NR547/ NR 547 PMHNP MIDTERM & FINAL
EXAM 150 QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
Question 1: A 45-year-old patient presents with anhedonia, psychomotor
retardation, and significant weight loss. Which neuroanatomical structure is
primarily implicated in the regulation of appetite and psychomotor activity in
this presentation?
A. Amygdala
B. Hippocampus
C. Basal Ganglia
D. Hypothalamus
Rationale: The hypothalamus is the primary regulator of homeostasis,
including appetite, sleep, and psychomotor activity. The basal ganglia are
more involved in movement disorders, while the amygdala and hippocampus
are involved in emotion and memory.
Question 2: A PMHNP is reviewing the role of the hypothalamic-pituitary-
adrenal (HPA) axis in mood disorders. Which finding is most consistent with
chronic major depressive disorder?
A. Decreased cortisol secretion
B. Increased dexamethasone suppression test (DST) nonsuppression
C. Enlarged hippocampal volume
D. Hypercortisolemia with feedback resistance
,Rationale: Chronic MDD often leads to HPA axis dysregulation, resulting in
elevated cortisol levels (hypercortisolemia) and a failure to suppress cortisol
after dexamethasone administration (DST nonsuppression).
Question 3: A 78-year-old man leans in with the right side of his head,
frequently asks for things to be repeated, and has become increasingly
isolated and irritable because he believes people are yelling at him. What
should the PMHNP do FIRST?
A. Order a CT scan of the head
B. Separate the patient from his daughter and interview him alone
C. Examine the patient's ear canals
D. Provide anticipatory guidance regarding aging parents
Rationale: The presentation is classic for hearing loss. Irritability and social
isolation are common consequences of untreated hearing impairment. Ruling
out hearing loss is the least invasive and most critical first step before
considering a primary psychiatric diagnosis.
Question 4: Which description best characterizes Cluster A personality
disorders?
A. Characterized by dramatic, emotional, or erratic behavior
B. Characterized by anxious or fearful behavior
C. Characterized by odd, eccentric thinking or behavior
D. Characterized by a lack of remorse or empathy
Rationale: The DSM-5 organizes personality disorders into three clusters.
Cluster A includes paranoid, schizoid, and schizotypal personality disorders,
which are all marked by odd and eccentric behaviors and thinking patterns.
Question 5: A 35-year-old man with bipolar disorder mentions that he felt a
lump on his left testicle a few months ago but "didn't want to be a bother." He
is now seeking care for depressive symptoms. What is the most appropriate
action for the PMHNP?
,A. Reassure him that testicular lumps are often benign
B. Document the history and continue to focus on the mood disorder
C. Prescribe an antidepressant to stabilize his mood first
D. Perform a physical examination or refer for one immediately
Rationale: A lump in the testicle is a potential sign of testicular cancer. The
PMHNP must ensure a medical evaluation is prioritized. A psychiatric
diagnosis should never be made without ruling out underlying medical
conditions that could present with psychiatric symptoms.
Question 6: A client was diagnosed with major neurocognitive disorder due to
Alzheimer's disease. What pharmacologic therapy would be anticipated?
A. Carbidopa/levodopa
B. Donepezil
C. Memantine
D. Rivastigmine
Rationale: Memantine is an NMDA receptor antagonist used for moderate to
severe Alzheimer's disease. While donepezil and rivastigmine (cholinesterase
inhibitors) are also used, they are typically first-line for mild to moderate
stages. The question asks for an anticipated therapy for a general Alzheimer's
diagnosis.
Question 7: An 89-year-old presents with symptoms of dementia. Which
diagnostic test should be performed initially to rule out treatable causes of
symptoms?
A. Brain MRI
B. Cobalamin (Vitamin B12) level
C. Lumbar puncture
D. EEG
Rationale: Before diagnosing a permanent neurocognitive disorder, it is
essential to rule out reversible causes of cognitive impairment. Vitamin B12
, deficiency is a common, treatable cause, and a serum B12 level is a standard
initial screening test in the elderly.
Question 8: A mother is unable to acknowledge that her teenage son's mental
illness is perpetuated by his polysubstance use disorder and insists that his
father's genes are to blame. Which defense mechanism is being employed?
A. Regression
B. Dissociation
C. Reaction formation
D. Denial
Rationale: Denial is the refusal to accept reality or facts, blocking external
events from awareness. The mother cannot acknowledge the role of substance
use despite clear evidence.
Question 9: A client presents with ataxia, short-term memory loss, and
nystagmus. The client has a history of prolonged, heavy alcohol use. What is
the most likely diagnosis?
A. Korsakoff syndrome
B. Wernicke encephalopathy
C. Alcohol withdrawal delirium
D. Hepatic encephalopathy
Rationale: The classic triad of nystagmus, ataxia, and confusion (often with
short-term memory loss) in a patient with alcohol use disorder is Wernicke
encephalopathy, caused by thiamine (vitamin B1) deficiency.
Question 10: Which of the following best describes the pathophysiology of the
"kindling" phenomenon in bipolar disorder?
A. The process by which antipsychotics induce dopamine supersensitivity
B. The gradual increase in serotonin transporter density leading to mania
C. The neurotoxic effect of lithium on the prefrontal cortex
EXAM 150 QUESTIONS AND CORRECT
ANSWERS WITH RATIONALES
Question 1: A 45-year-old patient presents with anhedonia, psychomotor
retardation, and significant weight loss. Which neuroanatomical structure is
primarily implicated in the regulation of appetite and psychomotor activity in
this presentation?
A. Amygdala
B. Hippocampus
C. Basal Ganglia
D. Hypothalamus
Rationale: The hypothalamus is the primary regulator of homeostasis,
including appetite, sleep, and psychomotor activity. The basal ganglia are
more involved in movement disorders, while the amygdala and hippocampus
are involved in emotion and memory.
Question 2: A PMHNP is reviewing the role of the hypothalamic-pituitary-
adrenal (HPA) axis in mood disorders. Which finding is most consistent with
chronic major depressive disorder?
A. Decreased cortisol secretion
B. Increased dexamethasone suppression test (DST) nonsuppression
C. Enlarged hippocampal volume
D. Hypercortisolemia with feedback resistance
,Rationale: Chronic MDD often leads to HPA axis dysregulation, resulting in
elevated cortisol levels (hypercortisolemia) and a failure to suppress cortisol
after dexamethasone administration (DST nonsuppression).
Question 3: A 78-year-old man leans in with the right side of his head,
frequently asks for things to be repeated, and has become increasingly
isolated and irritable because he believes people are yelling at him. What
should the PMHNP do FIRST?
A. Order a CT scan of the head
B. Separate the patient from his daughter and interview him alone
C. Examine the patient's ear canals
D. Provide anticipatory guidance regarding aging parents
Rationale: The presentation is classic for hearing loss. Irritability and social
isolation are common consequences of untreated hearing impairment. Ruling
out hearing loss is the least invasive and most critical first step before
considering a primary psychiatric diagnosis.
Question 4: Which description best characterizes Cluster A personality
disorders?
A. Characterized by dramatic, emotional, or erratic behavior
B. Characterized by anxious or fearful behavior
C. Characterized by odd, eccentric thinking or behavior
D. Characterized by a lack of remorse or empathy
Rationale: The DSM-5 organizes personality disorders into three clusters.
Cluster A includes paranoid, schizoid, and schizotypal personality disorders,
which are all marked by odd and eccentric behaviors and thinking patterns.
Question 5: A 35-year-old man with bipolar disorder mentions that he felt a
lump on his left testicle a few months ago but "didn't want to be a bother." He
is now seeking care for depressive symptoms. What is the most appropriate
action for the PMHNP?
,A. Reassure him that testicular lumps are often benign
B. Document the history and continue to focus on the mood disorder
C. Prescribe an antidepressant to stabilize his mood first
D. Perform a physical examination or refer for one immediately
Rationale: A lump in the testicle is a potential sign of testicular cancer. The
PMHNP must ensure a medical evaluation is prioritized. A psychiatric
diagnosis should never be made without ruling out underlying medical
conditions that could present with psychiatric symptoms.
Question 6: A client was diagnosed with major neurocognitive disorder due to
Alzheimer's disease. What pharmacologic therapy would be anticipated?
A. Carbidopa/levodopa
B. Donepezil
C. Memantine
D. Rivastigmine
Rationale: Memantine is an NMDA receptor antagonist used for moderate to
severe Alzheimer's disease. While donepezil and rivastigmine (cholinesterase
inhibitors) are also used, they are typically first-line for mild to moderate
stages. The question asks for an anticipated therapy for a general Alzheimer's
diagnosis.
Question 7: An 89-year-old presents with symptoms of dementia. Which
diagnostic test should be performed initially to rule out treatable causes of
symptoms?
A. Brain MRI
B. Cobalamin (Vitamin B12) level
C. Lumbar puncture
D. EEG
Rationale: Before diagnosing a permanent neurocognitive disorder, it is
essential to rule out reversible causes of cognitive impairment. Vitamin B12
, deficiency is a common, treatable cause, and a serum B12 level is a standard
initial screening test in the elderly.
Question 8: A mother is unable to acknowledge that her teenage son's mental
illness is perpetuated by his polysubstance use disorder and insists that his
father's genes are to blame. Which defense mechanism is being employed?
A. Regression
B. Dissociation
C. Reaction formation
D. Denial
Rationale: Denial is the refusal to accept reality or facts, blocking external
events from awareness. The mother cannot acknowledge the role of substance
use despite clear evidence.
Question 9: A client presents with ataxia, short-term memory loss, and
nystagmus. The client has a history of prolonged, heavy alcohol use. What is
the most likely diagnosis?
A. Korsakoff syndrome
B. Wernicke encephalopathy
C. Alcohol withdrawal delirium
D. Hepatic encephalopathy
Rationale: The classic triad of nystagmus, ataxia, and confusion (often with
short-term memory loss) in a patient with alcohol use disorder is Wernicke
encephalopathy, caused by thiamine (vitamin B1) deficiency.
Question 10: Which of the following best describes the pathophysiology of the
"kindling" phenomenon in bipolar disorder?
A. The process by which antipsychotics induce dopamine supersensitivity
B. The gradual increase in serotonin transporter density leading to mania
C. The neurotoxic effect of lithium on the prefrontal cortex
