NR-607 Diagnosis & Management in Psychiatric Mental
Health III
Chamberlain University - Final Exam Practice Questions
85 Original Practice Questions with Correct Answers &
Rationales
1. A 34-year-old patient presents with persistent low mood, anhedonia, fatigue, and
difficulty concentrating for 6 weeks. Which assessment finding would MOST strongly
support a diagnosis of Major Depressive Disorder rather than Adjustment Disorder with
Depressed Mood?
A. Recent job loss 3 weeks ago
B. Symptoms causing significant impairment in occupational functioning
C. Presence of suicidal ideation with a plan
D. Symptoms persisting beyond 6 months after stressor resolution
Correct Answer: C
Rationale: While both disorders can involve functional impairment, suicidal ideation
with a plan is more characteristic of Major Depressive Disorder (MDD) and indicates
greater severity. Adjustment Disorder symptoms typically emerge within 3 months of a
stressor and resolve within 6 months after stressor termination. MDD requires
symptoms for ≥2 weeks with ≥5 specific criteria including depressed mood or
anhedonia plus additional neurovegetative symptoms. Suicidal planning suggests more
severe pathology consistent with MDD.
2. When initiating sertraline for a patient with Generalized Anxiety Disorder, which
teaching point is MOST important for the PMHNP to emphasize?
A. "Take this medication with food to reduce nausea"
,B. "Therapeutic effects may take 4-6 weeks to become apparent"
C. "Avoid consuming aged cheeses while taking this medication"
D. "This medication is habit-forming; do not stop abruptly"
Correct Answer: B
Rationale: SSRIs like sertraline typically require 4-6 weeks for full therapeutic effect on
anxiety symptoms, though some improvement may occur earlier. Setting realistic
expectations improves adherence. Option A is correct but less critical. Option C applies
to MAOIs, not SSRIs. Option D is misleading—SSRIs are not considered habit-forming
like benzodiazepines, though discontinuation syndrome can occur with abrupt
cessation.
3. A patient with Bipolar I Disorder is maintained on lithium. Which laboratory value
requires immediate intervention?
A. Lithium level: 0.8 mEq/L
B. TSH: 4.8 mIU/L
C. Creatinine: 1.4 mg/dL (baseline 0.9 mg/dL)
D. Sodium: 136 mEq/L
Correct Answer: C
Rationale: Lithium is nephrotoxic; a rising creatinine suggests declining renal function
requiring dose adjustment or discontinuation. Therapeutic lithium levels are 0.6-1.2
mEq/L for maintenance (0.8 is therapeutic). Mild TSH elevation may indicate subclinical
hypothyroidism (a lithium side effect) but is not emergent. Sodium 136 is mildly low but
not critical; however, significant hyponatremia can increase lithium toxicity risk.
4. Which psychotherapeutic approach is considered FIRST-LINE for treating Panic
Disorder with Agoraphobia?
A. Psychodynamic therapy
B. Cognitive Behavioral Therapy (CBT) with exposure components
C. Supportive therapy
,D. Interpersonal therapy
Correct Answer: B
Rationale: CBT with interoceptive and in vivo exposure is the gold-standard
psychotherapy for Panic Disorder with Agoraphobia, with strong evidence for reducing
panic attacks and avoidance behaviors. Exposure helps patients confront feared bodily
sensations and situations. While other therapies may provide support, they lack the
specific evidence base for this condition.
5. A 22-year-old college student presents with recurrent, intrusive thoughts about
contamination and engages in excessive handwashing. These symptoms cause
significant distress and consume >2 hours daily. What is the MOST appropriate initial
pharmacotherapy?
A. Alprazolam 0.5 mg TID PRN
B. Fluoxetine 20 mg daily
C. Risperidone 1 mg BID
D. Bupropion 150 mg XL daily
Correct Answer: B
Rationale: The presentation is consistent with Obsessive-Compulsive Disorder (OCD).
SSRIs (like fluoxetine) are first-line pharmacotherapy for OCD, typically requiring higher
doses and longer trials (10-12 weeks) than for depression. Benzodiazepines (A) are not
recommended for OCD core symptoms. Antipsychotics (C) may be adjunctive for
treatment-resistant cases but not first-line. Bupropion (D) lacks efficacy for OCD and
may worsen anxiety.
6. When assessing a patient for Post-Traumatic Stress Disorder (PTSD), which symptom
cluster is REQUIRED for diagnosis per DSM-5-TR?
A. Dissociative symptoms (depersonalization/derealization)
B. Negative alterations in cognitions and mood
C. Hyperarousal symptoms only
, D. Avoidance of trauma-related stimuli alone
Correct Answer: B
Rationale: DSM-5-TR requires symptoms from ALL four clusters: (1) intrusion
symptoms, (2) avoidance, (3) negative alterations in cognitions/mood, AND (4)
hyperarousal/reactivity. While avoidance (D) or hyperarousal (C) alone are insufficient,
negative cognitions/mood (B) is one required cluster. Dissociative symptoms (A) specify
a PTSD subtype but are not required for diagnosis.
7. A patient with Schizophrenia is prescribed clozapine. Which monitoring parameter is
MOST critical during the first 6 months?
A. Monthly liver function tests
B. Weekly absolute neutrophil count (ANC)
C. Quarterly ECG for QTc prolongation
D. Biannual fasting glucose
Correct Answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis. REMS program
mandates weekly ANC monitoring for first 6 months, then biweekly for months 7-12,
then monthly. While metabolic monitoring (D) and cardiac monitoring (C) are important,
ANC is life-saving for early detection of agranulocytosis. LFTs (A) are not specifically
required for clozapine.
8. Which statement by a patient with Borderline Personality Disorder indicates progress
in Dialectical Behavior Therapy (DBT)?
A. "I no longer feel intense emotions"
B. "I used the TIPP skill when I felt overwhelmed yesterday"
C. "I think my family is the cause of all my problems"
D. "I don't need to practice skills anymore"
Correct Answer: B
Health III
Chamberlain University - Final Exam Practice Questions
85 Original Practice Questions with Correct Answers &
Rationales
1. A 34-year-old patient presents with persistent low mood, anhedonia, fatigue, and
difficulty concentrating for 6 weeks. Which assessment finding would MOST strongly
support a diagnosis of Major Depressive Disorder rather than Adjustment Disorder with
Depressed Mood?
A. Recent job loss 3 weeks ago
B. Symptoms causing significant impairment in occupational functioning
C. Presence of suicidal ideation with a plan
D. Symptoms persisting beyond 6 months after stressor resolution
Correct Answer: C
Rationale: While both disorders can involve functional impairment, suicidal ideation
with a plan is more characteristic of Major Depressive Disorder (MDD) and indicates
greater severity. Adjustment Disorder symptoms typically emerge within 3 months of a
stressor and resolve within 6 months after stressor termination. MDD requires
symptoms for ≥2 weeks with ≥5 specific criteria including depressed mood or
anhedonia plus additional neurovegetative symptoms. Suicidal planning suggests more
severe pathology consistent with MDD.
2. When initiating sertraline for a patient with Generalized Anxiety Disorder, which
teaching point is MOST important for the PMHNP to emphasize?
A. "Take this medication with food to reduce nausea"
,B. "Therapeutic effects may take 4-6 weeks to become apparent"
C. "Avoid consuming aged cheeses while taking this medication"
D. "This medication is habit-forming; do not stop abruptly"
Correct Answer: B
Rationale: SSRIs like sertraline typically require 4-6 weeks for full therapeutic effect on
anxiety symptoms, though some improvement may occur earlier. Setting realistic
expectations improves adherence. Option A is correct but less critical. Option C applies
to MAOIs, not SSRIs. Option D is misleading—SSRIs are not considered habit-forming
like benzodiazepines, though discontinuation syndrome can occur with abrupt
cessation.
3. A patient with Bipolar I Disorder is maintained on lithium. Which laboratory value
requires immediate intervention?
A. Lithium level: 0.8 mEq/L
B. TSH: 4.8 mIU/L
C. Creatinine: 1.4 mg/dL (baseline 0.9 mg/dL)
D. Sodium: 136 mEq/L
Correct Answer: C
Rationale: Lithium is nephrotoxic; a rising creatinine suggests declining renal function
requiring dose adjustment or discontinuation. Therapeutic lithium levels are 0.6-1.2
mEq/L for maintenance (0.8 is therapeutic). Mild TSH elevation may indicate subclinical
hypothyroidism (a lithium side effect) but is not emergent. Sodium 136 is mildly low but
not critical; however, significant hyponatremia can increase lithium toxicity risk.
4. Which psychotherapeutic approach is considered FIRST-LINE for treating Panic
Disorder with Agoraphobia?
A. Psychodynamic therapy
B. Cognitive Behavioral Therapy (CBT) with exposure components
C. Supportive therapy
,D. Interpersonal therapy
Correct Answer: B
Rationale: CBT with interoceptive and in vivo exposure is the gold-standard
psychotherapy for Panic Disorder with Agoraphobia, with strong evidence for reducing
panic attacks and avoidance behaviors. Exposure helps patients confront feared bodily
sensations and situations. While other therapies may provide support, they lack the
specific evidence base for this condition.
5. A 22-year-old college student presents with recurrent, intrusive thoughts about
contamination and engages in excessive handwashing. These symptoms cause
significant distress and consume >2 hours daily. What is the MOST appropriate initial
pharmacotherapy?
A. Alprazolam 0.5 mg TID PRN
B. Fluoxetine 20 mg daily
C. Risperidone 1 mg BID
D. Bupropion 150 mg XL daily
Correct Answer: B
Rationale: The presentation is consistent with Obsessive-Compulsive Disorder (OCD).
SSRIs (like fluoxetine) are first-line pharmacotherapy for OCD, typically requiring higher
doses and longer trials (10-12 weeks) than for depression. Benzodiazepines (A) are not
recommended for OCD core symptoms. Antipsychotics (C) may be adjunctive for
treatment-resistant cases but not first-line. Bupropion (D) lacks efficacy for OCD and
may worsen anxiety.
6. When assessing a patient for Post-Traumatic Stress Disorder (PTSD), which symptom
cluster is REQUIRED for diagnosis per DSM-5-TR?
A. Dissociative symptoms (depersonalization/derealization)
B. Negative alterations in cognitions and mood
C. Hyperarousal symptoms only
, D. Avoidance of trauma-related stimuli alone
Correct Answer: B
Rationale: DSM-5-TR requires symptoms from ALL four clusters: (1) intrusion
symptoms, (2) avoidance, (3) negative alterations in cognitions/mood, AND (4)
hyperarousal/reactivity. While avoidance (D) or hyperarousal (C) alone are insufficient,
negative cognitions/mood (B) is one required cluster. Dissociative symptoms (A) specify
a PTSD subtype but are not required for diagnosis.
7. A patient with Schizophrenia is prescribed clozapine. Which monitoring parameter is
MOST critical during the first 6 months?
A. Monthly liver function tests
B. Weekly absolute neutrophil count (ANC)
C. Quarterly ECG for QTc prolongation
D. Biannual fasting glucose
Correct Answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis. REMS program
mandates weekly ANC monitoring for first 6 months, then biweekly for months 7-12,
then monthly. While metabolic monitoring (D) and cardiac monitoring (C) are important,
ANC is life-saving for early detection of agranulocytosis. LFTs (A) are not specifically
required for clozapine.
8. Which statement by a patient with Borderline Personality Disorder indicates progress
in Dialectical Behavior Therapy (DBT)?
A. "I no longer feel intense emotions"
B. "I used the TIPP skill when I felt overwhelmed yesterday"
C. "I think my family is the cause of all my problems"
D. "I don't need to practice skills anymore"
Correct Answer: B
