NR 547 Midterm Exam Study Guide
2026 | Mental Health Nursing
Practice Test
Questions
SECTION 9: Psychopharmacology and Medication Management
SECTION 1: Foundations of Differential Diagnosis
Question 1
A 42-year-old female presents with persistent sadness, fatigue, and difficulty
concentrating for the past 6 weeks. She denies suicidal ideation but reports
decreased appetite and insomnia. Her medical history is significant for
hypothyroidism. Which initial diagnostic step is most essential before formulating
a psychiatric differential diagnosis?
A. Initiating a selective serotonin reuptake inhibitor (SSRI) for presumed major
depressive disorder
B. Ordering a thyroid-stimulating hormone (TSH) level to assess thyroid function
C. Administering the Patient Health Questionnaire-9 (PHQ-9) as the sole
diagnostic instrument
D. Referring the patient immediately to a psychiatrist for complex case
management
Correct Answer: B – Ordering a thyroid-stimulating hormone (TSH) level to
assess thyroid function
Rationale: Hypothyroidism is a well-established medical mimic of depression;
evaluating TSH is essential to rule out physiologic causes before attributing
symptoms to a primary psychiatric disorder. Initiating medication without
,completing the differential diagnostic process violates fundamental diagnostic
reasoning principles. Screening tools like the PHQ-9 should supplement, not
replace, thorough medical evaluation .
Question 2
What is the initial hypothesis formulated by a provider trying to uncover the
cause of a client's signs and symptoms?
A. Final Diagnosis
B. Differential Diagnosis
C. Treatment Plan
D. Subjective History
Correct Answer: B – Differential Diagnosis
Rationale: The provider's initial hypothesis is known as the differential
diagnosis—a working list of potential problems associated with the chief
complaint. Establishing a differential is a critical step in clinical reasoning to
distinguish one disease from another based on evidence. The DSM-5-TR provides
guidance for identifying psychiatric disorders, but the differential process begins
before applying diagnostic criteria .
Question 3
A PMHNP is evaluating a 19-year-old college student who presents with acute
onset of paranoia, disorganized speech, and auditory hallucinations following a
week of heavy amphetamine use. The patient's mother reports no prior
psychiatric history. Which principle of differential diagnosis best guides the initial
diagnostic formulation?
A. Assuming schizophrenia spectrum disorder given the presence of first-rank
symptoms
B. Prioritizing substance-induced psychotic disorder in the differential given
temporal association with amphetamine use
C. Diagnosing brief psychotic disorder due to acute stress from academic
,pressures
D. Ruling out malingering before considering any genuine psychiatric condition
Correct Answer: B – Prioritizing substance-induced psychotic disorder
Rationale: The temporal association between amphetamine use and psychotic
symptoms strongly suggests substance-induced psychotic disorder. The DSM-5-TR
requires ruling out substances before diagnosing primary psychotic disorders.
According to DSM-5 criteria, psychiatric symptoms can be attributed to substance
abuse if they stop within one month of stopping the substance. If symptoms
persist without substances, then a primary psychiatric disorder should be
considered .
Question 4
A 35-year-old male veteran presents with irritability, hypervigilance, intrusive
memories of combat, and emotional numbing. He also reports drinking 6-8 beers
nightly to "quiet his mind." Which diagnostic approach best addresses the
complexity of co-occurring conditions?
A. Diagnosing post-traumatic stress disorder (PTSD) and deferring alcohol use
assessment until PTSD is stabilized
B. Diagnosing both PTSD and alcohol use disorder concurrently, recognizing their
bidirectional relationship
C. Attributing all symptoms to alcohol use disorder and deferring PTSD evaluation
D. Diagnosing adjustment disorder with mixed anxiety and depressed mood as
the primary condition
Correct Answer: B – Diagnosing both PTSD and alcohol use disorder
concurrently
Rationale: PTSD and alcohol use disorder frequently co-occur with bidirectional
maintenance. The DSM-5-TR permits concurrent diagnoses, and integrated
treatment addressing both conditions yields superior outcomes. Sequential rather
than integrated diagnostic reasoning may delay necessary substance use
intervention .
, Question 5
Which of the following is a step in the "SNAPPS" method used for client
presentations?
A. Summarize, Narrow, Analyze, Probe, Plan, Select
B. State, Name, Assess, Present, Plan, Summarize
C. Screen, Notify, Assess, Process, Plan, Solve
D. Summarize, Navigate, Assess, Present, Plan, Select
Correct Answer: A – Summarize, Narrow, Analyze, Probe, Plan, Select
Rationale: SNAPPS is a structured method for case presentations used in clinical
education. The acronym stands for: Summarize the case, Narrow the differential
diagnosis, Analyze the differential, Probe the preceptor about uncertainties, Plan
management, and Select an issue for self-directed learning. This approach
enhances clinical reasoning and educational outcomes .
Question 6
A 28-year-old woman with a 2-year history of fluctuating mood symptoms,
impulsivity, unstable relationships, and recurrent self-harm reports that
antidepressants prescribed by her primary care provider worsened her mood
swings. Which diagnostic consideration is most critical in this case?
A. Confirming bipolar II disorder based on antidepressant-induced mood elevation
B. Evaluating for borderline personality disorder as a primary or comorbid
diagnosis
C. Diagnosing major depressive disorder with anxious distress and continuing
antidepressant therapy
D. Attributing symptoms to premenstrual dysphoric disorder given the patient's
gender
Correct Answer: B – Evaluating for borderline personality disorder as a primary
or comorbid diagnosis
Rationale: The pattern of chronic interpersonal instability, impulsivity, self-harm,
and affective dysregulation in a young adult woman warrants evaluation for
2026 | Mental Health Nursing
Practice Test
Questions
SECTION 9: Psychopharmacology and Medication Management
SECTION 1: Foundations of Differential Diagnosis
Question 1
A 42-year-old female presents with persistent sadness, fatigue, and difficulty
concentrating for the past 6 weeks. She denies suicidal ideation but reports
decreased appetite and insomnia. Her medical history is significant for
hypothyroidism. Which initial diagnostic step is most essential before formulating
a psychiatric differential diagnosis?
A. Initiating a selective serotonin reuptake inhibitor (SSRI) for presumed major
depressive disorder
B. Ordering a thyroid-stimulating hormone (TSH) level to assess thyroid function
C. Administering the Patient Health Questionnaire-9 (PHQ-9) as the sole
diagnostic instrument
D. Referring the patient immediately to a psychiatrist for complex case
management
Correct Answer: B – Ordering a thyroid-stimulating hormone (TSH) level to
assess thyroid function
Rationale: Hypothyroidism is a well-established medical mimic of depression;
evaluating TSH is essential to rule out physiologic causes before attributing
symptoms to a primary psychiatric disorder. Initiating medication without
,completing the differential diagnostic process violates fundamental diagnostic
reasoning principles. Screening tools like the PHQ-9 should supplement, not
replace, thorough medical evaluation .
Question 2
What is the initial hypothesis formulated by a provider trying to uncover the
cause of a client's signs and symptoms?
A. Final Diagnosis
B. Differential Diagnosis
C. Treatment Plan
D. Subjective History
Correct Answer: B – Differential Diagnosis
Rationale: The provider's initial hypothesis is known as the differential
diagnosis—a working list of potential problems associated with the chief
complaint. Establishing a differential is a critical step in clinical reasoning to
distinguish one disease from another based on evidence. The DSM-5-TR provides
guidance for identifying psychiatric disorders, but the differential process begins
before applying diagnostic criteria .
Question 3
A PMHNP is evaluating a 19-year-old college student who presents with acute
onset of paranoia, disorganized speech, and auditory hallucinations following a
week of heavy amphetamine use. The patient's mother reports no prior
psychiatric history. Which principle of differential diagnosis best guides the initial
diagnostic formulation?
A. Assuming schizophrenia spectrum disorder given the presence of first-rank
symptoms
B. Prioritizing substance-induced psychotic disorder in the differential given
temporal association with amphetamine use
C. Diagnosing brief psychotic disorder due to acute stress from academic
,pressures
D. Ruling out malingering before considering any genuine psychiatric condition
Correct Answer: B – Prioritizing substance-induced psychotic disorder
Rationale: The temporal association between amphetamine use and psychotic
symptoms strongly suggests substance-induced psychotic disorder. The DSM-5-TR
requires ruling out substances before diagnosing primary psychotic disorders.
According to DSM-5 criteria, psychiatric symptoms can be attributed to substance
abuse if they stop within one month of stopping the substance. If symptoms
persist without substances, then a primary psychiatric disorder should be
considered .
Question 4
A 35-year-old male veteran presents with irritability, hypervigilance, intrusive
memories of combat, and emotional numbing. He also reports drinking 6-8 beers
nightly to "quiet his mind." Which diagnostic approach best addresses the
complexity of co-occurring conditions?
A. Diagnosing post-traumatic stress disorder (PTSD) and deferring alcohol use
assessment until PTSD is stabilized
B. Diagnosing both PTSD and alcohol use disorder concurrently, recognizing their
bidirectional relationship
C. Attributing all symptoms to alcohol use disorder and deferring PTSD evaluation
D. Diagnosing adjustment disorder with mixed anxiety and depressed mood as
the primary condition
Correct Answer: B – Diagnosing both PTSD and alcohol use disorder
concurrently
Rationale: PTSD and alcohol use disorder frequently co-occur with bidirectional
maintenance. The DSM-5-TR permits concurrent diagnoses, and integrated
treatment addressing both conditions yields superior outcomes. Sequential rather
than integrated diagnostic reasoning may delay necessary substance use
intervention .
, Question 5
Which of the following is a step in the "SNAPPS" method used for client
presentations?
A. Summarize, Narrow, Analyze, Probe, Plan, Select
B. State, Name, Assess, Present, Plan, Summarize
C. Screen, Notify, Assess, Process, Plan, Solve
D. Summarize, Navigate, Assess, Present, Plan, Select
Correct Answer: A – Summarize, Narrow, Analyze, Probe, Plan, Select
Rationale: SNAPPS is a structured method for case presentations used in clinical
education. The acronym stands for: Summarize the case, Narrow the differential
diagnosis, Analyze the differential, Probe the preceptor about uncertainties, Plan
management, and Select an issue for self-directed learning. This approach
enhances clinical reasoning and educational outcomes .
Question 6
A 28-year-old woman with a 2-year history of fluctuating mood symptoms,
impulsivity, unstable relationships, and recurrent self-harm reports that
antidepressants prescribed by her primary care provider worsened her mood
swings. Which diagnostic consideration is most critical in this case?
A. Confirming bipolar II disorder based on antidepressant-induced mood elevation
B. Evaluating for borderline personality disorder as a primary or comorbid
diagnosis
C. Diagnosing major depressive disorder with anxious distress and continuing
antidepressant therapy
D. Attributing symptoms to premenstrual dysphoric disorder given the patient's
gender
Correct Answer: B – Evaluating for borderline personality disorder as a primary
or comorbid diagnosis
Rationale: The pattern of chronic interpersonal instability, impulsivity, self-harm,
and affective dysregulation in a young adult woman warrants evaluation for
