2026/2027
NR 547 PMHNP Midterm Exam
Comprehensive Study Guide and
Test Bank Review for Advanced
Psychiatric Mental Health Nursing
2026/2027 Edition
Question 1:
Which condition best describes unipolar depression?
A. Episodes of mania only
B. History of hypomania and depression
C. Major depressive episodes without any history of mania or hypomania
D. Rapid cycling mood changes
Correct Answer: C. Major depressive episodes without any history of mania or
hypomania
Rationale:
Unipolar depression, also known as major depressive disorder, is characterized by one
or more major depressive episodes without any past history of manic or hypomanic
episodes. Option A describes manic episodes only, which is not depression. Option B
reflects bipolar II disorder. Option D describes rapid cycling bipolar disorder, not
unipolar depression.
Question 2:
A geriatric patient scores 7 on the Geriatric Depression Scale (GDS-15). How should
this score be interpreted?
A. No depression
B. Mild depression
C. Moderate depression
D. Severe depression
Correct Answer: B. Mild depression
Rationale:
A GDS score of 5–8 indicates mild depression. Scores 0–4 are considered normal,
while higher scores indicate increasing severity. Moderate depression ranges from 9–
,2026/2027
11, and severe depression from 12–15. Therefore, a score of 7 falls within the mild
range requiring clinical follow-up.
Question 3:
Which tool is widely used for screening and measuring severity of depression in
primary care?
A. MMSE
B. PHQ-9
C. Glasgow Coma Scale
D. APGAR score
Correct Answer: B. PHQ-9
Rationale:
The PHQ-9 is a validated 9-item self-report tool used to screen for depression and
assess severity. MMSE evaluates cognition, Glasgow Coma Scale assesses
consciousness, and APGAR is used in newborn assessment.
Question 4:
Which neurotransmitters are most commonly associated with depression?
A. Dopamine, serotonin, norepinephrine
B. GABA and histamine only
C. Acetylcholine and glutamate
D. Epinephrine and insulin
Correct Answer: A. Dopamine, serotonin, norepinephrine
Rationale:
Depression is strongly linked to reduced levels or dysfunction of serotonin, dopamine,
and norepinephrine. These neurotransmitters regulate mood, motivation, and
emotional stability. The other options are not primary in depression pathophysiology.
Question 5:
Which symptom is MOST consistent with melancholic features of depression?
A. Improved mood with positive events
B. Heavy limbs and hypersomnia
C. Lack of pleasure in previously enjoyable activities
D. Rapid speech and elevated energy
,2026/2027
Correct Answer: C. Lack of pleasure in previously enjoyable activities
Rationale:
Melancholic depression is characterized by anhedonia (loss of pleasure), early
morning awakening, worse mood in the morning, and psychomotor changes. Option
A describes atypical depression, while D suggests mania. Option B is more consistent
with atypical depression.
Question 6:
Which scale is specifically used to screen for depression in dementia patients?
A. PHQ-9
B. Cornell Scale for Depression in Dementia
C. HAM-D
D. Beck Depression Inventory
Correct Answer: B. Cornell Scale for Depression in Dementia
Rationale:
The Cornell Scale is designed for assessing depression in patients with dementia,
especially when self-report tools are unreliable. PHQ-9 and BDI rely on patient
insight, which may be impaired in dementia.
Question 7:
A patient presents with elevated mood lasting 6 days, increased energy, and decreased
need for sleep but no severe impairment. This is most consistent with:
A. Major depressive disorder
B. Bipolar I disorder
C. Hypomanic episode
D. Cyclothymic disorder
Correct Answer: C. Hypomanic episode
Rationale:
Hypomania lasts at least 4 days and is less severe than mania, with no marked
impairment or hospitalization required. Bipolar I requires full mania lasting ≥7 days
or hospitalization. Cyclothymia involves chronic subthreshold symptoms.
Question 8:
Which antidepressant class is generally considered first-line in older adults?
, 2026/2027
A. MAOIs
B. TCAs
C. SSRIs
D. Lithium
Correct Answer: C. SSRIs
Rationale:
SSRIs such as sertraline and escitalopram are preferred in older adults due to fewer
side effects and drug interactions. TCAs and MAOIs have higher risk profiles.
Lithium is a mood stabilizer, not first-line for depression.
Question 9:
Which feature is characteristic of atypical depression?
A. Weight loss and insomnia
B. Mood improvement with positive events
C. Early morning awakening
D. Severe psychomotor retardation
Correct Answer: B. Mood improvement with positive events
Rationale:
Atypical depression includes mood reactivity, increased appetite, hypersomnia, and
rejection sensitivity. Option A, C, and D are more consistent with melancholic or
severe depression.
Question 10:
Which condition is an independent risk factor for dementia?
A. Anxiety
B. Depression
C. Bipolar disorder
D. PTSD
Correct Answer: B. Depression
Rationale:
Depression is a known independent risk factor for dementia and may accelerate
cognitive decline. It is important to evaluate cognition in depressed older adults.
Question 11:
NR 547 PMHNP Midterm Exam
Comprehensive Study Guide and
Test Bank Review for Advanced
Psychiatric Mental Health Nursing
2026/2027 Edition
Question 1:
Which condition best describes unipolar depression?
A. Episodes of mania only
B. History of hypomania and depression
C. Major depressive episodes without any history of mania or hypomania
D. Rapid cycling mood changes
Correct Answer: C. Major depressive episodes without any history of mania or
hypomania
Rationale:
Unipolar depression, also known as major depressive disorder, is characterized by one
or more major depressive episodes without any past history of manic or hypomanic
episodes. Option A describes manic episodes only, which is not depression. Option B
reflects bipolar II disorder. Option D describes rapid cycling bipolar disorder, not
unipolar depression.
Question 2:
A geriatric patient scores 7 on the Geriatric Depression Scale (GDS-15). How should
this score be interpreted?
A. No depression
B. Mild depression
C. Moderate depression
D. Severe depression
Correct Answer: B. Mild depression
Rationale:
A GDS score of 5–8 indicates mild depression. Scores 0–4 are considered normal,
while higher scores indicate increasing severity. Moderate depression ranges from 9–
,2026/2027
11, and severe depression from 12–15. Therefore, a score of 7 falls within the mild
range requiring clinical follow-up.
Question 3:
Which tool is widely used for screening and measuring severity of depression in
primary care?
A. MMSE
B. PHQ-9
C. Glasgow Coma Scale
D. APGAR score
Correct Answer: B. PHQ-9
Rationale:
The PHQ-9 is a validated 9-item self-report tool used to screen for depression and
assess severity. MMSE evaluates cognition, Glasgow Coma Scale assesses
consciousness, and APGAR is used in newborn assessment.
Question 4:
Which neurotransmitters are most commonly associated with depression?
A. Dopamine, serotonin, norepinephrine
B. GABA and histamine only
C. Acetylcholine and glutamate
D. Epinephrine and insulin
Correct Answer: A. Dopamine, serotonin, norepinephrine
Rationale:
Depression is strongly linked to reduced levels or dysfunction of serotonin, dopamine,
and norepinephrine. These neurotransmitters regulate mood, motivation, and
emotional stability. The other options are not primary in depression pathophysiology.
Question 5:
Which symptom is MOST consistent with melancholic features of depression?
A. Improved mood with positive events
B. Heavy limbs and hypersomnia
C. Lack of pleasure in previously enjoyable activities
D. Rapid speech and elevated energy
,2026/2027
Correct Answer: C. Lack of pleasure in previously enjoyable activities
Rationale:
Melancholic depression is characterized by anhedonia (loss of pleasure), early
morning awakening, worse mood in the morning, and psychomotor changes. Option
A describes atypical depression, while D suggests mania. Option B is more consistent
with atypical depression.
Question 6:
Which scale is specifically used to screen for depression in dementia patients?
A. PHQ-9
B. Cornell Scale for Depression in Dementia
C. HAM-D
D. Beck Depression Inventory
Correct Answer: B. Cornell Scale for Depression in Dementia
Rationale:
The Cornell Scale is designed for assessing depression in patients with dementia,
especially when self-report tools are unreliable. PHQ-9 and BDI rely on patient
insight, which may be impaired in dementia.
Question 7:
A patient presents with elevated mood lasting 6 days, increased energy, and decreased
need for sleep but no severe impairment. This is most consistent with:
A. Major depressive disorder
B. Bipolar I disorder
C. Hypomanic episode
D. Cyclothymic disorder
Correct Answer: C. Hypomanic episode
Rationale:
Hypomania lasts at least 4 days and is less severe than mania, with no marked
impairment or hospitalization required. Bipolar I requires full mania lasting ≥7 days
or hospitalization. Cyclothymia involves chronic subthreshold symptoms.
Question 8:
Which antidepressant class is generally considered first-line in older adults?
, 2026/2027
A. MAOIs
B. TCAs
C. SSRIs
D. Lithium
Correct Answer: C. SSRIs
Rationale:
SSRIs such as sertraline and escitalopram are preferred in older adults due to fewer
side effects and drug interactions. TCAs and MAOIs have higher risk profiles.
Lithium is a mood stabilizer, not first-line for depression.
Question 9:
Which feature is characteristic of atypical depression?
A. Weight loss and insomnia
B. Mood improvement with positive events
C. Early morning awakening
D. Severe psychomotor retardation
Correct Answer: B. Mood improvement with positive events
Rationale:
Atypical depression includes mood reactivity, increased appetite, hypersomnia, and
rejection sensitivity. Option A, C, and D are more consistent with melancholic or
severe depression.
Question 10:
Which condition is an independent risk factor for dementia?
A. Anxiety
B. Depression
C. Bipolar disorder
D. PTSD
Correct Answer: B. Depression
Rationale:
Depression is a known independent risk factor for dementia and may accelerate
cognitive decline. It is important to evaluate cognition in depressed older adults.
Question 11:
