NR548/ NR 548 EXAM 1: LATEST UPDATE 2024/
2025 PSYCHIATRIC ASSESSMENT FOR THE
PSYCHIATRIC-MENTAL HEALTH NURSE
PRACTITIONER QUESTIONS WITH CORRECT
VERIED ANSWERS RATIONALE GRADED A+
1. Question: A 45-year-old patient presents with symptoms of depression,
including low mood, fatigue, and an inability to enjoy activities. Which is the most
appropriate first-line treatment for this patient?
Answer: The most appropriate first-line treatment would be selective serotonin
reuptake inhibitors (SSRIs) such as sertraline or fluoxetine.
Rationale: SSRIs are considered first-line pharmacotherapy for major depressive
disorder due to their favorable side effect profile and efficacy in improving
depressive symptoms. Cognitive-behavioral therapy (CBT) is also a first-line
option, often used in combination with medications.
2. Question: A patient with schizophrenia is prescribed a second-generation
antipsychotic medication. Which of the following should be closely monitored?
Answer: The patient's weight, blood glucose levels, and lipid profile should be
closely monitored.
Rationale: Second-generation antipsychotics (SGAs) are associated with
metabolic side effects such as weight gain, hyperglycemia, and dyslipidemia.
Regular monitoring is necessary to identify and address these concerns early.
3. Question: A 30-year-old female patient with generalized anxiety disorder
(GAD) is requesting a medication to manage her symptoms. Which medication
would you prescribe first?
Answer: A selective serotonin reuptake inhibitor (SSRI), such as escitalopram,
would be an appropriate first choice.
Rationale: SSRIs are first-line pharmacologic treatments for GAD. They help to
regulate serotonin levels, which are often dysregulated in anxiety disorders. SSRIs
have a lower risk of dependence compared to benzodiazepines, making them a
better long-term option.
,4. Question: A 60-year-old male patient with a history of alcohol use disorder is
admitted to the hospital. He is experiencing tremors, agitation, and hallucinations.
What is the most likely diagnosis?
Answer: Alcohol withdrawal delirium (delirium tremens) is the most likely
diagnosis.
Rationale: Delirium tremens is a severe form of alcohol withdrawal that can
include symptoms like tremors, agitation, hallucinations, and seizures. This
condition requires immediate medical intervention and close monitoring for
complications.
5. Question: A 25-year-old female presents with recurrent episodes of binge
eating, followed by purging through self-induced vomiting. What is the most likely
diagnosis?
Answer: The most likely diagnosis is bulimia nervosa.
Rationale: Bulimia nervosa is characterized by episodes of binge eating followed
by compensatory behaviors such as vomiting, excessive exercise, or laxative use. It
is important to address both the psychiatric and physical aspects of this disorder
during treatment.
6. Question: A patient presents with symptoms of mania, including increased
energy, grandiosity, and decreased need for sleep. Which mood disorder should be
considered?
Answer: Bipolar disorder should be considered.
Rationale: Bipolar disorder is characterized by episodes of mania and depression.
The symptoms described in the patient, such as increased energy, grandiosity, and
decreased need for sleep, are indicative of a manic episode, which is a hallmark of
bipolar disorder.
7. Question: A 40-year-old female with a history of obsessive-compulsive disorder
(OCD) is asking about treatment options. Which of the following is considered the
most effective first-line therapy?
Answer: Cognitive-behavioral therapy (CBT) with exposure and response
prevention is the most effective first-line therapy.
,Rationale: CBT with exposure and response prevention (ERP) is highly effective
in treating OCD. ERP involves exposing patients to anxiety-provoking situations
and preventing the compulsive behaviors they typically engage in, which helps
reduce symptoms over time. SSRIs can also be used in combination for better
outcomes.
8. Question: A 45-year-old male presents with a history of uncontrollable
outbursts of anger, irritability, and difficulty managing stress. Which of the
following interventions would be most beneficial?
Answer: A comprehensive treatment plan including cognitive-behavioral therapy
(CBT) and possibly anger management therapy would be beneficial.
Rationale: Anger outbursts and irritability can be indicative of an underlying
psychiatric disorder such as intermittent explosive disorder (IED) or a mood
disorder. CBT can help patients learn to identify triggers, manage their emotions,
and develop more appropriate coping strategies. Anger management is often a key
component of treatment.
9. Question: Which of the following is the most significant risk factor for the
development of post-traumatic stress disorder (PTSD)?
Answer: A history of prior trauma is the most significant risk factor for developing
PTSD.
Rationale: Previous exposure to trauma, particularly during childhood or as a
result of severe or chronic stress, significantly increases the likelihood of
developing PTSD. Other factors such as genetics and social support also play roles,
but trauma history is the most critical factor.
10. Question: A 50-year-old female patient reports experiencing hot flashes, mood
swings, and sleep disturbances. Which diagnosis should be considered?
Answer: Perimenopause or menopause should be considered.
Rationale: Symptoms like hot flashes, mood swings, and sleep disturbances are
common in perimenopause or menopause. While these symptoms may overlap
with depression or anxiety, the context of age and reproductive history often points
to menopause as the cause.
, 11. Question: A 40-year-old male presents with a complaint of difficulty staying
asleep, waking up multiple times during the night, and feeling fatigued during the
day. Which diagnosis is most likely?
Answer: Insomnia.
Rationale: Insomnia is characterized by difficulty initiating or maintaining sleep,
and it often leads to daytime impairment such as fatigue. The symptoms described
in this patient—difficulty staying asleep and daytime fatigue—are consistent with
this diagnosis.
12. Question: A 25-year-old female is being evaluated for possible borderline
personality disorder (BPD). Which of the following behaviors is most consistent
with BPD?
Answer: Engaging in impulsive behaviors such as substance abuse, unsafe sexual
practices, or reckless driving.
Rationale: BPD is marked by a pattern of unstable relationships, self-image, and
emotions, often accompanied by impulsive behaviors. These behaviors may
include substance abuse, self-harm, or risky behaviors. It is essential to assess for
these behaviors when evaluating for BPD.
13. Question: A 32-year-old male with a history of depression reports that he has
been experiencing recurrent thoughts of death and has been feeling hopeless. What
is the most appropriate course of action?
Answer: Assess the patient for suicidal ideation and provide immediate
intervention if necessary, including hospitalization if there is a risk of harm to self.
Rationale: The patient’s report of recurrent thoughts of death and hopelessness
raises concern for suicidal ideation, which requires immediate and thorough
assessment. If the patient expresses suicidal thoughts or has a plan, inpatient care
may be necessary to ensure safety.
14. Question: A 40-year-old patient presents with uncontrollable, repetitive
movements such as blinking, facial grimacing, and shoulder shrugging. Which
medication side effect is most likely causing these symptoms?
Answer: Tardive dyskinesia, a side effect of antipsychotic medications.
2025 PSYCHIATRIC ASSESSMENT FOR THE
PSYCHIATRIC-MENTAL HEALTH NURSE
PRACTITIONER QUESTIONS WITH CORRECT
VERIED ANSWERS RATIONALE GRADED A+
1. Question: A 45-year-old patient presents with symptoms of depression,
including low mood, fatigue, and an inability to enjoy activities. Which is the most
appropriate first-line treatment for this patient?
Answer: The most appropriate first-line treatment would be selective serotonin
reuptake inhibitors (SSRIs) such as sertraline or fluoxetine.
Rationale: SSRIs are considered first-line pharmacotherapy for major depressive
disorder due to their favorable side effect profile and efficacy in improving
depressive symptoms. Cognitive-behavioral therapy (CBT) is also a first-line
option, often used in combination with medications.
2. Question: A patient with schizophrenia is prescribed a second-generation
antipsychotic medication. Which of the following should be closely monitored?
Answer: The patient's weight, blood glucose levels, and lipid profile should be
closely monitored.
Rationale: Second-generation antipsychotics (SGAs) are associated with
metabolic side effects such as weight gain, hyperglycemia, and dyslipidemia.
Regular monitoring is necessary to identify and address these concerns early.
3. Question: A 30-year-old female patient with generalized anxiety disorder
(GAD) is requesting a medication to manage her symptoms. Which medication
would you prescribe first?
Answer: A selective serotonin reuptake inhibitor (SSRI), such as escitalopram,
would be an appropriate first choice.
Rationale: SSRIs are first-line pharmacologic treatments for GAD. They help to
regulate serotonin levels, which are often dysregulated in anxiety disorders. SSRIs
have a lower risk of dependence compared to benzodiazepines, making them a
better long-term option.
,4. Question: A 60-year-old male patient with a history of alcohol use disorder is
admitted to the hospital. He is experiencing tremors, agitation, and hallucinations.
What is the most likely diagnosis?
Answer: Alcohol withdrawal delirium (delirium tremens) is the most likely
diagnosis.
Rationale: Delirium tremens is a severe form of alcohol withdrawal that can
include symptoms like tremors, agitation, hallucinations, and seizures. This
condition requires immediate medical intervention and close monitoring for
complications.
5. Question: A 25-year-old female presents with recurrent episodes of binge
eating, followed by purging through self-induced vomiting. What is the most likely
diagnosis?
Answer: The most likely diagnosis is bulimia nervosa.
Rationale: Bulimia nervosa is characterized by episodes of binge eating followed
by compensatory behaviors such as vomiting, excessive exercise, or laxative use. It
is important to address both the psychiatric and physical aspects of this disorder
during treatment.
6. Question: A patient presents with symptoms of mania, including increased
energy, grandiosity, and decreased need for sleep. Which mood disorder should be
considered?
Answer: Bipolar disorder should be considered.
Rationale: Bipolar disorder is characterized by episodes of mania and depression.
The symptoms described in the patient, such as increased energy, grandiosity, and
decreased need for sleep, are indicative of a manic episode, which is a hallmark of
bipolar disorder.
7. Question: A 40-year-old female with a history of obsessive-compulsive disorder
(OCD) is asking about treatment options. Which of the following is considered the
most effective first-line therapy?
Answer: Cognitive-behavioral therapy (CBT) with exposure and response
prevention is the most effective first-line therapy.
,Rationale: CBT with exposure and response prevention (ERP) is highly effective
in treating OCD. ERP involves exposing patients to anxiety-provoking situations
and preventing the compulsive behaviors they typically engage in, which helps
reduce symptoms over time. SSRIs can also be used in combination for better
outcomes.
8. Question: A 45-year-old male presents with a history of uncontrollable
outbursts of anger, irritability, and difficulty managing stress. Which of the
following interventions would be most beneficial?
Answer: A comprehensive treatment plan including cognitive-behavioral therapy
(CBT) and possibly anger management therapy would be beneficial.
Rationale: Anger outbursts and irritability can be indicative of an underlying
psychiatric disorder such as intermittent explosive disorder (IED) or a mood
disorder. CBT can help patients learn to identify triggers, manage their emotions,
and develop more appropriate coping strategies. Anger management is often a key
component of treatment.
9. Question: Which of the following is the most significant risk factor for the
development of post-traumatic stress disorder (PTSD)?
Answer: A history of prior trauma is the most significant risk factor for developing
PTSD.
Rationale: Previous exposure to trauma, particularly during childhood or as a
result of severe or chronic stress, significantly increases the likelihood of
developing PTSD. Other factors such as genetics and social support also play roles,
but trauma history is the most critical factor.
10. Question: A 50-year-old female patient reports experiencing hot flashes, mood
swings, and sleep disturbances. Which diagnosis should be considered?
Answer: Perimenopause or menopause should be considered.
Rationale: Symptoms like hot flashes, mood swings, and sleep disturbances are
common in perimenopause or menopause. While these symptoms may overlap
with depression or anxiety, the context of age and reproductive history often points
to menopause as the cause.
, 11. Question: A 40-year-old male presents with a complaint of difficulty staying
asleep, waking up multiple times during the night, and feeling fatigued during the
day. Which diagnosis is most likely?
Answer: Insomnia.
Rationale: Insomnia is characterized by difficulty initiating or maintaining sleep,
and it often leads to daytime impairment such as fatigue. The symptoms described
in this patient—difficulty staying asleep and daytime fatigue—are consistent with
this diagnosis.
12. Question: A 25-year-old female is being evaluated for possible borderline
personality disorder (BPD). Which of the following behaviors is most consistent
with BPD?
Answer: Engaging in impulsive behaviors such as substance abuse, unsafe sexual
practices, or reckless driving.
Rationale: BPD is marked by a pattern of unstable relationships, self-image, and
emotions, often accompanied by impulsive behaviors. These behaviors may
include substance abuse, self-harm, or risky behaviors. It is essential to assess for
these behaviors when evaluating for BPD.
13. Question: A 32-year-old male with a history of depression reports that he has
been experiencing recurrent thoughts of death and has been feeling hopeless. What
is the most appropriate course of action?
Answer: Assess the patient for suicidal ideation and provide immediate
intervention if necessary, including hospitalization if there is a risk of harm to self.
Rationale: The patient’s report of recurrent thoughts of death and hopelessness
raises concern for suicidal ideation, which requires immediate and thorough
assessment. If the patient expresses suicidal thoughts or has a plan, inpatient care
may be necessary to ensure safety.
14. Question: A 40-year-old patient presents with uncontrollable, repetitive
movements such as blinking, facial grimacing, and shoulder shrugging. Which
medication side effect is most likely causing these symptoms?
Answer: Tardive dyskinesia, a side effect of antipsychotic medications.
