PROCESSES FOR PMHNPS QUESTIONS AND
CORRECT DETAILED ANSWERS WITH RATIONALES
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Question 1
A 29-year-old woman presents with low mood, poor sleep, and fatigue for 3 weeks
following the death of her mother. She reports sadness but continues working and
caring for her children. She denies guilt, hopelessness, or suicidal ideation. What is
the most appropriate diagnosis?
A. Major depressive disorder
B. Persistent depressive disorder
C. Adjustment disorder with depressed mood
D. Prolonged grief disorder
Correct Answer: C
Rationale: Symptoms are time-limited, occur after an identifiable stressor, and do
not meet full criteria for major depressive disorder. Preserved functioning supports
adjustment disorder rather than pathological grief.
,Question 2
During a psychiatric interview, a patient becomes increasingly idealizing of the
PMHNP and begins requesting personal contact outside of appointments. This
reflects which phenomenon?
A. Countertransference
B. Boundary testing
C. Projection
D. Therapeutic alliance
Correct Answer: B
Rationale: Boundary testing occurs when patients attempt to alter professional
limits. While idealization may involve transference, the behavior described
specifically challenges boundaries.
Question 3
Which component of the Mental Status Exam best captures the statement: “My
thoughts jump so fast I can’t keep up”?
A. Thought content
B. Insight
C. Thought process
D. Cognition
Correct Answer: C
Rationale: Thought process evaluates how ideas are connected. Rapid, pressured
shifts suggest flight of ideas, a disturbance of process rather than content.
,Question 4
A patient with schizophrenia presents with new-onset confusion, fluctuating
alertness, and visual hallucinations after starting an anticholinergic medication.
What should be prioritized?
A. Increasing antipsychotic dose
B. Diagnosing schizophrenia relapse
C. Assessing for delirium
D. Adding a mood stabilizer
Correct Answer: C
Rationale: Acute changes in attention and consciousness suggest delirium,
especially in the context of medication effects. Diagnostic overshadowing must be
avoided.
Question 5
Which finding most strongly supports a diagnosis of bipolar I disorder rather than
major depressive disorder?
A. Recurrent depressive episodes
B. Psychomotor retardation
C. History of a manic episode
D. Poor concentration
Correct Answer: C
Rationale: A single lifetime manic episode is diagnostic for bipolar I disorder
regardless of depressive history.
, Question 6
A patient scores 22 on the PHQ-9. How should this result be interpreted?
A. Minimal depression
B. Mild depression
C. Moderate depression
D. Severe depression
Correct Answer: D
Rationale: PHQ-9 scores ≥20 indicate severe depressive symptoms and require
prompt clinical intervention.
Question 7
When collecting a psychiatric history, which question best assesses insight?
A. “How long have you felt this way?”
B. “Why do you think you are here today?”
C. “Have you been sleeping well?”
D. “Do you hear voices others cannot?”
Correct Answer: B
Rationale: Insight reflects the patient’s awareness and understanding of their
condition and need for treatment.
Question 8
A patient with chronic alcohol use presents with tremors, anxiety, and tachycardia
12 hours after last drink. Which diagnosis is most appropriate?
A. Generalized anxiety disorder
B. Panic disorder
C. Alcohol withdrawal
D. Substance-induced mood disorder
Correct Answer: C