NR602 Primary Care – Sarah Jamieson Mood Case
Actual Exam 2026/2027 | Complete Exam-Style
Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Mood Disorder Presentation & Differential | Q1 – Q10
Section 2 | Obstetric & Postpartum Mood History | Q11 – Q20
Section 3 | Screening Tools & Diagnostic Criteria | Q21 – Q30
Section 4 | Safety Assessment, Suicide Risk & Referral | Q31 – Q40
Section 5 | Treatment, Pharmacotherapy & Follow-Up | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
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SECTION 1: MOOD DISORDER PRESENTATION & DIFFERENTIAL DIAGNOSIS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
Sarah Jamieson is a 28-year-old G1P1 who presents to her primary care clinic three
weeks after an uncomplicated vaginal delivery of a healthy 7-pound 4-ounce baby girl.
She reports feeling overwhelmed, crying several times daily, and difficulty sleeping even
when the baby sleeps. She states, "I just don't feel like myself, but I know this is probably
normal." Which clinical presentation best differentiates her current symptoms from
typical postpartum blues?
A. Crying episodes that resolve with reassurance from her partner
B. Symptoms persisting beyond two weeks with functional impairment ✓ CORRECT
C. Mild irritability that improves by late afternoon each day
D. Fatigue that correlates directly with nighttime feedings
,Correct Answer: B
Rationale: Postpartum blues typically resolve within 10–14 days without functional
impairment, whereas symptoms persisting beyond two weeks with difficulty caring for
herself or the infant suggest postpartum depression. Crying and fatigue can occur in
both conditions, making them poor discriminators. Primary care NPs should schedule a
follow-up visit at two weeks postpartum specifically to reassess mood symptoms and
catch depression early before it becomes entrenched.
Question 2 of 50
Sarah returns at her six-week postpartum visit and now reports persistent sadness, loss
of interest in activities she previously enjoyed, and feelings of worthlessness. She
mentions that she has not felt bonded with her baby and feels guilty about it. Her
symptoms have worsened since her two-week visit. Which differential diagnosis should
be prioritized?
A. Adjustment disorder with depressed mood
B. Major depressive disorder with peripartum onset ✓ CORRECT
C. Postpartum thyroiditis
D. Bipolar II disorder
Correct Answer: B
Rationale: Sarah's symptoms meet DSM-5 criteria for major depressive disorder with
peripartum onset, which requires five or more depressive symptoms present for at least
two weeks during pregnancy or within four weeks postpartum. Adjustment disorder
symptoms are less severe and do not include the full symptom cluster of anhedonia,
worthlessness, and guilt seen here. While thyroid dysfunction should be ruled out with a
TSH, the clinical picture is most consistent with peripartum depression requiring
immediate intervention.
Question 3 of 50
,At her eight-week postpartum visit, Sarah's husband calls the clinic concerned that
Sarah has been up all night reorganizing the nursery, speaking rapidly about starting a
baby clothing business, and insisting the baby is a genius who will change the world.
She has not slept in 48 hours but seems euphoric and energized. Which diagnosis must
be urgently ruled out?
A. Severe postpartum anxiety with insomnia
B. Postpartum psychosis with manic features ✓ CORRECT
C. Normal maternal excitement about new motherhood
D. Postpartum obsessive-compulsive disorder
Correct Answer: B
Rationale: The acute onset of decreased need for sleep, grandiose delusions about the
infant, pressured speech, and euphoria in the early postpartum period is highly
suggestive of postpartum psychosis, which frequently presents with manic or mixed
features and requires emergency psychiatric evaluation. Normal maternal excitement
does not include delusional thinking or complete sleep deprivation. Postpartum
psychosis is a psychiatric emergency with high risk of infanticide and suicide,
necessitating immediate hospitalization.
Question 4 of 50
Sarah's sister, who also had a baby six months ago, experienced two weeks of mild
tearfulness, anxiety, and mood lability that resolved completely without treatment. She
asks if this is what Sarah has. Which statement best distinguishes postpartum blues
from postpartum depression?
A. Postpartum blues always require antidepressant medication
B. Postpartum blues peak around day 3–5 and resolve within two weeks ✓ CORRECT
C. Postpartum blues include suicidal ideation in 50% of cases
D. Postpartum blues only occur after cesarean deliveries
Correct Answer: B
, Rationale: Postpartum blues affect up to 80% of new mothers, peak around the third to
fifth postpartum day, and characteristically resolve spontaneously within 10–14 days
without functional impairment or need for medication. Suicidal ideation is never a
feature of postpartum blues and its presence indicates depression or psychosis
requiring immediate evaluation. Educating patients and families about this timeline
helps them know when to seek additional help if symptoms persist.
Question 5 of 50
Sarah mentions that her mother had "postpartum depression" after Sarah was born and
was hospitalized for several weeks. She asks if this increases her risk. Which risk factor
for postpartum depression is most strongly supported by evidence?
A. History of postpartum depression in a first-degree relative ✓ CORRECT
B. Delivery by cesarean section versus vaginal birth
C. Infant birth weight below the 10th percentile
D. Maternal age between 25 and 30 years
Correct Answer: A
Rationale: A family history of postpartum depression, particularly in a first-degree
relative, is one of the strongest identified risk factors for developing postpartum
depression, likely reflecting both genetic vulnerability and shared environmental factors.
Mode of delivery and infant birth weight have weaker or inconsistent associations with
postpartum mood disorders. Primary care NPs should routinely screen for family history
of perinatal mood disorders during prenatal care and early postpartum visits to identify
high-risk patients.
Question 6 of 50
Sarah's friend tells her that her symptoms might be caused by her thyroid "acting up"
after delivery. Which laboratory finding would most support a diagnosis of postpartum
thyroiditis rather than primary postpartum depression?
Actual Exam 2026/2027 | Complete Exam-Style
Questions with Detailed Rationales | Pass
Guaranteed – A+ Graded
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Mood Disorder Presentation & Differential | Q1 – Q10
Section 2 | Obstetric & Postpartum Mood History | Q11 – Q20
Section 3 | Screening Tools & Diagnostic Criteria | Q21 – Q30
Section 4 | Safety Assessment, Suicide Risk & Referral | Q31 – Q40
Section 5 | Treatment, Pharmacotherapy & Follow-Up | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: MOOD DISORDER PRESENTATION & DIFFERENTIAL DIAGNOSIS Q1 – Q10
══════════════════════════════════════
Question 1 of 50
Sarah Jamieson is a 28-year-old G1P1 who presents to her primary care clinic three
weeks after an uncomplicated vaginal delivery of a healthy 7-pound 4-ounce baby girl.
She reports feeling overwhelmed, crying several times daily, and difficulty sleeping even
when the baby sleeps. She states, "I just don't feel like myself, but I know this is probably
normal." Which clinical presentation best differentiates her current symptoms from
typical postpartum blues?
A. Crying episodes that resolve with reassurance from her partner
B. Symptoms persisting beyond two weeks with functional impairment ✓ CORRECT
C. Mild irritability that improves by late afternoon each day
D. Fatigue that correlates directly with nighttime feedings
,Correct Answer: B
Rationale: Postpartum blues typically resolve within 10–14 days without functional
impairment, whereas symptoms persisting beyond two weeks with difficulty caring for
herself or the infant suggest postpartum depression. Crying and fatigue can occur in
both conditions, making them poor discriminators. Primary care NPs should schedule a
follow-up visit at two weeks postpartum specifically to reassess mood symptoms and
catch depression early before it becomes entrenched.
Question 2 of 50
Sarah returns at her six-week postpartum visit and now reports persistent sadness, loss
of interest in activities she previously enjoyed, and feelings of worthlessness. She
mentions that she has not felt bonded with her baby and feels guilty about it. Her
symptoms have worsened since her two-week visit. Which differential diagnosis should
be prioritized?
A. Adjustment disorder with depressed mood
B. Major depressive disorder with peripartum onset ✓ CORRECT
C. Postpartum thyroiditis
D. Bipolar II disorder
Correct Answer: B
Rationale: Sarah's symptoms meet DSM-5 criteria for major depressive disorder with
peripartum onset, which requires five or more depressive symptoms present for at least
two weeks during pregnancy or within four weeks postpartum. Adjustment disorder
symptoms are less severe and do not include the full symptom cluster of anhedonia,
worthlessness, and guilt seen here. While thyroid dysfunction should be ruled out with a
TSH, the clinical picture is most consistent with peripartum depression requiring
immediate intervention.
Question 3 of 50
,At her eight-week postpartum visit, Sarah's husband calls the clinic concerned that
Sarah has been up all night reorganizing the nursery, speaking rapidly about starting a
baby clothing business, and insisting the baby is a genius who will change the world.
She has not slept in 48 hours but seems euphoric and energized. Which diagnosis must
be urgently ruled out?
A. Severe postpartum anxiety with insomnia
B. Postpartum psychosis with manic features ✓ CORRECT
C. Normal maternal excitement about new motherhood
D. Postpartum obsessive-compulsive disorder
Correct Answer: B
Rationale: The acute onset of decreased need for sleep, grandiose delusions about the
infant, pressured speech, and euphoria in the early postpartum period is highly
suggestive of postpartum psychosis, which frequently presents with manic or mixed
features and requires emergency psychiatric evaluation. Normal maternal excitement
does not include delusional thinking or complete sleep deprivation. Postpartum
psychosis is a psychiatric emergency with high risk of infanticide and suicide,
necessitating immediate hospitalization.
Question 4 of 50
Sarah's sister, who also had a baby six months ago, experienced two weeks of mild
tearfulness, anxiety, and mood lability that resolved completely without treatment. She
asks if this is what Sarah has. Which statement best distinguishes postpartum blues
from postpartum depression?
A. Postpartum blues always require antidepressant medication
B. Postpartum blues peak around day 3–5 and resolve within two weeks ✓ CORRECT
C. Postpartum blues include suicidal ideation in 50% of cases
D. Postpartum blues only occur after cesarean deliveries
Correct Answer: B
, Rationale: Postpartum blues affect up to 80% of new mothers, peak around the third to
fifth postpartum day, and characteristically resolve spontaneously within 10–14 days
without functional impairment or need for medication. Suicidal ideation is never a
feature of postpartum blues and its presence indicates depression or psychosis
requiring immediate evaluation. Educating patients and families about this timeline
helps them know when to seek additional help if symptoms persist.
Question 5 of 50
Sarah mentions that her mother had "postpartum depression" after Sarah was born and
was hospitalized for several weeks. She asks if this increases her risk. Which risk factor
for postpartum depression is most strongly supported by evidence?
A. History of postpartum depression in a first-degree relative ✓ CORRECT
B. Delivery by cesarean section versus vaginal birth
C. Infant birth weight below the 10th percentile
D. Maternal age between 25 and 30 years
Correct Answer: A
Rationale: A family history of postpartum depression, particularly in a first-degree
relative, is one of the strongest identified risk factors for developing postpartum
depression, likely reflecting both genetic vulnerability and shared environmental factors.
Mode of delivery and infant birth weight have weaker or inconsistent associations with
postpartum mood disorders. Primary care NPs should routinely screen for family history
of perinatal mood disorders during prenatal care and early postpartum visits to identify
high-risk patients.
Question 6 of 50
Sarah's friend tells her that her symptoms might be caused by her thyroid "acting up"
after delivery. Which laboratory finding would most support a diagnosis of postpartum
thyroiditis rather than primary postpartum depression?
