NU 665 Final Exam — Week 11 | PMHNP Preparation 100 Questions + Answers + Rationales
NU 665 FINAL EXAM — WEEK 11
Questions and Answers (Questions and Correct Answers) — Best Test Bank for NU 665 Final Exam Preparation
Psychiatric-Mental Health Nurse Practitioner (PMHNP) | Graduate-Level Cumulative Final Examination | Week 11
Coverage
100 Questions | 6 Sections | Cognitive Distribution: 25% Recall, 50% Application, 25% Analysis | 80% Scenario-Based, 20% Direct
Recall
Instructions: This cumulative final examination consists of 100 multiple-choice questions distributed across six (6)
sections aligned with the PMHNP core competencies and NU 665 course objectives. Each question has four options (A–D)
with exactly one correct answer marked [CORRECT]. A detailed rationale with advanced-practice nursing clinical
reasoning is provided for each item. Cognitive level distribution: 25% recall, 50% application, 25% analysis.
Approximately 80% of items are scenario-based to mirror clinical practice.
SECTION 1: PSYCHIATRIC ASSESSMENT AND DIAGNOSTIC REASONING
Psychiatric History, Mental Status Examination, Diagnostic Criteria, & Differential Diagnosis (Q1–Q20)
Q1: A 34-year-old female presents to the clinic reporting persistent sadness, anhedonia, and a 12-pound weight loss
over the past 8 weeks. She denies suicidal ideation but endorses feeling 'worthless' and 'hopeless.' During the
psychiatric interview, the PMHNP should first:
A. Obtain a detailed family psychiatric history to rule out bipolar disorder
B. Perform a comprehensive suicide risk assessment using a validated tool such as the Columbia-Suicide
Severity Rating Scale (C-SSRS) [CORRECT]
C. Administer the PHQ-9 to confirm the diagnosis of major depressive disorder
D. Refer the patient for laboratory testing including TSH and vitamin B12 levels
Correct Answer: B
Rationale: Safety assessment is always the highest priority. Even when a patient denies suicidal ideation, the
presence of hopelessness and worthlessness are well-established risk factors for suicide, warranting a structured
risk assessment with a validated instrument such as the C-SSRS. Family history, screening tools, and laboratory
workup are important components of the evaluation but follow safety prioritization.
Page 1
,NU 665 Final Exam — Week 11 | PMHNP Preparation 100 Questions + Answers + Rationales
Q2: During a mental status examination, the PMHNP observes that the patient's speech is minimal in quantity, with
brief responses to questions, lacking additional spontaneous elaboration. This finding is best described as:
A. Tangential speech indicative of a thought disorder
B. Poverty of speech suggestive of depressive disorder or schizophrenia negative symptoms [CORRECT]
C. Perseveration consistent with frontal lobe dysfunction
D. Circumstantial speech reflective of cognitive rigidity
Correct Answer: B
Rationale: Poverty of speech (alogia) is a negative symptom characterized by restricted speech output with
brief, unelaborated responses. It is a core negative symptom of schizophrenia but also commonly observed in
major depressive disorder. Tangential speech, perseveration, and circumstantial speech represent distinct thought
process disturbances and are not consistent with this presentation.
Q3: A 67-year-old male with no prior psychiatric history is brought in by his daughter after he was found wandering
his neighborhood unable to identify his home. On MSE, he is alert but oriented only to person, misidentifies the
year as 1987, and cannot recall three objects after 5 minutes. The PMHNP's initial priority is to:
A. Initiate a cholinesterase inhibitor for suspected Alzheimer dementia
B. Order a comprehensive metabolic panel, TSH, vitamin B12, folate, RPR, and head imaging to rule out
reversible causes of cognitive impairment [CORRECT]
C. Diagnose neurocognitive disorder due to Alzheimer disease based on DSM-5-TR criteria
D. Refer for outpatient neuropsychological testing within 4 weeks
Correct Answer: B
Rationale: New-onset cognitive impairment in an older adult requires urgent evaluation for reversible causes
(delirium, hypothyroidism, B12 deficiency, neurosyphilis, subdural hematoma, normal pressure hydrocephalus)
before attributing symptoms to a neurodegenerative process. Initiating cholinesterase inhibitors prematurely
bypasses the essential differential diagnostic workup mandated by current practice guidelines.
Q4: A 28-year-old female presents with intrusive thoughts of her sexual assault that occurred 6 months ago,
nightmares, hypervigilance, and avoidance of crowds. She has been unable to return to work. Per DSM-5-TR,
the minimum duration of symptoms required for PTSD diagnosis is:
A. 3 days
B. 1 month [CORRECT]
C. 3 months
D. 6 months
Correct Answer: B
Rationale: Per DSM-5-TR criteria for posttraumatic stress disorder, symptoms must persist for more than one
month following the traumatic event. Symptoms lasting 3 days to 1 month meet criteria for acute stress disorder
rather than PTSD. The 3- and 6-month thresholds are not part of the PTSD diagnostic criteria but may inform
severity specifiers.
Page 2
,NU 665 Final Exam — Week 11 | PMHNP Preparation 100 Questions + Answers + Rationales
Q5: A 19-year-old college student is brought to the emergency department after telling his roommate he planned to
'end it all' by jumping off a bridge. He has a history of one prior suicide attempt by overdose. Which component
of the suicide risk assessment most strongly predicts future completed suicide?
A. Current suicidal ideation with a plan
B. Prior suicide attempt history [CORRECT]
C. Access to lethal means
D. Co-occurring substance use disorder
Correct Answer: B
Rationale: A prior suicide attempt is the single strongest predictor of future completed suicide, conferring a 30-
to 40-fold increased risk compared with the general population. While current ideation, plan specificity, access to
lethal means, and substance use all meaningfully contribute to acute risk stratification, the prior attempt history
carries the highest predictive weight in evidence-based risk assessment frameworks.
Q6: A 42-year-old male with schizophrenia demonstrates the following: when asked to explain the proverb 'People
in glass houses shouldn't throw stones,' he responds, 'Glass is fragile, stones are hard, houses have windows,
windows break.' This response best illustrates:
A. Concrete thinking characteristic of schizophrenia [CORRECT]
B. Loose associations reflecting formal thought disorder
C. Perseveration of recent content
D. Echolalia consistent with catatonia
Correct Answer: A
Rationale: Concrete thinking reflects an inability to abstract meaning from figurative language, producing literal
interpretations. The patient addresses each component of the proverb literally rather than extracting the
metaphorical meaning about hypocrisy. This is a classic finding in schizophrenia and other conditions with
cognitive impairment, distinct from loose associations (loss of logical connection), perseveration (repetition of
prior content), or echolalia (repetition of examiner's words).
Q7: Which of the following best describes the function of the Cultural Formulation Interview (CFI) included in
DSM-5-TR?
A. It provides standardized diagnostic criteria for culture-bound syndromes
B. It is a structured tool to assess cultural identity, cultural explanations of distress, cultural stressors, and
cultural features of the clinician-patient relationship [CORRECT]
C. It is a screening tool for psychiatric disorders in non-English-speaking patients
D. It replaces the standard mental status examination for culturally diverse populations
Correct Answer: B
Rationale: The Cultural Formulation Interview is a semi-structured interview designed to assess the patient's
cultural background and how it shapes their illness experience, help-seeking behavior, and the clinical encounter.
It complements rather than replaces the standard MSE and does not provide diagnostic criteria or function as a
screening tool. Its purpose is to enhance diagnostic accuracy and treatment planning through cultural humility.
Page 3
, NU 665 Final Exam — Week 11 | PMHNP Preparation 100 Questions + Answers + Rationales
Q8: A 56-year-old female is being evaluated for capacity to refuse a recommended cardiac catheterization. Which of
the following is the most important element the PMHNP must assess?
A. Whether the patient's refusal aligns with her family's wishes
B. Whether the patient can communicate a choice, understand relevant information, appreciate the
situation and consequences, and reason about treatment options [CORRECT]
C. Whether the patient has a documented advance directive
D. Whether the patient's decision is medically reasonable from the clinician's perspective
Correct Answer: B
Rationale: Decision-making capacity requires four distinct components: the ability to communicate a consistent
choice, to comprehend relevant information, to appreciate the situation and consequences as they apply to
oneself, and to reason about treatment alternatives. The Appelbaum criteria form the legal and ethical standard.
Capacity is decision-specific and time-specific; agreement with medical recommendations or family preferences
is not required for capacity determination.
Q9: A PMHNP is evaluating a 31-year-old male who reports a 2-year history of pervasive depressed mood, low
self-esteem, and fatigue without discrete episodes meeting criteria for major depressive disorder. The most
accurate DSM-5-TR diagnosis is:
A. Major depressive disorder, recurrent, mild
B. Persistent depressive disorder (dysthymia) [CORRECT]
C. Adjustment disorder with depressed mood
D. Unspecified depressive disorder
Correct Answer: B
Rationale: Persistent depressive disorder (dysthymia) is characterized by depressed mood present for at least
two years (one year in children/adolescents) more days than not, without remission sufficient to meet major
depressive episode criteria for over two consecutive months. Major depressive disorder requires discrete
episodes; adjustment disorder requires a clear stressor within 3 months; unspecified depressive disorder is
reserved for atypical presentations not meeting full criteria.
Q10: A 24-year-old male presents with euphoric mood, decreased need for sleep (3 hours/night for 4 days),
pressured speech, flight of ideas, and grandiose delusions that he has been chosen by God to lead a worldwide
humanitarian movement. He denies hallucinations. The most accurate DSM-5-TR diagnosis is:
A. Bipolar II disorder, current episode hypomanic
B. Bipolar I disorder, current episode manic with mood-congruent psychotic features [CORRECT]
C. Schizoaffective disorder, bipolar type
D. Cyclothymic disorder
Correct Answer: B
Rationale: Bipolar I disorder requires at least one manic episode. The presence of mood-congruent psychotic
features (grandiose delusions) and marked functional impairment with decreased need for sleep and pressured
speech confirms a manic episode. Bipolar II requires hypomania without psychosis or marked impairment.
Schizoaffective disorder requires psychotic symptoms in the absence of mood episodes for at least 2 weeks;
cyclothymic disorder requires chronic fluctuating mood without full manic/hypomanic/major depressive
episodes.
Page 4
NU 665 FINAL EXAM — WEEK 11
Questions and Answers (Questions and Correct Answers) — Best Test Bank for NU 665 Final Exam Preparation
Psychiatric-Mental Health Nurse Practitioner (PMHNP) | Graduate-Level Cumulative Final Examination | Week 11
Coverage
100 Questions | 6 Sections | Cognitive Distribution: 25% Recall, 50% Application, 25% Analysis | 80% Scenario-Based, 20% Direct
Recall
Instructions: This cumulative final examination consists of 100 multiple-choice questions distributed across six (6)
sections aligned with the PMHNP core competencies and NU 665 course objectives. Each question has four options (A–D)
with exactly one correct answer marked [CORRECT]. A detailed rationale with advanced-practice nursing clinical
reasoning is provided for each item. Cognitive level distribution: 25% recall, 50% application, 25% analysis.
Approximately 80% of items are scenario-based to mirror clinical practice.
SECTION 1: PSYCHIATRIC ASSESSMENT AND DIAGNOSTIC REASONING
Psychiatric History, Mental Status Examination, Diagnostic Criteria, & Differential Diagnosis (Q1–Q20)
Q1: A 34-year-old female presents to the clinic reporting persistent sadness, anhedonia, and a 12-pound weight loss
over the past 8 weeks. She denies suicidal ideation but endorses feeling 'worthless' and 'hopeless.' During the
psychiatric interview, the PMHNP should first:
A. Obtain a detailed family psychiatric history to rule out bipolar disorder
B. Perform a comprehensive suicide risk assessment using a validated tool such as the Columbia-Suicide
Severity Rating Scale (C-SSRS) [CORRECT]
C. Administer the PHQ-9 to confirm the diagnosis of major depressive disorder
D. Refer the patient for laboratory testing including TSH and vitamin B12 levels
Correct Answer: B
Rationale: Safety assessment is always the highest priority. Even when a patient denies suicidal ideation, the
presence of hopelessness and worthlessness are well-established risk factors for suicide, warranting a structured
risk assessment with a validated instrument such as the C-SSRS. Family history, screening tools, and laboratory
workup are important components of the evaluation but follow safety prioritization.
Page 1
,NU 665 Final Exam — Week 11 | PMHNP Preparation 100 Questions + Answers + Rationales
Q2: During a mental status examination, the PMHNP observes that the patient's speech is minimal in quantity, with
brief responses to questions, lacking additional spontaneous elaboration. This finding is best described as:
A. Tangential speech indicative of a thought disorder
B. Poverty of speech suggestive of depressive disorder or schizophrenia negative symptoms [CORRECT]
C. Perseveration consistent with frontal lobe dysfunction
D. Circumstantial speech reflective of cognitive rigidity
Correct Answer: B
Rationale: Poverty of speech (alogia) is a negative symptom characterized by restricted speech output with
brief, unelaborated responses. It is a core negative symptom of schizophrenia but also commonly observed in
major depressive disorder. Tangential speech, perseveration, and circumstantial speech represent distinct thought
process disturbances and are not consistent with this presentation.
Q3: A 67-year-old male with no prior psychiatric history is brought in by his daughter after he was found wandering
his neighborhood unable to identify his home. On MSE, he is alert but oriented only to person, misidentifies the
year as 1987, and cannot recall three objects after 5 minutes. The PMHNP's initial priority is to:
A. Initiate a cholinesterase inhibitor for suspected Alzheimer dementia
B. Order a comprehensive metabolic panel, TSH, vitamin B12, folate, RPR, and head imaging to rule out
reversible causes of cognitive impairment [CORRECT]
C. Diagnose neurocognitive disorder due to Alzheimer disease based on DSM-5-TR criteria
D. Refer for outpatient neuropsychological testing within 4 weeks
Correct Answer: B
Rationale: New-onset cognitive impairment in an older adult requires urgent evaluation for reversible causes
(delirium, hypothyroidism, B12 deficiency, neurosyphilis, subdural hematoma, normal pressure hydrocephalus)
before attributing symptoms to a neurodegenerative process. Initiating cholinesterase inhibitors prematurely
bypasses the essential differential diagnostic workup mandated by current practice guidelines.
Q4: A 28-year-old female presents with intrusive thoughts of her sexual assault that occurred 6 months ago,
nightmares, hypervigilance, and avoidance of crowds. She has been unable to return to work. Per DSM-5-TR,
the minimum duration of symptoms required for PTSD diagnosis is:
A. 3 days
B. 1 month [CORRECT]
C. 3 months
D. 6 months
Correct Answer: B
Rationale: Per DSM-5-TR criteria for posttraumatic stress disorder, symptoms must persist for more than one
month following the traumatic event. Symptoms lasting 3 days to 1 month meet criteria for acute stress disorder
rather than PTSD. The 3- and 6-month thresholds are not part of the PTSD diagnostic criteria but may inform
severity specifiers.
Page 2
,NU 665 Final Exam — Week 11 | PMHNP Preparation 100 Questions + Answers + Rationales
Q5: A 19-year-old college student is brought to the emergency department after telling his roommate he planned to
'end it all' by jumping off a bridge. He has a history of one prior suicide attempt by overdose. Which component
of the suicide risk assessment most strongly predicts future completed suicide?
A. Current suicidal ideation with a plan
B. Prior suicide attempt history [CORRECT]
C. Access to lethal means
D. Co-occurring substance use disorder
Correct Answer: B
Rationale: A prior suicide attempt is the single strongest predictor of future completed suicide, conferring a 30-
to 40-fold increased risk compared with the general population. While current ideation, plan specificity, access to
lethal means, and substance use all meaningfully contribute to acute risk stratification, the prior attempt history
carries the highest predictive weight in evidence-based risk assessment frameworks.
Q6: A 42-year-old male with schizophrenia demonstrates the following: when asked to explain the proverb 'People
in glass houses shouldn't throw stones,' he responds, 'Glass is fragile, stones are hard, houses have windows,
windows break.' This response best illustrates:
A. Concrete thinking characteristic of schizophrenia [CORRECT]
B. Loose associations reflecting formal thought disorder
C. Perseveration of recent content
D. Echolalia consistent with catatonia
Correct Answer: A
Rationale: Concrete thinking reflects an inability to abstract meaning from figurative language, producing literal
interpretations. The patient addresses each component of the proverb literally rather than extracting the
metaphorical meaning about hypocrisy. This is a classic finding in schizophrenia and other conditions with
cognitive impairment, distinct from loose associations (loss of logical connection), perseveration (repetition of
prior content), or echolalia (repetition of examiner's words).
Q7: Which of the following best describes the function of the Cultural Formulation Interview (CFI) included in
DSM-5-TR?
A. It provides standardized diagnostic criteria for culture-bound syndromes
B. It is a structured tool to assess cultural identity, cultural explanations of distress, cultural stressors, and
cultural features of the clinician-patient relationship [CORRECT]
C. It is a screening tool for psychiatric disorders in non-English-speaking patients
D. It replaces the standard mental status examination for culturally diverse populations
Correct Answer: B
Rationale: The Cultural Formulation Interview is a semi-structured interview designed to assess the patient's
cultural background and how it shapes their illness experience, help-seeking behavior, and the clinical encounter.
It complements rather than replaces the standard MSE and does not provide diagnostic criteria or function as a
screening tool. Its purpose is to enhance diagnostic accuracy and treatment planning through cultural humility.
Page 3
, NU 665 Final Exam — Week 11 | PMHNP Preparation 100 Questions + Answers + Rationales
Q8: A 56-year-old female is being evaluated for capacity to refuse a recommended cardiac catheterization. Which of
the following is the most important element the PMHNP must assess?
A. Whether the patient's refusal aligns with her family's wishes
B. Whether the patient can communicate a choice, understand relevant information, appreciate the
situation and consequences, and reason about treatment options [CORRECT]
C. Whether the patient has a documented advance directive
D. Whether the patient's decision is medically reasonable from the clinician's perspective
Correct Answer: B
Rationale: Decision-making capacity requires four distinct components: the ability to communicate a consistent
choice, to comprehend relevant information, to appreciate the situation and consequences as they apply to
oneself, and to reason about treatment alternatives. The Appelbaum criteria form the legal and ethical standard.
Capacity is decision-specific and time-specific; agreement with medical recommendations or family preferences
is not required for capacity determination.
Q9: A PMHNP is evaluating a 31-year-old male who reports a 2-year history of pervasive depressed mood, low
self-esteem, and fatigue without discrete episodes meeting criteria for major depressive disorder. The most
accurate DSM-5-TR diagnosis is:
A. Major depressive disorder, recurrent, mild
B. Persistent depressive disorder (dysthymia) [CORRECT]
C. Adjustment disorder with depressed mood
D. Unspecified depressive disorder
Correct Answer: B
Rationale: Persistent depressive disorder (dysthymia) is characterized by depressed mood present for at least
two years (one year in children/adolescents) more days than not, without remission sufficient to meet major
depressive episode criteria for over two consecutive months. Major depressive disorder requires discrete
episodes; adjustment disorder requires a clear stressor within 3 months; unspecified depressive disorder is
reserved for atypical presentations not meeting full criteria.
Q10: A 24-year-old male presents with euphoric mood, decreased need for sleep (3 hours/night for 4 days),
pressured speech, flight of ideas, and grandiose delusions that he has been chosen by God to lead a worldwide
humanitarian movement. He denies hallucinations. The most accurate DSM-5-TR diagnosis is:
A. Bipolar II disorder, current episode hypomanic
B. Bipolar I disorder, current episode manic with mood-congruent psychotic features [CORRECT]
C. Schizoaffective disorder, bipolar type
D. Cyclothymic disorder
Correct Answer: B
Rationale: Bipolar I disorder requires at least one manic episode. The presence of mood-congruent psychotic
features (grandiose delusions) and marked functional impairment with decreased need for sleep and pressured
speech confirms a manic episode. Bipolar II requires hypomania without psychosis or marked impairment.
Schizoaffective disorder requires psychotic symptoms in the absence of mood episodes for at least 2 weeks;
cyclothymic disorder requires chronic fluctuating mood without full manic/hypomanic/major depressive
episodes.
Page 4
