1
Wilkes NSG 526 Exam 3 Clinical Modalities
Advanced Psych Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
[SECTION 1: Anxiety Disorders, OCD & Trauma Disorders — Questions 1-18]
Q1: A 32-year-old patient presents to the clinic reporting excessive worry about her job, health,
and finances for the past 9 months. She reports feeling restless, fatigued, and has difficulty
concentrating. She states these symptoms are making it hard to function at work. Which criteria
must be met to confirm a diagnosis of Generalized Anxiety Disorder (GAD)?
A. Excessive worry occurring for at least 3 months.
B. Excessive worry occurring for at least 6 months plus at least three specific physical or
cognitive symptoms.
C. Excessive worry occurring for at least 6 months plus difficulty controlling the worry.
[CORRECT]
D. The presence of panic attacks followed by 1 month of worry about future attacks.
Correct Answer: C
Rationale: According to DSM-5-TR criteria, GAD is characterized by excessive anxiety and
worry occurring more days than not for at least 6 months about a number of events or activities.
The individual finds it difficult to control the worry. While three or more symptoms (restlessness,
fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance) are also required,
the core defining feature is the duration and the difficulty controlling the worry, which
distinguishes it from normal apprehension. Option A is incorrect because the duration must be at
least 6 months. Option D describes Panic Disorder.
Q2: A patient arrives in the emergency department complaining of chest pain, palpitations,
shortness of breath, and a fear of "losing control." The symptoms began abruptly 20 minutes ago.
The patient states, "I feel like I'm dying." What is the priority nursing intervention?
A. Administer an anxiolytic medication immediately.
B. Leave the patient alone to rest and reduce stimulation.
,2
C. Stay with the patient and provide a calm, grounding presence. [CORRECT]
D. Teach the patient deep breathing exercises before assessing vital signs.
Correct Answer: C
Rationale: The patient is experiencing a panic attack. The priority intervention during a panic
attack is to ensure safety and provide a calm, stable presence. The nurse should stay with the
patient to reduce the sense of impending doom and offer reassurance. Grounding techniques,
such as the 5-4-3-2-1 method, can help anchor the patient in reality. While medication may be
needed later, immediate psychological support is the first step. Leaving the patient alone (B) can
increase fear. Deep breathing (D) is helpful but secondary to the nurse's presence and assessment.
Medication (A) requires a physician's order and assessment.
Q3: A PMHNP is selecting a first-line pharmacologic treatment for a patient diagnosed with
Panic Disorder. The patient has a history of substance use disorder. Which medication class is the
most appropriate choice?
A. Benzodiazepines
B. Tricyclic Antidepressants (TCAs)
C. Selective Serotonin Reuptake Inhibitors (SSRIs) [CORRECT]
D. Monoamine Oxidase Inhibitors (MAOIs)
Correct Answer: C
Rationale: SSRIs (e.g., sertraline, paroxetine, fluoxetine) are considered the first-line
pharmacologic treatment for Panic Disorder due to their efficacy and safety profile. They are not
associated with dependence or abuse, making them the safest choice for a patient with a history
of substance use disorder. Benzodiazepines (A) are effective for acute relief but carry a high risk
of dependence and abuse, which is contraindicated in this patient. TCAs (B) and MAOIs (D)
have more side effect burdens and dietary restrictions, respectively, making them second- or
third-line options.
Q4: A patient with Obsessive-Compulsive Disorder (OCD) spends approximately 2 hours every
evening checking the locks on the doors and stove before bed. This behavior causes significant
distress and interferes with sleep. How are these checking behaviors best described?
,3
A. Obsessions
B. Compulsions [CORRECT]
C. Delusions
D. Illusions
Correct Answer: B
Rationale: Compulsions are repetitive behaviors or mental acts that a person feels driven to
perform in response to an obsession or according to rules that must be applied rigidly. The
behaviors are aimed at preventing or reducing anxiety or distress, or preventing some dreaded
event or situation; however, these behaviors are not connected in a realistic way with what they
are designed to neutralize or prevent, or are clearly excessive. Obsessions (A) are intrusive
thoughts, not actions. Delusions (C) are fixed false beliefs. Illusions (D) are misinterpretations of
external stimuli.
Q5: Which therapeutic modality is considered the gold standard psychotherapy for treating
Obsessive-Compulsive Disorder?
A. Psychodynamic Psychotherapy
B. Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP)
[CORRECT]
C. Dialectical Behavior Therapy (DBT)
D. Supportive Psychotherapy
Correct Answer: B
Rationale: CBT incorporating Exposure and Response Prevention (ERP) is the evidence-based
gold standard psychotherapeutic treatment for OCD. ERP involves exposing the patient to the
anxiety-provoking stimulus (the obsession) while preventing them from engaging in the
compulsive behavior, thereby allowing habituation to occur. Psychodynamic therapy (A)
explores unconscious conflicts but is not as effective for symptom reduction in OCD. DBT (C) is
primarily used for Borderline Personality Disorder. Supportive psychotherapy (D) alone does not
effectively manage OCD symptoms.
, 4
Q6: A college student has a severe fear of public speaking and avoids taking classes that require
presentations. This fear has persisted for 2 years and affects his academic progress. He
understands the fear is irrational but cannot control it. Which diagnosis best fits this clinical
picture?
A. Panic Disorder
B. Social Anxiety Disorder (Social Phobia) [CORRECT]
C. Agoraphobia
D. Generalized Anxiety Disorder
Correct Answer: B
Rationale: Social Anxiety Disorder involves a marked fear or anxiety about one or more social
situations where the individual is exposed to possible scrutiny by others. The individual fears
that he or she will act in a way or show anxiety symptoms that will be negatively evaluated. This
fear is specific to social performance situations (like public speaking) and leads to avoidance.
Panic Disorder (A) involves recurrent panic attacks. Agoraphobia (C) involves fear of open
spaces or situations where escape is difficult. GAD (D) involves excessive worry about multiple
domains, not just social performance.
Q7: A patient diagnosed with Post-Traumatic Stress Disorder (PTSD) reports frequent
nightmares, flashbacks, and severe hypervigilance since a car accident 6 months ago. The patient
avoids driving or being a passenger. Which medication is FDA-approved specifically for treating
the nightmares associated with PTSD?
A. Sertraline
B. Prazosin [CORRECT]
C. Lorazepam
D. Risperidone
Correct Answer: B
Rationale: Prazosin, an alpha-1 adrenergic antagonist, is widely used off-label (and supported by
clinical guidelines) specifically to reduce trauma-related nightmares and improve sleep quality in
patients with PTSD. While SSRIs like Sertraline (A) and Paroxetine are FDA-approved for the
broad treatment of PTSD symptoms, Prazosin is the specific agent targeted for nightmares.
Wilkes NSG 526 Exam 3 Clinical Modalities
Advanced Psych Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed
Rationales | Pass Guaranteed – A+ Graded
[SECTION 1: Anxiety Disorders, OCD & Trauma Disorders — Questions 1-18]
Q1: A 32-year-old patient presents to the clinic reporting excessive worry about her job, health,
and finances for the past 9 months. She reports feeling restless, fatigued, and has difficulty
concentrating. She states these symptoms are making it hard to function at work. Which criteria
must be met to confirm a diagnosis of Generalized Anxiety Disorder (GAD)?
A. Excessive worry occurring for at least 3 months.
B. Excessive worry occurring for at least 6 months plus at least three specific physical or
cognitive symptoms.
C. Excessive worry occurring for at least 6 months plus difficulty controlling the worry.
[CORRECT]
D. The presence of panic attacks followed by 1 month of worry about future attacks.
Correct Answer: C
Rationale: According to DSM-5-TR criteria, GAD is characterized by excessive anxiety and
worry occurring more days than not for at least 6 months about a number of events or activities.
The individual finds it difficult to control the worry. While three or more symptoms (restlessness,
fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance) are also required,
the core defining feature is the duration and the difficulty controlling the worry, which
distinguishes it from normal apprehension. Option A is incorrect because the duration must be at
least 6 months. Option D describes Panic Disorder.
Q2: A patient arrives in the emergency department complaining of chest pain, palpitations,
shortness of breath, and a fear of "losing control." The symptoms began abruptly 20 minutes ago.
The patient states, "I feel like I'm dying." What is the priority nursing intervention?
A. Administer an anxiolytic medication immediately.
B. Leave the patient alone to rest and reduce stimulation.
,2
C. Stay with the patient and provide a calm, grounding presence. [CORRECT]
D. Teach the patient deep breathing exercises before assessing vital signs.
Correct Answer: C
Rationale: The patient is experiencing a panic attack. The priority intervention during a panic
attack is to ensure safety and provide a calm, stable presence. The nurse should stay with the
patient to reduce the sense of impending doom and offer reassurance. Grounding techniques,
such as the 5-4-3-2-1 method, can help anchor the patient in reality. While medication may be
needed later, immediate psychological support is the first step. Leaving the patient alone (B) can
increase fear. Deep breathing (D) is helpful but secondary to the nurse's presence and assessment.
Medication (A) requires a physician's order and assessment.
Q3: A PMHNP is selecting a first-line pharmacologic treatment for a patient diagnosed with
Panic Disorder. The patient has a history of substance use disorder. Which medication class is the
most appropriate choice?
A. Benzodiazepines
B. Tricyclic Antidepressants (TCAs)
C. Selective Serotonin Reuptake Inhibitors (SSRIs) [CORRECT]
D. Monoamine Oxidase Inhibitors (MAOIs)
Correct Answer: C
Rationale: SSRIs (e.g., sertraline, paroxetine, fluoxetine) are considered the first-line
pharmacologic treatment for Panic Disorder due to their efficacy and safety profile. They are not
associated with dependence or abuse, making them the safest choice for a patient with a history
of substance use disorder. Benzodiazepines (A) are effective for acute relief but carry a high risk
of dependence and abuse, which is contraindicated in this patient. TCAs (B) and MAOIs (D)
have more side effect burdens and dietary restrictions, respectively, making them second- or
third-line options.
Q4: A patient with Obsessive-Compulsive Disorder (OCD) spends approximately 2 hours every
evening checking the locks on the doors and stove before bed. This behavior causes significant
distress and interferes with sleep. How are these checking behaviors best described?
,3
A. Obsessions
B. Compulsions [CORRECT]
C. Delusions
D. Illusions
Correct Answer: B
Rationale: Compulsions are repetitive behaviors or mental acts that a person feels driven to
perform in response to an obsession or according to rules that must be applied rigidly. The
behaviors are aimed at preventing or reducing anxiety or distress, or preventing some dreaded
event or situation; however, these behaviors are not connected in a realistic way with what they
are designed to neutralize or prevent, or are clearly excessive. Obsessions (A) are intrusive
thoughts, not actions. Delusions (C) are fixed false beliefs. Illusions (D) are misinterpretations of
external stimuli.
Q5: Which therapeutic modality is considered the gold standard psychotherapy for treating
Obsessive-Compulsive Disorder?
A. Psychodynamic Psychotherapy
B. Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP)
[CORRECT]
C. Dialectical Behavior Therapy (DBT)
D. Supportive Psychotherapy
Correct Answer: B
Rationale: CBT incorporating Exposure and Response Prevention (ERP) is the evidence-based
gold standard psychotherapeutic treatment for OCD. ERP involves exposing the patient to the
anxiety-provoking stimulus (the obsession) while preventing them from engaging in the
compulsive behavior, thereby allowing habituation to occur. Psychodynamic therapy (A)
explores unconscious conflicts but is not as effective for symptom reduction in OCD. DBT (C) is
primarily used for Borderline Personality Disorder. Supportive psychotherapy (D) alone does not
effectively manage OCD symptoms.
, 4
Q6: A college student has a severe fear of public speaking and avoids taking classes that require
presentations. This fear has persisted for 2 years and affects his academic progress. He
understands the fear is irrational but cannot control it. Which diagnosis best fits this clinical
picture?
A. Panic Disorder
B. Social Anxiety Disorder (Social Phobia) [CORRECT]
C. Agoraphobia
D. Generalized Anxiety Disorder
Correct Answer: B
Rationale: Social Anxiety Disorder involves a marked fear or anxiety about one or more social
situations where the individual is exposed to possible scrutiny by others. The individual fears
that he or she will act in a way or show anxiety symptoms that will be negatively evaluated. This
fear is specific to social performance situations (like public speaking) and leads to avoidance.
Panic Disorder (A) involves recurrent panic attacks. Agoraphobia (C) involves fear of open
spaces or situations where escape is difficult. GAD (D) involves excessive worry about multiple
domains, not just social performance.
Q7: A patient diagnosed with Post-Traumatic Stress Disorder (PTSD) reports frequent
nightmares, flashbacks, and severe hypervigilance since a car accident 6 months ago. The patient
avoids driving or being a passenger. Which medication is FDA-approved specifically for treating
the nightmares associated with PTSD?
A. Sertraline
B. Prazosin [CORRECT]
C. Lorazepam
D. Risperidone
Correct Answer: B
Rationale: Prazosin, an alpha-1 adrenergic antagonist, is widely used off-label (and supported by
clinical guidelines) specifically to reduce trauma-related nightmares and improve sleep quality in
patients with PTSD. While SSRIs like Sertraline (A) and Paroxetine are FDA-approved for the
broad treatment of PTSD symptoms, Prazosin is the specific agent targeted for nightmares.
