NR605 FINAL EXAM LATEST 2026/2027 | Diagnosis & Management in
Psychiatric-Mental Health Across Lifespan I | Weeks 5-8 Practicum
Review | Pass Guaranteed - A+ Graded
Section 1: Mood Disorders – MDD & PDD (Questions 1-15)
Q1. A 32-year-old female presents with depressed mood, anhedonia, insomnia, fatigue,
poor concentration, and feelings of worthlessness for the past 3 weeks. She denies
suicidal ideation. The most likely diagnosis is:
A. Adjustment disorder with depressed mood
B. Major depressive disorder [CORRECT]
C. Persistent depressive disorder
D. Bipolar II disorder
Rationale: This patient meets DSM-5-TR criteria for MDD: ≥5 symptoms in the same
2-week period including depressed mood and anhedonia, with clinically significant
distress. Adjustment disorder (A) requires symptoms within 3 months of an identifiable
stressor and does not meet full MDD criteria. Persistent depressive disorder (C) requires
symptoms for ≥2 years. Bipolar II (D) requires history of hypomania. The NR605
practicum emphasizes that screening for mania/hypomania history is essential before
diagnosing MDD.
Correct Answer: B
Q2. A patient with MDD experiences mood reactivity, significant weight gain with
hyperphagia, hypersomnia, leaden paralysis, and long-standing interpersonal rejection
sensitivity. The appropriate specifier is:
A. Melancholic features
B. Atypical features [CORRECT]
C. Psychotic features
,D. Catatonic features
Rationale: Atypical features specifier requires mood reactivity plus ≥2 of: hyperphagia,
hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. Melancholic
features (A) include anhedonia, non-reactive mood, early morning awakening,
psychomotor changes, and weight loss—opposite of this presentation. Psychotic (C)
and catatonic (D) specifiers have distinct criteria. The NR605 curriculum teaches that
"atypical" is historically misleading—this presentation is actually common, particularly in
younger patients and those with bipolar diathesis.
Correct Answer: B
Q3. A 28-year-old male presents with first-episode depression. Before initiating
antidepressant therapy, the most critical screening assessment is:
A. Family history of diabetes mellitus
B. History of mania or hypomania to rule out bipolar disorder [CORRECT]
C. Previous cholesterol levels
D. History of seasonal allergies
Rationale: Screening for past mania/hypomania is mandatory before treating
depression because antidepressant monotherapy in bipolar disorder can induce mania,
mixed states, or rapid cycling. Up to 20% of patients presenting with MDD may have
undiagnosed bipolar disorder. Family history of diabetes (A), cholesterol (C), and
allergies (D) are relevant to general health but not critical for antidepressant safety. The
NR605 practicum emphasizes the Mood Disorder Questionnaire (MDQ) as a screening
tool.
Correct Answer: B
Q4. A patient with moderate MDD (PHQ-9 score 14) has no prior treatment. The first-line
evidence-based treatment recommendation is:
,A. Electroconvulsive therapy
B. Combination of SSRI and cognitive-behavioral therapy [CORRECT]
C. MAOI monotherapy
D. Augmentation with aripiprazole
Rationale: For moderate MDD, combined SSRI and psychotherapy (CBT or IPT) produces
superior outcomes to either alone. ECT (A) is reserved for severe, treatment-resistant, or
psychotic depression. MAOIs (C) are not first-line due to dietary restrictions and drug
interactions. Augmentation (D) is for partial responders, not initial treatment. The
NR605 curriculum follows CANMAT/APA guidelines for stepped care.
Correct Answer: B
Q5. A patient on citalopram 60 mg daily presents with syncope. ECG shows QTc 520
ms. The most appropriate action is:
A. Continue current dose and add a beta-blocker
B. Reduce citalopram to ≤40 mg (≤20 mg if >60 years) and repeat ECG [CORRECT]
C. Switch to paroxetine 60 mg daily
D. Discontinue all antidepressants permanently
Rationale: Citalopram >40 mg/day prolongs QTc and is not recommended; >20 mg is
cautioned in patients >60 years. The dose must be reduced and cardiac monitoring
continued. Beta-blockers (A) do not address the medication cause. Paroxetine (C) at 60
mg exceeds usual maximum and carries its own risks. Permanent discontinuation (D) is
excessive; safer alternatives exist. The NR605 curriculum emphasizes cardiac safety
with citalopram and escitalopram.
Correct Answer: B
Q6. A patient with treatment-resistant depression has failed sertraline 200 mg and
venlafaxine XR 225 mg. The next evidence-based step is:
A. Increase venlafaxine to 375 mg
, B. Trial intranasal esketamine (Spravato) with an oral antidepressant or ECT [CORRECT]
C. Add a second SSRI to the venlafaxine
D. Discontinue all medications and use psychotherapy alone
Rationale: After two failed antidepressant trials, TRD is diagnosed. Esketamine
(FDA-approved for TRD) or ECT are evidence-based options. Higher venlafaxine (A)
lacks efficacy evidence and increases cardiovascular risk. Combining SSRIs/SNRIs (C)
risks serotonin syndrome. Psychotherapy alone (D) is insufficient for severe TRD. The
NR605 curriculum positions esketamine and ECT as critical options for TRD with
suicidality.
Correct Answer: B
Q7. A patient with PDD (dysthymia) reports depressed mood most days for 3 years, with
poor appetite, low energy, low self-esteem, and hopelessness. She has never been
symptom-free for >2 months. The required duration for adult PDD is:
A. ≥1 year
B. ≥2 years [CORRECT]
C. ≥6 months
D. ≥5 years
Rationale: DSM-5-TR requires depressed mood most of the day, more days than not, for
≥2 years in adults (≥1 year in children/adolescents), plus ≥2 associated symptoms, with
no symptom-free periods >2 months. Options A, C, and D do not match criteria. The
NR605 curriculum distinguishes PDD's chronicity from MDD's episodic nature and notes
the "double depression" phenomenon when MDD superimposes on PDD.
Correct Answer: B
Q8. A patient with MDD and prominent insomnia, anorexia, and weight loss is started on
mirtazapine 15 mg at bedtime. After 2 weeks, she reports improved sleep and appetite
but excessive daytime sedation. The best adjustment is:
Psychiatric-Mental Health Across Lifespan I | Weeks 5-8 Practicum
Review | Pass Guaranteed - A+ Graded
Section 1: Mood Disorders – MDD & PDD (Questions 1-15)
Q1. A 32-year-old female presents with depressed mood, anhedonia, insomnia, fatigue,
poor concentration, and feelings of worthlessness for the past 3 weeks. She denies
suicidal ideation. The most likely diagnosis is:
A. Adjustment disorder with depressed mood
B. Major depressive disorder [CORRECT]
C. Persistent depressive disorder
D. Bipolar II disorder
Rationale: This patient meets DSM-5-TR criteria for MDD: ≥5 symptoms in the same
2-week period including depressed mood and anhedonia, with clinically significant
distress. Adjustment disorder (A) requires symptoms within 3 months of an identifiable
stressor and does not meet full MDD criteria. Persistent depressive disorder (C) requires
symptoms for ≥2 years. Bipolar II (D) requires history of hypomania. The NR605
practicum emphasizes that screening for mania/hypomania history is essential before
diagnosing MDD.
Correct Answer: B
Q2. A patient with MDD experiences mood reactivity, significant weight gain with
hyperphagia, hypersomnia, leaden paralysis, and long-standing interpersonal rejection
sensitivity. The appropriate specifier is:
A. Melancholic features
B. Atypical features [CORRECT]
C. Psychotic features
,D. Catatonic features
Rationale: Atypical features specifier requires mood reactivity plus ≥2 of: hyperphagia,
hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. Melancholic
features (A) include anhedonia, non-reactive mood, early morning awakening,
psychomotor changes, and weight loss—opposite of this presentation. Psychotic (C)
and catatonic (D) specifiers have distinct criteria. The NR605 curriculum teaches that
"atypical" is historically misleading—this presentation is actually common, particularly in
younger patients and those with bipolar diathesis.
Correct Answer: B
Q3. A 28-year-old male presents with first-episode depression. Before initiating
antidepressant therapy, the most critical screening assessment is:
A. Family history of diabetes mellitus
B. History of mania or hypomania to rule out bipolar disorder [CORRECT]
C. Previous cholesterol levels
D. History of seasonal allergies
Rationale: Screening for past mania/hypomania is mandatory before treating
depression because antidepressant monotherapy in bipolar disorder can induce mania,
mixed states, or rapid cycling. Up to 20% of patients presenting with MDD may have
undiagnosed bipolar disorder. Family history of diabetes (A), cholesterol (C), and
allergies (D) are relevant to general health but not critical for antidepressant safety. The
NR605 practicum emphasizes the Mood Disorder Questionnaire (MDQ) as a screening
tool.
Correct Answer: B
Q4. A patient with moderate MDD (PHQ-9 score 14) has no prior treatment. The first-line
evidence-based treatment recommendation is:
,A. Electroconvulsive therapy
B. Combination of SSRI and cognitive-behavioral therapy [CORRECT]
C. MAOI monotherapy
D. Augmentation with aripiprazole
Rationale: For moderate MDD, combined SSRI and psychotherapy (CBT or IPT) produces
superior outcomes to either alone. ECT (A) is reserved for severe, treatment-resistant, or
psychotic depression. MAOIs (C) are not first-line due to dietary restrictions and drug
interactions. Augmentation (D) is for partial responders, not initial treatment. The
NR605 curriculum follows CANMAT/APA guidelines for stepped care.
Correct Answer: B
Q5. A patient on citalopram 60 mg daily presents with syncope. ECG shows QTc 520
ms. The most appropriate action is:
A. Continue current dose and add a beta-blocker
B. Reduce citalopram to ≤40 mg (≤20 mg if >60 years) and repeat ECG [CORRECT]
C. Switch to paroxetine 60 mg daily
D. Discontinue all antidepressants permanently
Rationale: Citalopram >40 mg/day prolongs QTc and is not recommended; >20 mg is
cautioned in patients >60 years. The dose must be reduced and cardiac monitoring
continued. Beta-blockers (A) do not address the medication cause. Paroxetine (C) at 60
mg exceeds usual maximum and carries its own risks. Permanent discontinuation (D) is
excessive; safer alternatives exist. The NR605 curriculum emphasizes cardiac safety
with citalopram and escitalopram.
Correct Answer: B
Q6. A patient with treatment-resistant depression has failed sertraline 200 mg and
venlafaxine XR 225 mg. The next evidence-based step is:
A. Increase venlafaxine to 375 mg
, B. Trial intranasal esketamine (Spravato) with an oral antidepressant or ECT [CORRECT]
C. Add a second SSRI to the venlafaxine
D. Discontinue all medications and use psychotherapy alone
Rationale: After two failed antidepressant trials, TRD is diagnosed. Esketamine
(FDA-approved for TRD) or ECT are evidence-based options. Higher venlafaxine (A)
lacks efficacy evidence and increases cardiovascular risk. Combining SSRIs/SNRIs (C)
risks serotonin syndrome. Psychotherapy alone (D) is insufficient for severe TRD. The
NR605 curriculum positions esketamine and ECT as critical options for TRD with
suicidality.
Correct Answer: B
Q7. A patient with PDD (dysthymia) reports depressed mood most days for 3 years, with
poor appetite, low energy, low self-esteem, and hopelessness. She has never been
symptom-free for >2 months. The required duration for adult PDD is:
A. ≥1 year
B. ≥2 years [CORRECT]
C. ≥6 months
D. ≥5 years
Rationale: DSM-5-TR requires depressed mood most of the day, more days than not, for
≥2 years in adults (≥1 year in children/adolescents), plus ≥2 associated symptoms, with
no symptom-free periods >2 months. Options A, C, and D do not match criteria. The
NR605 curriculum distinguishes PDD's chronicity from MDD's episodic nature and notes
the "double depression" phenomenon when MDD superimposes on PDD.
Correct Answer: B
Q8. A patient with MDD and prominent insomnia, anorexia, and weight loss is started on
mirtazapine 15 mg at bedtime. After 2 weeks, she reports improved sleep and appetite
but excessive daytime sedation. The best adjustment is:
