NRNP 6665 MIDTERM EXAM PRACTICE |
COMPREHENSIVE STUDY GUIDE | ADVANCED
TESTBANK | PRACTICE 2026/2027 UPDATE EXAM
QUESTIONS 100% WITH CORRECT ANSWERS AND
RATIOALES
Question: A psychiatric mental health nurse practitioner (PMHNP) evaluates an
adult patient who reports two weeks of depressed mood, loss of interest in
previously enjoyable activities, fatigue, impaired concentration, and feelings of
worthlessness. Which additional finding would most strongly support a diagnosis
of a major depressive episode?
A. Symptoms occurring exclusively during periods of intoxication
B. Symptoms causing clinically significant impairment in social or occupational
functioning
C. A history of elevated mood lasting two days
D. Depressed mood occurring only after interpersonal disagreements
Answer: B. Symptoms causing clinically significant impairment in social or
occupational functioning
Rationale: Clinically significant distress or impairment is an important
component of a major depressive episode. The symptoms must represent a
change from previous functioning and cannot be better explained by substances,
another medical condition, or another psychiatric disorder. A brief period of
elevated mood does not establish mania or hypomania, while depressive
symptoms that occur exclusively with intoxication suggest a possible substance-
induced condition. Symptoms limited to ordinary reactions to interpersonal
conflict also require careful differentiation from a depressive disorder.
Question: A patient presents with persistent anxiety, excessive worry about
several areas of life, difficulty controlling the worry, muscle tension, restlessness,
Page 1 of 53
,and sleep disturbance. The symptoms have persisted for more than six months.
Which diagnosis is most consistent with this presentation?
A. Panic disorder
B. Generalized anxiety disorder
C. Specific phobia
D. Adjustment disorder
Answer: B. Generalized anxiety disorder
Rationale: Generalized anxiety disorder is characterized by excessive anxiety
and worry about multiple areas of life that are difficult to control and occur more
days than not over an extended period. Associated symptoms may include
restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep
disturbance. Panic disorder instead centers on recurrent unexpected panic attacks
and concern about additional attacks or their consequences. Specific phobia
involves marked fear of a particular object or situation, while adjustment disorder
involves emotional or behavioral symptoms occurring in response to an
identifiable stressor and does not typically meet criteria for another specific
disorder.
Question: A patient reports sudden episodes of intense fear accompanied by
palpitations, trembling, shortness of breath, chest discomfort, dizziness, and fear
of losing control. The episodes occur unexpectedly. Which diagnosis should the
PMHNP consider most strongly?
A. Panic disorder
B. Generalized anxiety disorder
C. Social anxiety disorder
D. Obsessive-compulsive disorder
Answer: A. Panic disorder
Rationale: Panic attacks involve an abrupt surge of intense fear or discomfort
accompanied by physical and cognitive symptoms such as palpitations, sweating,
trembling, shortness of breath, chest discomfort, dizziness, and fear of losing
Page 2 of 53
,control. Panic disorder is considered when recurrent unexpected panic attacks are
followed by persistent concern or maladaptive behavioral changes related to the
attacks. Generalized anxiety disorder involves chronic excessive worry rather than
discrete episodes of intense fear. Social anxiety disorder centers on fear of
scrutiny or negative evaluation, whereas obsessive-compulsive disorder involves
obsessions, compulsions, or both.
Question: During an assessment, a patient describes recurrent intrusive thoughts
that their hands are contaminated despite recognizing that the thoughts are
excessive. The patient repeatedly washes their hands to reduce anxiety. Which
feature most clearly distinguishes this presentation from a psychotic disorder?
A. The thoughts are accompanied by anxiety
B. The patient recognizes that the thoughts are unreasonable or excessive
C. The patient performs repetitive behaviors
D. The symptoms interfere with daily functioning
Answer: B. The patient recognizes that the thoughts are unreasonable or
excessive
Rationale: Obsessions are intrusive, unwanted, recurrent thoughts, urges, or
images that cause anxiety or distress. Compulsions are repetitive behaviors or
mental acts performed in response to the obsession or according to rigid rules.
Importantly, patients with obsessive-compulsive disorder commonly retain at least
some degree of insight into the excessive or unreasonable nature of their
symptoms. Psychotic delusions, in contrast, are fixed beliefs that are not typically
recognized by the patient as irrational. The presence of anxiety, repetitive
behavior, and functional impairment can occur in several psychiatric conditions
and therefore is not sufficient by itself to distinguish OCD from psychosis.
Question: A patient has experienced elevated and expansive mood, markedly
increased energy, decreased need for sleep, pressured speech, grandiosity, and
impulsive spending for eight days. The symptoms have resulted in significant
occupational impairment. Which diagnosis is most appropriate?
Page 3 of 53
, A. Major depressive disorder
B. Generalized anxiety disorder
C. Bipolar I disorder
D. Persistent depressive disorder
Answer: C. Bipolar I disorder
Rationale: Bipolar I disorder requires the occurrence of at least one manic
episode. Mania involves a distinct period of abnormally elevated, expansive, or
irritable mood and increased goal-directed activity or energy, accompanied by
characteristic symptoms such as decreased need for sleep, grandiosity, pressured
speech, racing thoughts, distractibility, increased activity, or risky behavior. A
manic episode causes marked impairment, may require hospitalization, or may
include psychotic features. The duration and severity described here are
consistent with mania. Hypomania is less severe and does not cause marked
functional impairment or require hospitalization.
Question: A patient has periods of elevated mood, increased productivity,
decreased need for sleep, and increased sociability lasting several days, followed
by periods of depression. During the elevated periods, the patient remains able to
work and has no psychosis or marked functional impairment. Which diagnosis is
most consistent with this presentation if full mania has never occurred?
A. Bipolar I disorder
B. Bipolar II disorder
C. Schizophrenia
D. Cyclothymic disorder
Answer: B. Bipolar II disorder
Rationale: Bipolar II disorder is characterized by at least one hypomanic
episode and at least one major depressive episode, without a history of a manic
episode. Hypomania produces a noticeable change in functioning but is not severe
enough to cause marked impairment, require hospitalization, or involve psychosis.
Bipolar I requires at least one manic episode and does not require a major
depressive episode for diagnosis. Cyclothymic disorder involves numerous periods
Page 4 of 53
COMPREHENSIVE STUDY GUIDE | ADVANCED
TESTBANK | PRACTICE 2026/2027 UPDATE EXAM
QUESTIONS 100% WITH CORRECT ANSWERS AND
RATIOALES
Question: A psychiatric mental health nurse practitioner (PMHNP) evaluates an
adult patient who reports two weeks of depressed mood, loss of interest in
previously enjoyable activities, fatigue, impaired concentration, and feelings of
worthlessness. Which additional finding would most strongly support a diagnosis
of a major depressive episode?
A. Symptoms occurring exclusively during periods of intoxication
B. Symptoms causing clinically significant impairment in social or occupational
functioning
C. A history of elevated mood lasting two days
D. Depressed mood occurring only after interpersonal disagreements
Answer: B. Symptoms causing clinically significant impairment in social or
occupational functioning
Rationale: Clinically significant distress or impairment is an important
component of a major depressive episode. The symptoms must represent a
change from previous functioning and cannot be better explained by substances,
another medical condition, or another psychiatric disorder. A brief period of
elevated mood does not establish mania or hypomania, while depressive
symptoms that occur exclusively with intoxication suggest a possible substance-
induced condition. Symptoms limited to ordinary reactions to interpersonal
conflict also require careful differentiation from a depressive disorder.
Question: A patient presents with persistent anxiety, excessive worry about
several areas of life, difficulty controlling the worry, muscle tension, restlessness,
Page 1 of 53
,and sleep disturbance. The symptoms have persisted for more than six months.
Which diagnosis is most consistent with this presentation?
A. Panic disorder
B. Generalized anxiety disorder
C. Specific phobia
D. Adjustment disorder
Answer: B. Generalized anxiety disorder
Rationale: Generalized anxiety disorder is characterized by excessive anxiety
and worry about multiple areas of life that are difficult to control and occur more
days than not over an extended period. Associated symptoms may include
restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep
disturbance. Panic disorder instead centers on recurrent unexpected panic attacks
and concern about additional attacks or their consequences. Specific phobia
involves marked fear of a particular object or situation, while adjustment disorder
involves emotional or behavioral symptoms occurring in response to an
identifiable stressor and does not typically meet criteria for another specific
disorder.
Question: A patient reports sudden episodes of intense fear accompanied by
palpitations, trembling, shortness of breath, chest discomfort, dizziness, and fear
of losing control. The episodes occur unexpectedly. Which diagnosis should the
PMHNP consider most strongly?
A. Panic disorder
B. Generalized anxiety disorder
C. Social anxiety disorder
D. Obsessive-compulsive disorder
Answer: A. Panic disorder
Rationale: Panic attacks involve an abrupt surge of intense fear or discomfort
accompanied by physical and cognitive symptoms such as palpitations, sweating,
trembling, shortness of breath, chest discomfort, dizziness, and fear of losing
Page 2 of 53
,control. Panic disorder is considered when recurrent unexpected panic attacks are
followed by persistent concern or maladaptive behavioral changes related to the
attacks. Generalized anxiety disorder involves chronic excessive worry rather than
discrete episodes of intense fear. Social anxiety disorder centers on fear of
scrutiny or negative evaluation, whereas obsessive-compulsive disorder involves
obsessions, compulsions, or both.
Question: During an assessment, a patient describes recurrent intrusive thoughts
that their hands are contaminated despite recognizing that the thoughts are
excessive. The patient repeatedly washes their hands to reduce anxiety. Which
feature most clearly distinguishes this presentation from a psychotic disorder?
A. The thoughts are accompanied by anxiety
B. The patient recognizes that the thoughts are unreasonable or excessive
C. The patient performs repetitive behaviors
D. The symptoms interfere with daily functioning
Answer: B. The patient recognizes that the thoughts are unreasonable or
excessive
Rationale: Obsessions are intrusive, unwanted, recurrent thoughts, urges, or
images that cause anxiety or distress. Compulsions are repetitive behaviors or
mental acts performed in response to the obsession or according to rigid rules.
Importantly, patients with obsessive-compulsive disorder commonly retain at least
some degree of insight into the excessive or unreasonable nature of their
symptoms. Psychotic delusions, in contrast, are fixed beliefs that are not typically
recognized by the patient as irrational. The presence of anxiety, repetitive
behavior, and functional impairment can occur in several psychiatric conditions
and therefore is not sufficient by itself to distinguish OCD from psychosis.
Question: A patient has experienced elevated and expansive mood, markedly
increased energy, decreased need for sleep, pressured speech, grandiosity, and
impulsive spending for eight days. The symptoms have resulted in significant
occupational impairment. Which diagnosis is most appropriate?
Page 3 of 53
, A. Major depressive disorder
B. Generalized anxiety disorder
C. Bipolar I disorder
D. Persistent depressive disorder
Answer: C. Bipolar I disorder
Rationale: Bipolar I disorder requires the occurrence of at least one manic
episode. Mania involves a distinct period of abnormally elevated, expansive, or
irritable mood and increased goal-directed activity or energy, accompanied by
characteristic symptoms such as decreased need for sleep, grandiosity, pressured
speech, racing thoughts, distractibility, increased activity, or risky behavior. A
manic episode causes marked impairment, may require hospitalization, or may
include psychotic features. The duration and severity described here are
consistent with mania. Hypomania is less severe and does not cause marked
functional impairment or require hospitalization.
Question: A patient has periods of elevated mood, increased productivity,
decreased need for sleep, and increased sociability lasting several days, followed
by periods of depression. During the elevated periods, the patient remains able to
work and has no psychosis or marked functional impairment. Which diagnosis is
most consistent with this presentation if full mania has never occurred?
A. Bipolar I disorder
B. Bipolar II disorder
C. Schizophrenia
D. Cyclothymic disorder
Answer: B. Bipolar II disorder
Rationale: Bipolar II disorder is characterized by at least one hypomanic
episode and at least one major depressive episode, without a history of a manic
episode. Hypomania produces a noticeable change in functioning but is not severe
enough to cause marked impairment, require hospitalization, or involve psychosis.
Bipolar I requires at least one manic episode and does not require a major
depressive episode for diagnosis. Cyclothymic disorder involves numerous periods
Page 4 of 53
