MCPHS NUR 807 FINAL EXAM PMHNP
Comprehensive Exam Questions and Answers with
Rationale (Graded A+) | New Update 2026/2027
Psychiatric Mental Health Nurse Practitioner / Advanced Clinical Decision-Making
SECTION A: ADVANCED CLINICAL DECISION-MAKING & DIAGNOSTIC REASONING
(Questions 1-50)
Question 1
A 34-year-old female presents with a 3-week history of depressed mood,
anhedonia, insomnia, fatigue, and difficulty concentrating. She reports these
symptoms began after the birth of her second child 4 months ago. She has no
prior psychiatric history. Which of the following is the most appropriate initial
diagnostic consideration?
• □
A. Major Depressive Disorder, severe with psychotic features
• □
B. Bipolar II Disorder, current episode depressed
• □
C. Adjustment Disorder with depressed mood
• ☑
D. Major Depressive Disorder, postpartum onset
Correct Answer: D — Major Depressive Disorder, postpartum onset
Rationale: The patient meets DSM-5-TR criteria for Major Depressive Disorder
with peripartum onset. Symptoms onset within 4 weeks postpartum, the presence
of five or more depressive symptoms (depressed mood, anhedonia, insomnia,
fatigue, concentration difficulties), and functional impairment are consistent with
,this diagnosis. Postpartum depression affects approximately 10-20% of women.
The absence of psychotic features (A) distinguishes this from postpartum
psychosis. Bipolar II disorder (B) requires evidence of hypomanic episodes, which
are not described. Adjustment Disorder (C) would typically involve less severe
symptoms or a clearer relationship to a specific stressor. The PMHNP should
screen for postpartum depression using validated tools (EPDS) and assess for risk
of harm to self or infant.
Question 2
A 19-year-old college student presents with significant anxiety about social
situations, fear of being judged negatively, and avoidance of group activities.
These symptoms have been present since early adolescence and have worsened
since starting college. Which is the most likely diagnosis?
• □
A. Generalized Anxiety Disorder
• □
B. Panic Disorder
• ☑
C. Social Anxiety Disorder (Social Phobia)
• □
D. Avoidant Personality Disorder
Correct Answer: C — Social Anxiety Disorder (Social Phobia)
Rationale: Social Anxiety Disorder is characterized by marked fear or anxiety
about social situations in which the individual is exposed to possible scrutiny by
others. The fear of negative evaluation and avoidance of social situations are
hallmark features. The early adolescent onset and exacerbation during college
transition are typical. Generalized Anxiety Disorder (A) involves excessive worry
about multiple domains, not specifically social evaluation. Panic Disorder (B)
involves recurrent unexpected panic attacks. Avoidant Personality Disorder (D) is a
,pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity
to negative evaluation, which is a more pervasive and stable pattern; the
distinction from social anxiety disorder is based on severity and pervasiveness
(personality disorder criteria are more enduring and impairing across multiple
domains). The PMHNP should consider evidence-based treatments including CBT
and SSRIs.
Question 3
A 62-year-old male with a history of hypertension and type 2 diabetes presents
with a 6-month history of progressive memory loss, difficulty finding words, and
personality changes. His wife reports he has become apathetic and withdrawn.
On cognitive testing, he performs poorly on recall and executive function tasks.
Which is the most appropriate initial evaluation step?
• □
A. Prescribe donepezil immediately
• □
B. Refer to neurology for MRI
• ☑
C. Obtain comprehensive metabolic panel, TSH, B12, and neuroimaging
• □
D. Diagnose Alzheimer's disease and initiate psychosocial support
Correct Answer: C — Obtain comprehensive metabolic panel, TSH, B12, and
neuroimaging
Rationale: Before diagnosing a neurodegenerative disorder, the PMHNP must rule
out reversible causes of cognitive impairment. Reversible causes include:
metabolic disturbances (electrolyte imbalances, renal/hepatic dysfunction),
thyroid disorders (hypothyroidism), vitamin deficiencies (B12, folate), and
structural lesions (stroke, tumor, normal pressure hydrocephalus). Neuroimaging
(CT or MRI) can identify vascular changes, masses, or atrophy patterns. Prescribing
, donepezil (A) without a confirmed diagnosis is premature. While neurology
referral (B) may be appropriate after initial workup, the PMHNP can initiate the
evaluation. Diagnosing Alzheimer's disease (D) without ruling out reversible
causes is inappropriate. The PMHNP should also screen for depression
(pseudodementia) and perform a thorough medication review for cognitive-
impairing drugs.
Question 4
A 28-year-old male presents with a 1-week history of elevated mood, decreased
need for sleep, grandiosity, racing thoughts, and increased goal-directed activity.
He reports having "brilliant ideas" and has started multiple new business
ventures. He denies any prior episodes of depression. Which is the most likely
diagnosis?
• □
A. Major Depressive Disorder with mixed features
• □
B. Schizophrenia
• ☑
C. Bipolar I Disorder, manic episode
• □
D. Substance/Medication-Induced Mania
Correct Answer: C — Bipolar I Disorder, manic episode
Rationale: The patient meets DSM-5-TR criteria for a manic episode: distinct
period of abnormally and persistently elevated, expansive, or irritable mood,
lasting at least 1 week (or any duration if hospitalization is required), with at least
three of the following: inflated self-esteem/grandiosity, decreased need for sleep,
pressured speech, flight of ideas/racing thoughts, distractibility, increased goal-
directed activity, excessive involvement in activities with high potential for painful
consequences. The absence of prior depressive episodes does not exclude Bipolar
Comprehensive Exam Questions and Answers with
Rationale (Graded A+) | New Update 2026/2027
Psychiatric Mental Health Nurse Practitioner / Advanced Clinical Decision-Making
SECTION A: ADVANCED CLINICAL DECISION-MAKING & DIAGNOSTIC REASONING
(Questions 1-50)
Question 1
A 34-year-old female presents with a 3-week history of depressed mood,
anhedonia, insomnia, fatigue, and difficulty concentrating. She reports these
symptoms began after the birth of her second child 4 months ago. She has no
prior psychiatric history. Which of the following is the most appropriate initial
diagnostic consideration?
• □
A. Major Depressive Disorder, severe with psychotic features
• □
B. Bipolar II Disorder, current episode depressed
• □
C. Adjustment Disorder with depressed mood
• ☑
D. Major Depressive Disorder, postpartum onset
Correct Answer: D — Major Depressive Disorder, postpartum onset
Rationale: The patient meets DSM-5-TR criteria for Major Depressive Disorder
with peripartum onset. Symptoms onset within 4 weeks postpartum, the presence
of five or more depressive symptoms (depressed mood, anhedonia, insomnia,
fatigue, concentration difficulties), and functional impairment are consistent with
,this diagnosis. Postpartum depression affects approximately 10-20% of women.
The absence of psychotic features (A) distinguishes this from postpartum
psychosis. Bipolar II disorder (B) requires evidence of hypomanic episodes, which
are not described. Adjustment Disorder (C) would typically involve less severe
symptoms or a clearer relationship to a specific stressor. The PMHNP should
screen for postpartum depression using validated tools (EPDS) and assess for risk
of harm to self or infant.
Question 2
A 19-year-old college student presents with significant anxiety about social
situations, fear of being judged negatively, and avoidance of group activities.
These symptoms have been present since early adolescence and have worsened
since starting college. Which is the most likely diagnosis?
• □
A. Generalized Anxiety Disorder
• □
B. Panic Disorder
• ☑
C. Social Anxiety Disorder (Social Phobia)
• □
D. Avoidant Personality Disorder
Correct Answer: C — Social Anxiety Disorder (Social Phobia)
Rationale: Social Anxiety Disorder is characterized by marked fear or anxiety
about social situations in which the individual is exposed to possible scrutiny by
others. The fear of negative evaluation and avoidance of social situations are
hallmark features. The early adolescent onset and exacerbation during college
transition are typical. Generalized Anxiety Disorder (A) involves excessive worry
about multiple domains, not specifically social evaluation. Panic Disorder (B)
involves recurrent unexpected panic attacks. Avoidant Personality Disorder (D) is a
,pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity
to negative evaluation, which is a more pervasive and stable pattern; the
distinction from social anxiety disorder is based on severity and pervasiveness
(personality disorder criteria are more enduring and impairing across multiple
domains). The PMHNP should consider evidence-based treatments including CBT
and SSRIs.
Question 3
A 62-year-old male with a history of hypertension and type 2 diabetes presents
with a 6-month history of progressive memory loss, difficulty finding words, and
personality changes. His wife reports he has become apathetic and withdrawn.
On cognitive testing, he performs poorly on recall and executive function tasks.
Which is the most appropriate initial evaluation step?
• □
A. Prescribe donepezil immediately
• □
B. Refer to neurology for MRI
• ☑
C. Obtain comprehensive metabolic panel, TSH, B12, and neuroimaging
• □
D. Diagnose Alzheimer's disease and initiate psychosocial support
Correct Answer: C — Obtain comprehensive metabolic panel, TSH, B12, and
neuroimaging
Rationale: Before diagnosing a neurodegenerative disorder, the PMHNP must rule
out reversible causes of cognitive impairment. Reversible causes include:
metabolic disturbances (electrolyte imbalances, renal/hepatic dysfunction),
thyroid disorders (hypothyroidism), vitamin deficiencies (B12, folate), and
structural lesions (stroke, tumor, normal pressure hydrocephalus). Neuroimaging
(CT or MRI) can identify vascular changes, masses, or atrophy patterns. Prescribing
, donepezil (A) without a confirmed diagnosis is premature. While neurology
referral (B) may be appropriate after initial workup, the PMHNP can initiate the
evaluation. Diagnosing Alzheimer's disease (D) without ruling out reversible
causes is inappropriate. The PMHNP should also screen for depression
(pseudodementia) and perform a thorough medication review for cognitive-
impairing drugs.
Question 4
A 28-year-old male presents with a 1-week history of elevated mood, decreased
need for sleep, grandiosity, racing thoughts, and increased goal-directed activity.
He reports having "brilliant ideas" and has started multiple new business
ventures. He denies any prior episodes of depression. Which is the most likely
diagnosis?
• □
A. Major Depressive Disorder with mixed features
• □
B. Schizophrenia
• ☑
C. Bipolar I Disorder, manic episode
• □
D. Substance/Medication-Induced Mania
Correct Answer: C — Bipolar I Disorder, manic episode
Rationale: The patient meets DSM-5-TR criteria for a manic episode: distinct
period of abnormally and persistently elevated, expansive, or irritable mood,
lasting at least 1 week (or any duration if hospitalization is required), with at least
three of the following: inflated self-esteem/grandiosity, decreased need for sleep,
pressured speech, flight of ideas/racing thoughts, distractibility, increased goal-
directed activity, excessive involvement in activities with high potential for painful
consequences. The absence of prior depressive episodes does not exclude Bipolar
