NURS 6675 Week 11 Final Exam Actual Exam 2026/2027 –
PMHNP Care Across the Lifespan II with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section 1: Complex Psychiatric Disorders & Differential Diagnosis
Q1: A 32-year-old woman presents three months postpartum with persistent sadness,
feelings of guilt and inadequacy as a mother, difficulty bonding with her baby, and
intrusive thoughts of harming the infant. She reports these thoughts are ego-dystonic
and distressing. Which diagnosis is most appropriate?
A. Postpartum psychosis
B. Postpartum blues
C. Major depressive disorder with peripartum onset [CORRECT]
D. Adjustment disorder with depressed mood
Correct Answer: C
Rationale: Postpartum depression typically onset 3-6 months postpartum and is
characterized by persistent depressed mood, guilt, inadequacy, and intrusive thoughts
of harm that are ego-dystonic and distressing to the mother; this distinguishes it from
postpartum psychosis where thoughts may not be distressing.
Q2: A 28-year-old man presents with chronic feelings of emptiness, unstable
relationships marked by idealization and devaluation, recurrent self-cutting, chronic
suicidal ideation, and intense fear of abandonment. Which personality disorder best fits
this presentation?
A. Narcissistic personality disorder
B. Histrionic personality disorder
C. Borderline personality disorder [CORRECT]
D. Antisocial personality disorder
Correct Answer: C
Rationale: Borderline personality disorder is characterized by pervasive instability in
interpersonal relationships, self-image, and affect, with marked impulsivity, recurrent
,self-harm, chronic emptiness, and fear of abandonment, as described in DSM-5-TR
criteria.
Q3: A 45-year-old man with schizophrenia has failed trials of risperidone and olanzapine
at adequate doses and durations. He continues to experience persistent auditory
hallucinations and paranoid delusions. Which intervention is most appropriate?
A. Increase the dose of the current antipsychotic
B. Switch to clozapine [CORRECT]
C. Discontinue all antipsychotics and use benzodiazepines only
D. Add a mood stabilizer as monotherapy
Correct Answer: B
Rationale: Clozapine is indicated for treatment-resistant schizophrenia, defined as
failure to respond to at least two adequate trials of different antipsychotics; it is the only
antipsychotic with demonstrated superior efficacy for treatment-resistant cases.
Q4: A 55-year-old woman presents with depression, fatigue, weight gain, and
constipation. Laboratory studies reveal elevated TSH and low free T4. Which condition
should be considered as a medical mimic of depression?
A. Addison's disease
B. Hyperthyroidism
C. Hypothyroidism [CORRECT]
D. Cushing's syndrome
Correct Answer: C
Rationale: Hypothyroidism commonly presents with depressive symptoms, fatigue,
weight gain, and constipation due to decreased metabolic activity; elevated TSH with
low free T4 confirms the diagnosis, and thyroid replacement often resolves psychiatric
symptoms.
Q5: A 35-year-old man presents with grandiose delusions, decreased need for sleep,
pressured speech, flight of ideas, and excessive involvement in risky pleasurable
activities for one week. He has no history of depression. Which diagnosis is most
appropriate?
A. Bipolar II disorder
B. Cyclothymic disorder
C. Bipolar I disorder, current episode manic [CORRECT]
D. Schizoaffective disorder
,Correct Answer: C
Rationale: A distinct period of abnormally elevated or irritable mood with increased
energy lasting at least one week, accompanied by grandiosity, decreased need for sleep,
pressured speech, and risky behavior, meets criteria for a manic episode and bipolar I
disorder.
Q6: A 40-year-old woman presents with episodes of intense fear, palpitations, chest
pain, sweating, and fear of dying that occur unexpectedly and peak within minutes. She
has been to the emergency department multiple times fearing cardiac events. Which
diagnosis best fits?
A. Generalized anxiety disorder
B. Panic disorder [CORRECT]
C. Specific phobia
D. Acute stress disorder
Correct Answer: B
Rationale: Panic disorder is characterized by recurrent, unexpected panic attacks with
intense fear and physical symptoms peaking within minutes, followed by persistent
concern about future attacks or their consequences, often leading to emergency
medical visits.
Q7: A 50-year-old man with a long history of alcohol use presents with confusion, ataxia,
ophthalmoplegia (nystagmus and ptosis), and memory deficits. Which condition should
the PMHNP suspect?
A. Korsakoff psychosis only
B. Wernicke's encephalopathy [CORRECT]
C. Delirium tremens
D. Hepatic encephalopathy
Correct Answer: B
Rationale: Wernicke's encephalopathy is characterized by the classic triad of confusion,
ataxia, and oculomotor disturbances (nystagmus, ptosis, lateral gaze palsy) in patients
with chronic alcohol use and thiamine deficiency; it requires immediate thiamine
replacement.
Q8: A 22-year-old woman presents with recurrent episodes of binge eating followed by
purging through self-induced vomiting, occurring at least twice weekly for three months.
, She is of normal weight and excessively concerned about body shape. Which diagnosis
is indicated?
A. Anorexia nervosa, binge-eating/purging type
B. Bulimia nervosa [CORRECT]
C. Binge-eating disorder
D. Avoidant/restrictive food intake disorder
Correct Answer: B
Rationale: Bulimia nervosa requires recurrent episodes of binge eating with
compensatory behaviors (purging) at least weekly for three months, with self-evaluation
unduly influenced by body shape and weight; normal weight distinguishes it from
anorexia nervosa.
Q9: A 60-year-old man presents with depressed mood, psychomotor retardation, apathy,
and executive dysfunction six months after a right hemisphere stroke. Which diagnosis
best describes this presentation?
A. Major depressive disorder only
B. Post-stroke depression [CORRECT]
C. Vascular dementia only
D. Normal aging
Correct Answer: B
Rationale: Post-stroke depression occurs in approximately one-third of stroke survivors,
particularly with left frontal or basal ganglia lesions; it presents with mood symptoms,
apathy, and cognitive changes that may overlap with vascular cognitive impairment,
requiring integrated treatment.
Q10: A 38-year-old woman presents with dissociative episodes, recurrent nightmares,
flashbacks, hypervigilance, and emotional dysregulation following prolonged childhood
sexual abuse. She reports gaps in autobiographical memory. Which diagnosis is most
appropriate?
A. Acute stress disorder
B. Posttraumatic stress disorder
C. Complex PTSD [CORRECT]
D. Dissociative identity disorder
Correct Answer: C
Rationale: Complex PTSD results from prolonged, repeated trauma (such as childhood
abuse) and includes core PTSD symptoms plus affect dysregulation, negative
PMHNP Care Across the Lifespan II with Detailed Rationales |
100% Verified | Pass Guaranteed – A+ Graded
Section 1: Complex Psychiatric Disorders & Differential Diagnosis
Q1: A 32-year-old woman presents three months postpartum with persistent sadness,
feelings of guilt and inadequacy as a mother, difficulty bonding with her baby, and
intrusive thoughts of harming the infant. She reports these thoughts are ego-dystonic
and distressing. Which diagnosis is most appropriate?
A. Postpartum psychosis
B. Postpartum blues
C. Major depressive disorder with peripartum onset [CORRECT]
D. Adjustment disorder with depressed mood
Correct Answer: C
Rationale: Postpartum depression typically onset 3-6 months postpartum and is
characterized by persistent depressed mood, guilt, inadequacy, and intrusive thoughts
of harm that are ego-dystonic and distressing to the mother; this distinguishes it from
postpartum psychosis where thoughts may not be distressing.
Q2: A 28-year-old man presents with chronic feelings of emptiness, unstable
relationships marked by idealization and devaluation, recurrent self-cutting, chronic
suicidal ideation, and intense fear of abandonment. Which personality disorder best fits
this presentation?
A. Narcissistic personality disorder
B. Histrionic personality disorder
C. Borderline personality disorder [CORRECT]
D. Antisocial personality disorder
Correct Answer: C
Rationale: Borderline personality disorder is characterized by pervasive instability in
interpersonal relationships, self-image, and affect, with marked impulsivity, recurrent
,self-harm, chronic emptiness, and fear of abandonment, as described in DSM-5-TR
criteria.
Q3: A 45-year-old man with schizophrenia has failed trials of risperidone and olanzapine
at adequate doses and durations. He continues to experience persistent auditory
hallucinations and paranoid delusions. Which intervention is most appropriate?
A. Increase the dose of the current antipsychotic
B. Switch to clozapine [CORRECT]
C. Discontinue all antipsychotics and use benzodiazepines only
D. Add a mood stabilizer as monotherapy
Correct Answer: B
Rationale: Clozapine is indicated for treatment-resistant schizophrenia, defined as
failure to respond to at least two adequate trials of different antipsychotics; it is the only
antipsychotic with demonstrated superior efficacy for treatment-resistant cases.
Q4: A 55-year-old woman presents with depression, fatigue, weight gain, and
constipation. Laboratory studies reveal elevated TSH and low free T4. Which condition
should be considered as a medical mimic of depression?
A. Addison's disease
B. Hyperthyroidism
C. Hypothyroidism [CORRECT]
D. Cushing's syndrome
Correct Answer: C
Rationale: Hypothyroidism commonly presents with depressive symptoms, fatigue,
weight gain, and constipation due to decreased metabolic activity; elevated TSH with
low free T4 confirms the diagnosis, and thyroid replacement often resolves psychiatric
symptoms.
Q5: A 35-year-old man presents with grandiose delusions, decreased need for sleep,
pressured speech, flight of ideas, and excessive involvement in risky pleasurable
activities for one week. He has no history of depression. Which diagnosis is most
appropriate?
A. Bipolar II disorder
B. Cyclothymic disorder
C. Bipolar I disorder, current episode manic [CORRECT]
D. Schizoaffective disorder
,Correct Answer: C
Rationale: A distinct period of abnormally elevated or irritable mood with increased
energy lasting at least one week, accompanied by grandiosity, decreased need for sleep,
pressured speech, and risky behavior, meets criteria for a manic episode and bipolar I
disorder.
Q6: A 40-year-old woman presents with episodes of intense fear, palpitations, chest
pain, sweating, and fear of dying that occur unexpectedly and peak within minutes. She
has been to the emergency department multiple times fearing cardiac events. Which
diagnosis best fits?
A. Generalized anxiety disorder
B. Panic disorder [CORRECT]
C. Specific phobia
D. Acute stress disorder
Correct Answer: B
Rationale: Panic disorder is characterized by recurrent, unexpected panic attacks with
intense fear and physical symptoms peaking within minutes, followed by persistent
concern about future attacks or their consequences, often leading to emergency
medical visits.
Q7: A 50-year-old man with a long history of alcohol use presents with confusion, ataxia,
ophthalmoplegia (nystagmus and ptosis), and memory deficits. Which condition should
the PMHNP suspect?
A. Korsakoff psychosis only
B. Wernicke's encephalopathy [CORRECT]
C. Delirium tremens
D. Hepatic encephalopathy
Correct Answer: B
Rationale: Wernicke's encephalopathy is characterized by the classic triad of confusion,
ataxia, and oculomotor disturbances (nystagmus, ptosis, lateral gaze palsy) in patients
with chronic alcohol use and thiamine deficiency; it requires immediate thiamine
replacement.
Q8: A 22-year-old woman presents with recurrent episodes of binge eating followed by
purging through self-induced vomiting, occurring at least twice weekly for three months.
, She is of normal weight and excessively concerned about body shape. Which diagnosis
is indicated?
A. Anorexia nervosa, binge-eating/purging type
B. Bulimia nervosa [CORRECT]
C. Binge-eating disorder
D. Avoidant/restrictive food intake disorder
Correct Answer: B
Rationale: Bulimia nervosa requires recurrent episodes of binge eating with
compensatory behaviors (purging) at least weekly for three months, with self-evaluation
unduly influenced by body shape and weight; normal weight distinguishes it from
anorexia nervosa.
Q9: A 60-year-old man presents with depressed mood, psychomotor retardation, apathy,
and executive dysfunction six months after a right hemisphere stroke. Which diagnosis
best describes this presentation?
A. Major depressive disorder only
B. Post-stroke depression [CORRECT]
C. Vascular dementia only
D. Normal aging
Correct Answer: B
Rationale: Post-stroke depression occurs in approximately one-third of stroke survivors,
particularly with left frontal or basal ganglia lesions; it presents with mood symptoms,
apathy, and cognitive changes that may overlap with vascular cognitive impairment,
requiring integrated treatment.
Q10: A 38-year-old woman presents with dissociative episodes, recurrent nightmares,
flashbacks, hypervigilance, and emotional dysregulation following prolonged childhood
sexual abuse. She reports gaps in autobiographical memory. Which diagnosis is most
appropriate?
A. Acute stress disorder
B. Posttraumatic stress disorder
C. Complex PTSD [CORRECT]
D. Dissociative identity disorder
Correct Answer: C
Rationale: Complex PTSD results from prolonged, repeated trauma (such as childhood
abuse) and includes core PTSD symptoms plus affect dysregulation, negative
