NR 547 PMHNP Midterm Study Guide | Practice Questions, Answers &
Rationales | 2026–2027 Edition
Prepare for the NR 547 PMHNP Midterm with this comprehensive study guide featuring original practice
questions, accurate answers, and detailed rationales. Covers psychiatric assessment, differential
diagnosis, DSM-5-TR disorders, psychopharmacology, neurobiology, evidence-based treatment, and
clinical decision-making essential for psychiatric-mental health nurse practitioner students. Perfect for
focused review, self-assessment, and building confidence before your NR 547 midterm exam.
QUESTION 1
A 52-year-old client presents to the emergency department following a car accident.
The ED physician is concerned the client may have intentionally crashed her car and
requests a stat PMHNP consult. The client describes persistent feelings of sadness and
hopelessness. She states that she often wonders if her husband would be happier if she
wasn't around anymore since she's never happy and sometimes thinks about what it
would be like to just take a handful of sleeping pills and go to sleep forever. The client
reports a previous suicide attempt when she was 16 but denies that she is considering
killing herself right now. Based on the client's ASQ score, what is the most appropriate
response?
A) No action is necessary as the client is not currently considering suicide
B) Provide a brief suicide safety assessment
C) Alert the client's primary care physician
D) Provide a stat full mental health evaluation
Correct Answer: B) Provide a brief suicide safety assessment
Rationale: While the client's responses do not indicate a need for a stat full safety and
mental health evaluation, the client requires a brief suicide safety assessment to determine
whether a full mental health evaluation is necessary. It is also important to notify the
physician or clinician responsible for the client's care.
QUESTION 2
A 28-year-old client presents with passive thoughts that life is "not worth living" but
denies active suicidal ideation, plan, or intent. She reports a 10-day history of depressed
,mood, anhedonia, insomnia, decreased appetite, and poor concentration causing
marked occupational impairment. There is no prior history of mania or hypomania. What
is the most appropriate next step?
A) Hospitalize the client immediately
B) Provide a brief suicide safety assessment and schedule follow-up
C) Prescribe antidepressants and discharge
D) No action is needed as passive thoughts are not concerning
Correct Answer: B) Provide a brief suicide safety assessment and schedule follow-
up
Rationale: Passive suicidal thoughts warrant assessment but do not necessarily require
hospitalization. A brief suicide safety assessment should be conducted to determine acuity,
with appropriate follow-up scheduled based on findings. The presence of a major
depressive episode increases risk and requires monitoring.
QUESTION 3
Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L. What is the most
appropriate action?
A) Begin treatment for depression
B) Refer for treatment of hypothyroidism
C) Order additional thyroid studies
D) Reassure and schedule follow-up
Correct Answer: B) Refer for treatment of hypothyroidism
Rationale: A TSH level >4.0 is indicative of hypothyroidism, which is associated with
fatigue. Referral for treatment of hypothyroidism is required. The client can be reevaluated
for fatigue if symptoms persist after hypothyroid treatment has been initiated and TSH
levels are within normal limits.
QUESTION 4
Terri is a 79-year-old who presents with confusion. She has positive urine leukocyte
esterase. What is the most appropriate action?
,A) Begin antipsychotic therapy
B) Refer for treatment of urinary tract infection
C) Order head CT
D) Begin antidepressant therapy
Correct Answer: B) Refer for treatment of urinary tract infection
Rationale: A positive urine leukocyte esterase indicates the presence of a urinary tract
infection (UTI), which may cause confusion in older adults. This client should be referred
for treatment of the UTI. Confusion from a UTI is a medical condition that must be
addressed before psychiatric causes are considered.
QUESTION 5
Julio is a 66-year-old who presents with depression. His vitamin D level is 11 ng/mL.
What is the most appropriate action?
A) Begin antidepressant therapy
B) Refer for treatment of vitamin D deficiency
C) Order additional lab work
D) Reassure and schedule follow-up
Correct Answer: B) Refer for treatment of vitamin D deficiency
Rationale: Vitamin D deficiency is associated with depressive symptoms. The PMHNP may
refer or treat vitamin D deficiency depending on the level of comfort of the provider.
Normal vitamin D levels are generally >30 ng/mL.
QUESTION 6
Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL. What is the most
appropriate action?
A) Begin antianxiety medication
B) Refer for treatment of hyperthyroidism
C) Order additional thyroid studies
D) Begin cognitive behavioral therapy
, Correct Answer: B) Refer for treatment of hyperthyroidism
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is
associated with anxiety symptoms. The client can be reevaluated for anxiety once
hyperthyroid treatment has been initiated and T3 levels are within normal limits.
QUESTION 7
Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL and
hematocrit is 42%. What is the most appropriate action?
A) Refer for evaluation of anemia
B) Begin treatment based on complete evaluation
C) Order iron studies
D) Reassure and discharge
Correct Answer: B) Begin treatment based on complete evaluation
Rationale: The hemoglobin and hematocrit are within normal limits. This client's
complaint of fatigue is not due to anemia. Begin treatment based on a complete
evaluation.
QUESTION 8
Fred is a 19-year-old who presents with psychosis. His vitamin B12 level is 900
picograms/mL. What is the most appropriate action?
A) Refer for treatment of B12 deficiency
B) Begin treatment for psychosis
C) Order additional lab work
D) Hospitalize the client
Correct Answer: B) Begin treatment for psychosis
Rationale: The B12 level is within normal limits. Treatment for symptoms of psychosis
should be initiated.
Rationales | 2026–2027 Edition
Prepare for the NR 547 PMHNP Midterm with this comprehensive study guide featuring original practice
questions, accurate answers, and detailed rationales. Covers psychiatric assessment, differential
diagnosis, DSM-5-TR disorders, psychopharmacology, neurobiology, evidence-based treatment, and
clinical decision-making essential for psychiatric-mental health nurse practitioner students. Perfect for
focused review, self-assessment, and building confidence before your NR 547 midterm exam.
QUESTION 1
A 52-year-old client presents to the emergency department following a car accident.
The ED physician is concerned the client may have intentionally crashed her car and
requests a stat PMHNP consult. The client describes persistent feelings of sadness and
hopelessness. She states that she often wonders if her husband would be happier if she
wasn't around anymore since she's never happy and sometimes thinks about what it
would be like to just take a handful of sleeping pills and go to sleep forever. The client
reports a previous suicide attempt when she was 16 but denies that she is considering
killing herself right now. Based on the client's ASQ score, what is the most appropriate
response?
A) No action is necessary as the client is not currently considering suicide
B) Provide a brief suicide safety assessment
C) Alert the client's primary care physician
D) Provide a stat full mental health evaluation
Correct Answer: B) Provide a brief suicide safety assessment
Rationale: While the client's responses do not indicate a need for a stat full safety and
mental health evaluation, the client requires a brief suicide safety assessment to determine
whether a full mental health evaluation is necessary. It is also important to notify the
physician or clinician responsible for the client's care.
QUESTION 2
A 28-year-old client presents with passive thoughts that life is "not worth living" but
denies active suicidal ideation, plan, or intent. She reports a 10-day history of depressed
,mood, anhedonia, insomnia, decreased appetite, and poor concentration causing
marked occupational impairment. There is no prior history of mania or hypomania. What
is the most appropriate next step?
A) Hospitalize the client immediately
B) Provide a brief suicide safety assessment and schedule follow-up
C) Prescribe antidepressants and discharge
D) No action is needed as passive thoughts are not concerning
Correct Answer: B) Provide a brief suicide safety assessment and schedule follow-
up
Rationale: Passive suicidal thoughts warrant assessment but do not necessarily require
hospitalization. A brief suicide safety assessment should be conducted to determine acuity,
with appropriate follow-up scheduled based on findings. The presence of a major
depressive episode increases risk and requires monitoring.
QUESTION 3
Toni is a 58-year-old who presents with fatigue. Her TSH is 6.3 mIU/L. What is the most
appropriate action?
A) Begin treatment for depression
B) Refer for treatment of hypothyroidism
C) Order additional thyroid studies
D) Reassure and schedule follow-up
Correct Answer: B) Refer for treatment of hypothyroidism
Rationale: A TSH level >4.0 is indicative of hypothyroidism, which is associated with
fatigue. Referral for treatment of hypothyroidism is required. The client can be reevaluated
for fatigue if symptoms persist after hypothyroid treatment has been initiated and TSH
levels are within normal limits.
QUESTION 4
Terri is a 79-year-old who presents with confusion. She has positive urine leukocyte
esterase. What is the most appropriate action?
,A) Begin antipsychotic therapy
B) Refer for treatment of urinary tract infection
C) Order head CT
D) Begin antidepressant therapy
Correct Answer: B) Refer for treatment of urinary tract infection
Rationale: A positive urine leukocyte esterase indicates the presence of a urinary tract
infection (UTI), which may cause confusion in older adults. This client should be referred
for treatment of the UTI. Confusion from a UTI is a medical condition that must be
addressed before psychiatric causes are considered.
QUESTION 5
Julio is a 66-year-old who presents with depression. His vitamin D level is 11 ng/mL.
What is the most appropriate action?
A) Begin antidepressant therapy
B) Refer for treatment of vitamin D deficiency
C) Order additional lab work
D) Reassure and schedule follow-up
Correct Answer: B) Refer for treatment of vitamin D deficiency
Rationale: Vitamin D deficiency is associated with depressive symptoms. The PMHNP may
refer or treat vitamin D deficiency depending on the level of comfort of the provider.
Normal vitamin D levels are generally >30 ng/mL.
QUESTION 6
Beth is a 24-year-old who presents with anxiety. Her T3 is 260 ng/dL. What is the most
appropriate action?
A) Begin antianxiety medication
B) Refer for treatment of hyperthyroidism
C) Order additional thyroid studies
D) Begin cognitive behavioral therapy
, Correct Answer: B) Refer for treatment of hyperthyroidism
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is
associated with anxiety symptoms. The client can be reevaluated for anxiety once
hyperthyroid treatment has been initiated and T3 levels are within normal limits.
QUESTION 7
Leo is a 49-year-old who presents with fatigue. His hemoglobin is 15 g/dL and
hematocrit is 42%. What is the most appropriate action?
A) Refer for evaluation of anemia
B) Begin treatment based on complete evaluation
C) Order iron studies
D) Reassure and discharge
Correct Answer: B) Begin treatment based on complete evaluation
Rationale: The hemoglobin and hematocrit are within normal limits. This client's
complaint of fatigue is not due to anemia. Begin treatment based on a complete
evaluation.
QUESTION 8
Fred is a 19-year-old who presents with psychosis. His vitamin B12 level is 900
picograms/mL. What is the most appropriate action?
A) Refer for treatment of B12 deficiency
B) Begin treatment for psychosis
C) Order additional lab work
D) Hospitalize the client
Correct Answer: B) Begin treatment for psychosis
Rationale: The B12 level is within normal limits. Treatment for symptoms of psychosis
should be initiated.
