NR607 Diagnosis & Management in Psychiatric Mental
Health III – Complete Review (Weeks 5–8) (2026/2027)
Actual Exam 2026/2027 – Complete Exam-Style Questions
with Detailed Rationales | 100% Verified – Pass Guaranteed –
A+ Graded
Instructions: Select the single best answer for each question. Each question is worth one
point. Choose the response that best reflects evidence-based psychiatric-mental health
practice.
Section A – Complex Mood and Anxiety Disorders: Advanced Diagnosis and Management
(Week 5)
Q1: 45F with MDD failed sertraline and venlafaxine. Persistent anhedonia. Next step?
A. Increase current SSRI dose beyond maximum FDA limits
B. Recommend only supportive psychotherapy without pharmacologic intervention
C. Add second SSRI for synergistic serotonergic effect
D. Augment with atypical antipsychotic (e.g., aripiprazole) [CORRECT]
Correct Answer: D
Rationale: Augmentation is evidence-based for TRD after two failed antidepressant trials.
Q2: 28M with elevated mood, decreased sleep, racing thoughts x5 days, work impairment.
Diagnosis?
A. Recommend only supportive psychotherapy without pharmacologic intervention
B. Bipolar I disorder, current episode manic [CORRECT]
C. Increase current SSRI dose beyond maximum FDA limits
D. Discontinue all current psychotropic medications abruptly
Correct Answer: B
Rationale: 5 days of elevated mood with significant impairment meets DSM-5 criteria for
mania.
Q3: 35F with bipolar I reports 4 distinct mood episodes in the past year. Avoid?
A. Recommend only supportive psychotherapy without pharmacologic intervention
B. Antidepressant monotherapy [CORRECT]
C. Switch to MAOI immediately without adequate washout period
D. Add second SSRI for synergistic serotonergic effect
Correct Answer: B
Rationale: Antidepressant monotherapy can worsen rapid cycling and induce mood
instability.
Q4: 30F with severe irritability and mood swings only in luteal phase, resolving with menses.
First-line?
,A. Initiate high-dose benzodiazepine monotherapy immediately
B. SSRI (continuous or luteal phase dosing) [CORRECT]
C. Add second SSRI for synergistic serotonergic effect
D. Prescribe as-needed antipsychotic as sole intervention
Correct Answer: B
Rationale: SSRIs are first-line for PMDD and can be dosed continuously or just in the luteal
phase.
Q5: 50M with chronic low mood x3 years and comorbid generalized anxiety. First-line?
A. Discontinue all current psychotropic medications abruptly
B. Refer for immediate ECT without prior medication trials
C. Switch to MAOI immediately without adequate washout period
D. SSRI or SNRI [CORRECT]
Correct Answer: D
Rationale: SSRIs or SNRIs effectively target both chronic depressive symptoms and comorbid
anxiety.
Q6: 26F with sudden surges of fear, palpitations, avoids crowded places. Initial treatment?
A. Recommend only supportive psychotherapy without pharmacologic intervention
B. SSRI combined with CBT [CORRECT]
C. Increase current SSRI dose beyond maximum FDA limits
D. Prescribe as-needed antipsychotic as sole intervention
Correct Answer: B
Rationale: SSRI plus CBT is the gold standard for panic disorder with agoraphobia.
Q7: 45M with chronic worry, muscle tension, fatigue x8 months. FDA-approved med?
A. Discontinue all current psychotropic medications abruptly
B. Escitalopram or duloxetine [CORRECT]
C. Initiate high-dose benzodiazepine monotherapy immediately
D. Refer for immediate ECT without prior medication trials
Correct Answer: B
Rationale: These are FDA-approved and target both cognitive and somatic symptoms of
GAD.
Q8: 22M spends 4 hrs/day washing hands due to contamination fears. First-line
pharmacologic?
A. Add second SSRI for synergistic serotonergic effect
B. Discontinue all current psychotropic medications abruptly
C. High-dose SSRI (e.g., fluoxetine, sertraline) [CORRECT]
D. Increase current SSRI dose beyond maximum FDA limits
Correct Answer: C
Rationale: OCD guidelines require higher-than-standard SSRI doses for adequate symptom
control.
Q9: 19F preoccupied with perceived skin flaw, causing severe distress. Most effective med
class?
A. Increase current SSRI dose beyond maximum FDA limits
, B. Initiate high-dose benzodiazepine monotherapy immediately
C. Recommend only supportive psychotherapy without pharmacologic intervention
D. SSRI (often requires higher doses) [CORRECT]
Correct Answer: D
Rationale: SSRIs are first-line for BDD, often requiring higher doses similar to OCD.
Q10: 65M accumulated excessive possessions, blocking home exits. Most effective
psychotherapy?
A. CBT tailored for hoarding [CORRECT]
B. Increase current SSRI dose beyond maximum FDA limits
C. Discontinue all current psychotropic medications abruptly
D. Switch to MAOI immediately without adequate washout period
Correct Answer: A
Rationale: CBT tailored specifically for hoarding is most effective, as standard CBT is less
effective.
Q11: 16F with noticeable hair loss from recurrent pulling, tension before, relief after.
Effective med?
A. Refer for immediate ECT without prior medication trials
B. Clomipramine or N-acetylcysteine (NAC) [CORRECT]
C. Add second SSRI for synergistic serotonergic effect
D. Increase current SSRI dose beyond maximum FDA limits
Correct Answer: B
Rationale: Clomipramine or NAC has the most clinical evidence for reducing hair-pulling
behaviors.
Q12: TRD patient considered for augmentation, history of weight gain. Best atypical
antipsychotic?
A. Add second SSRI for synergistic serotonergic effect
B. Aripiprazole [CORRECT]
C. Increase current SSRI dose beyond maximum FDA limits
D. Initiate high-dose benzodiazepine monotherapy immediately
Correct Answer: B
Rationale: Aripiprazole has strong FDA approval for TRD augmentation and a favorable
metabolic profile.
Q13: Patient on SSRI for severe anxiety/depression has residual anxiety. Rationale for
adding buspirone?
A. Target residual anxiety without adding another SSRI [CORRECT]
B. Refer for immediate ECT without prior medication trials
C. Add second SSRI for synergistic serotonergic effect
D. Switch to MAOI immediately without adequate washout period
Correct Answer: A
Rationale: Buspirone targets residual anxiety without significantly increasing serotonin
syndrome risk.
Q14: Panic disorder patient starting CBT. Core mechanism of exposure therapy?
Health III – Complete Review (Weeks 5–8) (2026/2027)
Actual Exam 2026/2027 – Complete Exam-Style Questions
with Detailed Rationales | 100% Verified – Pass Guaranteed –
A+ Graded
Instructions: Select the single best answer for each question. Each question is worth one
point. Choose the response that best reflects evidence-based psychiatric-mental health
practice.
Section A – Complex Mood and Anxiety Disorders: Advanced Diagnosis and Management
(Week 5)
Q1: 45F with MDD failed sertraline and venlafaxine. Persistent anhedonia. Next step?
A. Increase current SSRI dose beyond maximum FDA limits
B. Recommend only supportive psychotherapy without pharmacologic intervention
C. Add second SSRI for synergistic serotonergic effect
D. Augment with atypical antipsychotic (e.g., aripiprazole) [CORRECT]
Correct Answer: D
Rationale: Augmentation is evidence-based for TRD after two failed antidepressant trials.
Q2: 28M with elevated mood, decreased sleep, racing thoughts x5 days, work impairment.
Diagnosis?
A. Recommend only supportive psychotherapy without pharmacologic intervention
B. Bipolar I disorder, current episode manic [CORRECT]
C. Increase current SSRI dose beyond maximum FDA limits
D. Discontinue all current psychotropic medications abruptly
Correct Answer: B
Rationale: 5 days of elevated mood with significant impairment meets DSM-5 criteria for
mania.
Q3: 35F with bipolar I reports 4 distinct mood episodes in the past year. Avoid?
A. Recommend only supportive psychotherapy without pharmacologic intervention
B. Antidepressant monotherapy [CORRECT]
C. Switch to MAOI immediately without adequate washout period
D. Add second SSRI for synergistic serotonergic effect
Correct Answer: B
Rationale: Antidepressant monotherapy can worsen rapid cycling and induce mood
instability.
Q4: 30F with severe irritability and mood swings only in luteal phase, resolving with menses.
First-line?
,A. Initiate high-dose benzodiazepine monotherapy immediately
B. SSRI (continuous or luteal phase dosing) [CORRECT]
C. Add second SSRI for synergistic serotonergic effect
D. Prescribe as-needed antipsychotic as sole intervention
Correct Answer: B
Rationale: SSRIs are first-line for PMDD and can be dosed continuously or just in the luteal
phase.
Q5: 50M with chronic low mood x3 years and comorbid generalized anxiety. First-line?
A. Discontinue all current psychotropic medications abruptly
B. Refer for immediate ECT without prior medication trials
C. Switch to MAOI immediately without adequate washout period
D. SSRI or SNRI [CORRECT]
Correct Answer: D
Rationale: SSRIs or SNRIs effectively target both chronic depressive symptoms and comorbid
anxiety.
Q6: 26F with sudden surges of fear, palpitations, avoids crowded places. Initial treatment?
A. Recommend only supportive psychotherapy without pharmacologic intervention
B. SSRI combined with CBT [CORRECT]
C. Increase current SSRI dose beyond maximum FDA limits
D. Prescribe as-needed antipsychotic as sole intervention
Correct Answer: B
Rationale: SSRI plus CBT is the gold standard for panic disorder with agoraphobia.
Q7: 45M with chronic worry, muscle tension, fatigue x8 months. FDA-approved med?
A. Discontinue all current psychotropic medications abruptly
B. Escitalopram or duloxetine [CORRECT]
C. Initiate high-dose benzodiazepine monotherapy immediately
D. Refer for immediate ECT without prior medication trials
Correct Answer: B
Rationale: These are FDA-approved and target both cognitive and somatic symptoms of
GAD.
Q8: 22M spends 4 hrs/day washing hands due to contamination fears. First-line
pharmacologic?
A. Add second SSRI for synergistic serotonergic effect
B. Discontinue all current psychotropic medications abruptly
C. High-dose SSRI (e.g., fluoxetine, sertraline) [CORRECT]
D. Increase current SSRI dose beyond maximum FDA limits
Correct Answer: C
Rationale: OCD guidelines require higher-than-standard SSRI doses for adequate symptom
control.
Q9: 19F preoccupied with perceived skin flaw, causing severe distress. Most effective med
class?
A. Increase current SSRI dose beyond maximum FDA limits
, B. Initiate high-dose benzodiazepine monotherapy immediately
C. Recommend only supportive psychotherapy without pharmacologic intervention
D. SSRI (often requires higher doses) [CORRECT]
Correct Answer: D
Rationale: SSRIs are first-line for BDD, often requiring higher doses similar to OCD.
Q10: 65M accumulated excessive possessions, blocking home exits. Most effective
psychotherapy?
A. CBT tailored for hoarding [CORRECT]
B. Increase current SSRI dose beyond maximum FDA limits
C. Discontinue all current psychotropic medications abruptly
D. Switch to MAOI immediately without adequate washout period
Correct Answer: A
Rationale: CBT tailored specifically for hoarding is most effective, as standard CBT is less
effective.
Q11: 16F with noticeable hair loss from recurrent pulling, tension before, relief after.
Effective med?
A. Refer for immediate ECT without prior medication trials
B. Clomipramine or N-acetylcysteine (NAC) [CORRECT]
C. Add second SSRI for synergistic serotonergic effect
D. Increase current SSRI dose beyond maximum FDA limits
Correct Answer: B
Rationale: Clomipramine or NAC has the most clinical evidence for reducing hair-pulling
behaviors.
Q12: TRD patient considered for augmentation, history of weight gain. Best atypical
antipsychotic?
A. Add second SSRI for synergistic serotonergic effect
B. Aripiprazole [CORRECT]
C. Increase current SSRI dose beyond maximum FDA limits
D. Initiate high-dose benzodiazepine monotherapy immediately
Correct Answer: B
Rationale: Aripiprazole has strong FDA approval for TRD augmentation and a favorable
metabolic profile.
Q13: Patient on SSRI for severe anxiety/depression has residual anxiety. Rationale for
adding buspirone?
A. Target residual anxiety without adding another SSRI [CORRECT]
B. Refer for immediate ECT without prior medication trials
C. Add second SSRI for synergistic serotonergic effect
D. Switch to MAOI immediately without adequate washout period
Correct Answer: A
Rationale: Buspirone targets residual anxiety without significantly increasing serotonin
syndrome risk.
Q14: Panic disorder patient starting CBT. Core mechanism of exposure therapy?
