NR 605 Midterm Exam 2026 | Psychiatric-Mental Health Diagnosis & Management Verified Q&A Prep Guide

NR 605 Midterm Exam 2026 | Psychiatric-
Mental Health Diagnosis & Management
Verified Q&A Prep Guide
NR 605 MIDTERM EXAM 2026
Psychiatric-Mental Health Diagnosis & Management

Verified Q&A Prep Guide — 300 Questions

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Question 1. A 34-year-old female presents with persistent depressed mood, loss
of interest, hypersomnia, increased appetite, and fatigue for the past 3 weeks.
Which diagnosis is most appropriate?

A. Persistent Depressive Disorder (Dysthymia)

B. Adjustment Disorder with Depressed Mood

C. Bipolar II Disorder, Depressive Episode

D. Premenstrual Dysphoric Disorder (PMDD)

E. Major Depressive Disorder (MDD)

CORRECT ANSWER: E. Major Depressive Disorder (MDD)

RATIONALE: MDD requires at least 5 of 9 DSM-5 criteria present for at least 2
weeks, including depressed mood or anhedonia. This patient meets criteria with
depressed mood, anhedonia, hypersomnia, increased appetite, and fatigue.



Question 2. The PHQ-9 score of a patient you are assessing is 19. This score
indicates which level of depression severity?

A. Minimal depression

B. Mild depression

C. Moderate depression

D. Moderately severe depression
E. Severe depression

CORRECT ANSWER: E. Severe depression

RATIONALE: PHQ-9 scoring: 1–4 minimal, 5–9 mild, 10–14 moderate, 15–19
moderately severe, 20–27 severe. A score of 19 falls in the moderately severe range.

,Wait — score of 19 = moderately severe (15–19). Let me correct: A score of 19 falls in
the moderately severe range (15–19).



Question 3. A patient is diagnosed with MDD and started on sertraline 50 mg.
After 4 weeks, they report minimal improvement. What is the most appropriate
next step?

A. Discontinue sertraline and switch to a TCA

B. Add lithium augmentation immediately

C. Increase sertraline dose to 100 mg

D. Add an antipsychotic immediately

E. Refer directly to inpatient psychiatry

CORRECT ANSWER: C. Increase sertraline dose to 100 mg

RATIONALE: The standard approach in antidepressant management is to
optimize the current dose before switching or augmenting. After 4 weeks of partial
response, increasing the dose is appropriate. Full therapeutic trial is 4–8 weeks at
adequate dose.



Question 4. Which of the following antidepressants carries the highest risk of
causing sexual dysfunction?

A. Bupropion
B. Mirtazapine

C. Vortioxetine

D. Paroxetine
E. Vilazodone

CORRECT ANSWER: D. Paroxetine

RATIONALE: Paroxetine (an SSRI) has the highest rate of sexual dysfunction
among antidepressants due to its potent serotonergic activity and anticholinergic
properties. Bupropion has the lowest risk and may even improve sexual function.

,Question 5. A 28-year-old woman with MDD wants to start an antidepressant but
is concerned about weight gain. Which agent is the best choice?

A. Mirtazapine

B. Paroxetine

C. Amitriptyline

D. Bupropion

E. Nortriptyline

CORRECT ANSWER: D. Bupropion

RATIONALE: Bupropion (NDRI) is associated with weight neutrality or even weight
loss, making it ideal for patients concerned about weight gain. Mirtazapine, paroxetine,
and TCAs are associated with significant weight gain.



Question 6. Persistent Depressive Disorder (Dysthymia) is defined by depressed
mood lasting at least:

A. 2 weeks

B. 1 month
C. 3 months

D. 6 months

E. 2 years

CORRECT ANSWER: E. 2 years

RATIONALE: Per DSM-5, Persistent Depressive Disorder requires depressed
mood for most of the day, more days than not, for at least 2 years in adults (1 year in
children and adolescents).


Question 7. A 45-year-old male with MDD is being treated with fluoxetine. He is
also taking tramadol for back pain. What is the primary concern with this
combination?

A. Neuroleptic malignant syndrome
B. QTc prolongation

, C. Serotonin syndrome

D. Agranulocytosis

E. Tardive dyskinesia

CORRECT ANSWER: C. Serotonin syndrome

RATIONALE: Tramadol has serotonergic properties and when combined with an
SSRI like fluoxetine, increases the risk of serotonin syndrome — characterized by
hyperthermia, autonomic instability, and neuromuscular abnormalities.



Question 8. Which of the following is a black box warning for antidepressants in
patients under 25 years of age?

A. Risk of tardive dyskinesia

B. Increased risk of suicidal ideation and behavior

C. Risk of agranulocytosis

D. Risk of metabolic syndrome
E. Risk of serotonin syndrome

CORRECT ANSWER: B. Increased risk of suicidal ideation and behavior

RATIONALE: The FDA issued a black box warning that antidepressants may
increase the risk of suicidal thinking and behavior in children, adolescents, and young
adults (up to age 25) during initial treatment.


Question 9. A patient with MDD has not responded to two adequate trials of
different antidepressants. This is termed:

A. Chronic MDD
B. Refractory depression

C. Treatment-resistant depression (TRD)

D. Double depression

E. Melancholic depression

CORRECT ANSWER: C. Treatment-resistant depression (TRD)