NR605 / NR 605 Psychiatric Mental Health Across
Lifespan I ACTUAL FINAL EXAM PRACTICE
2026/2027 | Verified Questions and Answers | DSM-5-
TR & Evidence-Based Prescribing Focus | Grade A
Target | Pass Guaranteed
SECTION 1: Assessment, Diagnosis, & Lifespan Considerations (Questions 1-25)
Q1: A 19-year-old college freshman presents to the student health center stating, "I haven't slept
in three days because I need to finish my business plan—it's going to revolutionize the industry. I
dropped all my classes because they're slowing me down." His roommate reports he has been
talking rapidly, spending excessive money on electronics, and was found dancing on the library
roof at 3 AM. He has no prior psychiatric history. Vital signs show HR 118, BP 142/88. Which is
the most likely diagnosis?
A. Adjustment disorder with mixed anxiety and depressed mood
B. Bipolar I disorder, current episode manic [CORRECT]
C. Cannabis-induced psychotic disorder
D. Attention-deficit/hyperactivity disorder, predominantly hyperactive presentation
Correct Answer: B
Q2: A 67-year-old widow is brought by her daughter for evaluation. The daughter states, "She
keeps asking me the same questions every five minutes and got lost driving to the grocery store
she's gone to for 30 years." The patient is alert but scores 18/30 on the MMSE, showing deficits
in recall and orientation. She has hypertension and type 2 diabetes. Which is the most appropriate
initial assessment step?
A. Order a brain MRI with and without contrast immediately
B. Perform a comprehensive geriatric depression screening and review medications [CORRECT]
C. Initiate donepezil 10 mg daily immediately
D. Refer directly to a neurologist for lumbar puncture
Correct Answer: B
Q3: A 14-year-old male is brought to the emergency department by police after threatening to
"blow up the school." His mother reports he has been increasingly irritable, failing classes, and
was suspended for fighting. When interviewed alone, he states, "Everyone is against me. I hear
,them talking about me in the walls." He admits to smoking marijuana "a few times" but denies
other substances. Which component of the mental status examination is most critical to assess
next?
A. Thought process and form
B. Perceptual disturbances and reality testing [CORRECT]
C. Insight and judgment
D. Cognitive functioning and abstraction
Correct Answer: B
Q4: A 28-year-old female presents stating, "I check the stove 20 times before leaving the house
and wash my hands until they bleed. If I don't, something terrible will happen to my family." She
reports these thoughts and behaviors consume 4-5 hours daily and she is often late for work. She
denies mood symptoms or substance use. Which diagnosis best fits this presentation?
A. Generalized anxiety disorder
B. Obsessive-compulsive disorder [CORRECT]
C. Body dysmorphic disorder
D. Schizophrenia, paranoid type
Correct Answer: B
Q5: A 52-year-old male with major depressive disorder is started on fluoxetine 20 mg daily. At
his 2-week follow-up, his wife reports he is "more agitated, can't sit still, and paces all night."
The patient states, "I feel worse than when I started, like I want to jump out of my skin." Vital
signs are stable. Which is the safest next step?
A. Increase fluoxetine to 40 mg daily to achieve therapeutic effect
B. Discontinue fluoxetine and switch to a different antidepressant class [CORRECT]
C. Add lorazepam 2 mg TID for agitation
D. Continue current dose and reassess in 4 weeks
Correct Answer: B
Q6: During a psychiatric interview, a patient states, "The CIA is monitoring my thoughts through
the television. They planted a chip in my brain during my appendectomy." The patient is guarded
and suspicious but not overtly agitated. Which interviewing technique is most appropriate?
A. Confront the delusional beliefs directly to test reality testing
, B. Use therapeutic neutrality and explore the emotional impact of these beliefs [CORRECT]
C. Immediately involve law enforcement due to potential danger
D. Validate the delusions to build rapport
Correct Answer: B
Q7: A 35-year-old female presents with a 2-week history of "feeling empty," anhedonia,
hypersomnia, and a 10-pound weight gain. She reports, "I just want to sleep forever. I'm a burden
to everyone." She has no energy and has called in sick to work daily. Her PHQ-9 score is 18.
Which feature of this presentation requires immediate prioritization?
A. The significant weight gain indicating metabolic syndrome
B. Suicidal ideation and psychomotor retardation requiring safety assessment [CORRECT]
C. The need for immediate antidepressant initiation
D. Occupational dysfunction requiring disability paperwork
Correct Answer: B
Q8: A 9-year-old boy is referred by his teacher for evaluation. His mother reports, "He blurts out
answers, can't wait his turn, and is always running around. He climbed out a second-story
window last week 'just to see what would happen.'" He struggles academically despite average
intelligence. Symptoms are present in both school and home settings. Which is the most
appropriate initial treatment approach?
A. Initiate methylphenidate extended-release immediately
B. Comprehensive behavioral parent training and classroom interventions as first-line
[CORRECT]
C. Start atomoxetine due to lower abuse potential
D. Recommend private school with stricter discipline
Correct Answer: B
Q9: A 71-year-old veteran presents with nightmares, hypervigilance, and avoidance of fireworks.
He states, "I haven't been the same since Vietnam. I jump at loud noises and can't trust anyone."
He has hypertension, hyperlipidemia, and drinks 4 beers nightly to "sleep." Which assessment
finding would most significantly impact treatment planning?
A. The presence of combat-related trauma exposure
B. Alcohol use disorder comorbidity requiring integrated treatment [CORRECT]
C. His age as a barrier to trauma-focused therapy
Lifespan I ACTUAL FINAL EXAM PRACTICE
2026/2027 | Verified Questions and Answers | DSM-5-
TR & Evidence-Based Prescribing Focus | Grade A
Target | Pass Guaranteed
SECTION 1: Assessment, Diagnosis, & Lifespan Considerations (Questions 1-25)
Q1: A 19-year-old college freshman presents to the student health center stating, "I haven't slept
in three days because I need to finish my business plan—it's going to revolutionize the industry. I
dropped all my classes because they're slowing me down." His roommate reports he has been
talking rapidly, spending excessive money on electronics, and was found dancing on the library
roof at 3 AM. He has no prior psychiatric history. Vital signs show HR 118, BP 142/88. Which is
the most likely diagnosis?
A. Adjustment disorder with mixed anxiety and depressed mood
B. Bipolar I disorder, current episode manic [CORRECT]
C. Cannabis-induced psychotic disorder
D. Attention-deficit/hyperactivity disorder, predominantly hyperactive presentation
Correct Answer: B
Q2: A 67-year-old widow is brought by her daughter for evaluation. The daughter states, "She
keeps asking me the same questions every five minutes and got lost driving to the grocery store
she's gone to for 30 years." The patient is alert but scores 18/30 on the MMSE, showing deficits
in recall and orientation. She has hypertension and type 2 diabetes. Which is the most appropriate
initial assessment step?
A. Order a brain MRI with and without contrast immediately
B. Perform a comprehensive geriatric depression screening and review medications [CORRECT]
C. Initiate donepezil 10 mg daily immediately
D. Refer directly to a neurologist for lumbar puncture
Correct Answer: B
Q3: A 14-year-old male is brought to the emergency department by police after threatening to
"blow up the school." His mother reports he has been increasingly irritable, failing classes, and
was suspended for fighting. When interviewed alone, he states, "Everyone is against me. I hear
,them talking about me in the walls." He admits to smoking marijuana "a few times" but denies
other substances. Which component of the mental status examination is most critical to assess
next?
A. Thought process and form
B. Perceptual disturbances and reality testing [CORRECT]
C. Insight and judgment
D. Cognitive functioning and abstraction
Correct Answer: B
Q4: A 28-year-old female presents stating, "I check the stove 20 times before leaving the house
and wash my hands until they bleed. If I don't, something terrible will happen to my family." She
reports these thoughts and behaviors consume 4-5 hours daily and she is often late for work. She
denies mood symptoms or substance use. Which diagnosis best fits this presentation?
A. Generalized anxiety disorder
B. Obsessive-compulsive disorder [CORRECT]
C. Body dysmorphic disorder
D. Schizophrenia, paranoid type
Correct Answer: B
Q5: A 52-year-old male with major depressive disorder is started on fluoxetine 20 mg daily. At
his 2-week follow-up, his wife reports he is "more agitated, can't sit still, and paces all night."
The patient states, "I feel worse than when I started, like I want to jump out of my skin." Vital
signs are stable. Which is the safest next step?
A. Increase fluoxetine to 40 mg daily to achieve therapeutic effect
B. Discontinue fluoxetine and switch to a different antidepressant class [CORRECT]
C. Add lorazepam 2 mg TID for agitation
D. Continue current dose and reassess in 4 weeks
Correct Answer: B
Q6: During a psychiatric interview, a patient states, "The CIA is monitoring my thoughts through
the television. They planted a chip in my brain during my appendectomy." The patient is guarded
and suspicious but not overtly agitated. Which interviewing technique is most appropriate?
A. Confront the delusional beliefs directly to test reality testing
, B. Use therapeutic neutrality and explore the emotional impact of these beliefs [CORRECT]
C. Immediately involve law enforcement due to potential danger
D. Validate the delusions to build rapport
Correct Answer: B
Q7: A 35-year-old female presents with a 2-week history of "feeling empty," anhedonia,
hypersomnia, and a 10-pound weight gain. She reports, "I just want to sleep forever. I'm a burden
to everyone." She has no energy and has called in sick to work daily. Her PHQ-9 score is 18.
Which feature of this presentation requires immediate prioritization?
A. The significant weight gain indicating metabolic syndrome
B. Suicidal ideation and psychomotor retardation requiring safety assessment [CORRECT]
C. The need for immediate antidepressant initiation
D. Occupational dysfunction requiring disability paperwork
Correct Answer: B
Q8: A 9-year-old boy is referred by his teacher for evaluation. His mother reports, "He blurts out
answers, can't wait his turn, and is always running around. He climbed out a second-story
window last week 'just to see what would happen.'" He struggles academically despite average
intelligence. Symptoms are present in both school and home settings. Which is the most
appropriate initial treatment approach?
A. Initiate methylphenidate extended-release immediately
B. Comprehensive behavioral parent training and classroom interventions as first-line
[CORRECT]
C. Start atomoxetine due to lower abuse potential
D. Recommend private school with stricter discipline
Correct Answer: B
Q9: A 71-year-old veteran presents with nightmares, hypervigilance, and avoidance of fireworks.
He states, "I haven't been the same since Vietnam. I jump at loud noises and can't trust anyone."
He has hypertension, hyperlipidemia, and drinks 4 beers nightly to "sleep." Which assessment
finding would most significantly impact treatment planning?
A. The presence of combat-related trauma exposure
B. Alcohol use disorder comorbidity requiring integrated treatment [CORRECT]
C. His age as a barrier to trauma-focused therapy
