NR 547 PMHNP Midterm & Final Exam Study Guide | Chamberlain
University | Practice Questions, Answers & Rationales | 2026–2027
Edition
Prepare for the NR 547 PMHNP Midterm and Final Exams with this comprehensive study guide featuring
original practice questions, accurate answers, and detailed rationales. Covers psychiatric assessment,
differential diagnosis, DSM-5-TR disorders, psychopharmacology, therapeutic communication, substance
use disorders, mood and personality disorders, anxiety disorders, psychotic disorders, and evidence-
based clinical decision-making. Perfect for focused review, self-assessment, and building confidence
throughout the NR 547 course
QUESTION 1
Roberto is a 26-year-old male who intentionally punctured his foot with a rusty nail and
smothered the wound with dirt. Several days later he sought medical care. He verbalized
to his PCP that he must have stepped on something while walking his dog. In the
absence of secondary gain, this example best represents:
A) Malingering
B) Factitious disorder
C) Somatic symptom disorder
D) Illness anxiety disorder
ANSWER: B) Factitious disorder
,Rationale: Factitious disorder involves deceptive behavior present even in the absence of
external rewards. Malingering, by contrast, is based on motivation with a clearly
recognizable goal (insurance, legal, obtaining drugs). The absence of secondary gain
indicates factitious disorder rather than malingering.
QUESTION 2
What is the first step in creating a differential diagnosis?
A) Determine the specific primary disorder using DSM-5
B) Rule out malingering or factitious disorder
C) Rule out disorder due to a medical condition
D) Differentiate adjustment disorders from residual disorders
ANSWER: B) Rule out malingering or factitious disorder
Rationale: The six-step differential diagnosis process begins with ruling out malingering or
factitious disorder. This ensures that symptoms are not being feigned for external gain or
psychological reasons before proceeding with other diagnostic considerations.
QUESTION 3
The DSM-5 criteria for substance and medication-induced presentation state that psych
symptoms can be attributed to substance use if:
A) Symptoms persist for more than one month after stopping the substance
B) Symptoms stop within one month of stopping the substance
C) Symptoms improve when the substance is increased
D) Symptoms are present only during substance intoxication
,ANSWER: B) Symptoms stop within one month of stopping the substance
Rationale: If psych symptoms improve and stop within one month of stopping the
substance, the substance is considered the primary cause. If symptoms persist without
substances, then the psych disorder is primary.
QUESTION 4
A general medical condition needs to be considered in the differential diagnosis when:
A) The psych presentation is typical in symptom pattern and age at onset
B) The psych presentation is atypical in symptom pattern, age at onset, or course
C) The patient has a family history of mental illness
D) The patient has previously been diagnosed with a psychiatric disorder
ANSWER: B) The psych presentation is atypical in symptom pattern, age at onset,
or course
Rationale: A medical condition should be suspected when the psychiatric presentation is
atypical—for example, when severe memory loss accompanies depression. If psych
symptoms begin following onset of a medical condition, vary in severity with the medical
condition, or disappear when the medical condition resolves, a medical etiology should be
considered.
, QUESTION 5
Which of the following is a screening tool used to assess depression severity?
A) Hamilton Anxiety Scale
B) Patient Health Questionnaire (PHQ-9)
C) Mini-Mental State Examination
D) CAGE Questionnaire
ANSWER: B) Patient Health Questionnaire (PHQ-9)
Rationale: The PHQ-9 is a validated screening tool for depression severity. Other tools
include the Beck Depression Inventory-II (BDI-II), Hamilton Depression Rating Scale (HAM-
D), Geriatric Depression Scale (GDS), and Edinburgh Postnatal Depression Scale (EPDS).
QUESTION 6
A patient presents with symptoms of depression but also reports episodes of elevated
mood, increased energy, and decreased need for sleep lasting several days. What
condition should be ruled out before treating for depression?
A) Generalized anxiety disorder
B) Bipolar disorder
C) Adjustment disorder
D) Substance-induced mood disorder
ANSWER: B) Bipolar disorder
University | Practice Questions, Answers & Rationales | 2026–2027
Edition
Prepare for the NR 547 PMHNP Midterm and Final Exams with this comprehensive study guide featuring
original practice questions, accurate answers, and detailed rationales. Covers psychiatric assessment,
differential diagnosis, DSM-5-TR disorders, psychopharmacology, therapeutic communication, substance
use disorders, mood and personality disorders, anxiety disorders, psychotic disorders, and evidence-
based clinical decision-making. Perfect for focused review, self-assessment, and building confidence
throughout the NR 547 course
QUESTION 1
Roberto is a 26-year-old male who intentionally punctured his foot with a rusty nail and
smothered the wound with dirt. Several days later he sought medical care. He verbalized
to his PCP that he must have stepped on something while walking his dog. In the
absence of secondary gain, this example best represents:
A) Malingering
B) Factitious disorder
C) Somatic symptom disorder
D) Illness anxiety disorder
ANSWER: B) Factitious disorder
,Rationale: Factitious disorder involves deceptive behavior present even in the absence of
external rewards. Malingering, by contrast, is based on motivation with a clearly
recognizable goal (insurance, legal, obtaining drugs). The absence of secondary gain
indicates factitious disorder rather than malingering.
QUESTION 2
What is the first step in creating a differential diagnosis?
A) Determine the specific primary disorder using DSM-5
B) Rule out malingering or factitious disorder
C) Rule out disorder due to a medical condition
D) Differentiate adjustment disorders from residual disorders
ANSWER: B) Rule out malingering or factitious disorder
Rationale: The six-step differential diagnosis process begins with ruling out malingering or
factitious disorder. This ensures that symptoms are not being feigned for external gain or
psychological reasons before proceeding with other diagnostic considerations.
QUESTION 3
The DSM-5 criteria for substance and medication-induced presentation state that psych
symptoms can be attributed to substance use if:
A) Symptoms persist for more than one month after stopping the substance
B) Symptoms stop within one month of stopping the substance
C) Symptoms improve when the substance is increased
D) Symptoms are present only during substance intoxication
,ANSWER: B) Symptoms stop within one month of stopping the substance
Rationale: If psych symptoms improve and stop within one month of stopping the
substance, the substance is considered the primary cause. If symptoms persist without
substances, then the psych disorder is primary.
QUESTION 4
A general medical condition needs to be considered in the differential diagnosis when:
A) The psych presentation is typical in symptom pattern and age at onset
B) The psych presentation is atypical in symptom pattern, age at onset, or course
C) The patient has a family history of mental illness
D) The patient has previously been diagnosed with a psychiatric disorder
ANSWER: B) The psych presentation is atypical in symptom pattern, age at onset,
or course
Rationale: A medical condition should be suspected when the psychiatric presentation is
atypical—for example, when severe memory loss accompanies depression. If psych
symptoms begin following onset of a medical condition, vary in severity with the medical
condition, or disappear when the medical condition resolves, a medical etiology should be
considered.
, QUESTION 5
Which of the following is a screening tool used to assess depression severity?
A) Hamilton Anxiety Scale
B) Patient Health Questionnaire (PHQ-9)
C) Mini-Mental State Examination
D) CAGE Questionnaire
ANSWER: B) Patient Health Questionnaire (PHQ-9)
Rationale: The PHQ-9 is a validated screening tool for depression severity. Other tools
include the Beck Depression Inventory-II (BDI-II), Hamilton Depression Rating Scale (HAM-
D), Geriatric Depression Scale (GDS), and Edinburgh Postnatal Depression Scale (EPDS).
QUESTION 6
A patient presents with symptoms of depression but also reports episodes of elevated
mood, increased energy, and decreased need for sleep lasting several days. What
condition should be ruled out before treating for depression?
A) Generalized anxiety disorder
B) Bipolar disorder
C) Adjustment disorder
D) Substance-induced mood disorder
ANSWER: B) Bipolar disorder
