NP Mental Health Case Scenarios
Mastery Test Bank Exam -
150Questions, Answers And Rationales
2025/2026
1. A 32-year-old female presents with persistent sadness, low
energy, and loss of interest in activities she previously enjoyed.
She reports difficulty sleeping and poor appetite. Which is the
most appropriate initial pharmacologic intervention?
SSRIs (e.g., sertraline)
Rationale: SSRIs are first-line treatment for major depressive
disorder due to efficacy, tolerability, and safety profile.
2. A 45-year-old male with schizophrenia is experiencing auditory
hallucinations and paranoid delusions. He has been noncompliant
with oral medications. What is the most appropriate next step?
Consider long-acting injectable antipsychotic
Rationale: Long-acting injectables improve adherence in patients
with poor compliance and reduce relapse risk.
3. A 28-year-old female presents with panic attacks occurring
unexpectedly, accompanied by palpitations, sweating, and fear of
dying. What is the first-line treatment?
Cognitive Behavioral Therapy (CBT) and SSRIs
Rationale: CBT is highly effective for panic disorder, and SSRIs
are first-line pharmacotherapy.
4. A patient presents with chronic insomnia. Which
nonpharmacologic intervention should be prioritized?
Cognitive Behavioral Therapy for Insomnia (CBT-I)
, Rationale: CBT-I is more effective than pharmacologic treatment
for long-term management of insomnia.
5. A 19-year-old college student reports social anxiety, fear of
embarrassment, and avoidance of social situations. Which
intervention is most appropriate?
CBT with exposure therapy
Rationale: CBT with exposure therapy is first-line for social
anxiety disorder.
6. A patient with bipolar disorder presents in a manic episode with
psychotic features. What is the best initial treatment?
Lithium or atypical antipsychotic
Rationale: Mood stabilizers or atypical antipsychotics are
indicated for acute mania; lithium is first-line unless
contraindicated.
7. A 60-year-old male reports gradual memory decline, difficulty
performing daily tasks, and personality changes. What is the most
likely diagnosis?
Alzheimer’s disease
Rationale: Progressive memory loss, functional decline, and
personality changes are hallmark features of Alzheimer’s
dementia.
8. A patient presents with excessive worry, restlessness, and muscle
tension for more than 6 months. Which pharmacologic agent is
preferred?
SSRIs (e.g., escitalopram)
Rationale: SSRIs are first-line treatment for generalized anxiety
disorder due to efficacy and safety.
, 9. A patient with major depressive disorder has inadequate response
to an SSRI after 8 weeks. What is the next step?
Switch to a different class antidepressant (e.g., SNRI)
Rationale: Switching to another class is appropriate after an
inadequate response to optimize efficacy.
10. A patient presents with obsessive hand-washing rituals
causing distress and functional impairment. What is first-line
treatment?
CBT with exposure and response prevention (ERP)
Rationale: ERP is the gold-standard therapy for OCD; SSRIs can
be adjunctive if symptoms are severe.
11. A 35-year-old patient presents with chronic fatigue, low
mood, and hopelessness. She denies suicidal ideation. Which
assessment is essential before starting pharmacologic treatment?
Screen for bipolar disorder
Rationale: Antidepressants alone can precipitate mania in
undiagnosed bipolar disorder.
12. A patient with PTSD experiences nightmares, flashbacks, and
hypervigilance after a traumatic event. First-line treatment
includes:
Trauma-focused CBT and SSRIs
Rationale: Evidence supports trauma-focused CBT and SSRIs as
first-line interventions for PTSD.
13. A 40-year-old male with a history of alcohol use disorder
presents with insomnia and anxiety after 3 days of abstinence.
Which intervention is most appropriate?
Benzodiazepine taper for acute withdrawal
Rationale: Benzodiazepines prevent severe withdrawal
symptoms such as seizures and delirium tremens.
Mastery Test Bank Exam -
150Questions, Answers And Rationales
2025/2026
1. A 32-year-old female presents with persistent sadness, low
energy, and loss of interest in activities she previously enjoyed.
She reports difficulty sleeping and poor appetite. Which is the
most appropriate initial pharmacologic intervention?
SSRIs (e.g., sertraline)
Rationale: SSRIs are first-line treatment for major depressive
disorder due to efficacy, tolerability, and safety profile.
2. A 45-year-old male with schizophrenia is experiencing auditory
hallucinations and paranoid delusions. He has been noncompliant
with oral medications. What is the most appropriate next step?
Consider long-acting injectable antipsychotic
Rationale: Long-acting injectables improve adherence in patients
with poor compliance and reduce relapse risk.
3. A 28-year-old female presents with panic attacks occurring
unexpectedly, accompanied by palpitations, sweating, and fear of
dying. What is the first-line treatment?
Cognitive Behavioral Therapy (CBT) and SSRIs
Rationale: CBT is highly effective for panic disorder, and SSRIs
are first-line pharmacotherapy.
4. A patient presents with chronic insomnia. Which
nonpharmacologic intervention should be prioritized?
Cognitive Behavioral Therapy for Insomnia (CBT-I)
, Rationale: CBT-I is more effective than pharmacologic treatment
for long-term management of insomnia.
5. A 19-year-old college student reports social anxiety, fear of
embarrassment, and avoidance of social situations. Which
intervention is most appropriate?
CBT with exposure therapy
Rationale: CBT with exposure therapy is first-line for social
anxiety disorder.
6. A patient with bipolar disorder presents in a manic episode with
psychotic features. What is the best initial treatment?
Lithium or atypical antipsychotic
Rationale: Mood stabilizers or atypical antipsychotics are
indicated for acute mania; lithium is first-line unless
contraindicated.
7. A 60-year-old male reports gradual memory decline, difficulty
performing daily tasks, and personality changes. What is the most
likely diagnosis?
Alzheimer’s disease
Rationale: Progressive memory loss, functional decline, and
personality changes are hallmark features of Alzheimer’s
dementia.
8. A patient presents with excessive worry, restlessness, and muscle
tension for more than 6 months. Which pharmacologic agent is
preferred?
SSRIs (e.g., escitalopram)
Rationale: SSRIs are first-line treatment for generalized anxiety
disorder due to efficacy and safety.
, 9. A patient with major depressive disorder has inadequate response
to an SSRI after 8 weeks. What is the next step?
Switch to a different class antidepressant (e.g., SNRI)
Rationale: Switching to another class is appropriate after an
inadequate response to optimize efficacy.
10. A patient presents with obsessive hand-washing rituals
causing distress and functional impairment. What is first-line
treatment?
CBT with exposure and response prevention (ERP)
Rationale: ERP is the gold-standard therapy for OCD; SSRIs can
be adjunctive if symptoms are severe.
11. A 35-year-old patient presents with chronic fatigue, low
mood, and hopelessness. She denies suicidal ideation. Which
assessment is essential before starting pharmacologic treatment?
Screen for bipolar disorder
Rationale: Antidepressants alone can precipitate mania in
undiagnosed bipolar disorder.
12. A patient with PTSD experiences nightmares, flashbacks, and
hypervigilance after a traumatic event. First-line treatment
includes:
Trauma-focused CBT and SSRIs
Rationale: Evidence supports trauma-focused CBT and SSRIs as
first-line interventions for PTSD.
13. A 40-year-old male with a history of alcohol use disorder
presents with insomnia and anxiety after 3 days of abstinence.
Which intervention is most appropriate?
Benzodiazepine taper for acute withdrawal
Rationale: Benzodiazepines prevent severe withdrawal
symptoms such as seizures and delirium tremens.
