NU 671 EXAM with Questions and Answers/Plus a Rationale
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE - 1. Diagnostic Criteria and Psychopathology
Across the Lifespan - 2. Major Psychotherapeutic Theories and
Modalities - 3. Advanced Psychiatric Clinical Decision-Making and
Differential Diagnosis
1. A 34-year-old patient presents to the psychiatric mental health nurse practitioner exhibiting a
pervasive pattern of grandiosity, a constant need for admiration, and a lack of empathy starting in
early adulthood and present in various contexts. The patient reacts to minor criticism with hidden
rage and profound shame. Which of the following personality disorders is most consistent with
this clinical presentation?
A. Antisocial Personality Disorder
B. Narcissistic Personality Disorder
C. Borderline Personality Disorder
D. Histrionic Personality Disorder
CORRECT ANSWER : B
Rationale: Narcissistic Personality Disorder is characterized by a pervasive pattern of
grandiosity, need for admiration, and lack of empathy, often masking fragile self-esteem that
reacts poorly to perceived criticism. Antisocial personality disorder involves a disregard for the
rights of others, borderline personality disorder features emotional instability and abandonment
fears, and histrionic personality disorder is marked by excessive emotionality and attention-
seeking.
2. A 28-year-old male is brought to the clinic by his family due to a 3-week history of bizarre
behavior, persecutory delusions, and auditory hallucinations commenting on his actions. He
believes the television broadcasters are sending him coded messages. He exhibits flat affect and
poverty of speech. Urine toxicology is completely negative. Which diagnosis best fits this
clinical picture based on DSM-5-TR criteria?
A. Schizophreniform Disorder
B. Schizophrenia
C. Brief Psychotic Disorder
D. Delusional Disorder
, CORRECT ANSWER : B
Rationale: Schizophrenia requires continuous signs of the disturbance persisting for at least 6
months, including at least 1 month of active-phase symptoms (such as delusions and
hallucinations). Schizophreniform disorder has identical active-phase symptoms but lasts
between 1 and 6 months total. Brief psychotic disorder lasts less than 1 month, and delusional
disorder features non-bizarre delusions without the characteristic negative symptoms or broader
criterion A symptoms of schizophrenia.
3. During an initial clinical interview, a 45-year-old female reports a 3-month period of depressed
mood, insomnia, weight loss, psychomotor agitation, and recurrent thoughts of death, occurring
nearly every day. She notes that she experienced a nearly identical major depressive episode 2
years ago, which fully resolved between episodes. What is the most accurate diagnosis?
A. Persistent Depressive Disorder (Dysthymia)
B. Bipolar II Disorder
C. Major Depressive Disorder, Recurrent Episode
D. Adjustment Disorder with Depressed Mood
CORRECT ANSWER : C
Rationale: Major Depressive Disorder, Recurrent Episode is diagnosed when an individual
experiences two or more major depressive episodes separated by at least 2 consecutive months
of symptom remission. Persistent depressive disorder requires a chronic depressed mood lasting
at least 2 years in adults. Bipolar II requires a hypomanic episode history, and adjustment
disorder occurs as a specific psychological response to an identifiable stressor within 3 months.
4. A psychiatric-mental health nurse practitioner is evaluating a 9-year-old child who displays a
persistent pattern of angry, irritable mood, argumentative behavior, and vindictiveness directed
toward authority figures lasting over 8 months. These behaviors cause significant impairment in
school and home settings, but the child does not violate the basic rights of others or commit acts
of physical aggression. Which diagnosis is most appropriate?
A. Conduct Disorder
B. Oppositional Defiant Disorder
C. Disruptive Mood Dysregulation Disorder
D. Attention-Deficit/Hyperactivity Disorder
CORRECT ANSWER : B
, Rationale: Oppositional Defiant Disorder is characterized by a pattern of angry/irritable mood,
argumentative/defiant behavior, or vindictiveness lasting at least 6 months without violating
major societal norms or rights of others. Conduct disorder involves more severe antisocial
behaviors violating basic rights of others. Disruptive mood dysregulation disorder requires
severe recurrent temper outbursts with persistent irritability, and ADHD focuses primarily on
inattention and/or hyperactivity.
5. A 52-year-old male presents with severe, recurrent panic attacks accompanied by persistent
worry about having additional attacks and significant maladaptive behavioral changes (such as
avoiding driving and public spaces) for the past 7 months. Which of the following represents the
most appropriate diagnosis?
A. Generalized Anxiety Disorder
B. Specific Phobia
C. Panic Disorder with Agoraphobia
D. Social Anxiety Disorder
CORRECT ANSWER : C
Rationale: Panic disorder involves recurrent unexpected panic attacks coupled with at least 1
month of persistent concern about additional attacks or maladaptive behavioral changes related
to them. When marked fear or avoidance of situations like public transportation, open spaces, or
crowds is present, agoraphobia is also diagnosed. Generalized anxiety disorder involves
chronic, generalized worry not restricted to panic attacks.
6. A 21-year-old college student presents with intrusive, unwanted thoughts of contaminating
others with germs, which compel him to wash his hands up to 50 times a day. He recognizes that
these thoughts are products of his own mind and excessive, yet he feels entirely unable to stop
them, causing marked distress and consuming 3 hours of his daily routine. What is the primary
diagnosis?
A. Obsessive-Compulsive Personality Disorder
B. Obsessive-Compulsive Disorder
C. Illness Anxiety Disorder
D. Generalized Anxiety Disorder
CORRECT ANSWER : B
Rationale: Obsessive-Compulsive Disorder is characterized by the presence of obsessions
(recurrent, intrusive thoughts/urges) and/or compulsions (repetitive behaviors or mental acts)
, that are time-consuming and cause marked distress. Obsessive-compulsive personality disorder
involves a pervasive pattern of preoccupation with orderliness, perfectionism, and control
without true ego-dystonic obsessions and compulsions.
7. A veteran returning from deployment presents with nightmares, flashbacks of combat, emotional
numbing, hypervigilance, and an exaggerated startle response persisting for 8 months. Which
neurobiological structure is primarily implicated in the hyper-reactivity and fear conditioning
observed in this disorder?
A. Basal Ganglia
B. Amygdala
C. Substantia Nigra
D. Nucleus Accumbens
CORRECT ANSWER : B
Rationale: The amygdala plays a central role in processing fear, emotional valence, and threat
detection, and is characteristically hyperactive in posttraumatic stress disorder. The basal
ganglia and substantia nigra are more closely tied to movement disorders, while the nucleus
accumbens is the core component of the brain reward pathway.
8. When applying psychodynamic psychotherapy, the nurse practitioner understands that a core
therapeutic mechanism involves working through unconscious conflicts. Which phenomenon
describes the patient unconsciously redirecting feelings and desires associated with significant
figures from childhood onto the therapist?
A. Countertransference
B. Transference
C. Resistance
D. Sublimation
CORRECT ANSWER : B
Rationale: Transference occurs when a patient projects feelings, expectations, or attitudes from
past significant relationships onto the therapist. Countertransference represents the therapist's
emotional reaction toward the patient. Resistance refers to psychological barriers blocking
therapeutic progress, and sublimation is a mature defense mechanism.
Updated 2026 A+/Instant Download PDF
EXAM COVERAGE - 1. Diagnostic Criteria and Psychopathology
Across the Lifespan - 2. Major Psychotherapeutic Theories and
Modalities - 3. Advanced Psychiatric Clinical Decision-Making and
Differential Diagnosis
1. A 34-year-old patient presents to the psychiatric mental health nurse practitioner exhibiting a
pervasive pattern of grandiosity, a constant need for admiration, and a lack of empathy starting in
early adulthood and present in various contexts. The patient reacts to minor criticism with hidden
rage and profound shame. Which of the following personality disorders is most consistent with
this clinical presentation?
A. Antisocial Personality Disorder
B. Narcissistic Personality Disorder
C. Borderline Personality Disorder
D. Histrionic Personality Disorder
CORRECT ANSWER : B
Rationale: Narcissistic Personality Disorder is characterized by a pervasive pattern of
grandiosity, need for admiration, and lack of empathy, often masking fragile self-esteem that
reacts poorly to perceived criticism. Antisocial personality disorder involves a disregard for the
rights of others, borderline personality disorder features emotional instability and abandonment
fears, and histrionic personality disorder is marked by excessive emotionality and attention-
seeking.
2. A 28-year-old male is brought to the clinic by his family due to a 3-week history of bizarre
behavior, persecutory delusions, and auditory hallucinations commenting on his actions. He
believes the television broadcasters are sending him coded messages. He exhibits flat affect and
poverty of speech. Urine toxicology is completely negative. Which diagnosis best fits this
clinical picture based on DSM-5-TR criteria?
A. Schizophreniform Disorder
B. Schizophrenia
C. Brief Psychotic Disorder
D. Delusional Disorder
, CORRECT ANSWER : B
Rationale: Schizophrenia requires continuous signs of the disturbance persisting for at least 6
months, including at least 1 month of active-phase symptoms (such as delusions and
hallucinations). Schizophreniform disorder has identical active-phase symptoms but lasts
between 1 and 6 months total. Brief psychotic disorder lasts less than 1 month, and delusional
disorder features non-bizarre delusions without the characteristic negative symptoms or broader
criterion A symptoms of schizophrenia.
3. During an initial clinical interview, a 45-year-old female reports a 3-month period of depressed
mood, insomnia, weight loss, psychomotor agitation, and recurrent thoughts of death, occurring
nearly every day. She notes that she experienced a nearly identical major depressive episode 2
years ago, which fully resolved between episodes. What is the most accurate diagnosis?
A. Persistent Depressive Disorder (Dysthymia)
B. Bipolar II Disorder
C. Major Depressive Disorder, Recurrent Episode
D. Adjustment Disorder with Depressed Mood
CORRECT ANSWER : C
Rationale: Major Depressive Disorder, Recurrent Episode is diagnosed when an individual
experiences two or more major depressive episodes separated by at least 2 consecutive months
of symptom remission. Persistent depressive disorder requires a chronic depressed mood lasting
at least 2 years in adults. Bipolar II requires a hypomanic episode history, and adjustment
disorder occurs as a specific psychological response to an identifiable stressor within 3 months.
4. A psychiatric-mental health nurse practitioner is evaluating a 9-year-old child who displays a
persistent pattern of angry, irritable mood, argumentative behavior, and vindictiveness directed
toward authority figures lasting over 8 months. These behaviors cause significant impairment in
school and home settings, but the child does not violate the basic rights of others or commit acts
of physical aggression. Which diagnosis is most appropriate?
A. Conduct Disorder
B. Oppositional Defiant Disorder
C. Disruptive Mood Dysregulation Disorder
D. Attention-Deficit/Hyperactivity Disorder
CORRECT ANSWER : B
, Rationale: Oppositional Defiant Disorder is characterized by a pattern of angry/irritable mood,
argumentative/defiant behavior, or vindictiveness lasting at least 6 months without violating
major societal norms or rights of others. Conduct disorder involves more severe antisocial
behaviors violating basic rights of others. Disruptive mood dysregulation disorder requires
severe recurrent temper outbursts with persistent irritability, and ADHD focuses primarily on
inattention and/or hyperactivity.
5. A 52-year-old male presents with severe, recurrent panic attacks accompanied by persistent
worry about having additional attacks and significant maladaptive behavioral changes (such as
avoiding driving and public spaces) for the past 7 months. Which of the following represents the
most appropriate diagnosis?
A. Generalized Anxiety Disorder
B. Specific Phobia
C. Panic Disorder with Agoraphobia
D. Social Anxiety Disorder
CORRECT ANSWER : C
Rationale: Panic disorder involves recurrent unexpected panic attacks coupled with at least 1
month of persistent concern about additional attacks or maladaptive behavioral changes related
to them. When marked fear or avoidance of situations like public transportation, open spaces, or
crowds is present, agoraphobia is also diagnosed. Generalized anxiety disorder involves
chronic, generalized worry not restricted to panic attacks.
6. A 21-year-old college student presents with intrusive, unwanted thoughts of contaminating
others with germs, which compel him to wash his hands up to 50 times a day. He recognizes that
these thoughts are products of his own mind and excessive, yet he feels entirely unable to stop
them, causing marked distress and consuming 3 hours of his daily routine. What is the primary
diagnosis?
A. Obsessive-Compulsive Personality Disorder
B. Obsessive-Compulsive Disorder
C. Illness Anxiety Disorder
D. Generalized Anxiety Disorder
CORRECT ANSWER : B
Rationale: Obsessive-Compulsive Disorder is characterized by the presence of obsessions
(recurrent, intrusive thoughts/urges) and/or compulsions (repetitive behaviors or mental acts)
, that are time-consuming and cause marked distress. Obsessive-compulsive personality disorder
involves a pervasive pattern of preoccupation with orderliness, perfectionism, and control
without true ego-dystonic obsessions and compulsions.
7. A veteran returning from deployment presents with nightmares, flashbacks of combat, emotional
numbing, hypervigilance, and an exaggerated startle response persisting for 8 months. Which
neurobiological structure is primarily implicated in the hyper-reactivity and fear conditioning
observed in this disorder?
A. Basal Ganglia
B. Amygdala
C. Substantia Nigra
D. Nucleus Accumbens
CORRECT ANSWER : B
Rationale: The amygdala plays a central role in processing fear, emotional valence, and threat
detection, and is characteristically hyperactive in posttraumatic stress disorder. The basal
ganglia and substantia nigra are more closely tied to movement disorders, while the nucleus
accumbens is the core component of the brain reward pathway.
8. When applying psychodynamic psychotherapy, the nurse practitioner understands that a core
therapeutic mechanism involves working through unconscious conflicts. Which phenomenon
describes the patient unconsciously redirecting feelings and desires associated with significant
figures from childhood onto the therapist?
A. Countertransference
B. Transference
C. Resistance
D. Sublimation
CORRECT ANSWER : B
Rationale: Transference occurs when a patient projects feelings, expectations, or attitudes from
past significant relationships onto the therapist. Countertransference represents the therapist's
emotional reaction toward the patient. Resistance refers to psychological barriers blocking
therapeutic progress, and sublimation is a mature defense mechanism.
