NR 547 PMHNP Midterm Study Guide | Practice Questions, Answers &
Rationales | 2026–2028 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 34-year-old male presents with sudden-onset auditory hallucinations, paranoia, and
disorganized speech. He has no prior psychiatric history but admits to heavy alcohol use
over the past 3 days. Urine toxicology is negative for illicit drugs. What is the MOST
appropriate next step?
A. Start olanzapine 10 mg daily
B. Admit to inpatient psychiatry for schizophrenia workup
C. Observe for 72 hours with supportive care and monitor for symptom resolution
D. Order a CT scan of the head immediately
Correct Answer: C. Observe for 72 hours with supportive care and monitor for
symptom resolution
Rationale: The first step in differential diagnosis is to rule out substance etiology.
Symptoms attributable to alcohol intoxication or withdrawal typically resolve within 72
hours of abstinence. Starting antipsychotics or inpatient admission without a period of
observation would be premature and could mask the true etiology.
QUESTION 2
,A 72-year-old female with no psychiatric history presents with new-onset depression,
anxiety, and memory impairment over the past 2 months. She also reports fatigue and
unintended weight loss. Which of the following should be ruled out FIRST?
A. Major depressive disorder
B. Generalized anxiety disorder
C. Hypothyroidism
D. Early-stage Alzheimer's disease
Correct Answer: C. Hypothyroidism
Rationale: The differential diagnosis process requires ruling out general medical conditions
before attributing symptoms to a primary psychiatric disorder. Hypothyroidism commonly
presents with depression, cognitive slowing, fatigue, and weight changes—especially in
older adults. Thyroid function tests are a standard initial screening tool.
QUESTION 3
A 45-year-old male is brought to the ED by police after threatening his wife. He is calm
during the interview and denies any intent to harm. He has a pending disability claim
and a history of multiple similar incidents with different agencies. What should the
PMHNP suspect FIRST?
A. Bipolar disorder, manic episode
B. Intermittent explosive disorder
C. Malingering
D. Antisocial personality disorder
Correct Answer: C. Malingering
Rationale: The six-step differential diagnosis process begins with ruling out malingering or
factitious disorder. This patient has a clear external incentive (disability claim) and a
pattern of similar presentations without follow-through, suggesting intentional fabrication
for secondary gain.
,QUESTION 4
A 28-year-old female reports auditory hallucinations, mood instability, and social
withdrawal for 6 months. She has a history of cannabis use daily for 2 years. She has
been abstinent for 10 days but symptoms persist. What is the MOST appropriate
diagnosis?
A. Substance-induced psychotic disorder
B. Schizophrenia
C. Schizoaffective disorder
D. Bipolar I disorder with psychotic features
Correct Answer: B. Schizophrenia
Rationale: To rule out substance etiology, symptoms must resolve within one month of
abstinence. Since this patient's symptoms persist beyond 10 days and she has a 6-month
history, a primary psychotic disorder such as schizophrenia is more likely. Substance-
induced disorders would have remitted or significantly improved.
QUESTION 5
Which of the following is a REQUIRED criterion for the diagnosis of major depressive
disorder according to the DSM-5-TR?
A. Depressed mood or anhedonia nearly every day for at least 2 weeks
B. At least one manic episode in the past year
C. Symptoms that occur only during bereavement
D. A history of substance use disorder
Correct Answer: A. Depressed mood or anhedonia nearly every day for at least 2
weeks
Rationale: The DSM-5-TR requires either depressed mood or loss of interest/pleasure
(anhedonia) for a minimum of 2 weeks, along with at least five total symptoms.
Bereavement is no longer an exclusion criterion, and manic episodes would suggest a
bipolar spectrum disorder.
, QUESTION 6
A 19-year-old college student reports episodes of intense fear, palpitations, sweating,
and a feeling of impending doom that peak within 10 minutes. She avoids the gym and
public transportation. What is the MOST likely diagnosis?
A. Generalized anxiety disorder
B. Social anxiety disorder
C. Panic disorder with agoraphobia
D. Specific phobia
Correct Answer: C. Panic disorder with agoraphobia
Rationale: The patient meets criteria for recurrent unexpected panic attacks with at least
one month of persistent concern or maladaptive behavior change (avoidance of places
where escape might be difficult). The avoidance of gym and public transportation indicates
agoraphobia.
QUESTION 7
A 60-year-old male with a 30-year history of alcohol use disorder presents with memory
loss, confabulation, and ataxia. Which of the following vitamin deficiencies is MOST
associated with this presentation?
A. Vitamin B12
B. Vitamin D
C. Thiamine (Vitamin B1)
D. Folate
Correct Answer: C. Thiamine (Vitamin B1)
Rationale: Chronic alcohol use can lead to thiamine deficiency, resulting in Wernicke-
Korsakoff syndrome, characterized by confabulation, ataxia, ophthalmoplegia, and
memory impairment. This is a medical emergency requiring immediate thiamine
replacement.
Rationales | 2026–2028 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 34-year-old male presents with sudden-onset auditory hallucinations, paranoia, and
disorganized speech. He has no prior psychiatric history but admits to heavy alcohol use
over the past 3 days. Urine toxicology is negative for illicit drugs. What is the MOST
appropriate next step?
A. Start olanzapine 10 mg daily
B. Admit to inpatient psychiatry for schizophrenia workup
C. Observe for 72 hours with supportive care and monitor for symptom resolution
D. Order a CT scan of the head immediately
Correct Answer: C. Observe for 72 hours with supportive care and monitor for
symptom resolution
Rationale: The first step in differential diagnosis is to rule out substance etiology.
Symptoms attributable to alcohol intoxication or withdrawal typically resolve within 72
hours of abstinence. Starting antipsychotics or inpatient admission without a period of
observation would be premature and could mask the true etiology.
QUESTION 2
,A 72-year-old female with no psychiatric history presents with new-onset depression,
anxiety, and memory impairment over the past 2 months. She also reports fatigue and
unintended weight loss. Which of the following should be ruled out FIRST?
A. Major depressive disorder
B. Generalized anxiety disorder
C. Hypothyroidism
D. Early-stage Alzheimer's disease
Correct Answer: C. Hypothyroidism
Rationale: The differential diagnosis process requires ruling out general medical conditions
before attributing symptoms to a primary psychiatric disorder. Hypothyroidism commonly
presents with depression, cognitive slowing, fatigue, and weight changes—especially in
older adults. Thyroid function tests are a standard initial screening tool.
QUESTION 3
A 45-year-old male is brought to the ED by police after threatening his wife. He is calm
during the interview and denies any intent to harm. He has a pending disability claim
and a history of multiple similar incidents with different agencies. What should the
PMHNP suspect FIRST?
A. Bipolar disorder, manic episode
B. Intermittent explosive disorder
C. Malingering
D. Antisocial personality disorder
Correct Answer: C. Malingering
Rationale: The six-step differential diagnosis process begins with ruling out malingering or
factitious disorder. This patient has a clear external incentive (disability claim) and a
pattern of similar presentations without follow-through, suggesting intentional fabrication
for secondary gain.
,QUESTION 4
A 28-year-old female reports auditory hallucinations, mood instability, and social
withdrawal for 6 months. She has a history of cannabis use daily for 2 years. She has
been abstinent for 10 days but symptoms persist. What is the MOST appropriate
diagnosis?
A. Substance-induced psychotic disorder
B. Schizophrenia
C. Schizoaffective disorder
D. Bipolar I disorder with psychotic features
Correct Answer: B. Schizophrenia
Rationale: To rule out substance etiology, symptoms must resolve within one month of
abstinence. Since this patient's symptoms persist beyond 10 days and she has a 6-month
history, a primary psychotic disorder such as schizophrenia is more likely. Substance-
induced disorders would have remitted or significantly improved.
QUESTION 5
Which of the following is a REQUIRED criterion for the diagnosis of major depressive
disorder according to the DSM-5-TR?
A. Depressed mood or anhedonia nearly every day for at least 2 weeks
B. At least one manic episode in the past year
C. Symptoms that occur only during bereavement
D. A history of substance use disorder
Correct Answer: A. Depressed mood or anhedonia nearly every day for at least 2
weeks
Rationale: The DSM-5-TR requires either depressed mood or loss of interest/pleasure
(anhedonia) for a minimum of 2 weeks, along with at least five total symptoms.
Bereavement is no longer an exclusion criterion, and manic episodes would suggest a
bipolar spectrum disorder.
, QUESTION 6
A 19-year-old college student reports episodes of intense fear, palpitations, sweating,
and a feeling of impending doom that peak within 10 minutes. She avoids the gym and
public transportation. What is the MOST likely diagnosis?
A. Generalized anxiety disorder
B. Social anxiety disorder
C. Panic disorder with agoraphobia
D. Specific phobia
Correct Answer: C. Panic disorder with agoraphobia
Rationale: The patient meets criteria for recurrent unexpected panic attacks with at least
one month of persistent concern or maladaptive behavior change (avoidance of places
where escape might be difficult). The avoidance of gym and public transportation indicates
agoraphobia.
QUESTION 7
A 60-year-old male with a 30-year history of alcohol use disorder presents with memory
loss, confabulation, and ataxia. Which of the following vitamin deficiencies is MOST
associated with this presentation?
A. Vitamin B12
B. Vitamin D
C. Thiamine (Vitamin B1)
D. Folate
Correct Answer: C. Thiamine (Vitamin B1)
Rationale: Chronic alcohol use can lead to thiamine deficiency, resulting in Wernicke-
Korsakoff syndrome, characterized by confabulation, ataxia, ophthalmoplegia, and
memory impairment. This is a medical emergency requiring immediate thiamine
replacement.
