NU665 Week 8 Midterm Exam ACTUAL
EXAM 2026/2027 | Psychiatric Mental
Health NP | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Foundations of PMHNP Practice & Therapeutic Alliance (10 questions)
Q1: A 24-year-old patient presents for initial psychiatric evaluation. During the interview, the PMHNP
notices the patient frequently glances at the door and provides minimal eye contact. Which component
of the mental status examination does this observation most directly assess?
A. Thought process
B. Appearance and behavior
C. Mood and affect
D. Insight and judgment
Correct Answer: B
Rationale: Appearance and behavior in the MSE includes observations of eye contact, body language,
and motor activity, which provide important diagnostic clues about anxiety, paranoia, or other
conditions.
Q2: A PMHNP is conducting a suicide risk assessment on a 45-year-old patient with major depressive
disorder. The patient reports having a plan to overdose on medications, has access to pills, is male,
divorced, and recently lost employment. Using the SAD PERSONS scale, what is the most appropriate
next step?
A. Schedule outpatient follow-up in 1 week
B. Initiate partial hospitalization program
C. Recommend voluntary inpatient admission
D. Obtain involuntary commitment order
Correct Answer: C
Rationale: This patient scores high on SAD PERSONS (Sex, Age, Depression, Previous attempt, Ethanol,
Rational thinking loss, Social supports lacking, Organized plan, No spouse, Sickness), indicating high risk
requiring immediate inpatient intervention for safety.
,Q3: During the third session with a patient, the PMHNP notices feeling unusually protective and finds
themselves offering to help the patient find housing outside the therapeutic context. This reaction most
likely represents:
A. Appropriate case management
B. Countertransference
C. Transference
D. Therapeutic alliance
Correct Answer: B
Rationale: Countertransference refers to the clinician's emotional reactions to the patient that stem
from the clinician's own unconscious conflicts, potentially compromising professional boundaries.
Q4: A 19-year-old patient discloses during an individual therapy session that they have been sexually
abused by a family member. The PMHNP's primary legal and ethical obligation is to:
A. Maintain confidentiality as requested by the patient
B. Report the abuse to child protective services
C. Confront the family member with the patient present
D. Document only in the psychotherapy notes section
Correct Answer: B
Rationale: All states mandate reporting of child abuse (including sexual abuse of minors), which
supersedes confidentiality requirements; the PMHNP must report immediately to protective services.
Q5: A patient with schizophrenia refuses antipsychotic medication, stating "I don't need these pills; the
voices are real and help me." The patient demonstrates intact understanding of the medication's
purpose and risks but rejects treatment. This represents:
A. Lack of capacity
B. Diminished insight
C. Preserved capacity with treatment refusal
D. Informed consent
Correct Answer: C
Rationale: Capacity requires understanding, appreciation, reasoning, and expression of choice; this
patient understands the information but makes a different value judgment, which constitutes valid
treatment refusal if not imminently dangerous.
Q6: When documenting a patient encounter using the SOAP format, where would the PMHNP
document that "Patient reports 50% improvement in anxiety symptoms since starting sertraline 50mg"?
, A. Subjective
B. Objective
C. Assessment
D. Plan
Correct Answer: A
Rationale: The Subjective section contains information reported by the patient, including symptom
severity, treatment response, and patient-reported outcomes.
Q7: A PMHNP is establishing a therapeutic alliance with a patient who has borderline personality
disorder. Which approach best demonstrates the core elements of a strong therapeutic alliance?
A. Maintaining strict neutrality and emotional distance
B. Establishing clear boundaries while demonstrating empathy and collaboration
C. Sharing personal experiences to normalize the patient's struggles
D. Focusing exclusively on medication management to avoid transference
Correct Answer: B
Rationale: The therapeutic alliance requires trust, empathy, active listening, and collaboration while
maintaining appropriate professional boundaries, which is particularly crucial with personality disorders.
Q8: During a psychiatric evaluation, a patient states "The FBI is monitoring my thoughts through the
television and they're going to arrest me tomorrow." This thought content represents:
A. Ideas of reference
B. Delusions of persecution
C. Thought broadcasting
D. Paranoid ideation without delusional intensity
Correct Answer: B
Rationale: Delusions of persecution involve fixed false beliefs of being harmed, harassed, or conspired
against; the specific belief about FBI monitoring and imminent arrest fits this category.
Q9: A PMHNP is conducting informed consent for lithium therapy. Which element is NOT required for
valid informed consent?
A. Explanation of lithium's mechanism in treating bipolar disorder
B. Discussion of alternative treatments including no treatment
C. Assessment of the patient's decision-making capacity
D. Disclosure of risks including teratogenicity and thyroid dysfunction
Correct Answer: A
EXAM 2026/2027 | Psychiatric Mental
Health NP | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Foundations of PMHNP Practice & Therapeutic Alliance (10 questions)
Q1: A 24-year-old patient presents for initial psychiatric evaluation. During the interview, the PMHNP
notices the patient frequently glances at the door and provides minimal eye contact. Which component
of the mental status examination does this observation most directly assess?
A. Thought process
B. Appearance and behavior
C. Mood and affect
D. Insight and judgment
Correct Answer: B
Rationale: Appearance and behavior in the MSE includes observations of eye contact, body language,
and motor activity, which provide important diagnostic clues about anxiety, paranoia, or other
conditions.
Q2: A PMHNP is conducting a suicide risk assessment on a 45-year-old patient with major depressive
disorder. The patient reports having a plan to overdose on medications, has access to pills, is male,
divorced, and recently lost employment. Using the SAD PERSONS scale, what is the most appropriate
next step?
A. Schedule outpatient follow-up in 1 week
B. Initiate partial hospitalization program
C. Recommend voluntary inpatient admission
D. Obtain involuntary commitment order
Correct Answer: C
Rationale: This patient scores high on SAD PERSONS (Sex, Age, Depression, Previous attempt, Ethanol,
Rational thinking loss, Social supports lacking, Organized plan, No spouse, Sickness), indicating high risk
requiring immediate inpatient intervention for safety.
,Q3: During the third session with a patient, the PMHNP notices feeling unusually protective and finds
themselves offering to help the patient find housing outside the therapeutic context. This reaction most
likely represents:
A. Appropriate case management
B. Countertransference
C. Transference
D. Therapeutic alliance
Correct Answer: B
Rationale: Countertransference refers to the clinician's emotional reactions to the patient that stem
from the clinician's own unconscious conflicts, potentially compromising professional boundaries.
Q4: A 19-year-old patient discloses during an individual therapy session that they have been sexually
abused by a family member. The PMHNP's primary legal and ethical obligation is to:
A. Maintain confidentiality as requested by the patient
B. Report the abuse to child protective services
C. Confront the family member with the patient present
D. Document only in the psychotherapy notes section
Correct Answer: B
Rationale: All states mandate reporting of child abuse (including sexual abuse of minors), which
supersedes confidentiality requirements; the PMHNP must report immediately to protective services.
Q5: A patient with schizophrenia refuses antipsychotic medication, stating "I don't need these pills; the
voices are real and help me." The patient demonstrates intact understanding of the medication's
purpose and risks but rejects treatment. This represents:
A. Lack of capacity
B. Diminished insight
C. Preserved capacity with treatment refusal
D. Informed consent
Correct Answer: C
Rationale: Capacity requires understanding, appreciation, reasoning, and expression of choice; this
patient understands the information but makes a different value judgment, which constitutes valid
treatment refusal if not imminently dangerous.
Q6: When documenting a patient encounter using the SOAP format, where would the PMHNP
document that "Patient reports 50% improvement in anxiety symptoms since starting sertraline 50mg"?
, A. Subjective
B. Objective
C. Assessment
D. Plan
Correct Answer: A
Rationale: The Subjective section contains information reported by the patient, including symptom
severity, treatment response, and patient-reported outcomes.
Q7: A PMHNP is establishing a therapeutic alliance with a patient who has borderline personality
disorder. Which approach best demonstrates the core elements of a strong therapeutic alliance?
A. Maintaining strict neutrality and emotional distance
B. Establishing clear boundaries while demonstrating empathy and collaboration
C. Sharing personal experiences to normalize the patient's struggles
D. Focusing exclusively on medication management to avoid transference
Correct Answer: B
Rationale: The therapeutic alliance requires trust, empathy, active listening, and collaboration while
maintaining appropriate professional boundaries, which is particularly crucial with personality disorders.
Q8: During a psychiatric evaluation, a patient states "The FBI is monitoring my thoughts through the
television and they're going to arrest me tomorrow." This thought content represents:
A. Ideas of reference
B. Delusions of persecution
C. Thought broadcasting
D. Paranoid ideation without delusional intensity
Correct Answer: B
Rationale: Delusions of persecution involve fixed false beliefs of being harmed, harassed, or conspired
against; the specific belief about FBI monitoring and imminent arrest fits this category.
Q9: A PMHNP is conducting informed consent for lithium therapy. Which element is NOT required for
valid informed consent?
A. Explanation of lithium's mechanism in treating bipolar disorder
B. Discussion of alternative treatments including no treatment
C. Assessment of the patient's decision-making capacity
D. Disclosure of risks including teratogenicity and thyroid dysfunction
Correct Answer: A
