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 female patient presents to the clinic complaining of excessive worry about her
health, finances, and job performance for the past nine months. She reports muscle tension,
irritability, and difficulty sleeping. Physical exam is unremarkable. Which medication is
considered a first-line pharmacological treatment for this condition?
A. Alprazolam (Xanax)
B. Lorazepam (Ativan)
C. Escitalopram (Lexapro) [CORRECT]
D. Risperidone (Risperdal)
Correct Answer: C
Rationale: The patient meets DSM-5-TR criteria for Generalized Anxiety Disorder (GAD),
characterized by excessive anxiety and worry occurring more days than not for at least 6 months,
along with symptoms like restlessness or muscle tension. First-line pharmacological treatment
for GAD includes SSRIs (such as escitalopram, sertraline, paroxetine) or SNRIs (such as
venlafaxine). Benzodiazepines (A and B) are generally recommended only for short-term or
acute relief due to risks of dependence and tolerance, while antipsychotics like risperidone (D)
are not first-line for GAD.
Q2: A PMHNP is caring for a patient experiencing an acute panic attack in the emergency
department. The patient is hyperventilating, reporting chest pain, and feels like they are dying.
Which is the priority nursing intervention?
A. Administer an oral benzodiazepine immediately.
B. Encourage the patient to hold their breath to stop hyperventilation.
C. Remain with the patient and use grounding techniques. [CORRECT]
,2
D. Place the patient in seclusion to reduce environmental stimuli.
Correct Answer: C
Rationale: During an acute panic attack, the priority intervention is to provide a calm presence
and ensure safety while using grounding techniques (such as the 5-4-3-2-1 method) or deep
breathing to help the patient regain control. While benzodiazepines (A) may be prescribed for
acute anxiety, oral administration takes too long to act in an emergency, and IV administration
requires medical orders; immediate nursing support is prioritized. Holding breath (B) can
increase anxiety and physical distress. Seclusion (D) is inappropriate as the patient is not a
danger to others but is experiencing internal distress.
Q3: A college student avoids public speaking and has dropped out of classes because of an
intense fear of being humiliated in front of others. This fear has significantly impacted their
academic progress. Which diagnosis best fits this presentation?
A. Specific Phobia
B. Social Anxiety Disorder (Social Phobia) [CORRECT]
C. Agoraphobia
D. Panic Disorder
Correct Answer: B
Rationale: Social Anxiety Disorder is characterized by marked fear or anxiety about one or more
social situations where the individual is exposed to possible scrutiny by others, fearing they will
act in a way or show anxiety symptoms that will be negatively evaluated. The student's
avoidance of public speaking and academic impact aligns perfectly with this diagnosis. Specific
Phobia (A) involves fear of a specific object or situation, not performance-based social scrutiny.
Agoraphobia (C) involves fear of situations where escape might be difficult. Panic Disorder (D)
involves recurrent panic attacks not necessarily tied to social performance.
Q4: A patient with Obsessive-Compulsive Disorder (OCD) spends 3 hours a day washing her
hands. She asks the nurse if she should stop washing immediately. What is the best response by
the nurse?
A. "Yes, you must stop washing your hands immediately to break the habit."
,3
B. "You should wash your hands only when they are visibly dirty."
C. "Stopping abruptly is difficult; let's work on gradually reducing the time spent washing."
[CORRECT]
D. "It is okay to continue washing as long as it makes you feel better."
Correct Answer: C
Rationale: Nursing care for OCD involves supporting the patient through Exposure and
Response Prevention (ERP) therapy. Abruptly stopping a ritual (A) can cause extreme anxiety
and is often unsuccessful. The best approach is to gradually delay or shorten the ritual duration
(C) to build tolerance to anxiety without performing the compulsion. While hygiene is important
(B), the rigid rule often fails in OCD treatment. Validating the compulsion (D) reinforces the
maladaptive behavior.
Q5: Which medication is FDA-approved specifically for the treatment of Obsessive-Compulsive
Disorder and is often utilized at higher doses than for depression?
A. Fluoxetine (Prozac) [CORRECT]
B. Buspirone (Buspar)
C. Diphenhydramine (Benadryl)
D. Trazodone (Oleptro)
Correct Answer: A
Rationale: SSRIs like Fluoxetine, Sertraline, and Paroxetine are FDA-approved for OCD and are
typically prescribed at higher doses than those used for depression (e.g., Fluoxetine up to 80
mg/day). Buspirone (B) is used for GAD but not OCD. Diphenhydramine (C) is an antihistamine
not used for OCD. Trazodone (D) is used for sleep or depression but is not a first-line treatment
for OCD.
Q6: A combat veteran presents with recurrent nightmares, flashbacks, and hypervigilance
following a traumatic event experienced 6 months ago. He avoids watching movies about war
and reports feeling detached from his family. What is the first-line psychotherapy for this
condition?
A. Psychodynamic Psychotherapy
, 4
B. Humanistic Therapy
C. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) [CORRECT]
D. Supportive Psychotherapy
Correct Answer: C
Rationale: The patient exhibits symptoms of Post-Traumatic Stress Disorder (PTSD). Trauma-
Focused CBT, which includes Cognitive Processing Therapy (CPT) and Prolonged Exposure
(PE), is considered the first-line psychotherapeutic intervention according to APA guidelines.
These therapies help patients process the trauma and modify maladaptive cognitions.
Psychodynamic (A) and Humanistic (B) therapies lack the robust evidence base for PTSD that
TF-CBT has. Supportive therapy (D) may be adjunctive but is not the primary treatment
modality.
Q7: A patient with PTSD reports severe insomnia and distressing nightmares that disrupt sleep.
Which medication is the PMHNP likely to prescribe as an adjunct to an SSRI to target
nightmares specifically?
A. Zolpidem (Ambien)
B. Melatonin
C. Prazosin (Minipress) [CORRECT]
D. Lithium (Lithobid)
Correct Answer: C
Rationale: Prazosin, an alpha-1 adrenergic antagonist, is widely used off-label but strongly
supported by clinical evidence for reducing nightmares and improving sleep quality in patients
with PTSD. Zolpidem (A) is a hypnotic for insomnia onset but does not specifically address
trauma nightmares. Melatonin (B) is a supplement for general sleep regulation. Lithium (D) is a
mood stabilizer used for Bipolar Disorder, not PTSD nightmares.
Q8: A nurse is educating a new staff member on trauma-informed care. Which principle is the
foundation of this approach?
A. Physical and emotional safety [CORRECT]
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 female patient presents to the clinic complaining of excessive worry about her
health, finances, and job performance for the past nine months. She reports muscle tension,
irritability, and difficulty sleeping. Physical exam is unremarkable. Which medication is
considered a first-line pharmacological treatment for this condition?
A. Alprazolam (Xanax)
B. Lorazepam (Ativan)
C. Escitalopram (Lexapro) [CORRECT]
D. Risperidone (Risperdal)
Correct Answer: C
Rationale: The patient meets DSM-5-TR criteria for Generalized Anxiety Disorder (GAD),
characterized by excessive anxiety and worry occurring more days than not for at least 6 months,
along with symptoms like restlessness or muscle tension. First-line pharmacological treatment
for GAD includes SSRIs (such as escitalopram, sertraline, paroxetine) or SNRIs (such as
venlafaxine). Benzodiazepines (A and B) are generally recommended only for short-term or
acute relief due to risks of dependence and tolerance, while antipsychotics like risperidone (D)
are not first-line for GAD.
Q2: A PMHNP is caring for a patient experiencing an acute panic attack in the emergency
department. The patient is hyperventilating, reporting chest pain, and feels like they are dying.
Which is the priority nursing intervention?
A. Administer an oral benzodiazepine immediately.
B. Encourage the patient to hold their breath to stop hyperventilation.
C. Remain with the patient and use grounding techniques. [CORRECT]
,2
D. Place the patient in seclusion to reduce environmental stimuli.
Correct Answer: C
Rationale: During an acute panic attack, the priority intervention is to provide a calm presence
and ensure safety while using grounding techniques (such as the 5-4-3-2-1 method) or deep
breathing to help the patient regain control. While benzodiazepines (A) may be prescribed for
acute anxiety, oral administration takes too long to act in an emergency, and IV administration
requires medical orders; immediate nursing support is prioritized. Holding breath (B) can
increase anxiety and physical distress. Seclusion (D) is inappropriate as the patient is not a
danger to others but is experiencing internal distress.
Q3: A college student avoids public speaking and has dropped out of classes because of an
intense fear of being humiliated in front of others. This fear has significantly impacted their
academic progress. Which diagnosis best fits this presentation?
A. Specific Phobia
B. Social Anxiety Disorder (Social Phobia) [CORRECT]
C. Agoraphobia
D. Panic Disorder
Correct Answer: B
Rationale: Social Anxiety Disorder is characterized by marked fear or anxiety about one or more
social situations where the individual is exposed to possible scrutiny by others, fearing they will
act in a way or show anxiety symptoms that will be negatively evaluated. The student's
avoidance of public speaking and academic impact aligns perfectly with this diagnosis. Specific
Phobia (A) involves fear of a specific object or situation, not performance-based social scrutiny.
Agoraphobia (C) involves fear of situations where escape might be difficult. Panic Disorder (D)
involves recurrent panic attacks not necessarily tied to social performance.
Q4: A patient with Obsessive-Compulsive Disorder (OCD) spends 3 hours a day washing her
hands. She asks the nurse if she should stop washing immediately. What is the best response by
the nurse?
A. "Yes, you must stop washing your hands immediately to break the habit."
,3
B. "You should wash your hands only when they are visibly dirty."
C. "Stopping abruptly is difficult; let's work on gradually reducing the time spent washing."
[CORRECT]
D. "It is okay to continue washing as long as it makes you feel better."
Correct Answer: C
Rationale: Nursing care for OCD involves supporting the patient through Exposure and
Response Prevention (ERP) therapy. Abruptly stopping a ritual (A) can cause extreme anxiety
and is often unsuccessful. The best approach is to gradually delay or shorten the ritual duration
(C) to build tolerance to anxiety without performing the compulsion. While hygiene is important
(B), the rigid rule often fails in OCD treatment. Validating the compulsion (D) reinforces the
maladaptive behavior.
Q5: Which medication is FDA-approved specifically for the treatment of Obsessive-Compulsive
Disorder and is often utilized at higher doses than for depression?
A. Fluoxetine (Prozac) [CORRECT]
B. Buspirone (Buspar)
C. Diphenhydramine (Benadryl)
D. Trazodone (Oleptro)
Correct Answer: A
Rationale: SSRIs like Fluoxetine, Sertraline, and Paroxetine are FDA-approved for OCD and are
typically prescribed at higher doses than those used for depression (e.g., Fluoxetine up to 80
mg/day). Buspirone (B) is used for GAD but not OCD. Diphenhydramine (C) is an antihistamine
not used for OCD. Trazodone (D) is used for sleep or depression but is not a first-line treatment
for OCD.
Q6: A combat veteran presents with recurrent nightmares, flashbacks, and hypervigilance
following a traumatic event experienced 6 months ago. He avoids watching movies about war
and reports feeling detached from his family. What is the first-line psychotherapy for this
condition?
A. Psychodynamic Psychotherapy
, 4
B. Humanistic Therapy
C. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) [CORRECT]
D. Supportive Psychotherapy
Correct Answer: C
Rationale: The patient exhibits symptoms of Post-Traumatic Stress Disorder (PTSD). Trauma-
Focused CBT, which includes Cognitive Processing Therapy (CPT) and Prolonged Exposure
(PE), is considered the first-line psychotherapeutic intervention according to APA guidelines.
These therapies help patients process the trauma and modify maladaptive cognitions.
Psychodynamic (A) and Humanistic (B) therapies lack the robust evidence base for PTSD that
TF-CBT has. Supportive therapy (D) may be adjunctive but is not the primary treatment
modality.
Q7: A patient with PTSD reports severe insomnia and distressing nightmares that disrupt sleep.
Which medication is the PMHNP likely to prescribe as an adjunct to an SSRI to target
nightmares specifically?
A. Zolpidem (Ambien)
B. Melatonin
C. Prazosin (Minipress) [CORRECT]
D. Lithium (Lithobid)
Correct Answer: C
Rationale: Prazosin, an alpha-1 adrenergic antagonist, is widely used off-label but strongly
supported by clinical evidence for reducing nightmares and improving sleep quality in patients
with PTSD. Zolpidem (A) is a hypnotic for insomnia onset but does not specifically address
trauma nightmares. Melatonin (B) is a supplement for general sleep regulation. Lithium (D) is a
mood stabilizer used for Bipolar Disorder, not PTSD nightmares.
Q8: A nurse is educating a new staff member on trauma-informed care. Which principle is the
foundation of this approach?
A. Physical and emotional safety [CORRECT]
