Wilkes NSG 526 Exam 2 Actual Exam 2026/2027 |
Detailed Rationales | Complete Exam-Style
Questions | Graded A+ | Pass Guaranteed
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Psychiatric Assessment & Diagnostic Interviewing | Q1 – Q10
Section 2 | Mood Disorders & Bipolar Spectrum | Q11 – Q20
Section 3 | Anxiety, OCD & Trauma-Related Disorders | Q21 – Q30
Section 4 | Psychotic Disorders & Schizophrenia | Q31 – Q40
Section 5 | Personality Disorders & Therapeutic Boundaries | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: PSYCHIATRIC ASSESSMENT & DIAGNOSTIC INTERVIEWING Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 19-year-old college student is brought to the counseling center by her roommate after
she found the student crying uncontrollably and saying "I can't do this anymore." During
the interview, the student avoids eye contact, speaks in a monotone, and states she has
not eaten or slept in three days. Her roommate reports finding a draft email on the
student's laptop addressed to her parents saying goodbye. What is the nurse's priority
action?
A. Ask the student to sign a no-harm contract
B. Complete a full mental status examination
C. Conduct a suicide risk assessment using a validated screening tool ✓ CORRECT
D. Contact the parents immediately to inform them of the situation
Correct Answer: C
,Rationale: When a patient presents with direct and indirect suicidal indicators, the
nurse's immediate priority is to conduct a formal suicide risk assessment using a
validated tool such as the Columbia Suicide Severity Rating Scale. While completing a
mental status examination is important, it does not take precedence over determining
imminent risk for self-harm. Contacting parents without the patient's consent would
violate confidentiality unless there is an immediate safety threat, and no-harm contracts
are no longer considered reliable or sufficient as a standalone intervention.
Question 2 of 50
A 42-year-old man is admitted to the inpatient psychiatric unit after his wife reported he
has been hearing voices for the past two weeks. During the initial nursing assessment,
the patient states the voices are commanding and frightening. When gathering the
history, what interviewing technique best promotes accurate data collection while
minimizing patient distress?
A. Begin with detailed questions about the content of the hallucinations
B. Use open-ended questions followed by gentle clarifying probes ✓ CORRECT
C. Focus primarily on the patient's childhood developmental history
D. Ask rapid-fire yes or no questions to gather facts efficiently
Correct Answer: B
Rationale: Open-ended questions followed by gentle clarification create a safe
therapeutic space that reduces anxiety and encourages the patient to share experiences
at his own pace. Beginning with detailed probing about distressing hallucinations can
increase paranoia and agitation, while rapid-fire questioning feels interrogative and may
shut down communication. Childhood history is relevant but should be explored after
establishing rapport and addressing current symptoms.
Question 3 of 50
,A 28-year-old woman diagnosed with borderline personality disorder is being
interviewed by the psychiatric nurse practitioner. The patient becomes intensely angry
when asked about recent self-harm and accuses the clinician of being "just like my
mother." This reaction is best understood as:
A. A sign that the patient is not ready for psychotherapy
B. An example of countertransference triggered by the interview
C. An instance of transference distorting the therapeutic relationship ✓ CORRECT
D. Evidence of an emerging psychotic process
Correct Answer: C
Rationale: The patient is unconsciously redirecting feelings about a significant figure in
her past onto the clinician, which is the classic definition of transference commonly
seen in personality disorders. Countertransference refers to the clinician's emotional
reaction toward the patient, not the patient's reaction toward the clinician. This behavior
is characteristic of borderline personality organization and does not indicate psychosis
or unsuitability for therapy.
Question 4 of 50
During a routine psychiatric intake, a 35-year-old man reports he has been feeling
"down" for the past month but denies suicidal ideation. He scores 14 on the PHQ-9.
When interpreting this score, the nurse recognizes that:
A. The patient meets criteria for severe major depression
B. The score indicates mild depression and warrants watchful waiting
C. A PHQ-9 score above 10 always requires immediate hospitalization
D. A score of 14 falls within the moderate depression range ✓ CORRECT
Correct Answer: D
Rationale: The PHQ-9 scoring categorizes 10-14 as moderate depression, which
typically warrants active treatment such as psychotherapy and possible pharmacologic
intervention. Scores of 15-19 indicate moderately severe and 20-27 severe depression,
, so 14 does not represent severe illness. Watchful waiting is generally reserved for
scores below 10, and no specific PHQ-9 score alone mandates hospitalization without
clinical judgment regarding safety and functional impairment.
Question 5 of 50
A psychiatric nurse is conducting a mental status examination on a 67-year-old woman
brought in by her son, who is concerned about memory changes. The patient is alert
and oriented to person and place but thinks it is 2019 when it is 2024. She recalls three
out of five words immediately but none after five minutes. These findings most strongly
suggest:
A. Impairment in recent memory and orientation to time ✓ CORRECT
B. A normal variant of age-related cognitive slowing
C. Intact immediate and long-term memory function
D. Evidence of malingering for secondary gain
Correct Answer: A
Rationale: Disorientation to time and failure to retain information after a delay are
specific indicators of recent memory impairment that require further neurocognitive
workup. Normal aging may involve mild word-finding difficulties but does not typically
include disorientation to year or complete failure of delayed recall. Malingering is
unlikely given the clinical context of a concerned family member bringing the patient for
evaluation.
Question 6 of 50
A 22-year-old veteran presents to the VA mental health clinic stating he has trouble
sleeping, feels "on edge" in crowds, and has been avoiding driving since his return from
deployment six months ago. He denies depressed mood but reports frequent
nightmares. The nurse's initial screening should prioritize:
Detailed Rationales | Complete Exam-Style
Questions | Graded A+ | Pass Guaranteed
Total Questions: 50 | Time: 90 min | Pass: 80%
TABLE OF CONTENTS
Section 1 | Psychiatric Assessment & Diagnostic Interviewing | Q1 – Q10
Section 2 | Mood Disorders & Bipolar Spectrum | Q11 – Q20
Section 3 | Anxiety, OCD & Trauma-Related Disorders | Q21 – Q30
Section 4 | Psychotic Disorders & Schizophrenia | Q31 – Q40
Section 5 | Personality Disorders & Therapeutic Boundaries | Q41 – Q50
Instructions: Choose the single best answer. Pass: 80% in 90 minutes.
══════════════════════════════════════
SECTION 1: PSYCHIATRIC ASSESSMENT & DIAGNOSTIC INTERVIEWING Q1 – Q10
══════════════════════════════════════
Question 1 of 50
A 19-year-old college student is brought to the counseling center by her roommate after
she found the student crying uncontrollably and saying "I can't do this anymore." During
the interview, the student avoids eye contact, speaks in a monotone, and states she has
not eaten or slept in three days. Her roommate reports finding a draft email on the
student's laptop addressed to her parents saying goodbye. What is the nurse's priority
action?
A. Ask the student to sign a no-harm contract
B. Complete a full mental status examination
C. Conduct a suicide risk assessment using a validated screening tool ✓ CORRECT
D. Contact the parents immediately to inform them of the situation
Correct Answer: C
,Rationale: When a patient presents with direct and indirect suicidal indicators, the
nurse's immediate priority is to conduct a formal suicide risk assessment using a
validated tool such as the Columbia Suicide Severity Rating Scale. While completing a
mental status examination is important, it does not take precedence over determining
imminent risk for self-harm. Contacting parents without the patient's consent would
violate confidentiality unless there is an immediate safety threat, and no-harm contracts
are no longer considered reliable or sufficient as a standalone intervention.
Question 2 of 50
A 42-year-old man is admitted to the inpatient psychiatric unit after his wife reported he
has been hearing voices for the past two weeks. During the initial nursing assessment,
the patient states the voices are commanding and frightening. When gathering the
history, what interviewing technique best promotes accurate data collection while
minimizing patient distress?
A. Begin with detailed questions about the content of the hallucinations
B. Use open-ended questions followed by gentle clarifying probes ✓ CORRECT
C. Focus primarily on the patient's childhood developmental history
D. Ask rapid-fire yes or no questions to gather facts efficiently
Correct Answer: B
Rationale: Open-ended questions followed by gentle clarification create a safe
therapeutic space that reduces anxiety and encourages the patient to share experiences
at his own pace. Beginning with detailed probing about distressing hallucinations can
increase paranoia and agitation, while rapid-fire questioning feels interrogative and may
shut down communication. Childhood history is relevant but should be explored after
establishing rapport and addressing current symptoms.
Question 3 of 50
,A 28-year-old woman diagnosed with borderline personality disorder is being
interviewed by the psychiatric nurse practitioner. The patient becomes intensely angry
when asked about recent self-harm and accuses the clinician of being "just like my
mother." This reaction is best understood as:
A. A sign that the patient is not ready for psychotherapy
B. An example of countertransference triggered by the interview
C. An instance of transference distorting the therapeutic relationship ✓ CORRECT
D. Evidence of an emerging psychotic process
Correct Answer: C
Rationale: The patient is unconsciously redirecting feelings about a significant figure in
her past onto the clinician, which is the classic definition of transference commonly
seen in personality disorders. Countertransference refers to the clinician's emotional
reaction toward the patient, not the patient's reaction toward the clinician. This behavior
is characteristic of borderline personality organization and does not indicate psychosis
or unsuitability for therapy.
Question 4 of 50
During a routine psychiatric intake, a 35-year-old man reports he has been feeling
"down" for the past month but denies suicidal ideation. He scores 14 on the PHQ-9.
When interpreting this score, the nurse recognizes that:
A. The patient meets criteria for severe major depression
B. The score indicates mild depression and warrants watchful waiting
C. A PHQ-9 score above 10 always requires immediate hospitalization
D. A score of 14 falls within the moderate depression range ✓ CORRECT
Correct Answer: D
Rationale: The PHQ-9 scoring categorizes 10-14 as moderate depression, which
typically warrants active treatment such as psychotherapy and possible pharmacologic
intervention. Scores of 15-19 indicate moderately severe and 20-27 severe depression,
, so 14 does not represent severe illness. Watchful waiting is generally reserved for
scores below 10, and no specific PHQ-9 score alone mandates hospitalization without
clinical judgment regarding safety and functional impairment.
Question 5 of 50
A psychiatric nurse is conducting a mental status examination on a 67-year-old woman
brought in by her son, who is concerned about memory changes. The patient is alert
and oriented to person and place but thinks it is 2019 when it is 2024. She recalls three
out of five words immediately but none after five minutes. These findings most strongly
suggest:
A. Impairment in recent memory and orientation to time ✓ CORRECT
B. A normal variant of age-related cognitive slowing
C. Intact immediate and long-term memory function
D. Evidence of malingering for secondary gain
Correct Answer: A
Rationale: Disorientation to time and failure to retain information after a delay are
specific indicators of recent memory impairment that require further neurocognitive
workup. Normal aging may involve mild word-finding difficulties but does not typically
include disorientation to year or complete failure of delayed recall. Malingering is
unlikely given the clinical context of a concerned family member bringing the patient for
evaluation.
Question 6 of 50
A 22-year-old veteran presents to the VA mental health clinic stating he has trouble
sleeping, feels "on edge" in crowds, and has been avoiding driving since his return from
deployment six months ago. He denies depressed mood but reports frequent
nightmares. The nurse's initial screening should prioritize:
