NR 547: DIFFERENTIAL DIAGNOSIS IN
PSYCHIATRIC-MENTAL HEALTH MIDTERM
EXAM 2026
Section 1: Psychiatric Assessment, Mental Status Exam (MSE), & Rating Scales
Q1. Which rating scale is specifically validated to measure the severity of
depression and monitor treatment response over time?
A. GAD-7
B. PHQ-9
C. MDQ
D. MoCA
Answer: B. PHQ-9
Rationale: The Patient Health Questionnaire-9 (PHQ-9) is specific to depression
severity and treatment monitoring. The MDQ screens for bipolar disorder, the
GAD-7 for anxiety, and the MoCA for cognition.
Q2. A patient states, "I know I have brain cancer even though the MRI was
negative." The PMHNP documents this as an abnormality in which MSE
component?
A. Thought Process
B. Insight
C. Judgment
D. Sensorium
Answer: B. Insight
,Rationale: Insight refers to the patient's awareness of their own illness or
pathological condition. Poor insight is common in psychotic and somatic symptom
disorders.
Q3. When assessing a patient's thought process, the PMHNP notes the patient
uses excessive, unnecessary details but eventually reaches the goal. This is
documented as:
A. Tangentiality
B. Flight of ideas
C. Circumstantiality
D. Word salad
Answer: C. Circumstantiality
Rationale: Circumstantiality involves including irrelevant details but eventually
answering the question. Tangentiality wanders off-topic and never returns to the
original point.
Q4. Which screening tool is used specifically to identify symptoms of bipolar
mania/hypomania?
A. HAM-D
B. Columbia Suicide Severity Rating Scale (C-SSRS)
C. Mood Disorder Questionnaire (MDQ)
D. BPRS
Answer: C. Mood Disorder Questionnaire (MDQ)
Rationale: The MDQ is a widely used screening tool for Bipolar Disorder. The
HAM-D assesses depression severity, and the C-SSRS assesses suicide risk.
Q5. In the MSE, "affect" differs from "mood" because affect is:
A. The patient's subjective emotional state.
B. The objective, observed emotional expression.
,C. Always congruent with the thought content.
D. A long-term psychological baseline.
Answer: B. The objective, observed emotional expression.
Rationale: Mood is the patient's subjective, sustained internal emotional state
(like climate). Affect is the objective, outward expression of emotion observed by
the clinician (like weather).
Q6. A patient with advanced dementia is being assessed. Which tool is most
appropriate to evaluate cognitive decline?
A. MMSE or MoCA
B. PHQ-9
C. C-SSRS
D. HAM-A
Answer: A. MMSE or MoCA
Rationale: The Mini-Mental State Examination (MMSE) and Montreal Cognitive
Assessment (MoCA) are standard tools to screen for cognitive impairment and
dementia.
Q7. During a psychiatric interview, asking the patient, "What would you do if you
found a stamped, addressed envelope on the sidewalk?" assesses:
A. Insight
B. Abstract thinking
C. Judgment
D. Memory
Answer: C. Judgment
Rationale: Hypothetical scenarios are classic assessments for judgment, which
evaluates the patient's ability to make sound, reasoned decisions.
, Q8. The DSM-5-TR Level 1 Cross-Cutting Symptom Measure is designed to:
A. Provide a definitive primary diagnosis.
B. Assess domains of psychopathology that cut across multiple diagnostic
boundaries.
C. Replace the need for a structured clinical interview.
D. Determine the patient's legal competency.
Answer: B. Assess domains of psychopathology that cut across multiple
diagnostic boundaries.
Rationale: Cross-cutting measures help clinicians identify additional symptoms
not captured by the primary diagnosis, aiding comprehensive differential
diagnosis.
Q9. A patient scores 24/30 on the MoCA. The PMHNP notes this suggests:
A. Normal cognition
B. Mild Cognitive Impairment (MCI)
C. Severe Delirium
D. Advanced Alzheimer's
Answer: B. Mild Cognitive Impairment (MCI)
Rationale: A MoCA score of 26 or above is generally considered normal. Scores
between 18–25 often suggest Mild Cognitive Impairment (MCI).
Q10. Which of the following is the most critical component of assessing suicide
risk?
A. Family history of depression
B. Asking about specific intent, plan, and access to lethal means
C. Evaluating the patient's sleep patterns
D. Assessing the patient's appetite
PSYCHIATRIC-MENTAL HEALTH MIDTERM
EXAM 2026
Section 1: Psychiatric Assessment, Mental Status Exam (MSE), & Rating Scales
Q1. Which rating scale is specifically validated to measure the severity of
depression and monitor treatment response over time?
A. GAD-7
B. PHQ-9
C. MDQ
D. MoCA
Answer: B. PHQ-9
Rationale: The Patient Health Questionnaire-9 (PHQ-9) is specific to depression
severity and treatment monitoring. The MDQ screens for bipolar disorder, the
GAD-7 for anxiety, and the MoCA for cognition.
Q2. A patient states, "I know I have brain cancer even though the MRI was
negative." The PMHNP documents this as an abnormality in which MSE
component?
A. Thought Process
B. Insight
C. Judgment
D. Sensorium
Answer: B. Insight
,Rationale: Insight refers to the patient's awareness of their own illness or
pathological condition. Poor insight is common in psychotic and somatic symptom
disorders.
Q3. When assessing a patient's thought process, the PMHNP notes the patient
uses excessive, unnecessary details but eventually reaches the goal. This is
documented as:
A. Tangentiality
B. Flight of ideas
C. Circumstantiality
D. Word salad
Answer: C. Circumstantiality
Rationale: Circumstantiality involves including irrelevant details but eventually
answering the question. Tangentiality wanders off-topic and never returns to the
original point.
Q4. Which screening tool is used specifically to identify symptoms of bipolar
mania/hypomania?
A. HAM-D
B. Columbia Suicide Severity Rating Scale (C-SSRS)
C. Mood Disorder Questionnaire (MDQ)
D. BPRS
Answer: C. Mood Disorder Questionnaire (MDQ)
Rationale: The MDQ is a widely used screening tool for Bipolar Disorder. The
HAM-D assesses depression severity, and the C-SSRS assesses suicide risk.
Q5. In the MSE, "affect" differs from "mood" because affect is:
A. The patient's subjective emotional state.
B. The objective, observed emotional expression.
,C. Always congruent with the thought content.
D. A long-term psychological baseline.
Answer: B. The objective, observed emotional expression.
Rationale: Mood is the patient's subjective, sustained internal emotional state
(like climate). Affect is the objective, outward expression of emotion observed by
the clinician (like weather).
Q6. A patient with advanced dementia is being assessed. Which tool is most
appropriate to evaluate cognitive decline?
A. MMSE or MoCA
B. PHQ-9
C. C-SSRS
D. HAM-A
Answer: A. MMSE or MoCA
Rationale: The Mini-Mental State Examination (MMSE) and Montreal Cognitive
Assessment (MoCA) are standard tools to screen for cognitive impairment and
dementia.
Q7. During a psychiatric interview, asking the patient, "What would you do if you
found a stamped, addressed envelope on the sidewalk?" assesses:
A. Insight
B. Abstract thinking
C. Judgment
D. Memory
Answer: C. Judgment
Rationale: Hypothetical scenarios are classic assessments for judgment, which
evaluates the patient's ability to make sound, reasoned decisions.
, Q8. The DSM-5-TR Level 1 Cross-Cutting Symptom Measure is designed to:
A. Provide a definitive primary diagnosis.
B. Assess domains of psychopathology that cut across multiple diagnostic
boundaries.
C. Replace the need for a structured clinical interview.
D. Determine the patient's legal competency.
Answer: B. Assess domains of psychopathology that cut across multiple
diagnostic boundaries.
Rationale: Cross-cutting measures help clinicians identify additional symptoms
not captured by the primary diagnosis, aiding comprehensive differential
diagnosis.
Q9. A patient scores 24/30 on the MoCA. The PMHNP notes this suggests:
A. Normal cognition
B. Mild Cognitive Impairment (MCI)
C. Severe Delirium
D. Advanced Alzheimer's
Answer: B. Mild Cognitive Impairment (MCI)
Rationale: A MoCA score of 26 or above is generally considered normal. Scores
between 18–25 often suggest Mild Cognitive Impairment (MCI).
Q10. Which of the following is the most critical component of assessing suicide
risk?
A. Family history of depression
B. Asking about specific intent, plan, and access to lethal means
C. Evaluating the patient's sleep patterns
D. Assessing the patient's appetite
