NRNP6665 Midterm Exam - 2026/2027 |
Questions & Verified Answers | 100% Correct |
Grade A | PMHNP Assessment
Time limit: 2 h Pass mark: 80 % (44/55)
DOMAIN 1 – DIAGNOSIS & INITIAL MANAGEMENT OF MAJOR DISORDERS
(22 QUESTIONS)
Q1
A 19-year-old college student presents with 3-week history of severely depressed mood,
anhedonia, 10-lb weight loss, insomnia, fatigue, and difficulty concentrating. He reports
passive suicidal ideation but no plan. No prior psychiatric history, denies substances.
MSE: psychomotor retardation, constricted affect. The most appropriate initial
intervention is:
A. Start CBT and schedule weekly follow-up.
B. Start sertraline 50 mg daily, educate on activation, follow-up in 2 weeks for safety.
C. Start bupropion XL 150 mg daily for activating/weight-neutral profile.
D. Refer for immediate psychiatric hospitalization due to suicidal ideation.
Correct Answer: B
,Rationale: First-episode MDD moderate-severe; SSRI first-line with close safety
monitoring. Bupropion (C) may worsen insomnia/anxiety. Hospitalization (D) not
needed for passive SI without intent/plan.
Q2
A 36-year-old woman describes 6 months of near-daily worry about job security,
finances, and children’s health. She notes muscle tension, irritability, and sleep-onset
insomnia. PHQ-9 = 6. No discrete panic attacks. Which diagnosis is PRIMARY?
A. MDD
B. GAD
C. Panic disorder
D. Adjustment disorder
Correct Answer: B
Rationale: > 6 months of excessive worry plus 3 associated symptoms → GAD. Low
PHQ-9 rules out MDD.
Q3
The same patient (Q2) has no prior meds. Which initial pharmacotherapy is BEST?
A. Sertraline 25 mg daily.
B. Lorazepam 1 mg bid PRN.
C. Hydroxyzine 50 mg nightly.
,D. Quetiapine 50 mg hs.
Correct Answer: A
Rationale: SSRI (sertraline) first-line for GAD per APA. Benzodiazepines (B) not first-line;
hydroxyzine (C) short-acting, sedating; quetiapine (D) not first-line.
Q4
A 24-year-old graduate student reports discrete 10-minute episodes of palpitations,
dizziness, fear of dying, occurring 2×/week for 2 months. Between episodes she worries
about next attack. She avoids subways. Which INITIAL medication?
A. Sertraline 25 mg daily.
B. Propranolol 20 mg bid.
C. Alprazolam 0.5 mg bid.
D. Risperidone 1 mg hs.
Correct Answer: A
Rationale: Panic disorder → SSRI first-line. Propranolol (B) only situational; alprazolam
(C) high dependence risk.
Q5
A 32-year-old man with 8-year history of weekly migraine with aura is started on
sertraline 50 mg for panic disorder. Two weeks later he reports increased migraine
frequency. Which is BEST?
A. Discontinue sertraline immediately.
, B. Increase sertraline to 100 mg.
C. Switch to paroxetine.
D. Add sumatriptan PRN.
Correct Answer: C
Rationale: SSRIs can lower serotonin threshold for aura; switching to paroxetine
(stronger 2D6 inhibition, less serotonergic surge) often helps. Not class effect →
another SSRI reasonable before abandoning.
Q6
A 17-year-old girl presents with 4-week history of elevated mood, decreased sleep to 4
h, excessive texting with friends, and spending $300 on makeup. She denies
hallucinations. Previous similar 5-day episode 6 months ago. MOST likely diagnosis?
A. Bipolar I
B. Bipolar II
C. Cyclothymia
D. ADHD with mood lability
Correct Answer: B
Rationale: Hypomanic episode (4 days not requiring hospitalization) + previous similar
→ bipolar II. No psychosis → not bipolar I.
Q7
Questions & Verified Answers | 100% Correct |
Grade A | PMHNP Assessment
Time limit: 2 h Pass mark: 80 % (44/55)
DOMAIN 1 – DIAGNOSIS & INITIAL MANAGEMENT OF MAJOR DISORDERS
(22 QUESTIONS)
Q1
A 19-year-old college student presents with 3-week history of severely depressed mood,
anhedonia, 10-lb weight loss, insomnia, fatigue, and difficulty concentrating. He reports
passive suicidal ideation but no plan. No prior psychiatric history, denies substances.
MSE: psychomotor retardation, constricted affect. The most appropriate initial
intervention is:
A. Start CBT and schedule weekly follow-up.
B. Start sertraline 50 mg daily, educate on activation, follow-up in 2 weeks for safety.
C. Start bupropion XL 150 mg daily for activating/weight-neutral profile.
D. Refer for immediate psychiatric hospitalization due to suicidal ideation.
Correct Answer: B
,Rationale: First-episode MDD moderate-severe; SSRI first-line with close safety
monitoring. Bupropion (C) may worsen insomnia/anxiety. Hospitalization (D) not
needed for passive SI without intent/plan.
Q2
A 36-year-old woman describes 6 months of near-daily worry about job security,
finances, and children’s health. She notes muscle tension, irritability, and sleep-onset
insomnia. PHQ-9 = 6. No discrete panic attacks. Which diagnosis is PRIMARY?
A. MDD
B. GAD
C. Panic disorder
D. Adjustment disorder
Correct Answer: B
Rationale: > 6 months of excessive worry plus 3 associated symptoms → GAD. Low
PHQ-9 rules out MDD.
Q3
The same patient (Q2) has no prior meds. Which initial pharmacotherapy is BEST?
A. Sertraline 25 mg daily.
B. Lorazepam 1 mg bid PRN.
C. Hydroxyzine 50 mg nightly.
,D. Quetiapine 50 mg hs.
Correct Answer: A
Rationale: SSRI (sertraline) first-line for GAD per APA. Benzodiazepines (B) not first-line;
hydroxyzine (C) short-acting, sedating; quetiapine (D) not first-line.
Q4
A 24-year-old graduate student reports discrete 10-minute episodes of palpitations,
dizziness, fear of dying, occurring 2×/week for 2 months. Between episodes she worries
about next attack. She avoids subways. Which INITIAL medication?
A. Sertraline 25 mg daily.
B. Propranolol 20 mg bid.
C. Alprazolam 0.5 mg bid.
D. Risperidone 1 mg hs.
Correct Answer: A
Rationale: Panic disorder → SSRI first-line. Propranolol (B) only situational; alprazolam
(C) high dependence risk.
Q5
A 32-year-old man with 8-year history of weekly migraine with aura is started on
sertraline 50 mg for panic disorder. Two weeks later he reports increased migraine
frequency. Which is BEST?
A. Discontinue sertraline immediately.
, B. Increase sertraline to 100 mg.
C. Switch to paroxetine.
D. Add sumatriptan PRN.
Correct Answer: C
Rationale: SSRIs can lower serotonin threshold for aura; switching to paroxetine
(stronger 2D6 inhibition, less serotonergic surge) often helps. Not class effect →
another SSRI reasonable before abandoning.
Q6
A 17-year-old girl presents with 4-week history of elevated mood, decreased sleep to 4
h, excessive texting with friends, and spending $300 on makeup. She denies
hallucinations. Previous similar 5-day episode 6 months ago. MOST likely diagnosis?
A. Bipolar I
B. Bipolar II
C. Cyclothymia
D. ADHD with mood lability
Correct Answer: B
Rationale: Hypomanic episode (4 days not requiring hospitalization) + previous similar
→ bipolar II. No psychosis → not bipolar I.
Q7
