WGU D344 PMHNP Objective Assessment
(OA) Practice Examination Actual Exam
2026–2027 | Comprehensive 150-Question
Practice Test with Answers & Rationales|
Free Pdf Access
Section 1: Diagnostic Reasoning and Clinical Assessment
Question 1
A 32-year-old client presents with low mood, insomnia, poor concentration, and fatigue
for 3 weeks following job loss. The clinician immediately diagnoses major depressive
disorder without further inquiry. What is the most likely error in diagnostic reasoning?
A) Base rate neglect
B) Premature closure
C) Anchoring bias
D) Confirmation bias
Correct Answer: B
Explanation: Premature closure occurs when a clinician stops gathering information and
settles on a diagnosis too early in the assessment process, without fully exploring
alternative explanations or gathering sufficient data. In this scenario, the clinician reached
a diagnosis of MDD without considering other possibilities or completing a thorough
assessment. Premature closure is one of the most common cognitive errors in psychiatric
diagnosis and can lead to misdiagnosis and inappropriate treatment .
Question 2
When formulating a diagnosis, the PMHNP utilizes the "Biopsychosocial Model." Which
of the following is considered a "Social" factor in the assessment of a patient with
Alcohol Use Disorder?
,A) Genetic predisposition to addiction
B) Impaired executive functioning in the prefrontal cortex
C) Lack of stable housing and a peer group that heavily uses substances
D) Low self-esteem and maladaptive coping mechanisms
Correct Answer: C
Explanation: Social factors in the biopsychosocial model include environmental influences,
housing stability, support systems, peer group influences, and cultural factors. Choice A
(genetics) and Choice B (brain functioning) are biological factors. Choice D (self-esteem,
coping) represents psychological factors. The biopsychosocial model emphasizes that
psychiatric conditions result from the interaction of biological, psychological, and social
factors, and a comprehensive assessment must address all three domains .
Question 3
A patient presents with "anhedonia." To meet the DSM-5-TR diagnostic criteria for a
Major Depressive Episode, this symptom must be present for at least:
A) One week
B) Two weeks
C) One month
D) Six months
Correct Answer: B
Explanation: According to DSM-5-TR criteria, a Major Depressive Episode requires at least
five symptoms (including depressed mood or anhedonia) to be present for a minimum of a
two-week period. This duration criterion helps distinguish MDD from normal sadness or
brief mood fluctuations that do not constitute a clinical depressive episode .
Question 4
A 55-year-old female with no prior psychiatric history presents with acute onset of
severe anxiety, palpitations, and weight loss. On physical exam, the PMHNP notes a fine
tremor and exophthalmos. What is the most appropriate next step in the diagnostic
process?
,A) Initiate a trial of a Selective Serotonin Reuptake Inhibitor (SSRI)
B) Administer the GAD-7 screening tool
C) Order a Serum TSH and Free T4
D) Refer the patient for Cognitive Behavioral Therapy (CBT)
Correct Answer: C
Explanation: New-onset anxiety in an older adult without a prior psychiatric history
warrants a thorough investigation for medical causes. The physical signs of tremor,
exophthalmos, palpitations, and weight loss strongly suggest hyperthyroidism. Ordering
thyroid function tests (TSH and Free T4) is the appropriate next step to rule out a medical
etiology before initiating psychiatric treatment. This demonstrates the importance of the
biopsychosocial approach and ruling out medical mimics of psychiatric conditions .
Question 5
A PMHNP uses the PHQ-9 to monitor a patient's response to Sertraline. The patient's
score has dropped from 18 to 9. This change indicates:
A) No clinical improvement
B) Full remission of symptoms
C) A 50% reduction in symptom severity, suggesting a positive treatment response
D) That the patient is now at high risk for suicide
Correct Answer: C
Explanation: In measurement-based care, a 50% reduction in standardized scale scores is
often used as the benchmark for a "clinically significant response" to treatment. The PHQ-
9 score dropping from 18 (moderately severe depression) to 9 (mild depression) represents
a 50% reduction, indicating a meaningful therapeutic response to the SSRI. This highlights
the importance of using validated screening tools to track treatment response objectively .
Question 6
During the Mental Status Exam (MSE), the PMHNP observes the patient is wearing a
winter coat and three hats in the middle of summer. This is documented under which
section of the MSE?
, A) Thought Content
B) Behavior
C) Appearance
D) Sensorium
Correct Answer: C
Explanation: The Appearance section of the Mental Status Exam includes observations
about the patient's grooming, hygiene, dress, and appropriateness of attire for the setting
and weather. Inappropriate dress (such as wearing heavy winter clothing in summer heat)
can indicate poor judgment, cognitive impairment, or psychotic processes and should be
documented in the appearance category .
Question 7
The "A" in the CAGE questionnaire stands for:
A) Alcohol
B) Annoyed
C) Addiction
D) Abuse
Correct Answer: B
Explanation: The CAGE questionnaire is a brief screening tool for alcohol use disorder. The
acronym stands for: Cut down (Have you ever felt you should cut down on your drinking?),
Annoyed (Have people annoyed you by criticizing your drinking?), Guilty (Have you ever
felt guilty about your drinking?), and Eye-opener (Have you ever had a drink first thing in
the morning to steady your nerves or get rid of a hangover?). The "A" represents
"Annoyed" .
Question 8
Which screening tool is most appropriate for assessing a 4-year-old child for Autism
Spectrum Disorder (ASD)?
A) PHQ-A
B) M-CHAT-R (Modified Checklist for Autism in Toddlers)
(OA) Practice Examination Actual Exam
2026–2027 | Comprehensive 150-Question
Practice Test with Answers & Rationales|
Free Pdf Access
Section 1: Diagnostic Reasoning and Clinical Assessment
Question 1
A 32-year-old client presents with low mood, insomnia, poor concentration, and fatigue
for 3 weeks following job loss. The clinician immediately diagnoses major depressive
disorder without further inquiry. What is the most likely error in diagnostic reasoning?
A) Base rate neglect
B) Premature closure
C) Anchoring bias
D) Confirmation bias
Correct Answer: B
Explanation: Premature closure occurs when a clinician stops gathering information and
settles on a diagnosis too early in the assessment process, without fully exploring
alternative explanations or gathering sufficient data. In this scenario, the clinician reached
a diagnosis of MDD without considering other possibilities or completing a thorough
assessment. Premature closure is one of the most common cognitive errors in psychiatric
diagnosis and can lead to misdiagnosis and inappropriate treatment .
Question 2
When formulating a diagnosis, the PMHNP utilizes the "Biopsychosocial Model." Which
of the following is considered a "Social" factor in the assessment of a patient with
Alcohol Use Disorder?
,A) Genetic predisposition to addiction
B) Impaired executive functioning in the prefrontal cortex
C) Lack of stable housing and a peer group that heavily uses substances
D) Low self-esteem and maladaptive coping mechanisms
Correct Answer: C
Explanation: Social factors in the biopsychosocial model include environmental influences,
housing stability, support systems, peer group influences, and cultural factors. Choice A
(genetics) and Choice B (brain functioning) are biological factors. Choice D (self-esteem,
coping) represents psychological factors. The biopsychosocial model emphasizes that
psychiatric conditions result from the interaction of biological, psychological, and social
factors, and a comprehensive assessment must address all three domains .
Question 3
A patient presents with "anhedonia." To meet the DSM-5-TR diagnostic criteria for a
Major Depressive Episode, this symptom must be present for at least:
A) One week
B) Two weeks
C) One month
D) Six months
Correct Answer: B
Explanation: According to DSM-5-TR criteria, a Major Depressive Episode requires at least
five symptoms (including depressed mood or anhedonia) to be present for a minimum of a
two-week period. This duration criterion helps distinguish MDD from normal sadness or
brief mood fluctuations that do not constitute a clinical depressive episode .
Question 4
A 55-year-old female with no prior psychiatric history presents with acute onset of
severe anxiety, palpitations, and weight loss. On physical exam, the PMHNP notes a fine
tremor and exophthalmos. What is the most appropriate next step in the diagnostic
process?
,A) Initiate a trial of a Selective Serotonin Reuptake Inhibitor (SSRI)
B) Administer the GAD-7 screening tool
C) Order a Serum TSH and Free T4
D) Refer the patient for Cognitive Behavioral Therapy (CBT)
Correct Answer: C
Explanation: New-onset anxiety in an older adult without a prior psychiatric history
warrants a thorough investigation for medical causes. The physical signs of tremor,
exophthalmos, palpitations, and weight loss strongly suggest hyperthyroidism. Ordering
thyroid function tests (TSH and Free T4) is the appropriate next step to rule out a medical
etiology before initiating psychiatric treatment. This demonstrates the importance of the
biopsychosocial approach and ruling out medical mimics of psychiatric conditions .
Question 5
A PMHNP uses the PHQ-9 to monitor a patient's response to Sertraline. The patient's
score has dropped from 18 to 9. This change indicates:
A) No clinical improvement
B) Full remission of symptoms
C) A 50% reduction in symptom severity, suggesting a positive treatment response
D) That the patient is now at high risk for suicide
Correct Answer: C
Explanation: In measurement-based care, a 50% reduction in standardized scale scores is
often used as the benchmark for a "clinically significant response" to treatment. The PHQ-
9 score dropping from 18 (moderately severe depression) to 9 (mild depression) represents
a 50% reduction, indicating a meaningful therapeutic response to the SSRI. This highlights
the importance of using validated screening tools to track treatment response objectively .
Question 6
During the Mental Status Exam (MSE), the PMHNP observes the patient is wearing a
winter coat and three hats in the middle of summer. This is documented under which
section of the MSE?
, A) Thought Content
B) Behavior
C) Appearance
D) Sensorium
Correct Answer: C
Explanation: The Appearance section of the Mental Status Exam includes observations
about the patient's grooming, hygiene, dress, and appropriateness of attire for the setting
and weather. Inappropriate dress (such as wearing heavy winter clothing in summer heat)
can indicate poor judgment, cognitive impairment, or psychotic processes and should be
documented in the appearance category .
Question 7
The "A" in the CAGE questionnaire stands for:
A) Alcohol
B) Annoyed
C) Addiction
D) Abuse
Correct Answer: B
Explanation: The CAGE questionnaire is a brief screening tool for alcohol use disorder. The
acronym stands for: Cut down (Have you ever felt you should cut down on your drinking?),
Annoyed (Have people annoyed you by criticizing your drinking?), Guilty (Have you ever
felt guilty about your drinking?), and Eye-opener (Have you ever had a drink first thing in
the morning to steady your nerves or get rid of a hangover?). The "A" represents
"Annoyed" .
Question 8
Which screening tool is most appropriate for assessing a 4-year-old child for Autism
Spectrum Disorder (ASD)?
A) PHQ-A
B) M-CHAT-R (Modified Checklist for Autism in Toddlers)
