PMHNP MIDTERM ASSESSMENT
NU 673 Midterm Exam
Actual Exam 2026/2027 A+
Psychiatric-Mental Health Nurse Practitioner • Graduate Level • Application & Analysis
A+ QUESTIONS 5 SECTIONS 100% RATIONALES
VERIFIED COMPLETE INCLUDED
CATEGORIES
Psychiatric Assessment & Mental Status Examination
DSM-5-TR Diagnostic Criteria & Differential Diagnosis
Psychopharmacology & Treatment Planning
Therapeutic Communication & Patient Interaction
Professional Role, Ethics, & Scope of Practice
STUVIAACTUALEXAM
Passing Score: 80% • 1 Mark per Question • Application/Analysis Level
, Psychiatric Assessment & Mental Status Examination
Q1. A 34-year-old client presents to the outpatient clinic reporting three weeks of depressed mood, anhedonia, and
difficulty concentrating at work. During the mental status examination the PMHNP notes that the client’s speech is
soft, slow, and sparse, with long pauses before answering. The client’s thought process appears linear but the
content is dominated by themes of worthlessness. The clinician must accurately document the speech finding
within the MSE framework.
A. Poverty of speech (alogia)
B. Pressured speech
C. Circumstantial speech
D. Clang associations
Correct Answer: A
Rationale: Soft, slow, sparse speech with prolonged latency is characteristic of poverty of speech (alogia), commonly observed in
major depressive episodes. Pressured speech and clang associations are associated with mania or thought-disorder
states, while circumstantial speech involves excessive detail before reaching the point.
Q2. During a comprehensive psychiatric evaluation of a 28-year-old client, the PMHNP systematically assesses
orientation, immediate recall, recent memory, and remote memory. The client correctly states the date, city, and
purpose of the visit, but cannot repeat three unrelated words after five minutes despite adequate registration. This
finding most specifically indicates impairment in which cognitive domain?
A. Remote memory
B. Immediate registration
C. Short-term (recent) memory
D. Orientation to time and place
Correct Answer: C
Rationale: Successful registration of three words followed by failure to recall them after a delay demonstrates impaired short-term or
recent memory. Orientation remains intact and remote memory was not tested by this specific task.
Q3. A 45-year-old client is brought to the emergency department after expressing passive suicidal ideation to a family
member. The PMHNP conducts a structured suicide-risk assessment. The client denies active intent or plan, has
no prior attempts, and identifies two supportive friends. However, the client reports recent job loss and increasing
alcohol use. The clinician must determine the most appropriate next step in risk stratification.
A. Immediate involuntary hospitalization
B. Safety planning, means restriction counseling, and close outpatient monitoring
C. Initiation of long-term residential treatment
D. Discharge with routine outpatient follow-up only
Correct Answer: B
Rationale: Absence of active intent or plan with protective factors supports outpatient management, yet acute stressors and
substance use elevate risk enough to require formal safety planning, means restriction, and intensified monitoring rather
than routine follow-up alone.
, Psychiatric Assessment & Mental Status Examination
Q4. While performing a mental status examination, the PMHNP observes that the client repeatedly returns to the same
topic despite attempts to redirect, yet the connections between ideas remain logical. The client does not lose the
goal of the conversation entirely. The clinician correctly labels this thought-process finding as:
A. Flight of ideas
B. Tangential thinking
C. Loose associations
D. Perseveration
Correct Answer: D
Rationale: Perseveration is the persistent repetition of a theme or response despite efforts to change the subject. Tangential thinking
never returns to the original point; flight of ideas and loose associations involve rapid or illogical shifts.
Q5. A 62-year-old client with a history of major depressive disorder is evaluated for possible cognitive decline. The
PMHNP administers the Montreal Cognitive Assessment (MoCA). The client scores 22/30, losing points primarily
on executive-function and delayed-recall items. The clinician integrates this finding with the clinical history to
decide the next diagnostic step.
A. Order laboratory studies and consider neuroimaging while monitoring mood symptoms
B. Attribute the score solely to normal aging
C. Conclude that dementia is definitively present
D. Immediately start a cholinesterase inhibitor
Correct Answer: A
Rationale: A MoCA score of 22 suggests mild cognitive impairment but is not diagnostic of dementia. Reversible causes (metabolic,
mood-related) must be excluded with labs and imaging before a neurodegenerative diagnosis is assigned or cholinesterase
inhibitors are initiated.
Q6. During the interview a client repeatedly looks around the room, appears startled by ordinary noises, and states that
“people are watching me through the cameras.” The PMHNP documents this as an abnormality of which
component of the mental status examination?
A. Affect regulation
B. Sensorium and cognition
C. Perception (paranoid ideation / ideas of reference)
D. Insight and judgment
Correct Answer: C
Rationale: Beliefs that one is being watched or that neutral events have special personal significance constitute ideas of reference or
paranoid ideation and are recorded under the perception or thought-content section of the MSE.
Q7. A 19-year-old college student is evaluated after a roommate reported bizarre behavior. On examination the client
exhibits flat affect, responds with one-word answers, and displays no spontaneous movement or speech for
several minutes. When the clinician places the client’s arm in an awkward position, the arm remains there. The
most precise description of this motor finding is:
A. Akathisia
B. Waxy flexibility
C. Tardive dyskinesia
D. Psychomotor agitation
Correct Answer: B
Rationale: Waxy flexibility is a catatonic feature in which the patient maintains a posture placed by the examiner. Akathisia is motor
restlessness; tardive dyskinesia involves involuntary choreiform movements; psychomotor agitation is non-purposeful
hyperactivity.
, Psychiatric Assessment & Mental Status Examination
Q8. The PMHNP is assessing a client’s insight. The client acknowledges having a diagnosis of bipolar disorder, can
name current medications, and recognizes that missing doses previously led to hospitalization. However, the client
insists that the current mild hypomanic symptoms are “just high energy from exercise.” How should the clinician
rate the client’s insight?
A. Full insight
B. Absent insight
C. Intellectual insight only
D. Partial insight
Correct Answer: D
Rationale: The client demonstrates intellectual acknowledgment of the illness and past consequences yet fails to recognize current
symptoms as pathological, meeting criteria for partial rather than full insight.
Q9. A standardized instrument is selected to screen for depression severity in a primary-care integrated
behavioral-health setting. The PMHNP chooses a tool that is self-administered, contains nine items corresponding
to DSM criteria, and yields a severity score that guides treatment intensity. The instrument selected is the:
A. Patient Health Questionnaire-9 (PHQ-9)
B. Beck Depression Inventory-II (BDI-II)
C. Hamilton Depression Rating Scale (HDRS)
D. Montgomery-Åsberg Depression Rating Scale (MADRS)
Correct Answer: A
Rationale: The PHQ-9 is a brief, self-report measure mapped directly onto the nine DSM symptom criteria and is widely validated for
screening and severity monitoring in primary-care and psychiatric settings. HDRS and MADRS are clinician-rated; BDI-II is
longer and less DSM-aligned.
Q10. While obtaining a developmental history from the parent of a 7-year-old referred for possible ADHD, the PMHNP
learns that the child was delayed in language acquisition, showed little reciprocal social smiling as an infant, and
currently engages in repetitive hand-flapping when excited. These historical details raise the strongest concern
for which differential diagnosis that must be ruled out before confirming ADHD?
A. Oppositional defiant disorder
B. Separation anxiety disorder
C. Autism spectrum disorder
D. Specific learning disorder
Correct Answer: C
Rationale: Early language delay, reduced social reciprocity, and stereotyped motor behaviors are core features of autism spectrum
disorder and must be carefully differentiated from ADHD, which does not include these social-communication deficits.
Q11. A client describes feeling “as if I am watching myself from outside my body” during periods of intense anxiety.
The PMHNP recognizes this phenomenon and documents it under the perceptual section of the MSE as:
A. Derealization
B. Depersonalization
C. Auditory hallucination
D. Illusion
Correct Answer: B
Rationale: Depersonalization is the experience of detachment from one’s own body or mental processes (“watching myself”).
Derealization refers to the external world feeling unreal; hallucinations and illusions involve sensory misperceptions of
external stimuli.
NU 673 Midterm Exam
Actual Exam 2026/2027 A+
Psychiatric-Mental Health Nurse Practitioner • Graduate Level • Application & Analysis
A+ QUESTIONS 5 SECTIONS 100% RATIONALES
VERIFIED COMPLETE INCLUDED
CATEGORIES
Psychiatric Assessment & Mental Status Examination
DSM-5-TR Diagnostic Criteria & Differential Diagnosis
Psychopharmacology & Treatment Planning
Therapeutic Communication & Patient Interaction
Professional Role, Ethics, & Scope of Practice
STUVIAACTUALEXAM
Passing Score: 80% • 1 Mark per Question • Application/Analysis Level
, Psychiatric Assessment & Mental Status Examination
Q1. A 34-year-old client presents to the outpatient clinic reporting three weeks of depressed mood, anhedonia, and
difficulty concentrating at work. During the mental status examination the PMHNP notes that the client’s speech is
soft, slow, and sparse, with long pauses before answering. The client’s thought process appears linear but the
content is dominated by themes of worthlessness. The clinician must accurately document the speech finding
within the MSE framework.
A. Poverty of speech (alogia)
B. Pressured speech
C. Circumstantial speech
D. Clang associations
Correct Answer: A
Rationale: Soft, slow, sparse speech with prolonged latency is characteristic of poverty of speech (alogia), commonly observed in
major depressive episodes. Pressured speech and clang associations are associated with mania or thought-disorder
states, while circumstantial speech involves excessive detail before reaching the point.
Q2. During a comprehensive psychiatric evaluation of a 28-year-old client, the PMHNP systematically assesses
orientation, immediate recall, recent memory, and remote memory. The client correctly states the date, city, and
purpose of the visit, but cannot repeat three unrelated words after five minutes despite adequate registration. This
finding most specifically indicates impairment in which cognitive domain?
A. Remote memory
B. Immediate registration
C. Short-term (recent) memory
D. Orientation to time and place
Correct Answer: C
Rationale: Successful registration of three words followed by failure to recall them after a delay demonstrates impaired short-term or
recent memory. Orientation remains intact and remote memory was not tested by this specific task.
Q3. A 45-year-old client is brought to the emergency department after expressing passive suicidal ideation to a family
member. The PMHNP conducts a structured suicide-risk assessment. The client denies active intent or plan, has
no prior attempts, and identifies two supportive friends. However, the client reports recent job loss and increasing
alcohol use. The clinician must determine the most appropriate next step in risk stratification.
A. Immediate involuntary hospitalization
B. Safety planning, means restriction counseling, and close outpatient monitoring
C. Initiation of long-term residential treatment
D. Discharge with routine outpatient follow-up only
Correct Answer: B
Rationale: Absence of active intent or plan with protective factors supports outpatient management, yet acute stressors and
substance use elevate risk enough to require formal safety planning, means restriction, and intensified monitoring rather
than routine follow-up alone.
, Psychiatric Assessment & Mental Status Examination
Q4. While performing a mental status examination, the PMHNP observes that the client repeatedly returns to the same
topic despite attempts to redirect, yet the connections between ideas remain logical. The client does not lose the
goal of the conversation entirely. The clinician correctly labels this thought-process finding as:
A. Flight of ideas
B. Tangential thinking
C. Loose associations
D. Perseveration
Correct Answer: D
Rationale: Perseveration is the persistent repetition of a theme or response despite efforts to change the subject. Tangential thinking
never returns to the original point; flight of ideas and loose associations involve rapid or illogical shifts.
Q5. A 62-year-old client with a history of major depressive disorder is evaluated for possible cognitive decline. The
PMHNP administers the Montreal Cognitive Assessment (MoCA). The client scores 22/30, losing points primarily
on executive-function and delayed-recall items. The clinician integrates this finding with the clinical history to
decide the next diagnostic step.
A. Order laboratory studies and consider neuroimaging while monitoring mood symptoms
B. Attribute the score solely to normal aging
C. Conclude that dementia is definitively present
D. Immediately start a cholinesterase inhibitor
Correct Answer: A
Rationale: A MoCA score of 22 suggests mild cognitive impairment but is not diagnostic of dementia. Reversible causes (metabolic,
mood-related) must be excluded with labs and imaging before a neurodegenerative diagnosis is assigned or cholinesterase
inhibitors are initiated.
Q6. During the interview a client repeatedly looks around the room, appears startled by ordinary noises, and states that
“people are watching me through the cameras.” The PMHNP documents this as an abnormality of which
component of the mental status examination?
A. Affect regulation
B. Sensorium and cognition
C. Perception (paranoid ideation / ideas of reference)
D. Insight and judgment
Correct Answer: C
Rationale: Beliefs that one is being watched or that neutral events have special personal significance constitute ideas of reference or
paranoid ideation and are recorded under the perception or thought-content section of the MSE.
Q7. A 19-year-old college student is evaluated after a roommate reported bizarre behavior. On examination the client
exhibits flat affect, responds with one-word answers, and displays no spontaneous movement or speech for
several minutes. When the clinician places the client’s arm in an awkward position, the arm remains there. The
most precise description of this motor finding is:
A. Akathisia
B. Waxy flexibility
C. Tardive dyskinesia
D. Psychomotor agitation
Correct Answer: B
Rationale: Waxy flexibility is a catatonic feature in which the patient maintains a posture placed by the examiner. Akathisia is motor
restlessness; tardive dyskinesia involves involuntary choreiform movements; psychomotor agitation is non-purposeful
hyperactivity.
, Psychiatric Assessment & Mental Status Examination
Q8. The PMHNP is assessing a client’s insight. The client acknowledges having a diagnosis of bipolar disorder, can
name current medications, and recognizes that missing doses previously led to hospitalization. However, the client
insists that the current mild hypomanic symptoms are “just high energy from exercise.” How should the clinician
rate the client’s insight?
A. Full insight
B. Absent insight
C. Intellectual insight only
D. Partial insight
Correct Answer: D
Rationale: The client demonstrates intellectual acknowledgment of the illness and past consequences yet fails to recognize current
symptoms as pathological, meeting criteria for partial rather than full insight.
Q9. A standardized instrument is selected to screen for depression severity in a primary-care integrated
behavioral-health setting. The PMHNP chooses a tool that is self-administered, contains nine items corresponding
to DSM criteria, and yields a severity score that guides treatment intensity. The instrument selected is the:
A. Patient Health Questionnaire-9 (PHQ-9)
B. Beck Depression Inventory-II (BDI-II)
C. Hamilton Depression Rating Scale (HDRS)
D. Montgomery-Åsberg Depression Rating Scale (MADRS)
Correct Answer: A
Rationale: The PHQ-9 is a brief, self-report measure mapped directly onto the nine DSM symptom criteria and is widely validated for
screening and severity monitoring in primary-care and psychiatric settings. HDRS and MADRS are clinician-rated; BDI-II is
longer and less DSM-aligned.
Q10. While obtaining a developmental history from the parent of a 7-year-old referred for possible ADHD, the PMHNP
learns that the child was delayed in language acquisition, showed little reciprocal social smiling as an infant, and
currently engages in repetitive hand-flapping when excited. These historical details raise the strongest concern
for which differential diagnosis that must be ruled out before confirming ADHD?
A. Oppositional defiant disorder
B. Separation anxiety disorder
C. Autism spectrum disorder
D. Specific learning disorder
Correct Answer: C
Rationale: Early language delay, reduced social reciprocity, and stereotyped motor behaviors are core features of autism spectrum
disorder and must be carefully differentiated from ADHD, which does not include these social-communication deficits.
Q11. A client describes feeling “as if I am watching myself from outside my body” during periods of intense anxiety.
The PMHNP recognizes this phenomenon and documents it under the perceptual section of the MSE as:
A. Derealization
B. Depersonalization
C. Auditory hallucination
D. Illusion
Correct Answer: B
Rationale: Depersonalization is the experience of detachment from one’s own body or mental processes (“watching myself”).
Derealization refers to the external world feeling unreal; hallucinations and illusions involve sensory misperceptions of
external stimuli.
