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NR605 WEEK 4 MIDTERM PRACTICE
EXAM
DIAGNOSIS & MANAGEMENT IN PSYCHIATRIC-
MENTAL HEALTH ACROSS THE LIFESPAN I
QUESTIONS 1-100 AND ANSWERS UPDATED 2026/2027 | DETAILED
RATIONALES
INTRODUCTION
NR605: Diagnosis & Management in Psychiatric-Mental Health Across the Lifespan I develops
advanced clinical reasoning skills required to assess, diagnose, and manage patients experiencing
psychiatric and behavioral-health conditions across developmental stages. The Week 4 midterm
material commonly requires the learner to integrate psychiatric interviewing, mental-status
examination findings, diagnostic criteria, differential diagnosis, risk assessment,
psychopharmacology, psychotherapy, and appropriate follow-up planning.
This practice question bank is designed for advanced PMHNP-level preparation. Rather than
emphasizing simple memorization, the questions use clinical scenarios that require interpretation
of symptoms, identification of the most likely diagnosis, selection of appropriate assessment or
treatment, recognition of medication adverse effects, and consideration of age-specific factors.
Each question contains four options with one best answer followed by a detailed rationale.
Students can use the rationales to identify reasoning errors and connect individual symptoms to
diagnostic and management principles.
The material should be studied together with current NR605 course resources, assigned readings,
instructor guidance, and current evidence-based psychiatric references.
CORE DOMAINS TESTED
1. Psychiatric Diagnostic Assessment — Comprehensive psychiatric history, presenting
concerns, biopsychosocial formulation, and differential diagnosis.
2. Mental Status Examination — Appearance, behavior, speech, mood, affect, thought
process, thought content, perception, cognition, insight, and judgment.
3. Psychiatric Interviewing — Therapeutic interviewing, symptom clarification, collateral
information, and culturally responsive assessment.
4. Risk Assessment and Patient Safety — Suicide, self-harm, violence, psychosis-related
risk, and identification of urgent psychiatric conditions.
5. Mood Disorders — Major depressive disorder, persistent depressive disorder, bipolar
disorders, and differentiation of depressive and manic presentations.
,2|Page
6. Anxiety and Trauma-Related Disorders — Generalized anxiety disorder, panic
disorder, social anxiety disorder, PTSD, and related conditions.
7. Obsessive-Compulsive and Related Disorders — Obsessions, compulsions, exposure-
based treatment, and differential diagnosis.
8. Psychotic Disorders — Schizophrenia-spectrum disorders, hallucinations, delusions,
disorganized thinking, and first-episode psychosis.
9. Personality Disorders — Diagnostic patterns, interpersonal functioning, boundaries, and
evidence-based treatment principles.
10. Neurodevelopmental and Childhood Disorders — ADHD, autism-spectrum
presentations, developmental considerations, and pediatric psychiatric assessment.
11. Older-Adult Psychiatry — Delirium, major neurocognitive disorder, depression in later
life, and medication considerations.
12. Psychopharmacology — Antidepressants, antipsychotics, mood stabilizers, anxiolytics,
adverse effects, interactions, and monitoring.
13. Psychotherapy — CBT, DBT, supportive therapy, motivational interviewing, exposure-
based interventions, and other evidence-based approaches.
14. Substance-Related Disorders — Substance-induced psychiatric symptoms, intoxication,
withdrawal, and differential diagnosis.
15. Cultural and Social Factors — Cultural formulation, social determinants of health,
family context, trauma, and culturally appropriate care.
16. Ethical and Legal Psychiatric Practice — Confidentiality, informed consent, capacity,
documentation, patient autonomy, and safety obligations.
QUESTIONS 1-100
Q1:
A 32-year-old patient presents with a 3-month history of depressed mood, loss of interest in
previously enjoyable activities, insomnia, fatigue, feelings of worthlessness, and impaired
concentration. The patient denies manic or hypomanic episodes and reports no substance use.
Which additional finding would most strongly support a diagnosis of major depressive disorder?
A) Symptoms occur exclusively during periods of alcohol intoxication
B) Symptoms cause clinically significant distress or impairment and are not better explained by
another medical or psychiatric condition
C) The patient has experienced occasional sadness following stressful events
D) The patient reports feeling better when spending time with friends
B) Symptoms cause clinically significant distress or impairment and are not better
explained by another medical or psychiatric condition
,3|Page
Rationale: Major depressive disorder requires a clinically significant depressive syndrome that
produces distress or impairment and cannot be better explained by substances, medical
conditions, or another psychiatric disorder. Option A suggests a substance-induced condition.
Option C describes a common emotional response and does not establish a depressive disorder.
Option D does not exclude depression because social interaction can temporarily improve mood
in some patients.
Q2:
A 24-year-old patient reports four days of decreased need for sleep, increased goal-directed
activity, rapid speech, racing thoughts, and unusually elevated energy. The patient has continued
working and has not required hospitalization. Which diagnosis should the PMHNP consider most
strongly?
A) Major depressive disorder
B) Hypomanic episode
C) Generalized anxiety disorder
D) Schizophrenia
B) Hypomanic episode
Rationale: A sustained period of elevated, expansive, or irritable mood accompanied by
increased energy and characteristic manic-spectrum symptoms without marked functional
impairment, hospitalization, or psychosis is consistent with hypomania. Option A does not
account for the elevated-energy syndrome. Option C does not explain the decreased need for
sleep and increased goal-directed activity. Option D requires a psychotic-spectrum presentation
rather than an isolated elevated mood episode.
Q3:
A patient reports sleeping only two hours nightly for the past week but insists that additional
sleep is unnecessary. The patient has become increasingly talkative, has started several
businesses, and has made multiple impulsive purchases. Which finding most strongly suggests
mania rather than ordinary enthusiasm?
A) Increased interest in hobbies
B) Decreased need for sleep accompanied by markedly increased goal-directed activity and
impaired judgment
C) Occasional excitement about future plans
D) Feeling optimistic about career opportunities
, 4|Page
B) Decreased need for sleep accompanied by markedly increased goal-directed activity and
impaired judgment
Rationale: A decreased need for sleep combined with increased activity, pressured speech,
impulsivity, and impaired judgment is characteristic of a manic syndrome. Normal enthusiasm
does not typically produce this degree of behavioral change or impairment. Options A, C, and D
can occur in healthy individuals and are insufficient by themselves to establish mania.
Q4:
A 41-year-old patient presents with anxiety occurring more days than not for eight months. The
patient reports excessive worry about finances, health, family, and work and states that the worry
is difficult to control. Which additional symptom most strongly supports generalized anxiety
disorder?
A) Recurrent unexpected panic attacks only
B) Muscle tension and persistent restlessness
C) A single traumatic event followed by nightmares
D) Repetitive checking rituals performed to neutralize intrusive thoughts
B) Muscle tension and persistent restlessness
Rationale: Generalized anxiety disorder involves excessive, difficult-to-control worry
accompanied by symptoms such as restlessness, fatigue, concentration difficulty, irritability,
muscle tension, or sleep disturbance. Option A points toward panic disorder. Option C suggests
a trauma-related disorder. Option D is more characteristic of obsessive-compulsive disorder.
Q5:
A 29-year-old patient suddenly develops intense fear, chest tightness, trembling, sweating,
dizziness, and a feeling of impending death. The symptoms peak within several minutes and
resolve spontaneously. Cardiac evaluation is normal. Which diagnosis should be considered?
A) Panic attack
B) Persistent depressive disorder
C) Delusional disorder
D) Somatic symptom disorder
A) Panic attack
NR605 WEEK 4 MIDTERM PRACTICE
EXAM
DIAGNOSIS & MANAGEMENT IN PSYCHIATRIC-
MENTAL HEALTH ACROSS THE LIFESPAN I
QUESTIONS 1-100 AND ANSWERS UPDATED 2026/2027 | DETAILED
RATIONALES
INTRODUCTION
NR605: Diagnosis & Management in Psychiatric-Mental Health Across the Lifespan I develops
advanced clinical reasoning skills required to assess, diagnose, and manage patients experiencing
psychiatric and behavioral-health conditions across developmental stages. The Week 4 midterm
material commonly requires the learner to integrate psychiatric interviewing, mental-status
examination findings, diagnostic criteria, differential diagnosis, risk assessment,
psychopharmacology, psychotherapy, and appropriate follow-up planning.
This practice question bank is designed for advanced PMHNP-level preparation. Rather than
emphasizing simple memorization, the questions use clinical scenarios that require interpretation
of symptoms, identification of the most likely diagnosis, selection of appropriate assessment or
treatment, recognition of medication adverse effects, and consideration of age-specific factors.
Each question contains four options with one best answer followed by a detailed rationale.
Students can use the rationales to identify reasoning errors and connect individual symptoms to
diagnostic and management principles.
The material should be studied together with current NR605 course resources, assigned readings,
instructor guidance, and current evidence-based psychiatric references.
CORE DOMAINS TESTED
1. Psychiatric Diagnostic Assessment — Comprehensive psychiatric history, presenting
concerns, biopsychosocial formulation, and differential diagnosis.
2. Mental Status Examination — Appearance, behavior, speech, mood, affect, thought
process, thought content, perception, cognition, insight, and judgment.
3. Psychiatric Interviewing — Therapeutic interviewing, symptom clarification, collateral
information, and culturally responsive assessment.
4. Risk Assessment and Patient Safety — Suicide, self-harm, violence, psychosis-related
risk, and identification of urgent psychiatric conditions.
5. Mood Disorders — Major depressive disorder, persistent depressive disorder, bipolar
disorders, and differentiation of depressive and manic presentations.
,2|Page
6. Anxiety and Trauma-Related Disorders — Generalized anxiety disorder, panic
disorder, social anxiety disorder, PTSD, and related conditions.
7. Obsessive-Compulsive and Related Disorders — Obsessions, compulsions, exposure-
based treatment, and differential diagnosis.
8. Psychotic Disorders — Schizophrenia-spectrum disorders, hallucinations, delusions,
disorganized thinking, and first-episode psychosis.
9. Personality Disorders — Diagnostic patterns, interpersonal functioning, boundaries, and
evidence-based treatment principles.
10. Neurodevelopmental and Childhood Disorders — ADHD, autism-spectrum
presentations, developmental considerations, and pediatric psychiatric assessment.
11. Older-Adult Psychiatry — Delirium, major neurocognitive disorder, depression in later
life, and medication considerations.
12. Psychopharmacology — Antidepressants, antipsychotics, mood stabilizers, anxiolytics,
adverse effects, interactions, and monitoring.
13. Psychotherapy — CBT, DBT, supportive therapy, motivational interviewing, exposure-
based interventions, and other evidence-based approaches.
14. Substance-Related Disorders — Substance-induced psychiatric symptoms, intoxication,
withdrawal, and differential diagnosis.
15. Cultural and Social Factors — Cultural formulation, social determinants of health,
family context, trauma, and culturally appropriate care.
16. Ethical and Legal Psychiatric Practice — Confidentiality, informed consent, capacity,
documentation, patient autonomy, and safety obligations.
QUESTIONS 1-100
Q1:
A 32-year-old patient presents with a 3-month history of depressed mood, loss of interest in
previously enjoyable activities, insomnia, fatigue, feelings of worthlessness, and impaired
concentration. The patient denies manic or hypomanic episodes and reports no substance use.
Which additional finding would most strongly support a diagnosis of major depressive disorder?
A) Symptoms occur exclusively during periods of alcohol intoxication
B) Symptoms cause clinically significant distress or impairment and are not better explained by
another medical or psychiatric condition
C) The patient has experienced occasional sadness following stressful events
D) The patient reports feeling better when spending time with friends
B) Symptoms cause clinically significant distress or impairment and are not better
explained by another medical or psychiatric condition
,3|Page
Rationale: Major depressive disorder requires a clinically significant depressive syndrome that
produces distress or impairment and cannot be better explained by substances, medical
conditions, or another psychiatric disorder. Option A suggests a substance-induced condition.
Option C describes a common emotional response and does not establish a depressive disorder.
Option D does not exclude depression because social interaction can temporarily improve mood
in some patients.
Q2:
A 24-year-old patient reports four days of decreased need for sleep, increased goal-directed
activity, rapid speech, racing thoughts, and unusually elevated energy. The patient has continued
working and has not required hospitalization. Which diagnosis should the PMHNP consider most
strongly?
A) Major depressive disorder
B) Hypomanic episode
C) Generalized anxiety disorder
D) Schizophrenia
B) Hypomanic episode
Rationale: A sustained period of elevated, expansive, or irritable mood accompanied by
increased energy and characteristic manic-spectrum symptoms without marked functional
impairment, hospitalization, or psychosis is consistent with hypomania. Option A does not
account for the elevated-energy syndrome. Option C does not explain the decreased need for
sleep and increased goal-directed activity. Option D requires a psychotic-spectrum presentation
rather than an isolated elevated mood episode.
Q3:
A patient reports sleeping only two hours nightly for the past week but insists that additional
sleep is unnecessary. The patient has become increasingly talkative, has started several
businesses, and has made multiple impulsive purchases. Which finding most strongly suggests
mania rather than ordinary enthusiasm?
A) Increased interest in hobbies
B) Decreased need for sleep accompanied by markedly increased goal-directed activity and
impaired judgment
C) Occasional excitement about future plans
D) Feeling optimistic about career opportunities
, 4|Page
B) Decreased need for sleep accompanied by markedly increased goal-directed activity and
impaired judgment
Rationale: A decreased need for sleep combined with increased activity, pressured speech,
impulsivity, and impaired judgment is characteristic of a manic syndrome. Normal enthusiasm
does not typically produce this degree of behavioral change or impairment. Options A, C, and D
can occur in healthy individuals and are insufficient by themselves to establish mania.
Q4:
A 41-year-old patient presents with anxiety occurring more days than not for eight months. The
patient reports excessive worry about finances, health, family, and work and states that the worry
is difficult to control. Which additional symptom most strongly supports generalized anxiety
disorder?
A) Recurrent unexpected panic attacks only
B) Muscle tension and persistent restlessness
C) A single traumatic event followed by nightmares
D) Repetitive checking rituals performed to neutralize intrusive thoughts
B) Muscle tension and persistent restlessness
Rationale: Generalized anxiety disorder involves excessive, difficult-to-control worry
accompanied by symptoms such as restlessness, fatigue, concentration difficulty, irritability,
muscle tension, or sleep disturbance. Option A points toward panic disorder. Option C suggests
a trauma-related disorder. Option D is more characteristic of obsessive-compulsive disorder.
Q5:
A 29-year-old patient suddenly develops intense fear, chest tightness, trembling, sweating,
dizziness, and a feeling of impending death. The symptoms peak within several minutes and
resolve spontaneously. Cardiac evaluation is normal. Which diagnosis should be considered?
A) Panic attack
B) Persistent depressive disorder
C) Delusional disorder
D) Somatic symptom disorder
A) Panic attack
