NR547 Midterm Exam | Questions & Correct Answers
| Latest Update | Graded A+
Section 1: Psychiatric Assessment & Diagnostic Frameworks (Q1–
Q30)
1. A PMHNP is conducting an initial psychiatric evaluation. Which component is
essential to include in the history of present illness?
A) The client's birth weight and delivery complications
B) The onset, duration, severity, and functional impact of current symptoms
C) The client's complete vaccination record
D) The client's financial history for the past 5 years
Answer: B) The onset, duration, severity, and functional impact of current
symptoms
Rationale: The history of present illness focuses on characterizing the current
psychiatric complaint: when symptoms began, how long they last, their severity, triggers,
and how they affect daily functioning. The other options are irrelevant or belong to
other sections of the history.
2. A PMHNP is differentiating between a primary psychiatric disorder and a
medical condition causing psychiatric symptoms. Which laboratory test should be
ordered first to rule out common medical etiologies of depression?
A) TSH, CBC, vitamin B12, and basic metabolic panel
B) Only a TSH level
C) MRI of the brain
D) Urine drug screen alone
Answer: A) TSH, CBC, vitamin B12, and basic metabolic panel
Rationale: A comprehensive medical workup for depression includes TSH (thyroid
dysfunction), CBC (anemia), B12 (deficiency), and BMP (electrolyte/renal function).
Ordering only TSH or a urine drug screen would miss other common contributors.
,3. A 28-year-old client presents with new-onset anxiety and palpitations. The
PMHNP notes the client has been taking an over-the-counter supplement. Which
supplement is most likely to cause anxiety-like symptoms?
A) Vitamin C
B) Caffeine-containing weight loss supplements
C) Calcium
D) Iron
Answer: B) Caffeine-containing weight loss supplements
Rationale: Caffeine and stimulant-containing supplements commonly produce anxiety,
palpitations, and tremors. Vitamins and minerals do not typically cause these symptoms.
4. A PMHNP is using the DSM-5-TR to formulate a diagnosis. Which statement
about the DSM-5-TR is correct?
A) It provides definitive biological markers for each disorder
B) It provides guidance for identifying psychiatric diagnoses based on symptom criteria
C) It replaces the need for clinical judgment
D) It only covers adult disorders
Answer: B) It provides guidance for identifying psychiatric diagnoses based on
symptom criteria
Rationale: The DSM-5-TR provides diagnostic criteria based on symptom clusters,
duration, and functional impairment. It does not include biological markers, does not
replace clinical judgment, and covers disorders across the lifespan.
5. A client presents with symptoms that could be explained by either a psychiatric
disorder or a medical condition. What is the most appropriate approach for the
PMHNP?
,A) Diagnose the psychiatric disorder and begin treatment
B) Diagnose the medical condition and refer back to primary care
C) Rule out medical conditions before making a psychiatric diagnosis
D) Treat both conditions simultaneously without further evaluation
Answer: C) Rule out medical conditions before making a psychiatric diagnosis
Rationale: Medical conditions can mimic psychiatric disorders, and failing to rule them
out can lead to inappropriate treatment. The standard approach is to rule out medical
etiologies first.
6. A PMHNP is obtaining a sexual history from a new client. Which opening
statement is most appropriate?
A) "You don't need to answer this, but are you sexually active?"
B) "I ask all my clients about sexual health because it can affect mental health. May I ask
you some questions?"
C) "Why haven't you told me about your sexual history yet?"
D) "We can skip this part if you're uncomfortable."
Answer: B) "I ask all my clients about sexual health because it can affect mental
health. May I ask you some questions?"
Rationale: Normalizing the sexual history as a routine part of care reduces stigma and
increases client comfort. The other options are leading, judgmental, or dismissive.
7. A PMHNP is assessing a client with suspected malingering. Which feature
distinguishes malingering from factitious disorder?
A) Malingering involves intentional symptom production for external gain
B) Malingering involves unintentional symptom production
C) Factitious disorder involves external incentives
D) Both conditions involve unconscious symptom production
Answer: A) Malingering involves intentional symptom production for external gain
, Rationale: Malingering involves intentional production of symptoms motivated by
external incentives (financial gain, avoiding work). Factitious disorder involves intentional
deception without obvious external rewards. Both involve intentional symptom
production.
8. A 52-year-old client presents to the ED after a car accident. The PMHNP is
consulted because the client describes persistent sadness and thoughts of "not
being around." The client reports a prior suicide attempt at age 16. Which action
should the PMHNP take next?
A) No action is needed since the prior attempt was decades ago
B) Provide a brief suicide safety assessment
C) Alert the primary care physician only
D) Discharge the client with a referral for outpatient therapy
Answer: B) Provide a brief suicide safety assessment
Rationale: Any current suicidal ideation warrants a safety assessment. A prior attempt,
regardless of how long ago, is a significant risk factor. Discharge without assessment
would be unsafe.
9. Which screening tool is designed specifically to assess suicide risk in a brief,
structured format?
A) PHQ-9
B) GAD-7
C) ASQ (Ask Suicide-Screening Questions)
D) MMSE
Answer: C) ASQ (Ask Suicide-Screening Questions)
Rationale: The ASQ is a brief, validated suicide risk screening tool. PHQ-9 assesses
depression, GAD-7 assesses anxiety, and MMSE assesses cognition.
| Latest Update | Graded A+
Section 1: Psychiatric Assessment & Diagnostic Frameworks (Q1–
Q30)
1. A PMHNP is conducting an initial psychiatric evaluation. Which component is
essential to include in the history of present illness?
A) The client's birth weight and delivery complications
B) The onset, duration, severity, and functional impact of current symptoms
C) The client's complete vaccination record
D) The client's financial history for the past 5 years
Answer: B) The onset, duration, severity, and functional impact of current
symptoms
Rationale: The history of present illness focuses on characterizing the current
psychiatric complaint: when symptoms began, how long they last, their severity, triggers,
and how they affect daily functioning. The other options are irrelevant or belong to
other sections of the history.
2. A PMHNP is differentiating between a primary psychiatric disorder and a
medical condition causing psychiatric symptoms. Which laboratory test should be
ordered first to rule out common medical etiologies of depression?
A) TSH, CBC, vitamin B12, and basic metabolic panel
B) Only a TSH level
C) MRI of the brain
D) Urine drug screen alone
Answer: A) TSH, CBC, vitamin B12, and basic metabolic panel
Rationale: A comprehensive medical workup for depression includes TSH (thyroid
dysfunction), CBC (anemia), B12 (deficiency), and BMP (electrolyte/renal function).
Ordering only TSH or a urine drug screen would miss other common contributors.
,3. A 28-year-old client presents with new-onset anxiety and palpitations. The
PMHNP notes the client has been taking an over-the-counter supplement. Which
supplement is most likely to cause anxiety-like symptoms?
A) Vitamin C
B) Caffeine-containing weight loss supplements
C) Calcium
D) Iron
Answer: B) Caffeine-containing weight loss supplements
Rationale: Caffeine and stimulant-containing supplements commonly produce anxiety,
palpitations, and tremors. Vitamins and minerals do not typically cause these symptoms.
4. A PMHNP is using the DSM-5-TR to formulate a diagnosis. Which statement
about the DSM-5-TR is correct?
A) It provides definitive biological markers for each disorder
B) It provides guidance for identifying psychiatric diagnoses based on symptom criteria
C) It replaces the need for clinical judgment
D) It only covers adult disorders
Answer: B) It provides guidance for identifying psychiatric diagnoses based on
symptom criteria
Rationale: The DSM-5-TR provides diagnostic criteria based on symptom clusters,
duration, and functional impairment. It does not include biological markers, does not
replace clinical judgment, and covers disorders across the lifespan.
5. A client presents with symptoms that could be explained by either a psychiatric
disorder or a medical condition. What is the most appropriate approach for the
PMHNP?
,A) Diagnose the psychiatric disorder and begin treatment
B) Diagnose the medical condition and refer back to primary care
C) Rule out medical conditions before making a psychiatric diagnosis
D) Treat both conditions simultaneously without further evaluation
Answer: C) Rule out medical conditions before making a psychiatric diagnosis
Rationale: Medical conditions can mimic psychiatric disorders, and failing to rule them
out can lead to inappropriate treatment. The standard approach is to rule out medical
etiologies first.
6. A PMHNP is obtaining a sexual history from a new client. Which opening
statement is most appropriate?
A) "You don't need to answer this, but are you sexually active?"
B) "I ask all my clients about sexual health because it can affect mental health. May I ask
you some questions?"
C) "Why haven't you told me about your sexual history yet?"
D) "We can skip this part if you're uncomfortable."
Answer: B) "I ask all my clients about sexual health because it can affect mental
health. May I ask you some questions?"
Rationale: Normalizing the sexual history as a routine part of care reduces stigma and
increases client comfort. The other options are leading, judgmental, or dismissive.
7. A PMHNP is assessing a client with suspected malingering. Which feature
distinguishes malingering from factitious disorder?
A) Malingering involves intentional symptom production for external gain
B) Malingering involves unintentional symptom production
C) Factitious disorder involves external incentives
D) Both conditions involve unconscious symptom production
Answer: A) Malingering involves intentional symptom production for external gain
, Rationale: Malingering involves intentional production of symptoms motivated by
external incentives (financial gain, avoiding work). Factitious disorder involves intentional
deception without obvious external rewards. Both involve intentional symptom
production.
8. A 52-year-old client presents to the ED after a car accident. The PMHNP is
consulted because the client describes persistent sadness and thoughts of "not
being around." The client reports a prior suicide attempt at age 16. Which action
should the PMHNP take next?
A) No action is needed since the prior attempt was decades ago
B) Provide a brief suicide safety assessment
C) Alert the primary care physician only
D) Discharge the client with a referral for outpatient therapy
Answer: B) Provide a brief suicide safety assessment
Rationale: Any current suicidal ideation warrants a safety assessment. A prior attempt,
regardless of how long ago, is a significant risk factor. Discharge without assessment
would be unsafe.
9. Which screening tool is designed specifically to assess suicide risk in a brief,
structured format?
A) PHQ-9
B) GAD-7
C) ASQ (Ask Suicide-Screening Questions)
D) MMSE
Answer: C) ASQ (Ask Suicide-Screening Questions)
Rationale: The ASQ is a brief, validated suicide risk screening tool. PHQ-9 assesses
depression, GAD-7 assesses anxiety, and MMSE assesses cognition.
