NP Mental Health & Psychiatric NP 1 — Questions and Answers
Question 1: According to the DSM-5, how many symptoms of major depressive disorder must be present for at least 2 weeks to meet diagnostic criteria?
- At least 3 symptoms including depressed mood
- At least 5 symptoms, including depressed mood or anhedonia (Correct answer)
- At least 4 symptoms including sleep disturbance
- At least 6 symptoms including suicidal ideation
Correct answer: At least 5 symptoms, including depressed mood or anhedonia
DSM-5 requires at least 5 of 9 symptoms for 2+ weeks, with depressed mood or anhedonia being required as one of the five.
Question 2: A 34-year-old patient presents with persistent worry, muscle tension, fatigue, and difficulty concentrating for 8 months. What is the first-line pharmacological treatment for generalized anxiety disorder?
- Alprazolam (Xanax)
- Buspirone or an SSRI/SNRI (Correct answer)
- Propranolol
- Hydroxyzine
Correct answer: Buspirone or an SSRI/SNRI
SSRIs and SNRIs (or buspirone) are first-line pharmacological treatments for GAD due to their efficacy and favorable safety profile.
Question 3: A patient on haloperidol develops sustained involuntary rhythmic movements of the tongue and lip-smacking after 2 years of treatment. What is this adverse effect?
- Akathisia
- Tardive dyskinesia (Correct answer)
- Neuroleptic malignant syndrome
- Acute dystonia
Correct answer: Tardive dyskinesia
Tardive dyskinesia is a late-onset movement disorder from prolonged antipsychotic use, characterized by repetitive involuntary orofacial movements.
Question 4: Which mechanism best describes how SSRIs achieve their antidepressant effect?
- Inhibition of monoamine oxidase enzymes
- Blockade of norepinephrine reuptake transporters
- Selective inhibition of serotonin reuptake at the presynaptic terminal (Correct answer)
- Agonism at postsynaptic serotonin receptors
Correct answer: Selective inhibition of serotonin reuptake at the presynaptic terminal
SSRIs work by selectively blocking the serotonin transporter (SERT) on the presynaptic neuron, increasing serotonin availability in the synapse.
Question 5: An NP uses the PHQ-9 to screen a patient for depression. A score of 15 on the PHQ-9 indicates which severity level?
- Mild depression
- Moderate depression
- Moderately severe depression (Correct answer)
- Severe depression
Correct answer: Moderately severe depression
PHQ-9 scores of 15–19 correspond to moderately severe depression, while scores ≥20 indicate severe depression.
Question 6: A patient with bipolar I disorder is stabilized on lithium. Which laboratory value requires the closest monitoring to prevent toxicity?
- Serum potassium
- Serum sodium and renal function (Correct answer)
- Liver function tests
- Complete blood count
Correct answer: Serum sodium and renal function
Lithium is renally cleared and its levels are affected by sodium balance; sodium depletion and renal impairment can cause lithium toxicity.
Question 7: Which symptom cluster represents the 'positive' symptoms of schizophrenia?
- Flat affect, alogia, and avolition
- Hallucinations, delusions, and disorganized speech (Correct answer)
- Cognitive impairment and working memory deficits
- Social withdrawal and anhedonia
Correct answer: Hallucinations, delusions, and disorganized speech
Positive symptoms are added or exaggerated behaviors including hallucinations, delusions, and disorganized thinking, in contrast to negative symptoms which are deficits.
NP Mental Health & Psychiatric NP 1
According to the DSM-5, how many symptoms of major depressive disorder must be present for at least 2 weeks to meet diagnostic criteria?