NR548 PMHNP PSYCHIATRIC
ASSESSMENT COMPREHENSIVE
PRACTICE EXAM QUESTIONS AND
ANSWERS
1. During a mental status examination, a PMHNP asks a patient to interpret the proverb
‘Don’t cry over spilled milk.’ The patient responds, ‘It means if you drop your milk, you
shouldn’t cry because you can’t put it back in the bottle.’ This response is indicative of:
A. Tangentiality
B. Abstract reasoning
C. Circumstantiality
D. Concrete thinking
Answer: D
Conceptual Explanation: Concrete thinking is characterized by a literal interpretation of
concepts and an inability to use abstract concepts or metaphors. In psychiatric assessment,
this is often seen in schizophrenia or cognitive impairment.
,2. When assessing a patient for suicide risk, which of the following is considered the strongest
single predictor of a future successful suicide attempt?
A. Family history of suicide
B. Active command hallucinations
C. A history of previous suicide attempts
D. Diagnosis of Major Depressive Disorder
Answer: C
Conceptual Explanation: While many factors contribute to risk, a history of prior suicide
attempts is statistically the strongest predictor of eventual completed suicide.
3. A 45-year-old patient presents with bradycardia, fine tremors, and a ‘metallic taste’ in their
mouth. Which laboratory level should the PMHNP order immediately?
A. Serum Valproate level
B. Serum Lithium level
C. Thyroid Stimulating Hormone (TSH)
D. Blood Urea Nitrogen (BUN)
Answer: B
Conceptual Explanation: These are classic signs of lithium toxicity. Common symptoms
include gastrointestinal distress, fine tremors, metallic taste, and in severe cases, ataxia and
arrhythmias.
, 4. Which cranial nerve is being assessed when the PMHNP asks the patient to shrug their
shoulders against resistance?
A. CN X (Vagus)
B. CN XI (Spinal Accessory)
C. CN XII (Hypoglossal)
D. CN IX (Glossopharyngeal)
Answer: B
Conceptual Explanation: Cranial Nerve XI, the Spinal Accessory nerve, innervates the
trapezius and sternocleidomastoid muscles; shrugging tests its motor function.
5. A patient exhibits rapid, pressured speech and moves quickly from one topic to another,
though the topics remain vaguely connected. The PMHNP documents this as:
A. Flight of ideas
B. Word salad
C. Neologisms
D. Clang associations
Answer: A
Conceptual Explanation: Flight of ideas is a near-continuous flow of accelerated speech
with abrupt changes from one topic to another, usually based on understandable
associations, commonly seen in mania.
ASSESSMENT COMPREHENSIVE
PRACTICE EXAM QUESTIONS AND
ANSWERS
1. During a mental status examination, a PMHNP asks a patient to interpret the proverb
‘Don’t cry over spilled milk.’ The patient responds, ‘It means if you drop your milk, you
shouldn’t cry because you can’t put it back in the bottle.’ This response is indicative of:
A. Tangentiality
B. Abstract reasoning
C. Circumstantiality
D. Concrete thinking
Answer: D
Conceptual Explanation: Concrete thinking is characterized by a literal interpretation of
concepts and an inability to use abstract concepts or metaphors. In psychiatric assessment,
this is often seen in schizophrenia or cognitive impairment.
,2. When assessing a patient for suicide risk, which of the following is considered the strongest
single predictor of a future successful suicide attempt?
A. Family history of suicide
B. Active command hallucinations
C. A history of previous suicide attempts
D. Diagnosis of Major Depressive Disorder
Answer: C
Conceptual Explanation: While many factors contribute to risk, a history of prior suicide
attempts is statistically the strongest predictor of eventual completed suicide.
3. A 45-year-old patient presents with bradycardia, fine tremors, and a ‘metallic taste’ in their
mouth. Which laboratory level should the PMHNP order immediately?
A. Serum Valproate level
B. Serum Lithium level
C. Thyroid Stimulating Hormone (TSH)
D. Blood Urea Nitrogen (BUN)
Answer: B
Conceptual Explanation: These are classic signs of lithium toxicity. Common symptoms
include gastrointestinal distress, fine tremors, metallic taste, and in severe cases, ataxia and
arrhythmias.
, 4. Which cranial nerve is being assessed when the PMHNP asks the patient to shrug their
shoulders against resistance?
A. CN X (Vagus)
B. CN XI (Spinal Accessory)
C. CN XII (Hypoglossal)
D. CN IX (Glossopharyngeal)
Answer: B
Conceptual Explanation: Cranial Nerve XI, the Spinal Accessory nerve, innervates the
trapezius and sternocleidomastoid muscles; shrugging tests its motor function.
5. A patient exhibits rapid, pressured speech and moves quickly from one topic to another,
though the topics remain vaguely connected. The PMHNP documents this as:
A. Flight of ideas
B. Word salad
C. Neologisms
D. Clang associations
Answer: A
Conceptual Explanation: Flight of ideas is a near-continuous flow of accelerated speech
with abrupt changes from one topic to another, usually based on understandable
associations, commonly seen in mania.
