NR 547 Final Exam Questions & Correct Detailed Answers
2025/2026 | Psychiatric-Mental Health across the Lifespan |
Mood Disorders, Personality Disorders, Substance Use,
Neurocognitive Disorders | Q&A | Grade A | 100% Correct
Verified Answers
Subject: Psychiatric-Mental Health – Hamilton Depression Rating Scale (HAM-D), Geriatric
Depression Scale (GDS), PHQ-9, Mood Disorder Questionnaire (MDQ), Lab Monitoring (TSH,
Hemoglobin, Lithium, Depakote Levels), MDD Specifiers (Anxious Distress, Mixed Features,
Melancholic, Atypical, Catatonia, Peripartum Onset, Seasonal Pattern), PMDD, Persistent Depressive
Disorder (PDD); Antidepressant Augmentation (Lithium, Atypical Antipsychotics, Bupropion, Modafinil,
Thyroid Hormone), Esketamine (Spravato), TCAs; ECT Indications; Bipolar Disorder (Type I, Type II,
Cyclothymia, Rapid Cycling, DIGFAST), Lithium Patient Education; Lamotrigine Rash Risk; Suicide
Risk Factors; Medical Mimics of Depression; MoCA; Neurocognitive Disorders (Alzheimer's, Vascular
Dementia, Lewy Body Dementia, Frontotemporal Dementia, TBI); Delirium (Causes I WATCH DEATH,
CAM, Sleep-Wake Cycle, Treatment); Personality Disorders (Cluster A, B, C – Paranoid, Schizoid,
Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependent, Obsessive-
Compulsive); Conduct Disorder vs Antisocial Personality Disorder; SBIRT, CIWA, CAGE, DAST-10,
AUDIT, CRAFFT; Substance Use Disorder Criteria, Severity (Mild/Moderate/Severe); Alcohol
Withdrawal (Mild, Moderate, Severe, Delirium Tremens); Opioid Withdrawal; Amphetamine Withdrawal;
Drug Detection Times; Cannabis Use Disorder, Intoxication, Induced Psychosis; MAT for OUD
(Methadone, Buprenorphine, Naltrexone, Clonidine, Lofexidine).
Source: NR 547 Final Exam 2025/2026, DSM-5-TR, APA, ASAM.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
Depression Rating Scales & Interpretation
What does a score of 0-7 on the Hamilton Depression Rating Scale (HAM-D) indicate?
Correct Answer: Normal (no depression).
1. HAM-D 17-item: 0-7 normal, 8-16 mild, 17-23 moderate, ≥24 severe. Each item scored 0-2 or 0-4.
Clinician-administered tool assessing psychological and physical aspects of depression.
2. Limitation: More focused on somatic symptoms can overestimate depression in medically ill patients.
Alternative: Montgomery-Åsberg Depression Rating Scale (MADRS) better for tracking treatment
response.
Geriatric Depression Scale (GDS) – scoring interpretation (GDS-30 and GDS-15)
Correct Answer: GDS-30: 0-9 normal, 10-19 mild, 20-30 moderate/severe. GDS-15: 0-4 normal, 5-8
mild, 9-11 moderate, 12-15 severe.
1. GDS consists of yes/no questions assessing emotional, cognitive, and behavioral symptoms of
depression in older adults. Avoids somatic symptoms that may overlap with medical conditions.
, PHQ-9 scoring interpretation and clinical use
Correct Answer: 0-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.
Score ≥10: possible clinical depression, further evaluation needed. ≥15: likely MDD, consider
therapy/medication. ≥20: severe depression, requires urgent intervention.
1. Each question scored 0-3 (not at all to nearly every day). Based on DSM-5 criteria for MDD, evaluated
over past 2 weeks. Self-report tool for screening, diagnosing, and monitoring depression.
Mood Disorder Questionnaire (MDQ) – parts and scoring
Correct Answer: Part 1: 13 yes/no symptoms. Part 2: symptom clustering (yes/no – have several
occurred during same period?). Part 3: functional impairment (no/minor/serious). Positive screen:
≥7 yes in Part 1 + yes in Part 2 + moderate/serious impairment in Part 3.
1. Screening tool for bipolar disorder. Helps differentiate bipolar from unipolar depression. More sensitive
to Bipolar I than Bipolar II or Cyclothymia. May produce false positives in borderline personality disorder.
Laboratory Monitoring
TSH normal range and significance
Correct Answer: TSH 0.4-4 mIU/L. For patients on thyroid medications, target 0.5-3. Elevated TSH =
hypothyroidism; low TSH = hyperthyroidism.
1. Hemoglobin: Men 13.8-17.2; Women 12.1-15.1; Pregnant women 11-14; Children 11-16 g/dL.
Lithium level – therapeutic range, toxicity, when to draw trough
Correct Answer: Therapeutic 0.6-1.2 mEq/L; toxicity risk >1.5; severe toxicity >2. Trough levels
drawn 12 hours after last dose. Monitor renal function and thyroid levels q6-12m.
1. Toxicity symptoms: confusion, seizures, tremors, coma. Poor metabolizers and drug interactions
(NSAIDs, diuretics) increase risk.
Depakote (Valproic Acid) level – therapeutic, toxicity, when to draw trough
Correct Answer: Therapeutic 50-125 mcg/mL; toxicity risk >150; severe toxicity >200. Draw trough
before next dose. Monitor liver enzymes, platelets, ammonia level.
1. Toxicity symptoms: liver toxicity, pancreatitis, CNS depression. Valproate can cause hyperammonemia
(asterixis, confusion).
MDD Specifiers
MDD specifiers and clinical importance
Correct Answer: Severity (mild, moderate, severe, with psychotic features), Episode features
(anxious distress, mixed features, melancholic features, atypical features, catatonia, peripartum
onset, seasonal pattern), Course specifiers (partial/full remission, rapid cycling – bipolar only).
1. Anxious distress: high suicide risk, treatment resistance. Mixed features: may indicate bipolar
spectrum. Melancholic: better response to antidepressants or ECT. Atypical: often seen in bipolar II,
responds to MAOIs. Peripartum onset: risk of postpartum psychosis. Seasonal pattern: responds to light
therapy.
2025/2026 | Psychiatric-Mental Health across the Lifespan |
Mood Disorders, Personality Disorders, Substance Use,
Neurocognitive Disorders | Q&A | Grade A | 100% Correct
Verified Answers
Subject: Psychiatric-Mental Health – Hamilton Depression Rating Scale (HAM-D), Geriatric
Depression Scale (GDS), PHQ-9, Mood Disorder Questionnaire (MDQ), Lab Monitoring (TSH,
Hemoglobin, Lithium, Depakote Levels), MDD Specifiers (Anxious Distress, Mixed Features,
Melancholic, Atypical, Catatonia, Peripartum Onset, Seasonal Pattern), PMDD, Persistent Depressive
Disorder (PDD); Antidepressant Augmentation (Lithium, Atypical Antipsychotics, Bupropion, Modafinil,
Thyroid Hormone), Esketamine (Spravato), TCAs; ECT Indications; Bipolar Disorder (Type I, Type II,
Cyclothymia, Rapid Cycling, DIGFAST), Lithium Patient Education; Lamotrigine Rash Risk; Suicide
Risk Factors; Medical Mimics of Depression; MoCA; Neurocognitive Disorders (Alzheimer's, Vascular
Dementia, Lewy Body Dementia, Frontotemporal Dementia, TBI); Delirium (Causes I WATCH DEATH,
CAM, Sleep-Wake Cycle, Treatment); Personality Disorders (Cluster A, B, C – Paranoid, Schizoid,
Schizotypal, Antisocial, Borderline, Histrionic, Narcissistic, Avoidant, Dependent, Obsessive-
Compulsive); Conduct Disorder vs Antisocial Personality Disorder; SBIRT, CIWA, CAGE, DAST-10,
AUDIT, CRAFFT; Substance Use Disorder Criteria, Severity (Mild/Moderate/Severe); Alcohol
Withdrawal (Mild, Moderate, Severe, Delirium Tremens); Opioid Withdrawal; Amphetamine Withdrawal;
Drug Detection Times; Cannabis Use Disorder, Intoxication, Induced Psychosis; MAT for OUD
(Methadone, Buprenorphine, Naltrexone, Clonidine, Lofexidine).
Source: NR 547 Final Exam 2025/2026, DSM-5-TR, APA, ASAM.
Format: Q&A Guide with Clinical Rationale | Verified Answers | Grade A Guaranteed
Depression Rating Scales & Interpretation
What does a score of 0-7 on the Hamilton Depression Rating Scale (HAM-D) indicate?
Correct Answer: Normal (no depression).
1. HAM-D 17-item: 0-7 normal, 8-16 mild, 17-23 moderate, ≥24 severe. Each item scored 0-2 or 0-4.
Clinician-administered tool assessing psychological and physical aspects of depression.
2. Limitation: More focused on somatic symptoms can overestimate depression in medically ill patients.
Alternative: Montgomery-Åsberg Depression Rating Scale (MADRS) better for tracking treatment
response.
Geriatric Depression Scale (GDS) – scoring interpretation (GDS-30 and GDS-15)
Correct Answer: GDS-30: 0-9 normal, 10-19 mild, 20-30 moderate/severe. GDS-15: 0-4 normal, 5-8
mild, 9-11 moderate, 12-15 severe.
1. GDS consists of yes/no questions assessing emotional, cognitive, and behavioral symptoms of
depression in older adults. Avoids somatic symptoms that may overlap with medical conditions.
, PHQ-9 scoring interpretation and clinical use
Correct Answer: 0-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe.
Score ≥10: possible clinical depression, further evaluation needed. ≥15: likely MDD, consider
therapy/medication. ≥20: severe depression, requires urgent intervention.
1. Each question scored 0-3 (not at all to nearly every day). Based on DSM-5 criteria for MDD, evaluated
over past 2 weeks. Self-report tool for screening, diagnosing, and monitoring depression.
Mood Disorder Questionnaire (MDQ) – parts and scoring
Correct Answer: Part 1: 13 yes/no symptoms. Part 2: symptom clustering (yes/no – have several
occurred during same period?). Part 3: functional impairment (no/minor/serious). Positive screen:
≥7 yes in Part 1 + yes in Part 2 + moderate/serious impairment in Part 3.
1. Screening tool for bipolar disorder. Helps differentiate bipolar from unipolar depression. More sensitive
to Bipolar I than Bipolar II or Cyclothymia. May produce false positives in borderline personality disorder.
Laboratory Monitoring
TSH normal range and significance
Correct Answer: TSH 0.4-4 mIU/L. For patients on thyroid medications, target 0.5-3. Elevated TSH =
hypothyroidism; low TSH = hyperthyroidism.
1. Hemoglobin: Men 13.8-17.2; Women 12.1-15.1; Pregnant women 11-14; Children 11-16 g/dL.
Lithium level – therapeutic range, toxicity, when to draw trough
Correct Answer: Therapeutic 0.6-1.2 mEq/L; toxicity risk >1.5; severe toxicity >2. Trough levels
drawn 12 hours after last dose. Monitor renal function and thyroid levels q6-12m.
1. Toxicity symptoms: confusion, seizures, tremors, coma. Poor metabolizers and drug interactions
(NSAIDs, diuretics) increase risk.
Depakote (Valproic Acid) level – therapeutic, toxicity, when to draw trough
Correct Answer: Therapeutic 50-125 mcg/mL; toxicity risk >150; severe toxicity >200. Draw trough
before next dose. Monitor liver enzymes, platelets, ammonia level.
1. Toxicity symptoms: liver toxicity, pancreatitis, CNS depression. Valproate can cause hyperammonemia
(asterixis, confusion).
MDD Specifiers
MDD specifiers and clinical importance
Correct Answer: Severity (mild, moderate, severe, with psychotic features), Episode features
(anxious distress, mixed features, melancholic features, atypical features, catatonia, peripartum
onset, seasonal pattern), Course specifiers (partial/full remission, rapid cycling – bipolar only).
1. Anxious distress: high suicide risk, treatment resistance. Mixed features: may indicate bipolar
spectrum. Melancholic: better response to antidepressants or ECT. Atypical: often seen in bipolar II,
responds to MAOIs. Peripartum onset: risk of postpartum psychosis. Seasonal pattern: responds to light
therapy.
