1
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Psychiatric Case Studies for Advanced
Practice – Test Bank
Edition/Reference: First Edition
Chapters
1. Preschooler with Emotional and Behavioral Difficulties
2. In Foster Care and Very Active
3. Aggression at a Young Age
4. Attention-Deficit/Hyperactivity Disorder and Low Frustration Tolerance
5. Attention and Behavior Problems
6. Not Cooperating and Being Aggressive
7. Transgender Youth
8. Self-Harm and Suicidality
9. Intrusive Thoughts
10. Depressed Adolescent
11. Test Taking Anxiety
12. Stimulants and Mania
13. Depressed and Anxious in College
14. Depressed and Voices Say to Kill Myself
15. Not Doing Well in College
16. Depressed and Anxious
17. Hates Everyone, Angry Everyday
18. Anxiety and Insomnia
19. Stressed and Biting Fingers More
20. Stressed and Cutting
21. Migraines and Impaired
22. Night Terrors
23. Still Has Auditory Hallucinations with Olanzapine
24. Out of Control Eating with a History of Depression
25. Depressed and Anxious Postpartum
26. Opiates Are Ruining My Life
27. Blacking Out
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28. Back in School and Cannot Focus
29. Feeling more Anxious and Obsessive-Compulsive Disorder Is Worse
30. Unsteady after Being on Risperidone
31. Thinks He May Be Depressed
32. Manic with Psychotic Features
33. Depression Post Brain Tumor
34. Feeling Paranoid
35. Pregnant and Anxious
36. Panic Attacks after Traumatic Incident
37. Depressed and Worried about Drinking
38. Telepsychiatry
39. Incarcerated and Substance Use Problems
40. Worried about a Brain Tumor
41. Still Crying about Her Father’s Death
42. Treatment after Rehab for Opiate Addiction
43. Depressed and Fatigued
44. Homeless and Problems with Alcohol
45. Renal Function Decreasing
46. Very Tired and Cannot Sleep
47. Withdrawn after Surgery
48. Lithium and the Older Adult
49. Worried about Father Dying
50. Older and Depressed
51. Seeing Dead People
52. Agitated and Clapping Hands
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Chapter 1: Preschooler with Emotional and Behavioral
Difficulties
Question 1. A young child in the case 'Preschooler with Emotional and Behavioral
Difficulties' presents for evaluation. Which assessment focus is the highest priority
during the initial interview?
A. Limit the interview to medication history and skip psychosocial context
B. Assess current safety risk, symptom acuity, and functional impairment related to
mood and anxiety symptoms
C. Postpone assessment of risk until rapport is fully established
D. Begin long-term treatment planning before clarifying the chief concern
✅ Correct Answer: B. Assess current safety risk, symptom acuity, and
functional impairment related to mood and anxiety symptoms
Rationale: Initial psychiatric assessment begins with acuity and safety. The nurse
practitioner should first clarify immediate safety, symptom timing, functional
impairment, and medical or substance-related contributors in this young child
presenting with mood and anxiety symptoms. This determines urgency, need for a
higher level of care, and whether outpatient treatment is appropriate. The other
options may eventually be appropriate, but they either delay priority assessment,
fail to address the highest-risk issue first, or provide a less targeted next step for
the presentation described.
DIF: Easy
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
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Question 2. In the case 'Preschooler with Emotional and Behavioral Difficulties',
which additional history would most strengthen diagnostic formulation?
A. A review of remote childhood milestones without present symptom analysis
B. Only family members' opinions about personality style
C. A detailed list of favorite foods without behavioral context
D. A timeline linking symptom onset, triggers, duration, and resulting impairment
✅ Correct Answer: D. A timeline linking symptom onset, triggers, duration,
and resulting impairment
Rationale: Psychiatric diagnosis depends on a longitudinal symptom history. A
clear timeline distinguishes episodic illness from chronic traits, clarifies
precipitating stressors, and shows how symptoms affect school, work, sleep, and
relationships. The other options may eventually be appropriate, but they either
delay priority assessment, fail to address the highest-risk issue first, or provide a
less targeted next step for the presentation described.
DIF: Easy
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
Question 3. Which presentation would be most consistent with the chapter theme
'Preschooler with Emotional and Behavioral Difficulties'?
A. Brief distress with no impairment and rapid spontaneous resolution
B. Symptoms explained entirely by lack of sleep the night before an exam
C. Symptoms that fit mood and anxiety symptoms and interfere with daily
functioning in a clinically meaningful way
D. A single isolated behavior with no emotional, cognitive, or functional correlates
, 6
✅ Correct Answer: C. Symptoms that fit mood and anxiety symptoms and
interfere with daily functioning in a clinically meaningful way
Rationale: The chapter theme points toward a clinically significant syndrome
rather than transient stress alone. The correct option includes both symptom pattern
and functional impact, which are central to DSM-based formulation and treatment
planning. The other options may eventually be appropriate, but they either delay
priority assessment, fail to address the highest-risk issue first, or provide a less
targeted next step for the presentation described.
DIF: Moderate
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
Question 4. When considering differential diagnosis for 'Preschooler with
Emotional and Behavioral Difficulties', which approach is best?
A. Rule out medical, developmental, trauma-related, and substance-related
explanations before finalizing the psychiatric diagnosis
B. Defer all differential diagnosis until medication has been tried
C. Avoid asking about trauma because it may worsen symptoms
D. Assume the first apparent diagnosis is correct if the patient is distressed
✅ Correct Answer: A. Rule out medical, developmental, trauma-related, and
substance-related explanations before finalizing the psychiatric diagnosis
Rationale: A strong advanced-practice differential is broad first and narrow second.
Symptoms in psychiatry can reflect neurologic illness, endocrine disease,
medication effects, trauma exposure, developmental disorders, or substance use.
Ruling these out prevents misdiagnosis and inappropriate treatment. The other
options may eventually be appropriate, but they either delay priority assessment,
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fail to address the highest-risk issue first, or provide a less targeted next step for
the presentation described.
DIF: Moderate
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
Question 5. For the patient in 'Preschooler with Emotional and Behavioral
Difficulties', which finding would require the most urgent intervention?
A. Mild ambivalence about treatment recommendations
B. An acute indicator that the patient may not be safe to remain in a routine
outpatient setting
C. A preference to include family later in care
D. Intermittent symptoms that have been stable for months
✅ Correct Answer: B. An acute indicator that the patient may not be safe to
remain in a routine outpatient setting
Rationale: Urgent intervention is triggered by evidence of imminent risk, inability
to care for self, or rapidly worsening symptoms. In psychiatric practice, identifying
when outpatient care is insufficient is a core safety responsibility. The other
options may eventually be appropriate, but they either delay priority assessment,
fail to address the highest-risk issue first, or provide a less targeted next step for
the presentation described.
DIF: Hard
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
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Question 6. Which evidence-based tool would be most useful to quantify baseline
severity in 'Preschooler with Emotional and Behavioral Difficulties'?
A. A nonstandard checklist created during the visit with no scoring anchors
B. An intelligence test used as the sole psychiatric outcome measure
C. A broad medical review form with no psychiatric symptom items
D. A validated rating scale matched to the dominant symptom cluster in mood and
anxiety symptoms
✅ Correct Answer: D. A validated rating scale matched to the dominant
symptom cluster in mood and anxiety symptoms
Rationale: Validated instruments improve diagnostic precision, establish a
measurable baseline, and support follow-up decisions. They are especially useful
when monitoring whether psychotherapy, medication, or environmental supports
are producing meaningful change. The other options may eventually be appropriate,
but they either delay priority assessment, fail to address the highest-risk issue first,
or provide a less targeted next step for the presentation described.
DIF: Easy
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
Question 7. Assuming no immediate need for hospitalization, which psychotherapy
recommendation best fits 'Preschooler with Emotional and Behavioral Difficulties'?
A. Avoid psychotherapy until all symptoms are eliminated by medication
B. A confrontational style that minimizes patient strengths and readiness
C. comprehensive psychiatric assessment and collaborative treatment planning
D. A purely nondirective approach with no symptom targets or structure
, 2
Psychiatric Case Studies for Advanced
Practice – Test Bank
Edition/Reference: First Edition
Chapters
1. Preschooler with Emotional and Behavioral Difficulties
2. In Foster Care and Very Active
3. Aggression at a Young Age
4. Attention-Deficit/Hyperactivity Disorder and Low Frustration Tolerance
5. Attention and Behavior Problems
6. Not Cooperating and Being Aggressive
7. Transgender Youth
8. Self-Harm and Suicidality
9. Intrusive Thoughts
10. Depressed Adolescent
11. Test Taking Anxiety
12. Stimulants and Mania
13. Depressed and Anxious in College
14. Depressed and Voices Say to Kill Myself
15. Not Doing Well in College
16. Depressed and Anxious
17. Hates Everyone, Angry Everyday
18. Anxiety and Insomnia
19. Stressed and Biting Fingers More
20. Stressed and Cutting
21. Migraines and Impaired
22. Night Terrors
23. Still Has Auditory Hallucinations with Olanzapine
24. Out of Control Eating with a History of Depression
25. Depressed and Anxious Postpartum
26. Opiates Are Ruining My Life
27. Blacking Out
, 3
28. Back in School and Cannot Focus
29. Feeling more Anxious and Obsessive-Compulsive Disorder Is Worse
30. Unsteady after Being on Risperidone
31. Thinks He May Be Depressed
32. Manic with Psychotic Features
33. Depression Post Brain Tumor
34. Feeling Paranoid
35. Pregnant and Anxious
36. Panic Attacks after Traumatic Incident
37. Depressed and Worried about Drinking
38. Telepsychiatry
39. Incarcerated and Substance Use Problems
40. Worried about a Brain Tumor
41. Still Crying about Her Father’s Death
42. Treatment after Rehab for Opiate Addiction
43. Depressed and Fatigued
44. Homeless and Problems with Alcohol
45. Renal Function Decreasing
46. Very Tired and Cannot Sleep
47. Withdrawn after Surgery
48. Lithium and the Older Adult
49. Worried about Father Dying
50. Older and Depressed
51. Seeing Dead People
52. Agitated and Clapping Hands
, 4
Chapter 1: Preschooler with Emotional and Behavioral
Difficulties
Question 1. A young child in the case 'Preschooler with Emotional and Behavioral
Difficulties' presents for evaluation. Which assessment focus is the highest priority
during the initial interview?
A. Limit the interview to medication history and skip psychosocial context
B. Assess current safety risk, symptom acuity, and functional impairment related to
mood and anxiety symptoms
C. Postpone assessment of risk until rapport is fully established
D. Begin long-term treatment planning before clarifying the chief concern
✅ Correct Answer: B. Assess current safety risk, symptom acuity, and
functional impairment related to mood and anxiety symptoms
Rationale: Initial psychiatric assessment begins with acuity and safety. The nurse
practitioner should first clarify immediate safety, symptom timing, functional
impairment, and medical or substance-related contributors in this young child
presenting with mood and anxiety symptoms. This determines urgency, need for a
higher level of care, and whether outpatient treatment is appropriate. The other
options may eventually be appropriate, but they either delay priority assessment,
fail to address the highest-risk issue first, or provide a less targeted next step for
the presentation described.
DIF: Easy
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
, 5
Question 2. In the case 'Preschooler with Emotional and Behavioral Difficulties',
which additional history would most strengthen diagnostic formulation?
A. A review of remote childhood milestones without present symptom analysis
B. Only family members' opinions about personality style
C. A detailed list of favorite foods without behavioral context
D. A timeline linking symptom onset, triggers, duration, and resulting impairment
✅ Correct Answer: D. A timeline linking symptom onset, triggers, duration,
and resulting impairment
Rationale: Psychiatric diagnosis depends on a longitudinal symptom history. A
clear timeline distinguishes episodic illness from chronic traits, clarifies
precipitating stressors, and shows how symptoms affect school, work, sleep, and
relationships. The other options may eventually be appropriate, but they either
delay priority assessment, fail to address the highest-risk issue first, or provide a
less targeted next step for the presentation described.
DIF: Easy
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
Question 3. Which presentation would be most consistent with the chapter theme
'Preschooler with Emotional and Behavioral Difficulties'?
A. Brief distress with no impairment and rapid spontaneous resolution
B. Symptoms explained entirely by lack of sleep the night before an exam
C. Symptoms that fit mood and anxiety symptoms and interfere with daily
functioning in a clinically meaningful way
D. A single isolated behavior with no emotional, cognitive, or functional correlates
, 6
✅ Correct Answer: C. Symptoms that fit mood and anxiety symptoms and
interfere with daily functioning in a clinically meaningful way
Rationale: The chapter theme points toward a clinically significant syndrome
rather than transient stress alone. The correct option includes both symptom pattern
and functional impact, which are central to DSM-based formulation and treatment
planning. The other options may eventually be appropriate, but they either delay
priority assessment, fail to address the highest-risk issue first, or provide a less
targeted next step for the presentation described.
DIF: Moderate
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
Question 4. When considering differential diagnosis for 'Preschooler with
Emotional and Behavioral Difficulties', which approach is best?
A. Rule out medical, developmental, trauma-related, and substance-related
explanations before finalizing the psychiatric diagnosis
B. Defer all differential diagnosis until medication has been tried
C. Avoid asking about trauma because it may worsen symptoms
D. Assume the first apparent diagnosis is correct if the patient is distressed
✅ Correct Answer: A. Rule out medical, developmental, trauma-related, and
substance-related explanations before finalizing the psychiatric diagnosis
Rationale: A strong advanced-practice differential is broad first and narrow second.
Symptoms in psychiatry can reflect neurologic illness, endocrine disease,
medication effects, trauma exposure, developmental disorders, or substance use.
Ruling these out prevents misdiagnosis and inappropriate treatment. The other
options may eventually be appropriate, but they either delay priority assessment,
, 7
fail to address the highest-risk issue first, or provide a less targeted next step for
the presentation described.
DIF: Moderate
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
Question 5. For the patient in 'Preschooler with Emotional and Behavioral
Difficulties', which finding would require the most urgent intervention?
A. Mild ambivalence about treatment recommendations
B. An acute indicator that the patient may not be safe to remain in a routine
outpatient setting
C. A preference to include family later in care
D. Intermittent symptoms that have been stable for months
✅ Correct Answer: B. An acute indicator that the patient may not be safe to
remain in a routine outpatient setting
Rationale: Urgent intervention is triggered by evidence of imminent risk, inability
to care for self, or rapidly worsening symptoms. In psychiatric practice, identifying
when outpatient care is insufficient is a core safety responsibility. The other
options may eventually be appropriate, but they either delay priority assessment,
fail to address the highest-risk issue first, or provide a less targeted next step for
the presentation described.
DIF: Hard
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
, 8
Question 6. Which evidence-based tool would be most useful to quantify baseline
severity in 'Preschooler with Emotional and Behavioral Difficulties'?
A. A nonstandard checklist created during the visit with no scoring anchors
B. An intelligence test used as the sole psychiatric outcome measure
C. A broad medical review form with no psychiatric symptom items
D. A validated rating scale matched to the dominant symptom cluster in mood and
anxiety symptoms
✅ Correct Answer: D. A validated rating scale matched to the dominant
symptom cluster in mood and anxiety symptoms
Rationale: Validated instruments improve diagnostic precision, establish a
measurable baseline, and support follow-up decisions. They are especially useful
when monitoring whether psychotherapy, medication, or environmental supports
are producing meaningful change. The other options may eventually be appropriate,
but they either delay priority assessment, fail to address the highest-risk issue first,
or provide a less targeted next step for the presentation described.
DIF: Easy
TOP: Preschooler with Emotional and Behavioral Difficulties / mood and anxiety
symptoms
MSC: NCLEX Client Needs Category: Psychosocial Integrity
Question 7. Assuming no immediate need for hospitalization, which psychotherapy
recommendation best fits 'Preschooler with Emotional and Behavioral Difficulties'?
A. Avoid psychotherapy until all symptoms are eliminated by medication
B. A confrontational style that minimizes patient strengths and readiness
C. comprehensive psychiatric assessment and collaborative treatment planning
D. A purely nondirective approach with no symptom targets or structure
