Rationale: Improves cognition. Clinical Implication: Monitor for nausea.
Question 12
A 32-year-old with PMDD. First-line non-pharmacologic?
Answer: Calcium 1200 mg/day + exercise
Rationale: Evidence-based lifestyle interventions. Clinical Implication: Symptom tracking.
Question 13
A 55-year-old with treatment-resistant depression. Next step after 3 failed SSRIs?
Answer: Esketamine nasal spray
Rationale: FDA-approved for TRD. Clinical Implication: REMS program required.
Question 14
A 40-year-old with bipolar I on lithium develops tremor. Management?
Answer: Reduce dose or add propranolol
Rationale: Dose-dependent side effect. Clinical Implication: Monitor thyroid/renal function.
Question 15
A 27-year-old with MDD and anxiety. Best initial SSRI?
Answer: Escitalopram
Rationale: FDA-approved for GAD and MDD. Clinical Implication: Start 10 mg.
Question 16
A 65-year-old with MDD and Parkinson’s. Best agent?
Answer: Bupropion
Rationale: Dopaminergic activity. Clinical Implication: Avoid anticholinergics.
Question 17
A 38-year-old with bipolar depression. Best agent?
Answer: Lurasidone
Rationale: FDA-approved for bipolar depression. Clinical Implication: Take with food.
2026): Diagnosis & Management in Psychiatric-
Mental Health across the Lifespan I Practicum |
Weeks 5 - 8 Covered | Questions and Verified Answers
| 100% Correct - Chamberlain
WEEK 5: MOOD DISORDERS
Question 1
A 28-year-old female reports 3 weeks of depressed mood, anhedonia, insomnia, fatigue, and
suicidal ideation. No manic symptoms. Diagnosis?
Answer: Major Depressive Disorder (MDD), Severe with Suicidal Ideation
Rationale: DSM-5-TR: ≥5 symptoms ≥2 weeks, including depressed mood/anhedonia. Clinical
Implication: Immediate safety assessment; SSRI + psychotherapy.
Question 2
A 35-year-old male has 5 days of elevated mood, grandiosity, decreased need for sleep, and risky
behavior. Past depressive episode. Diagnosis?
Answer: Bipolar I Disorder, Current Manic Episode
Rationale: DSM-5-TR: Manic episode ≥1 week + impairment. Clinical Implication: Mood
stabilizer (lithium/valproate) + antipsychotic.
Question 3
A 22-year-old female has mood swings, irritability, and bloating 1 week before menses,
resolving with menstruation. Diagnosis?
Answer: Premenstrual Dysphoric Disorder (PMDD)
Rationale: DSM-5-TR: ≥5 symptoms in luteal phase, remit post-menses. Clinical Implication:
SSRI (fluoxetine) or OCPs.
Question 4
First-line pharmacologic treatment for MDD in a 40-year-old with no prior treatment?
Answer: Sertraline 50 mg daily
Rationale: APA: SSRIs first-line; sertraline favorable side effect profile. Clinical Implication:
Titrate to 100–200 mg.
,Question 5
A 60-year-old male with MDD fails sertraline. Next step?
Answer: Augment with bupropion
Rationale: STAR*D: Augmentation improves response. Clinical Implication: Monitor BP with
bupropion.
Question 6
A 30-year-old female with bipolar I is pregnant. Safest mood stabilizer?
Answer: Lamotrigine
Rationale: Lowest teratogenic risk (Category C). Clinical Implication: Monitor for rash.
Question 7
A 45-year-old with MDD has sexual dysfunction on escitalopram. Next agent?
Answer: Bupropion
Rationale: Minimal sexual side effects. Clinical Implication: Avoid in seizure history.
Question 8
A 25-year-old with bipolar II has hypomania and depression. Best long-term agent?
Answer: Quetiapine
Rationale: FDA-approved for bipolar depression and maintenance. Clinical Implication:
Monitor metabolic parameters.
Question 9
A 50-year-old with MDD and insomnia. Best initial medication?
Answer: Mirtazapine 15 mg HS
Rationale: Sedating antidepressant. Clinical Implication: Weight gain risk.
Question 10
A 19-year-old with first manic episode. Acute treatment?
Answer: Lithium + risperidone
Rationale: Rapid control of mania. Clinical Implication: Monitor lithium levels (0.8–1.2
mEq/L).
, Question 11
A 70-year-old with MDD and cognitive impairment. Best agent?
Answer: Vortioxetine
Rationale: Improves cognition. Clinical Implication: Monitor for nausea.
Question 12
A 32-year-old with PMDD. First-line non-pharmacologic?
Answer: Calcium 1200 mg/day + exercise
Rationale: Evidence-based lifestyle interventions. Clinical Implication: Symptom tracking.
Question 13
A 55-year-old with treatment-resistant depression. Next step after 3 failed SSRIs?
Answer: Esketamine nasal spray
Rationale: FDA-approved for TRD. Clinical Implication: REMS program required.
Question 14
A 40-year-old with bipolar I on lithium develops tremor. Management?
Answer: Reduce dose or add propranolol
Rationale: Dose-dependent side effect. Clinical Implication: Monitor thyroid/renal function.
Question 15
A 27-year-old with MDD and anxiety. Best initial SSRI?
Answer: Escitalopram
Rationale: FDA-approved for GAD and MDD. Clinical Implication: Start 10 mg.
Question 16
A 65-year-old with MDD and Parkinson’s. Best agent?
Answer: Bupropion
Rationale: Dopaminergic activity. Clinical Implication: Avoid anticholinergics.
Question 17
A 38-year-old with bipolar depression. Best agent?
Answer: Lurasidone
Rationale: FDA-approved for bipolar depression. Clinical Implication: Take with food.
