NR547 MIDTERM EXAM 350 PRACTICE
QUESTIONS WITH RATIONALES
SECTION 1: FOUNDATIONS OF DIFFERENTIAL DIAGNOSIS (Questions 150)
1. What is the primary purpose of formulating a differential diagnosis in
psychiatric mental health?
A) To provide a definitive diagnosis on the first visit
B) To create a working list of potential problems associated with the chief
complaint
C) To justify prescribing multiple medications
D) To meet insurance requirements
Correct Answer: B
Rationale: The differential diagnosis is the provider's initial hypothesis—a
working list of potential problems that can be associated with the initial or
chief complaint. It helps the PMHNP gather useful responses to formulate and
narrow the list of potential diagnoses based on the client's presenting
symptoms .
2. A 52yearold client presents to the emergency department following a car
accident. The client describes persistent sadness and hopelessness, states she
often wonders if her husband would be happier if she wasn't around, reports
a previous suicide attempt at age 16, but denies current suicidal ideation.
Based on the 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 only
D) Admit the client involuntarily
Correct Answer: B
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 client's physician or the clinician responsible
for the client's care .
3. Which of the following is NOT considered a Social Determinant of Health
(SDOH) that impacts mental health?
A) Discrimination and racism
B) Genetic predisposition
C) Poverty and food insecurity
D) Poor housing quality
Correct Answer: B
Rationale: Social determinants of health are the conditions in which
individuals are "born, grow, live, work, and age" that contribute to the
development of both physical and psychiatric pathology. These include
discrimination, adverse early life experiences, poor education, unemployment,
poverty, neighborhood deprivation, food insecurity, and poor housing. Genetic
predisposition is a biological factor, not a social determinant .
,4. The SNAPPS method for clinical case presentations includes all of the
following EXCEPT:
A) Summarize the history and findings
B) Narrow the differential diagnosis to 23 possibilities
C) Prescribe treatment immediately
D) Probe the preceptor by asking questions
Correct Answer: C
Rationale: The SNAPPS method includes: Summarize the history and findings,
Narrow the differential diagnosis to 23 possibilities, Analyze the differential
by comparing and contrasting the possibilities, Probe the preceptor by asking
questions about alternative approaches or uncertainties, and Plan the
management of the client's health issues. Prescribing treatment immediately
is not part of this method.
5. Which of the following is a key component of the psychiatric history?
A) Complete blood count results
B) Family psychiatric history
C) MRI findings
D) Genetic testing results
Correct Answer: B
Rationale: The psychiatric history includes history of present illness, past
psychiatric history (hospitalizations, counseling, medications), medical
history, family psychiatric history, and social/developmental history. The
family history should explore whether any relatives have been hospitalized
for mental health issues or diagnosed with mental health conditions .
, 6. The DSM5TR provides guidance for:
A) Prescribing medications
B) Identifying psychiatric diagnoses
C) Performing physical examinations
D) Conducting laboratory tests
Correct Answer: B
Rationale: The Diagnostic and Statistical Manual of Mental Disorders
(DSM5TR) provides guidance for identifying psychiatric diagnoses. It serves
as the foundation for critical diagnostic skills in psychiatricmental health
practice .
7. Which of the following best describes the difference between subclinical
and clinical symptoms of OCD?
A) Subclinical symptoms cause significant impairment while clinical
symptoms do not
B) Clinical symptoms cause significant distress and impairment in functioning
C) Subclinical symptoms always progress to clinical OCD
D) There is no difference between the two
Correct Answer: B
Rationale: Clinical symptoms of OCD cause significant distress and
impairment in functioning, whereas subclinical symptoms may be present but
do not meet the full diagnostic criteria or cause clinically significant
impairment. Understanding this distinction is important for appropriate
diagnosis and treatment .
8. A provider's initial hypothesis is also known as:
QUESTIONS WITH RATIONALES
SECTION 1: FOUNDATIONS OF DIFFERENTIAL DIAGNOSIS (Questions 150)
1. What is the primary purpose of formulating a differential diagnosis in
psychiatric mental health?
A) To provide a definitive diagnosis on the first visit
B) To create a working list of potential problems associated with the chief
complaint
C) To justify prescribing multiple medications
D) To meet insurance requirements
Correct Answer: B
Rationale: The differential diagnosis is the provider's initial hypothesis—a
working list of potential problems that can be associated with the initial or
chief complaint. It helps the PMHNP gather useful responses to formulate and
narrow the list of potential diagnoses based on the client's presenting
symptoms .
2. A 52yearold client presents to the emergency department following a car
accident. The client describes persistent sadness and hopelessness, states she
often wonders if her husband would be happier if she wasn't around, reports
a previous suicide attempt at age 16, but denies current suicidal ideation.
Based on the 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 only
D) Admit the client involuntarily
Correct Answer: B
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 client's physician or the clinician responsible
for the client's care .
3. Which of the following is NOT considered a Social Determinant of Health
(SDOH) that impacts mental health?
A) Discrimination and racism
B) Genetic predisposition
C) Poverty and food insecurity
D) Poor housing quality
Correct Answer: B
Rationale: Social determinants of health are the conditions in which
individuals are "born, grow, live, work, and age" that contribute to the
development of both physical and psychiatric pathology. These include
discrimination, adverse early life experiences, poor education, unemployment,
poverty, neighborhood deprivation, food insecurity, and poor housing. Genetic
predisposition is a biological factor, not a social determinant .
,4. The SNAPPS method for clinical case presentations includes all of the
following EXCEPT:
A) Summarize the history and findings
B) Narrow the differential diagnosis to 23 possibilities
C) Prescribe treatment immediately
D) Probe the preceptor by asking questions
Correct Answer: C
Rationale: The SNAPPS method includes: Summarize the history and findings,
Narrow the differential diagnosis to 23 possibilities, Analyze the differential
by comparing and contrasting the possibilities, Probe the preceptor by asking
questions about alternative approaches or uncertainties, and Plan the
management of the client's health issues. Prescribing treatment immediately
is not part of this method.
5. Which of the following is a key component of the psychiatric history?
A) Complete blood count results
B) Family psychiatric history
C) MRI findings
D) Genetic testing results
Correct Answer: B
Rationale: The psychiatric history includes history of present illness, past
psychiatric history (hospitalizations, counseling, medications), medical
history, family psychiatric history, and social/developmental history. The
family history should explore whether any relatives have been hospitalized
for mental health issues or diagnosed with mental health conditions .
, 6. The DSM5TR provides guidance for:
A) Prescribing medications
B) Identifying psychiatric diagnoses
C) Performing physical examinations
D) Conducting laboratory tests
Correct Answer: B
Rationale: The Diagnostic and Statistical Manual of Mental Disorders
(DSM5TR) provides guidance for identifying psychiatric diagnoses. It serves
as the foundation for critical diagnostic skills in psychiatricmental health
practice .
7. Which of the following best describes the difference between subclinical
and clinical symptoms of OCD?
A) Subclinical symptoms cause significant impairment while clinical
symptoms do not
B) Clinical symptoms cause significant distress and impairment in functioning
C) Subclinical symptoms always progress to clinical OCD
D) There is no difference between the two
Correct Answer: B
Rationale: Clinical symptoms of OCD cause significant distress and
impairment in functioning, whereas subclinical symptoms may be present but
do not meet the full diagnostic criteria or cause clinically significant
impairment. Understanding this distinction is important for appropriate
diagnosis and treatment .
8. A provider's initial hypothesis is also known as:
