NRNP 6635 Psychopathology & Diagnostic Reasoning
Final Exam 2026/2027 - ANCC Board Certified
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TOTAL 85 ITEMS | 60 MC + 15 SATA + 10 Diagnostic Formulation + 8
Emerging Research + 7 Cultural/Special Populations
DOMAIN A Complex Diagnostic Formulation (30 Q)
1. A 34-year-old teacher reports 6-week sadness, fatigue, 4-kg weight gain, no SI.
TSH 6.5 mIU/L (high), free T4 low, morning cortisol 4 µg/dL. Which diagnoses are
PRIMARY?
A. Major depressive disorder
B. Hypothyroidism
C. Secondary adrenal insufficiency
D. Persistent depressive disorder
Answer: B, C – Medical causes explain mood symptoms; MDD cannot be primary until
medical treated & full criteria persist.
2. (SATA) Differentiating grief from MDD 2026 includes: (Select ALL)
A. Guilt unrelated to deceased
B. Anhedonia > 2 weeks
C. Preoccupation with worthlessness
D. Waves of sadness with preserved self-esteem
E. Hallucinations of deceased briefly
Answer: A, B, C – E is non-pathological in grief; D supports grief.
[3-30 continue: substance-induced vs primary depression, antidepressant-induced
mania, benzodiazepine withdrawal vs GAD, steroid-induced mood vs bipolar,
, opioid-induced hyperalgesia vs chronic pain disorder, functional neurological disorder vs
epilepsy, ICU delirium vs psychosis…]
DOMAIN B Advanced Psychopathology Clusters (25 Q)
Psychotic Disorders (7)
31. A 19-year-old hears voices commenting on actions, no medical issues, negative
toxicology, symptoms 5 months. MOST likely primary diagnosis?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
D. Delusional disorder
Answer: B – Symptoms 1-6 mo = schizophreniform; > 6 mo required for schizophrenia.
32. (SATA) Features favoring primary psychotic disorder over
methamphetamine-induced psychosis: (Select ALL)
A. Symptoms persist > 1 month after last use
B. First psychotic episode preceded heavy use by 2 weeks
C. Hallucinations present without mood symptoms
D. Family history of schizophrenia
E. Immediate onset during intoxication
Answer: A, C, D – Persistence & context suggest primary; B/E typical of
substance-induced.
Bipolar & Related (6)
33. A 32-year-old has 4-day elevated mood, ↑ energy, ↓ sleep, spends savings, no
psychosis. Symptoms resolve 2 weeks after starting SSRI for depression. MOST
accurate?
A. Bipolar I disorder
B. Bipolar II disorder
C. Antidepressant-induced hypomania
D. Cyclothymic disorder
Final Exam 2026/2027 - ANCC Board Certified
================================================================
TOTAL 85 ITEMS | 60 MC + 15 SATA + 10 Diagnostic Formulation + 8
Emerging Research + 7 Cultural/Special Populations
DOMAIN A Complex Diagnostic Formulation (30 Q)
1. A 34-year-old teacher reports 6-week sadness, fatigue, 4-kg weight gain, no SI.
TSH 6.5 mIU/L (high), free T4 low, morning cortisol 4 µg/dL. Which diagnoses are
PRIMARY?
A. Major depressive disorder
B. Hypothyroidism
C. Secondary adrenal insufficiency
D. Persistent depressive disorder
Answer: B, C – Medical causes explain mood symptoms; MDD cannot be primary until
medical treated & full criteria persist.
2. (SATA) Differentiating grief from MDD 2026 includes: (Select ALL)
A. Guilt unrelated to deceased
B. Anhedonia > 2 weeks
C. Preoccupation with worthlessness
D. Waves of sadness with preserved self-esteem
E. Hallucinations of deceased briefly
Answer: A, B, C – E is non-pathological in grief; D supports grief.
[3-30 continue: substance-induced vs primary depression, antidepressant-induced
mania, benzodiazepine withdrawal vs GAD, steroid-induced mood vs bipolar,
, opioid-induced hyperalgesia vs chronic pain disorder, functional neurological disorder vs
epilepsy, ICU delirium vs psychosis…]
DOMAIN B Advanced Psychopathology Clusters (25 Q)
Psychotic Disorders (7)
31. A 19-year-old hears voices commenting on actions, no medical issues, negative
toxicology, symptoms 5 months. MOST likely primary diagnosis?
A. Brief psychotic disorder
B. Schizophreniform disorder
C. Schizophrenia
D. Delusional disorder
Answer: B – Symptoms 1-6 mo = schizophreniform; > 6 mo required for schizophrenia.
32. (SATA) Features favoring primary psychotic disorder over
methamphetamine-induced psychosis: (Select ALL)
A. Symptoms persist > 1 month after last use
B. First psychotic episode preceded heavy use by 2 weeks
C. Hallucinations present without mood symptoms
D. Family history of schizophrenia
E. Immediate onset during intoxication
Answer: A, C, D – Persistence & context suggest primary; B/E typical of
substance-induced.
Bipolar & Related (6)
33. A 32-year-old has 4-day elevated mood, ↑ energy, ↓ sleep, spends savings, no
psychosis. Symptoms resolve 2 weeks after starting SSRI for depression. MOST
accurate?
A. Bipolar I disorder
B. Bipolar II disorder
C. Antidepressant-induced hypomania
D. Cyclothymic disorder
