1
, 2
Wilkes NSG 526 Exam (1, 2, 3)
Clinical Modalities Adv. Psych
(Latest ) Qs and Ans
with Explanation, Pass with
Confidence
Question 1
During a mental status examination, a patient reports feeling “empty and hopeless,” while the
clinician observes minimal facial expression and monotonous speech. How should these findings
be documented?
A. Depressed affect and blunted mood
B. Depressed mood and blunted affect
C. Flat mood and anxious affect
D. Anhedonic mood and restricted perception
Correct Answer: B. Depressed mood and blunted affect
Verified Explanation
Mood is the patient’s subjective emotional experience and is obtained through self-report,
whereas affect is the clinician’s objective observation of emotional expression. In this scenario,
the patient’s description of feeling empty and hopeless reflects a depressed mood, while the
observed lack of facial expression and monotonous speech reflects blunted affect. This
distinction is clearly defined in the DSM-5-TR and emphasized in advanced psychiatric
assessment literature because accurate documentation supports correct diagnosis and treatment
planning.
Question 2
A patient states, “I don’t want to live anymore,” and admits to having access to a firearm. What
is the PMHNP’s most appropriate immediate action?
A. Encourage protective factors and coping skills
B. Ask the patient to agree to a no-harm contract
C. Perform a structured suicide risk assessment
D. Refer the patient for outpatient psychotherapy
Correct Answer: C. Perform a structured suicide risk assessment
, 3
Verified Explanation
When suicidal ideation is accompanied by access to lethal means, the standard of care requires
an immediate and comprehensive suicide risk assessment. Evidence-based psychiatric guidelines
emphasize that no-harm contracts are not effective in preventing suicide and should not replace
formal evaluation. A structured risk assessment evaluates intent, specificity of the plan, access to
means, past attempts, and protective factors, allowing the clinician to determine the appropriate
level of care and implement safety interventions.
Question 3
Which psychotherapy is most appropriate as first-line treatment for generalized anxiety disorder
in an adult patient?
A. Supportive psychotherapy
B. Cognitive Behavioral Therapy
C. Psychoanalytic psychotherapy
D. Group process therapy
Correct Answer: B. Cognitive Behavioral Therapy
Verified Explanation
Cognitive Behavioral Therapy is widely recognized as the first-line treatment for generalized
anxiety disorder due to its strong evidence base and consistent effectiveness. CBT targets
maladaptive thought patterns and behaviors that perpetuate excessive worry and physiological
arousal. Clinical practice guidelines from major psychiatric organizations endorse CBT because
it provides durable symptom reduction and equips patients with practical coping skills, making it
highly appropriate for advanced psychiatric nursing practice.
Question 4
A patient newly started on sertraline asks why mood improvement has not occurred after one
week. What is the most accurate response?
A. The dose is too low to be effective
B. Antidepressants only work in severe depression
C. Therapeutic effects typically take several weeks
D. Immediate effects indicate placebo response
Correct Answer: C. Therapeutic effects typically take several weeks
, 2
Wilkes NSG 526 Exam (1, 2, 3)
Clinical Modalities Adv. Psych
(Latest ) Qs and Ans
with Explanation, Pass with
Confidence
Question 1
During a mental status examination, a patient reports feeling “empty and hopeless,” while the
clinician observes minimal facial expression and monotonous speech. How should these findings
be documented?
A. Depressed affect and blunted mood
B. Depressed mood and blunted affect
C. Flat mood and anxious affect
D. Anhedonic mood and restricted perception
Correct Answer: B. Depressed mood and blunted affect
Verified Explanation
Mood is the patient’s subjective emotional experience and is obtained through self-report,
whereas affect is the clinician’s objective observation of emotional expression. In this scenario,
the patient’s description of feeling empty and hopeless reflects a depressed mood, while the
observed lack of facial expression and monotonous speech reflects blunted affect. This
distinction is clearly defined in the DSM-5-TR and emphasized in advanced psychiatric
assessment literature because accurate documentation supports correct diagnosis and treatment
planning.
Question 2
A patient states, “I don’t want to live anymore,” and admits to having access to a firearm. What
is the PMHNP’s most appropriate immediate action?
A. Encourage protective factors and coping skills
B. Ask the patient to agree to a no-harm contract
C. Perform a structured suicide risk assessment
D. Refer the patient for outpatient psychotherapy
Correct Answer: C. Perform a structured suicide risk assessment
, 3
Verified Explanation
When suicidal ideation is accompanied by access to lethal means, the standard of care requires
an immediate and comprehensive suicide risk assessment. Evidence-based psychiatric guidelines
emphasize that no-harm contracts are not effective in preventing suicide and should not replace
formal evaluation. A structured risk assessment evaluates intent, specificity of the plan, access to
means, past attempts, and protective factors, allowing the clinician to determine the appropriate
level of care and implement safety interventions.
Question 3
Which psychotherapy is most appropriate as first-line treatment for generalized anxiety disorder
in an adult patient?
A. Supportive psychotherapy
B. Cognitive Behavioral Therapy
C. Psychoanalytic psychotherapy
D. Group process therapy
Correct Answer: B. Cognitive Behavioral Therapy
Verified Explanation
Cognitive Behavioral Therapy is widely recognized as the first-line treatment for generalized
anxiety disorder due to its strong evidence base and consistent effectiveness. CBT targets
maladaptive thought patterns and behaviors that perpetuate excessive worry and physiological
arousal. Clinical practice guidelines from major psychiatric organizations endorse CBT because
it provides durable symptom reduction and equips patients with practical coping skills, making it
highly appropriate for advanced psychiatric nursing practice.
Question 4
A patient newly started on sertraline asks why mood improvement has not occurred after one
week. What is the most accurate response?
A. The dose is too low to be effective
B. Antidepressants only work in severe depression
C. Therapeutic effects typically take several weeks
D. Immediate effects indicate placebo response
Correct Answer: C. Therapeutic effects typically take several weeks
