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1. Somatic symptom disorder is best characterized by:
■ One or more distressing somatic symptoms with excessive thoughts, feelings, or behaviors related to them
• Intentional production of symptoms for financial gain
• Persistent fear of having a serious illness despite no somatic symptoms
• Loss of memory caused by a neurologic lesion
Correct answer: One or more distressing somatic symptoms with excessive thoughts, feelings, or behaviors related to them
Rationale: The diagnosis centers on distressing somatic symptoms plus excessive health-related thoughts, feelings, or behaviors.
2. A patient has neurologic-appearing weakness that is internally inconsistent with recognized neurologic
disease. Which diagnosis is most appropriate?
■ Functional neurological symptom disorder
• Illness anxiety disorder
• Factitious disorder
• Delusional disorder
Correct answer: Functional neurological symptom disorder
Rationale: Functional neurologic symptoms are incompatible with recognized neurologic conditions and are not explained by another
neurologic disease.
3. A patient repeatedly seeks medical evaluation because of fear of cancer but reports little to no bodily
symptom burden. Which disorder is most likely?
■ Illness anxiety disorder
• Somatic symptom disorder
• Conversion disorder
• Factitious disorder
Correct answer: Illness anxiety disorder
Rationale: Illness anxiety disorder involves preoccupation with having or acquiring serious illness with minimal or absent somatic
symptoms.
4. Which feature most strongly suggests factitious disorder?
■ Symptoms are intentionally produced to assume the sick role
• Symptoms are produced for external financial gain
• Symptoms are always associated with psychosis
• Symptoms occur only during panic attacks
Correct answer: Symptoms are intentionally produced to assume the sick role
Rationale: Factitious disorder involves intentional falsification or induction of illness without an obvious external reward.
5. A patient exaggerates back pain after a workplace injury primarily to obtain compensation. Which concept
best explains the behavior?
■ Malingering
• Factitious disorder
• Somatic symptom disorder
• Illness anxiety disorder
Correct answer: Malingering
Rationale: Malingering is intentional symptom production for an external incentive.
NRNP 6665 Week 11 Practice Exam • Page 1
,6. The best initial communication strategy for a patient with persistent medically unexplained symptoms is to:
■ Acknowledge the symptoms as real while establishing a structured, limited evaluation and follow-up plan
• Tell the patient the symptoms are imaginary
• Order every available diagnostic test
• Avoid discussing symptoms to prevent reinforcement
Correct answer: Acknowledge the symptoms as real while establishing a structured, limited evaluation and follow-up plan
Rationale: Validation plus coordinated, structured care reduces fragmentation and unnecessary testing.
Original schematic diagram for study use.
7. Which finding argues against factitious disorder?
■ A clear external incentive for producing symptoms
• Repeated hospitalizations with inconsistent histories
• Knowledge of medical terminology
• Symptoms that change across encounters
Correct answer: A clear external incentive for producing symptoms
Rationale: A clear external incentive points toward malingering rather than factitious disorder.
8. A patient presents with blindness, but pupillary reflexes and visual pathways are intact and the pattern is
inconsistent with anatomy. What is the key diagnostic clue?
■ Incompatibility between the symptom and recognized neurologic disease
• A history of financial gain
• Presence of auditory hallucinations
• A fixed false belief about vision
Correct answer: Incompatibility between the symptom and recognized neurologic disease
Rationale: Incompatibility with recognized neurologic disease is a core diagnostic feature of functional neurologic symptom disorder.
9. Which management approach is least appropriate for somatic symptom disorder?
■ Repeated unnecessary invasive testing without a clinical indication
• Regular scheduled follow-up
• One coordinating clinician
• Treatment of coexisting anxiety or depression
Correct answer: Repeated unnecessary invasive testing without a clinical indication
Rationale: Repeated low-yield testing can increase harm and reinforce illness-focused behavior.
NRNP 6665 Week 11 Practice Exam • Page 2
,10. When assessing a patient with unexplained physical complaints, the PMHNP should first:
■ Rule out urgent medical causes while assessing psychiatric and psychosocial contributors
• Assume symptoms are psychiatric
• Avoid obtaining a medical history
• Diagnose malingering when tests are normal
Correct answer: Rule out urgent medical causes while assessing psychiatric and psychosocial contributors
Rationale: Psychiatric formulation should not replace appropriate assessment for potentially serious medical illness.
11. Dissociative identity disorder is characterized by:
■ Disruption of identity involving two or more distinct personality states
• Only episodic panic attacks
• Persistent depressed mood for 2 weeks
• Delusions lasting more than 1 month
Correct answer: Disruption of identity involving two or more distinct personality states
Rationale: Dissociative identity disorder involves disruption of identity with distinct personality states and associated discontinuity in sense
of self and behavior.
12. Dissociative amnesia primarily involves:
■ Inability to recall important autobiographical information
• Loss of all procedural memory
• Progressive global cognitive decline
• Delirium with fluctuating attention
Correct answer: Inability to recall important autobiographical information
Rationale: Dissociative amnesia is an inability to recall important autobiographical information, usually related to trauma or stress.
13. Depersonalization refers to:
■ Feeling detached from one's own self or mental processes
• Feeling that the external world is unreal
• Loss of autobiographical memory
• Hearing voices commenting on behavior
Correct answer: Feeling detached from one's own self or mental processes
Rationale: Depersonalization is an experience of detachment from oneself.
14. Derealization refers to:
■ Experiencing the external world as unreal or dreamlike
• Feeling detached from one's body
• Complete loss of identity
• Persistent inability to recognize family members
Correct answer: Experiencing the external world as unreal or dreamlike
Rationale: Derealization is a sense that surroundings are unreal, dreamlike, or visually distorted.
15. Which finding supports dissociative amnesia rather than dementia?
■ Abrupt autobiographical memory gaps with preserved general cognition
• Steady progressive decline across multiple cognitive domains
• New visuospatial deficits with gait impairment
• Persistent fluctuating attention caused by infection
Correct answer: Abrupt autobiographical memory gaps with preserved general cognition
Rationale: Dissociative amnesia can selectively affect autobiographical memory without the progressive global decline typical of dementia.
NRNP 6665 Week 11 Practice Exam • Page 3
, 16. The safest initial response when a patient reports a dissociative episode is to:
■ Assess immediate safety, orientation, substance use, medical causes, and trauma context
• Immediately confront the patient about lying
• Assume the episode is psychosis
• Use restraints to prevent further episodes
Correct answer: Assess immediate safety, orientation, substance use, medical causes, and trauma context
Rationale: Dissociation requires a broad safety and differential assessment.
Original schematic diagram for study use.
17. A patient experiences recurrent episodes of feeling detached from their body while recognizing the
experience is subjective. This suggests:
■ Depersonalization/derealization disorder
• Schizophrenia
• Delirium
• Mania
Correct answer: Depersonalization/derealization disorder
Rationale: Preserved reality testing is typical of depersonalization/derealization experiences.
18. Which treatment principle is most consistent with trauma-informed care in dissociative disorders?
■ Prioritize safety and stabilization before intensive trauma processing
• Force detailed trauma disclosure at the first visit
• Avoid discussing coping skills
• Use confrontation to eliminate dissociation
Correct answer: Prioritize safety and stabilization before intensive trauma processing
Rationale: Safety, stabilization, and development of coping skills generally precede intensive trauma processing.
NRNP 6665 Week 11 Practice Exam • Page 4