NRNP 6635 FINAL EXAM – WEEK 11 Actual Exam |
Advanced PMHNP: Psychopathology,
Psychopharmacology, & Integrated Care – Complete
Questions and Answers – Pass Guaranteed - A+ Graded
Part I – When Mood, Fear, and Trauma Take Over
Q1: A 34-year-old woman presents two weeks postpartum with severe insomnia,
feelings of worthlessness, and intrusive thoughts of harm coming to her baby that she
finds terrifying and ego-dystonic. She has no history of mania. Which specifier best
captures her presentation?
A. Seasonal pattern
B. With peripartum onset [CORRECT]
C. With melancholic features
D. With atypical features
Correct Answer: B
Rationale: Peripartum onset applies when a major depressive episode begins during
pregnancy or within four weeks after delivery, and the presence of intrusive harm
thoughts—when ego-dystonic and accompanied by anxiety—fits this clinical picture
rather than psychosis. The key is timing and the absence of manic history.
Q2: Which symptom cluster most reliably distinguishes melancholic features from
atypical features in major depressive disorder?
A. Hypersomnia and weight gain
B. Mood reactivity and leaden paralysis
C. Anhedonia, nonreactive mood, and early morning awakening [CORRECT]
D. Social withdrawal and psychomotor retardation
Correct Answer: C
Rationale: Melancholic features are defined by a complete loss of pleasure in almost all
activities, mood that does not improve even temporarily with positive events, and
,distinct quality of depressed mood along with early morning awakening and
psychomotor changes. Atypical features, by contrast, include mood reactivity and
reversed vegetative symptoms like hypersomnia.
Q3: A 28-year-old graduate student reports six months of excessive worry about
academic performance, finances, and family health that feels difficult to control. She
notes muscle tension, fatigue, and irritability but denies panic attacks. Which diagnosis
fits best?
A. Panic disorder
B. Social anxiety disorder
C. Generalized anxiety disorder [CORRECT]
D. Adjustment disorder with anxiety
Correct Answer: C
Rationale: The hallmark of generalized anxiety disorder is persistent, excessive worry
across multiple domains lasting at least six months with associated physical symptoms
like muscle tension and fatigue. The absence of discrete panic attacks and the diffuse
nature of the worry point away from panic disorder.
Q4: During a routine med check, a patient with bipolar I disorder mentions he has had
four distinct mood episodes—two manic and two depressive—within the past twelve
months. How would you document his course?
A. With rapid cycling [CORRECT]
B. With mixed features
C. With seasonal pattern
D. With catatonic features
Correct Answer: A
Rationale: Rapid cycling is defined as four or more mood episodes—mania, hypomania,
or depression—within a twelve-month period. This is an important course specifier
because it often signals a more treatment-resistant illness and may warrant different
medication strategies.
Q5: A patient experiencing a manic episode reports feeling fantastic, has not slept in
three days, and is spending recklessly. When asked, he says he has never had a full
major depressive episode. What is the most accurate diagnosis?
A. Bipolar I disorder [CORRECT]
, B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder, single episode
Correct Answer: A
Rationale: Bipolar I disorder requires only one lifetime manic episode for diagnosis; a
history of major depression is not required. The presence of a full manic episode with
marked impairment and no required depressive history makes bipolar I the correct
classification.
Q6: Which of the following is a required criterion for a hypomanic episode that does
NOT apply to a manic episode?
A. Duration of at least four consecutive days
B. A distinct period of abnormally elevated mood
C. The episode is not severe enough to cause marked impairment or require
hospitalization [CORRECT]
D. Presence of increased goal-directed activity
Correct Answer: C
Rationale: Hypomania is distinguished from mania specifically by the absence of
marked functional impairment, psychosis, or need for hospitalization. Both episodes
share mood elevation and increased energy, but the severity threshold separates them
diagnostically.
Q7: A 42-year-old man has avoided grocery stores, shopping malls, and public transit for
eight months after a panic attack in a crowded theater. He says he fears having another
attack and being unable to escape. Which diagnosis is most appropriate?
A. Panic disorder without agoraphobia
B. Agoraphobia [CORRECT]
C. Social anxiety disorder
D. Specific phobia, situational type
Correct Answer: B
Rationale: Agoraphobia involves intense fear of situations where escape might be
difficult or help unavailable, often following panic attacks, with avoidance lasting six
months or more. The fear is of the situation itself and the potential for incapacitation,
not of social evaluation.
Advanced PMHNP: Psychopathology,
Psychopharmacology, & Integrated Care – Complete
Questions and Answers – Pass Guaranteed - A+ Graded
Part I – When Mood, Fear, and Trauma Take Over
Q1: A 34-year-old woman presents two weeks postpartum with severe insomnia,
feelings of worthlessness, and intrusive thoughts of harm coming to her baby that she
finds terrifying and ego-dystonic. She has no history of mania. Which specifier best
captures her presentation?
A. Seasonal pattern
B. With peripartum onset [CORRECT]
C. With melancholic features
D. With atypical features
Correct Answer: B
Rationale: Peripartum onset applies when a major depressive episode begins during
pregnancy or within four weeks after delivery, and the presence of intrusive harm
thoughts—when ego-dystonic and accompanied by anxiety—fits this clinical picture
rather than psychosis. The key is timing and the absence of manic history.
Q2: Which symptom cluster most reliably distinguishes melancholic features from
atypical features in major depressive disorder?
A. Hypersomnia and weight gain
B. Mood reactivity and leaden paralysis
C. Anhedonia, nonreactive mood, and early morning awakening [CORRECT]
D. Social withdrawal and psychomotor retardation
Correct Answer: C
Rationale: Melancholic features are defined by a complete loss of pleasure in almost all
activities, mood that does not improve even temporarily with positive events, and
,distinct quality of depressed mood along with early morning awakening and
psychomotor changes. Atypical features, by contrast, include mood reactivity and
reversed vegetative symptoms like hypersomnia.
Q3: A 28-year-old graduate student reports six months of excessive worry about
academic performance, finances, and family health that feels difficult to control. She
notes muscle tension, fatigue, and irritability but denies panic attacks. Which diagnosis
fits best?
A. Panic disorder
B. Social anxiety disorder
C. Generalized anxiety disorder [CORRECT]
D. Adjustment disorder with anxiety
Correct Answer: C
Rationale: The hallmark of generalized anxiety disorder is persistent, excessive worry
across multiple domains lasting at least six months with associated physical symptoms
like muscle tension and fatigue. The absence of discrete panic attacks and the diffuse
nature of the worry point away from panic disorder.
Q4: During a routine med check, a patient with bipolar I disorder mentions he has had
four distinct mood episodes—two manic and two depressive—within the past twelve
months. How would you document his course?
A. With rapid cycling [CORRECT]
B. With mixed features
C. With seasonal pattern
D. With catatonic features
Correct Answer: A
Rationale: Rapid cycling is defined as four or more mood episodes—mania, hypomania,
or depression—within a twelve-month period. This is an important course specifier
because it often signals a more treatment-resistant illness and may warrant different
medication strategies.
Q5: A patient experiencing a manic episode reports feeling fantastic, has not slept in
three days, and is spending recklessly. When asked, he says he has never had a full
major depressive episode. What is the most accurate diagnosis?
A. Bipolar I disorder [CORRECT]
, B. Bipolar II disorder
C. Cyclothymic disorder
D. Major depressive disorder, single episode
Correct Answer: A
Rationale: Bipolar I disorder requires only one lifetime manic episode for diagnosis; a
history of major depression is not required. The presence of a full manic episode with
marked impairment and no required depressive history makes bipolar I the correct
classification.
Q6: Which of the following is a required criterion for a hypomanic episode that does
NOT apply to a manic episode?
A. Duration of at least four consecutive days
B. A distinct period of abnormally elevated mood
C. The episode is not severe enough to cause marked impairment or require
hospitalization [CORRECT]
D. Presence of increased goal-directed activity
Correct Answer: C
Rationale: Hypomania is distinguished from mania specifically by the absence of
marked functional impairment, psychosis, or need for hospitalization. Both episodes
share mood elevation and increased energy, but the severity threshold separates them
diagnostically.
Q7: A 42-year-old man has avoided grocery stores, shopping malls, and public transit for
eight months after a panic attack in a crowded theater. He says he fears having another
attack and being unable to escape. Which diagnosis is most appropriate?
A. Panic disorder without agoraphobia
B. Agoraphobia [CORRECT]
C. Social anxiety disorder
D. Specific phobia, situational type
Correct Answer: B
Rationale: Agoraphobia involves intense fear of situations where escape might be
difficult or help unavailable, often following panic attacks, with avoidance lasting six
months or more. The fear is of the situation itself and the potential for incapacitation,
not of social evaluation.
