NR 547 MENTAL HEALTH FINAL REVIEW 2026 |
COMPREHENSIVE PRACTICE QUESTIONS &
ANSWERS WITH RATIONALES
DOMAIN 1: FOUNDATIONS OF DIFFERENTIAL DIAGNOSIS & DIAGNOSTIC REASONING
Question 1
A PMHNP is conducting an initial psychiatric evaluation. Which of the following best describes the
primary purpose of the "differential diagnosis" process?
A) To confirm the patient's self-reported diagnosis
B) To develop a working list of potential disorders that could explain the patient's symptoms
C) To rule out all medical causes of psychiatric symptoms before considering any mental health
diagnosis
D) To assign a single diagnosis that will guide all future treatment decisions
Correct Answer: B
Rationale: Differential diagnosis involves developing a working hypothesis or list of potential disorders
that could account for the presenting symptoms. This list is prioritized, and each potential diagnosis is
systematically ruled in or out based on diagnostic criteria, history, and assessment findings. It is not
about confirming a single diagnosis prematurely or ruling out all medical causes before considering
psychiatric ones .
Question 2
According to the DSM-5-TR, which of the following must be ruled out before assigning most psychiatric
diagnoses?
A) Childhood trauma history
B) Substance use and other medical conditions
C) Family history of mental illness
D) Recent stressful life events
Correct Answer: B
Rationale: The DSM-5-TR requires clinicians to rule out substance/medication-induced conditions and
other medical conditions as the primary cause of symptoms before assigning a primary psychiatric
diagnosis. This hierarchical approach ensures that treatable underlying medical conditions are not
overlooked .
,Question 3
During a mental status examination, the PMHNP notes the patient has looseness of associations, flight
of ideas, and tangential responses. Which MSE component is being assessed?
A) Mood and affect
B) Thought process
C) Thought content
D) Insight and judgment
Correct Answer: B
Rationale: Thought process refers to how a person thinks, including goal-directedness, logical
connections, and organization. Looseness of associations, flight of ideas, tangentiality, circumstantiality,
and thought blocking are all thought process abnormalities. Thought content (delusions, suicidal
ideation) is different; mood is subjective emotional state; affect is observed emotional expression .
Question 4
A patient describes hearing voices commenting on their actions when no one is present. Which MSE
component does this represent?
A) Thought process
B) Perception
C) Thought content
D) Cognition
Correct Answer: B
Rationale: Perception includes hallucinations (auditory, visual, tactile, olfactory, gustatory), which are
sensory experiences without external stimuli. Auditory hallucinations, particularly commenting voices,
are characteristic of psychotic disorders. This differs from thought content (delusions, obsessions),
cognition (memory, attention, executive function), and thought process (form of thinking) .
Question 5
A patient with schizophrenia reports that the CIA is monitoring their thoughts through special devices.
This belief persists despite evidence to the contrary. Which term describes this symptom?
A) Overvalued idea
B) Delusion
C) Obsession
D) Magical thinking
Correct Answer: B
,Rationale: A delusion is a fixed, false belief that is not amenable to change despite conflicting evidence,
not culturally sanctioned, and not consistent with educational/intellectual background. This persecutory
delusion is characteristic of psychotic disorders. Overvalued ideas are less fixed; obsessions are ego-
dystonic intrusive thoughts; magical thinking is non-pathological in some cultures .
Question 6
A 52-year-old client presents to the emergency department following a car accident. The client describes
persistent feelings of sadness and hopelessness and states, "I sometimes think about what it would be
like to take a handful of sleeping pills and go to sleep forever." The client reports a previous suicide
attempt at age 16 but denies current suicidal intent. Based on the ASQ screening, 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) Provide a STAT safety and full mental health evaluation
Correct Answer: B
Rationale: While the client denies current intent, the presence of past attempts and passive suicidal
ideation requires a brief suicide safety assessment to determine whether a full mental health evaluation
is necessary. It is also important to notify the clinician responsible for the client's care .
Question 7
Social determinants of health (SDOH) influence mental health outcomes. Which is an example of an
SDOH?
A) Genetic predisposition to depression
B) Discrimination, racism, and social exclusion
C) Medication side effects
D) Neurotransmitter imbalances
Correct Answer: B
Rationale: Social determinants of health are conditions in which people are born, grow, live, work, and
age. These include discrimination, racism, social exclusion, adverse childhood experiences, poverty,
housing instability, and lack of access to care. Genetic predisposition and neurotransmitter imbalances
are biological factors .
DOMAIN 2: LABORATORY INTERPRETATION & MEDICAL RULE-OUT
Question 8
, A 58-year-old female presents with fatigue, depressed mood, and difficulty concentrating. Her TSH is 6.3
mIU/L (normal 0.4-4.5). What is the most appropriate next step?
A) Prescribe an SSRI for major depressive disorder
B) Refer to primary care for treatment of hypothyroidism before reassessing mood symptoms
C) Diagnose adjustment disorder with depressed mood
D) Order additional thyroid studies and begin antidepressant therapy simultaneously
Correct Answer: B
Rationale: A TSH level >4.0 mIU/L is indicative of hypothyroidism, which is associated with fatigue and
depressive symptoms. The client requires referral for treatment of hypothyroidism and can be
reevaluated for mood symptoms if they persist after thyroid treatment has been initiated and TSH levels
are within normal limits .
Question 9
A 79-year-old presents with confusion. Urinalysis shows positive urine leukocyte esterase. What is the
most appropriate action?
A) Begin treatment for depression
B) Refer for treatment of urinary tract infection
C) Start antipsychotic medication
D) Order a head CT
Correct Answer: B
Rationale: A positive urine leukocyte esterase indicates the presence of a urinary tract infection (UTI),
which may cause confusion, especially in older adults. The PMHNP should refer this client for treatment
of the UTI, as the acute mental status changes may resolve once the infection is treated .
Question 10
A 24-year-old presents with anxiety. Her T3 level is 260 ng/dL (elevated). What is the most appropriate
action?
A) Begin SSRI for generalized anxiety disorder
B) Refer for treatment of hyperthyroidism before reassessing anxiety
C) Order additional psychiatric screening
D) Prescribe benzodiazepines as needed
Correct Answer: B
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is associated with
anxiety symptoms. The client can be reevaluated for anxiety once hyperthyroid treatment has been
initiated and T3 levels are within normal limits .
COMPREHENSIVE PRACTICE QUESTIONS &
ANSWERS WITH RATIONALES
DOMAIN 1: FOUNDATIONS OF DIFFERENTIAL DIAGNOSIS & DIAGNOSTIC REASONING
Question 1
A PMHNP is conducting an initial psychiatric evaluation. Which of the following best describes the
primary purpose of the "differential diagnosis" process?
A) To confirm the patient's self-reported diagnosis
B) To develop a working list of potential disorders that could explain the patient's symptoms
C) To rule out all medical causes of psychiatric symptoms before considering any mental health
diagnosis
D) To assign a single diagnosis that will guide all future treatment decisions
Correct Answer: B
Rationale: Differential diagnosis involves developing a working hypothesis or list of potential disorders
that could account for the presenting symptoms. This list is prioritized, and each potential diagnosis is
systematically ruled in or out based on diagnostic criteria, history, and assessment findings. It is not
about confirming a single diagnosis prematurely or ruling out all medical causes before considering
psychiatric ones .
Question 2
According to the DSM-5-TR, which of the following must be ruled out before assigning most psychiatric
diagnoses?
A) Childhood trauma history
B) Substance use and other medical conditions
C) Family history of mental illness
D) Recent stressful life events
Correct Answer: B
Rationale: The DSM-5-TR requires clinicians to rule out substance/medication-induced conditions and
other medical conditions as the primary cause of symptoms before assigning a primary psychiatric
diagnosis. This hierarchical approach ensures that treatable underlying medical conditions are not
overlooked .
,Question 3
During a mental status examination, the PMHNP notes the patient has looseness of associations, flight
of ideas, and tangential responses. Which MSE component is being assessed?
A) Mood and affect
B) Thought process
C) Thought content
D) Insight and judgment
Correct Answer: B
Rationale: Thought process refers to how a person thinks, including goal-directedness, logical
connections, and organization. Looseness of associations, flight of ideas, tangentiality, circumstantiality,
and thought blocking are all thought process abnormalities. Thought content (delusions, suicidal
ideation) is different; mood is subjective emotional state; affect is observed emotional expression .
Question 4
A patient describes hearing voices commenting on their actions when no one is present. Which MSE
component does this represent?
A) Thought process
B) Perception
C) Thought content
D) Cognition
Correct Answer: B
Rationale: Perception includes hallucinations (auditory, visual, tactile, olfactory, gustatory), which are
sensory experiences without external stimuli. Auditory hallucinations, particularly commenting voices,
are characteristic of psychotic disorders. This differs from thought content (delusions, obsessions),
cognition (memory, attention, executive function), and thought process (form of thinking) .
Question 5
A patient with schizophrenia reports that the CIA is monitoring their thoughts through special devices.
This belief persists despite evidence to the contrary. Which term describes this symptom?
A) Overvalued idea
B) Delusion
C) Obsession
D) Magical thinking
Correct Answer: B
,Rationale: A delusion is a fixed, false belief that is not amenable to change despite conflicting evidence,
not culturally sanctioned, and not consistent with educational/intellectual background. This persecutory
delusion is characteristic of psychotic disorders. Overvalued ideas are less fixed; obsessions are ego-
dystonic intrusive thoughts; magical thinking is non-pathological in some cultures .
Question 6
A 52-year-old client presents to the emergency department following a car accident. The client describes
persistent feelings of sadness and hopelessness and states, "I sometimes think about what it would be
like to take a handful of sleeping pills and go to sleep forever." The client reports a previous suicide
attempt at age 16 but denies current suicidal intent. Based on the ASQ screening, 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) Provide a STAT safety and full mental health evaluation
Correct Answer: B
Rationale: While the client denies current intent, the presence of past attempts and passive suicidal
ideation requires a brief suicide safety assessment to determine whether a full mental health evaluation
is necessary. It is also important to notify the clinician responsible for the client's care .
Question 7
Social determinants of health (SDOH) influence mental health outcomes. Which is an example of an
SDOH?
A) Genetic predisposition to depression
B) Discrimination, racism, and social exclusion
C) Medication side effects
D) Neurotransmitter imbalances
Correct Answer: B
Rationale: Social determinants of health are conditions in which people are born, grow, live, work, and
age. These include discrimination, racism, social exclusion, adverse childhood experiences, poverty,
housing instability, and lack of access to care. Genetic predisposition and neurotransmitter imbalances
are biological factors .
DOMAIN 2: LABORATORY INTERPRETATION & MEDICAL RULE-OUT
Question 8
, A 58-year-old female presents with fatigue, depressed mood, and difficulty concentrating. Her TSH is 6.3
mIU/L (normal 0.4-4.5). What is the most appropriate next step?
A) Prescribe an SSRI for major depressive disorder
B) Refer to primary care for treatment of hypothyroidism before reassessing mood symptoms
C) Diagnose adjustment disorder with depressed mood
D) Order additional thyroid studies and begin antidepressant therapy simultaneously
Correct Answer: B
Rationale: A TSH level >4.0 mIU/L is indicative of hypothyroidism, which is associated with fatigue and
depressive symptoms. The client requires referral for treatment of hypothyroidism and can be
reevaluated for mood symptoms if they persist after thyroid treatment has been initiated and TSH levels
are within normal limits .
Question 9
A 79-year-old presents with confusion. Urinalysis shows positive urine leukocyte esterase. What is the
most appropriate action?
A) Begin treatment for depression
B) Refer for treatment of urinary tract infection
C) Start antipsychotic medication
D) Order a head CT
Correct Answer: B
Rationale: A positive urine leukocyte esterase indicates the presence of a urinary tract infection (UTI),
which may cause confusion, especially in older adults. The PMHNP should refer this client for treatment
of the UTI, as the acute mental status changes may resolve once the infection is treated .
Question 10
A 24-year-old presents with anxiety. Her T3 level is 260 ng/dL (elevated). What is the most appropriate
action?
A) Begin SSRI for generalized anxiety disorder
B) Refer for treatment of hyperthyroidism before reassessing anxiety
C) Order additional psychiatric screening
D) Prescribe benzodiazepines as needed
Correct Answer: B
Rationale: Clients with hyperthyroidism have elevated T3 levels. Hyperthyroidism is associated with
anxiety symptoms. The client can be reevaluated for anxiety once hyperthyroid treatment has been
initiated and T3 levels are within normal limits .
