NR607 Diagnosis & Management in
Psychiatric Mental Health III Final Exam
Actual Exam 2026/2027 – Complete
Exam-Style Questions | Detailed
Rationales – Pass Guaranteed – A+
Graded
Question 1
A 32-year-old woman reports depressed mood, anhedonia, fatigue, and poor
concentration for 8 months. She denies mania. PHQ-9 score is 18. She has tried
sertraline 200 mg daily for 10 weeks with minimal improvement.
What is the most appropriate next step?
A. Add buspirone
B. Switch to fluoxetine
C. Augment with aripiprazole
D. Refer for electroconvulsive therapy (ECT)
Correct ,,,,answer,,,: C
Rationale: After one adequate SSRI trial (sertraline 200 mg for 8+ weeks) with
insufficient response, augmentation with a second-generation antipsychotic
(aripiprazole) is evidence-based. Switching to another SSRI is less effective.
,Question 2
A 24-year-old man presents with 4 days of elevated mood, decreased need for
sleep, grandiosity, pressured speech, and reckless spending. He has no prior
psychiatric history.
What is the most likely diagnosis?
A. Major depressive disorder with mixed features
B. Bipolar I disorder, current episode manic
C. Bipolar II disorder, hypomanic episode
D. Substance-induced mood disorder
Correct ,,,,answer,,,: B
Rationale: Symptoms lasting >7 days with functional impairment (reckless
spending) and no prior episodes meet criteria for bipolar I, manic episode.
Hypomania is shorter (<7 days) and less severe.
Question 3
A patient with bipolar I disorder on lithium has a level of 1.2 mEq/L. He reports
polyuria and polydipsia.
What is the most likely cause?
A. Diabetes mellitus
B. Nephrogenic diabetes insipidus
C. Syndrome of inappropriate ADH (SIADH)
D. Hypercalcemia
Correct ,,,,answer,,,: B
Rationale: Lithium causes nephrogenic diabetes insipidus (inability to concentrate
urine) in up to 20% of patients, presenting with polyuria and polydipsia.
,Question 4
A 28-year-old woman has panic attacks with palpitations, sweating, trembling, and
fear of dying. She avoids driving on highways.
Which medication is FDA-approved for panic disorder with agoraphobia?
A. Alprazolam
B. Propranolol
C. Paroxetine
D. Hydroxyzine
Correct ,,,,answer,,,: C
Rationale: SSRIs (paroxetine, sertraline, fluoxetine) are first-line and FDA-
approved for panic disorder. Alprazolam has high abuse potential. Propranolol is
for performance anxiety.
Question 5
A 45-year-old man with schizophrenia has been stable on paliperidone palmitate
monthly injections. He now presents with muscle rigidity, fever, and elevated
creatine kinase (CK).
What is the most likely diagnosis?
A. Dystonia
B. Neuroleptic malignant syndrome (NMS)
C. Serotonin syndrome
D. Tardive dyskinesia
, Correct ,,,,answer,,,: B
Rationale: Fever, rigidity, elevated CK, and autonomic instability in a patient on
antipsychotics = NMS. Tardive dyskinesia has involuntary movements without
fever.
Question 6
A 35-year-old woman with borderline personality disorder reports chronic
emptiness, unstable relationships, and self-cutting.
Which psychotherapy is most effective?
A. Cognitive-behavioral therapy (CBT)
B. Dialectical behavior therapy (DBT)
C. Interpersonal therapy (IPT)
D. Motivational interviewing
Correct ,,,,answer,,,: B
Rationale: DBT was specifically developed for borderline personality disorder,
targeting emotion dysregulation, self-harm, and interpersonal chaos.
Question 7
A 50-year-old man with alcohol use disorder has a history of seizures. He drank
heavily yesterday and now reports visual hallucinations, tremor, and hypertension.
What is the most appropriate pharmacotherapy?
A. Disulfiram
B. Naltrexone
Psychiatric Mental Health III Final Exam
Actual Exam 2026/2027 – Complete
Exam-Style Questions | Detailed
Rationales – Pass Guaranteed – A+
Graded
Question 1
A 32-year-old woman reports depressed mood, anhedonia, fatigue, and poor
concentration for 8 months. She denies mania. PHQ-9 score is 18. She has tried
sertraline 200 mg daily for 10 weeks with minimal improvement.
What is the most appropriate next step?
A. Add buspirone
B. Switch to fluoxetine
C. Augment with aripiprazole
D. Refer for electroconvulsive therapy (ECT)
Correct ,,,,answer,,,: C
Rationale: After one adequate SSRI trial (sertraline 200 mg for 8+ weeks) with
insufficient response, augmentation with a second-generation antipsychotic
(aripiprazole) is evidence-based. Switching to another SSRI is less effective.
,Question 2
A 24-year-old man presents with 4 days of elevated mood, decreased need for
sleep, grandiosity, pressured speech, and reckless spending. He has no prior
psychiatric history.
What is the most likely diagnosis?
A. Major depressive disorder with mixed features
B. Bipolar I disorder, current episode manic
C. Bipolar II disorder, hypomanic episode
D. Substance-induced mood disorder
Correct ,,,,answer,,,: B
Rationale: Symptoms lasting >7 days with functional impairment (reckless
spending) and no prior episodes meet criteria for bipolar I, manic episode.
Hypomania is shorter (<7 days) and less severe.
Question 3
A patient with bipolar I disorder on lithium has a level of 1.2 mEq/L. He reports
polyuria and polydipsia.
What is the most likely cause?
A. Diabetes mellitus
B. Nephrogenic diabetes insipidus
C. Syndrome of inappropriate ADH (SIADH)
D. Hypercalcemia
Correct ,,,,answer,,,: B
Rationale: Lithium causes nephrogenic diabetes insipidus (inability to concentrate
urine) in up to 20% of patients, presenting with polyuria and polydipsia.
,Question 4
A 28-year-old woman has panic attacks with palpitations, sweating, trembling, and
fear of dying. She avoids driving on highways.
Which medication is FDA-approved for panic disorder with agoraphobia?
A. Alprazolam
B. Propranolol
C. Paroxetine
D. Hydroxyzine
Correct ,,,,answer,,,: C
Rationale: SSRIs (paroxetine, sertraline, fluoxetine) are first-line and FDA-
approved for panic disorder. Alprazolam has high abuse potential. Propranolol is
for performance anxiety.
Question 5
A 45-year-old man with schizophrenia has been stable on paliperidone palmitate
monthly injections. He now presents with muscle rigidity, fever, and elevated
creatine kinase (CK).
What is the most likely diagnosis?
A. Dystonia
B. Neuroleptic malignant syndrome (NMS)
C. Serotonin syndrome
D. Tardive dyskinesia
, Correct ,,,,answer,,,: B
Rationale: Fever, rigidity, elevated CK, and autonomic instability in a patient on
antipsychotics = NMS. Tardive dyskinesia has involuntary movements without
fever.
Question 6
A 35-year-old woman with borderline personality disorder reports chronic
emptiness, unstable relationships, and self-cutting.
Which psychotherapy is most effective?
A. Cognitive-behavioral therapy (CBT)
B. Dialectical behavior therapy (DBT)
C. Interpersonal therapy (IPT)
D. Motivational interviewing
Correct ,,,,answer,,,: B
Rationale: DBT was specifically developed for borderline personality disorder,
targeting emotion dysregulation, self-harm, and interpersonal chaos.
Question 7
A 50-year-old man with alcohol use disorder has a history of seizures. He drank
heavily yesterday and now reports visual hallucinations, tremor, and hypertension.
What is the most appropriate pharmacotherapy?
A. Disulfiram
B. Naltrexone
