NR547 Final Exam Questions & Detailed Answers 2025–2026 |
Chamberlain University PMHNP Review | HAM-D, PHQ-9, MDQ,
MDD, Bipolar & Psych Assessment Newest Version 2026-
2027 UP-TO-DATE EXAM
Section 1: HAM-D (Hamilton Depression Rating Scale) –
1. The Hamilton Depression Rating Scale (HAM-D) is best described as:
a) A self-report measure of depression severity
b) A clinician-administered scale to assess depression severity
c) A screening tool for bipolar disorder
d) A measure of psychosocial stressors
Correct Answer: b) A clinician-administered scale to assess depression severity
*Explanation: The HAM-D is a clinician-rated scale (requires a trained interviewer) that
assesses the severity of depressive symptoms. It is not a self-report tool. It is widely used
in clinical trials and research to measure treatment response. The PHQ-9 is the self-
report equivalent.*
2. The original and most commonly used version of the HAM-D contains how
many items?
a) 9
b) 13
c) 17
d) 24
Correct Answer: c) 17
*Explanation: The original HAM-D contains 17 items that assess core depressive
symptoms such as depressed mood, guilt, suicide, insomnia, work/activities,
psychomotor retardation/agitation, anxiety, somatic symptoms, and insight. Expanded
versions (21-24 items) exist but the 17-item version is the gold standard.*
,3. A patient scores 25 on the 17-item HAM-D. This indicates:
a) Remission
b) Mild depression
c) Moderate depression
d) Severe depression
Correct Answer: d) Severe depression
*Explanation: HAM-D scoring (17-item): 0-7 = normal/remission, 8-16 = mild
depression, 17-23 = moderate depression, ≥24 = severe depression. A score of 25
indicates severe depression requiring aggressive treatment and close follow-up.*
4. A major limitation of the HAM-D in geriatric or medically ill patients is:
a) It takes too long to administer
b) It overemphasizes somatic symptoms (insomnia, fatigue, appetite changes) which
may be due to medical illness rather than depression
c) It cannot be used in hospitalized patients
d) It requires special computer software
Correct Answer: b) It overemphasizes somatic symptoms (insomnia, fatigue, appetite
changes) which may be due to medical illness rather than depression
Explanation: The HAM-D includes multiple items assessing somatic symptoms (insomnia,
somatic complaints, fatigue, appetite/weight changes). In elderly or medically ill patients,
these symptoms may be caused by the underlying medical condition, leading to falsely
elevated scores that do not accurately reflect psychological depression.
5. Which of the following is NOT a core item on the 17-item HAM-D?
a) Depressed mood
b) Suicidal ideation
c) Mania
d) Insomnia (initial, middle, late)
Correct Answer: c) Mania
Explanation: The HAM-D assesses depressive symptoms only. It does not assess mania or
hypomania. The HAM-D does include: depressed mood, guilt, suicide, insomnia (initial,
middle, terminal), work/activities, psychomotor retardation, agitation, anxiety
(psychic/somatic), somatic symptoms, genital symptoms, hypochondriasis, weight loss, and
insight.
,6. A patient's HAM-D score drops from 28 to 12 after 8 weeks of antidepressant
treatment. This indicates:
a) Treatment failure
b) Partial response (still mild depression)
c) Full remission
d) Worsening of depression
Correct Answer: b) Partial response (still mild depression)
*Explanation: A score of 12 indicates mild depression (8-16 = mild). While the patient
has improved significantly (from severe to mild), full remission would be a score below
8. Partial response is defined as a ≥50% reduction in score but not reaching remission.*
7. The HAM-D is most appropriately used for:
a) Initial screening for depression in primary care
b) Measuring severity of depression and monitoring treatment response in patients
already diagnosed
c) Diagnosing bipolar disorder
d) Assessing suicide risk exclusively
Correct Answer: b) Measuring severity of depression and monitoring treatment
response in patients already diagnosed
*Explanation: The HAM-D is a severity measure, not a screening tool. It is used once a
diagnosis of depression is established to quantify severity and track response to
treatment over time. Screening is better done with the PHQ-9 or other self-report tools.*
8. A patient with severe depression and end-stage renal disease scores high on
HAM-D items for fatigue and anorexia. The PMHNP should:
a) Immediately increase the antidepressant dose
b) Consider that uremia (medical illness) may be contributing to these somatic
symptoms
c) Diagnose a factitious disorder
d) Discontinue all psychiatric treatment
Correct Answer: b) Consider that uremia (medical illness) may be contributing to these
somatic symptoms
Explanation: In patients with advanced medical illness (ESRD, cancer, COPD), somatic
symptoms on the HAM-D (fatigue, anorexia, insomnia) may be due to the medical disease
, rather than depression. The clinician must interpret the HAM-D in clinical context and not
attribute all symptoms to depression.
9. The HAM-D includes specific items assessing which three phases of insomnia?
a) Hypersomnia, narcolepsy, and sleep apnea
b) Initial, middle, and late (terminal) insomnia
c) Nightmares, night terrors, and sleepwalking
d) Restless leg syndrome, periodic limb movement, and bruxism
Correct Answer: b) Initial, middle, and late (terminal) insomnia
Explanation: The HAM-D assesses insomnia in three distinct phases: initial (difficulty
falling asleep), middle (waking during the night, difficulty returning to sleep), and
late/terminal (early morning awakening, cannot return to sleep). Early morning
awakening is particularly associated with melancholic depression.
10. A patient on an SSRI for 6 weeks has a HAM-D score of 22, unchanged from
baseline. The PMHNP should:
a) Continue the same dose for another 6 weeks
b) Consider switching antidepressants or augmenting, as there has been no response
c) Discontinue all medications
d) Diagnose bipolar disorder
Correct Answer: b) Consider switching antidepressants or augmenting, as there has
been no response
*Explanation: Lack of response (no reduction in HAM-D score) after an adequate trial (4-
8 weeks at therapeutic dose) indicates treatment-resistant depression. The PMHNP
should consider switching to another antidepressant or augmentation. Waiting longer
without change is unlikely to produce response.*
11. The HAM-D item for "psychomotor retardation" assesses:
a) Fidgeting and pacing
b) Slowed speech, thinking, and body movements
c) Racing thoughts and pressured speech
d) Tremors and rigidity
Correct Answer: b) Slowed speech, thinking, and body movements
Explanation: Psychomotor retardation refers to a slowing of physical and cognitive
processes: slow speech (long latency before responding), monotonous voice, slowed body
Chamberlain University PMHNP Review | HAM-D, PHQ-9, MDQ,
MDD, Bipolar & Psych Assessment Newest Version 2026-
2027 UP-TO-DATE EXAM
Section 1: HAM-D (Hamilton Depression Rating Scale) –
1. The Hamilton Depression Rating Scale (HAM-D) is best described as:
a) A self-report measure of depression severity
b) A clinician-administered scale to assess depression severity
c) A screening tool for bipolar disorder
d) A measure of psychosocial stressors
Correct Answer: b) A clinician-administered scale to assess depression severity
*Explanation: The HAM-D is a clinician-rated scale (requires a trained interviewer) that
assesses the severity of depressive symptoms. It is not a self-report tool. It is widely used
in clinical trials and research to measure treatment response. The PHQ-9 is the self-
report equivalent.*
2. The original and most commonly used version of the HAM-D contains how
many items?
a) 9
b) 13
c) 17
d) 24
Correct Answer: c) 17
*Explanation: The original HAM-D contains 17 items that assess core depressive
symptoms such as depressed mood, guilt, suicide, insomnia, work/activities,
psychomotor retardation/agitation, anxiety, somatic symptoms, and insight. Expanded
versions (21-24 items) exist but the 17-item version is the gold standard.*
,3. A patient scores 25 on the 17-item HAM-D. This indicates:
a) Remission
b) Mild depression
c) Moderate depression
d) Severe depression
Correct Answer: d) Severe depression
*Explanation: HAM-D scoring (17-item): 0-7 = normal/remission, 8-16 = mild
depression, 17-23 = moderate depression, ≥24 = severe depression. A score of 25
indicates severe depression requiring aggressive treatment and close follow-up.*
4. A major limitation of the HAM-D in geriatric or medically ill patients is:
a) It takes too long to administer
b) It overemphasizes somatic symptoms (insomnia, fatigue, appetite changes) which
may be due to medical illness rather than depression
c) It cannot be used in hospitalized patients
d) It requires special computer software
Correct Answer: b) It overemphasizes somatic symptoms (insomnia, fatigue, appetite
changes) which may be due to medical illness rather than depression
Explanation: The HAM-D includes multiple items assessing somatic symptoms (insomnia,
somatic complaints, fatigue, appetite/weight changes). In elderly or medically ill patients,
these symptoms may be caused by the underlying medical condition, leading to falsely
elevated scores that do not accurately reflect psychological depression.
5. Which of the following is NOT a core item on the 17-item HAM-D?
a) Depressed mood
b) Suicidal ideation
c) Mania
d) Insomnia (initial, middle, late)
Correct Answer: c) Mania
Explanation: The HAM-D assesses depressive symptoms only. It does not assess mania or
hypomania. The HAM-D does include: depressed mood, guilt, suicide, insomnia (initial,
middle, terminal), work/activities, psychomotor retardation, agitation, anxiety
(psychic/somatic), somatic symptoms, genital symptoms, hypochondriasis, weight loss, and
insight.
,6. A patient's HAM-D score drops from 28 to 12 after 8 weeks of antidepressant
treatment. This indicates:
a) Treatment failure
b) Partial response (still mild depression)
c) Full remission
d) Worsening of depression
Correct Answer: b) Partial response (still mild depression)
*Explanation: A score of 12 indicates mild depression (8-16 = mild). While the patient
has improved significantly (from severe to mild), full remission would be a score below
8. Partial response is defined as a ≥50% reduction in score but not reaching remission.*
7. The HAM-D is most appropriately used for:
a) Initial screening for depression in primary care
b) Measuring severity of depression and monitoring treatment response in patients
already diagnosed
c) Diagnosing bipolar disorder
d) Assessing suicide risk exclusively
Correct Answer: b) Measuring severity of depression and monitoring treatment
response in patients already diagnosed
*Explanation: The HAM-D is a severity measure, not a screening tool. It is used once a
diagnosis of depression is established to quantify severity and track response to
treatment over time. Screening is better done with the PHQ-9 or other self-report tools.*
8. A patient with severe depression and end-stage renal disease scores high on
HAM-D items for fatigue and anorexia. The PMHNP should:
a) Immediately increase the antidepressant dose
b) Consider that uremia (medical illness) may be contributing to these somatic
symptoms
c) Diagnose a factitious disorder
d) Discontinue all psychiatric treatment
Correct Answer: b) Consider that uremia (medical illness) may be contributing to these
somatic symptoms
Explanation: In patients with advanced medical illness (ESRD, cancer, COPD), somatic
symptoms on the HAM-D (fatigue, anorexia, insomnia) may be due to the medical disease
, rather than depression. The clinician must interpret the HAM-D in clinical context and not
attribute all symptoms to depression.
9. The HAM-D includes specific items assessing which three phases of insomnia?
a) Hypersomnia, narcolepsy, and sleep apnea
b) Initial, middle, and late (terminal) insomnia
c) Nightmares, night terrors, and sleepwalking
d) Restless leg syndrome, periodic limb movement, and bruxism
Correct Answer: b) Initial, middle, and late (terminal) insomnia
Explanation: The HAM-D assesses insomnia in three distinct phases: initial (difficulty
falling asleep), middle (waking during the night, difficulty returning to sleep), and
late/terminal (early morning awakening, cannot return to sleep). Early morning
awakening is particularly associated with melancholic depression.
10. A patient on an SSRI for 6 weeks has a HAM-D score of 22, unchanged from
baseline. The PMHNP should:
a) Continue the same dose for another 6 weeks
b) Consider switching antidepressants or augmenting, as there has been no response
c) Discontinue all medications
d) Diagnose bipolar disorder
Correct Answer: b) Consider switching antidepressants or augmenting, as there has
been no response
*Explanation: Lack of response (no reduction in HAM-D score) after an adequate trial (4-
8 weeks at therapeutic dose) indicates treatment-resistant depression. The PMHNP
should consider switching to another antidepressant or augmentation. Waiting longer
without change is unlikely to produce response.*
11. The HAM-D item for "psychomotor retardation" assesses:
a) Fidgeting and pacing
b) Slowed speech, thinking, and body movements
c) Racing thoughts and pressured speech
d) Tremors and rigidity
Correct Answer: b) Slowed speech, thinking, and body movements
Explanation: Psychomotor retardation refers to a slowing of physical and cognitive
processes: slow speech (long latency before responding), monotonous voice, slowed body
