PMHNP PRACTICE MIDTERM EXAM
PSYCHIATRIC ASSESSMENT, DIAGNOSIS,
AND PSYCHOPHARMACOLOGY REVIEW
PMHNP Practice Midterm Exam
Psychiatric Assessment, Diagnosis, and Psychopharmacology Review
Original practice questions for self-study — not affiliated with or copied from any
university, publisher, or exam-sharing service.
Table of Contents
1. Section 1: Mood Disorders (Q1–6)
2. Section 2: Anxiety, Trauma & OCD-Related Disorders (Q7–11)
3. Section 3: Psychotic Disorders (Q12–16)
4. Section 4: Psychopharmacology (Q17–23)
5. Section 5: Legal, Ethical & Clinical Practice Issues (Q24–28)
6. Answer Key Summary Table
Section 1: Mood Disorders
Q1. (Multiple Choice) A 34-year-old patient reports a 3-week history of depressed mood,
anhedonia, insomnia, poor concentration, and passive thoughts of death, without a specific plan.
Which diagnosis is most consistent with these findings?
A. Adjustment disorder with depressed mood B. Major depressive disorder, single episode C.
Persistent depressive disorder (dysthymia) D. Bipolar II disorder, depressed phase
Correct Answer: B. Major depressive disorder, single episode
Rationale: MDD requires at least 5 of 9 DSM-5-TR symptoms (including depressed mood or
anhedonia) present for a minimum of 2 weeks, causing significant distress or impairment. This
patient's symptom cluster and duration meet criteria. Persistent depressive disorder requires
, symptoms for at least 2 years, and adjustment disorder requires a clear identifiable stressor
without meeting full MDD criteria. Bipolar II requires a documented history of hypomania.
Q2. (Multiple Choice) Which clinical feature would most strongly suggest a diagnosis of
bipolar I disorder rather than recurrent major depressive disorder in a patient presenting with a
current depressive episode?
A. History of a manic episode lasting at least 7 days B. Family history of depression C. Early age
of onset of depressive symptoms D. Presence of psychotic features during the depressive episode
Correct Answer: A. History of a manic episode lasting at least 7 days
Rationale: Bipolar I disorder is defined by the occurrence of at least one manic episode (≥7
days, or any duration if hospitalization is required), regardless of whether depressive episodes
have occurred. Family history and early onset are nonspecific risk factors, and psychotic features
can occur in both unipolar and bipolar depression.
Q3. (Short Answer) Explain the key difference between cyclothymic disorder and bipolar II
disorder in terms of symptom severity and duration criteria.
Correct Answer: Cyclothymic disorder involves numerous periods of hypomanic and
depressive symptoms that do not meet full criteria for a hypomanic or major depressive episode,
present for at least 2 years in adults (1 year in children/adolescents), with no symptom-free
period longer than 2 months. Bipolar II disorder requires at least one full hypomanic episode and
at least one full major depressive episode meeting complete diagnostic criteria.
Rationale: The distinction is based on whether discrete mood episodes meet full DSM-5-TR
criteria. Cyclothymia is a more chronic, lower-amplitude mood instability pattern, while bipolar
II involves clearly defined episodes.
Q4. (Multiple Choice) A patient with major depressive disorder reports improved mood but
new-onset elevated energy, decreased need for sleep, and rapid speech beginning 5 days after
starting an SSRI. What is the most appropriate next step?
A. Increase the SSRI dose to address residual symptoms B. Reassess for substance-induced
mood disorder or unmasked bipolar disorder and consider discontinuing the antidepressant C.
Add a second antidepressant from a different class D. Continue the current regimen and reassess
in 4 weeks
Correct Answer: B. Reassess for substance-induced mood disorder or unmasked bipolar
disorder and consider discontinuing the antidepressant
PSYCHIATRIC ASSESSMENT, DIAGNOSIS,
AND PSYCHOPHARMACOLOGY REVIEW
PMHNP Practice Midterm Exam
Psychiatric Assessment, Diagnosis, and Psychopharmacology Review
Original practice questions for self-study — not affiliated with or copied from any
university, publisher, or exam-sharing service.
Table of Contents
1. Section 1: Mood Disorders (Q1–6)
2. Section 2: Anxiety, Trauma & OCD-Related Disorders (Q7–11)
3. Section 3: Psychotic Disorders (Q12–16)
4. Section 4: Psychopharmacology (Q17–23)
5. Section 5: Legal, Ethical & Clinical Practice Issues (Q24–28)
6. Answer Key Summary Table
Section 1: Mood Disorders
Q1. (Multiple Choice) A 34-year-old patient reports a 3-week history of depressed mood,
anhedonia, insomnia, poor concentration, and passive thoughts of death, without a specific plan.
Which diagnosis is most consistent with these findings?
A. Adjustment disorder with depressed mood B. Major depressive disorder, single episode C.
Persistent depressive disorder (dysthymia) D. Bipolar II disorder, depressed phase
Correct Answer: B. Major depressive disorder, single episode
Rationale: MDD requires at least 5 of 9 DSM-5-TR symptoms (including depressed mood or
anhedonia) present for a minimum of 2 weeks, causing significant distress or impairment. This
patient's symptom cluster and duration meet criteria. Persistent depressive disorder requires
, symptoms for at least 2 years, and adjustment disorder requires a clear identifiable stressor
without meeting full MDD criteria. Bipolar II requires a documented history of hypomania.
Q2. (Multiple Choice) Which clinical feature would most strongly suggest a diagnosis of
bipolar I disorder rather than recurrent major depressive disorder in a patient presenting with a
current depressive episode?
A. History of a manic episode lasting at least 7 days B. Family history of depression C. Early age
of onset of depressive symptoms D. Presence of psychotic features during the depressive episode
Correct Answer: A. History of a manic episode lasting at least 7 days
Rationale: Bipolar I disorder is defined by the occurrence of at least one manic episode (≥7
days, or any duration if hospitalization is required), regardless of whether depressive episodes
have occurred. Family history and early onset are nonspecific risk factors, and psychotic features
can occur in both unipolar and bipolar depression.
Q3. (Short Answer) Explain the key difference between cyclothymic disorder and bipolar II
disorder in terms of symptom severity and duration criteria.
Correct Answer: Cyclothymic disorder involves numerous periods of hypomanic and
depressive symptoms that do not meet full criteria for a hypomanic or major depressive episode,
present for at least 2 years in adults (1 year in children/adolescents), with no symptom-free
period longer than 2 months. Bipolar II disorder requires at least one full hypomanic episode and
at least one full major depressive episode meeting complete diagnostic criteria.
Rationale: The distinction is based on whether discrete mood episodes meet full DSM-5-TR
criteria. Cyclothymia is a more chronic, lower-amplitude mood instability pattern, while bipolar
II involves clearly defined episodes.
Q4. (Multiple Choice) A patient with major depressive disorder reports improved mood but
new-onset elevated energy, decreased need for sleep, and rapid speech beginning 5 days after
starting an SSRI. What is the most appropriate next step?
A. Increase the SSRI dose to address residual symptoms B. Reassess for substance-induced
mood disorder or unmasked bipolar disorder and consider discontinuing the antidepressant C.
Add a second antidepressant from a different class D. Continue the current regimen and reassess
in 4 weeks
Correct Answer: B. Reassess for substance-induced mood disorder or unmasked bipolar
disorder and consider discontinuing the antidepressant
