CHAMBERLAIN UNIVERSITY | MSN-PMHNP GRADUATE PROGRAM
FINAL EXAM: NR548 / NR 548 (LATEST UPDATE
)
PSYCHIATRIC ASSESSMENT FOR PSYCHIATRIC-MENTAL HEALTH
NURSE PRACTITIONER
QUESTIONS & ANSWERS | 100% CORRECT | GRADE A - CHAMBERLAIN
This comprehensive final examination evaluates the full NR 548 curriculum: diagnostic reasoning, DSM-5-TR
classification, structured interviewing, the mental status examination, evidence-based rating scales, suicide risk
assessment, differential diagnosis across psychiatric and medical etiologies, and lifespan and cultural
considerations. Each item provides the correct answer marked in place, the answer key line, and a rationale
grounded in NR 548 content, DSM-5-TR criteria, and evidence-based psychiatric assessment standards. The
examination is aligned with the Chamberlain University NR 548 course syllabus, the AACN Essentials of
Master's Education in Nursing, PMHNP competencies, and current psychiatric assessment standards.
Exam Overview Details
Total questions 150 (Q1 through Q150, sequential)
Content sections 9 sections mirroring the NR 548 module sequence
Item format Multiple choice, 4 options (A-D), exactly one correct answer with rationale
Item style 80% scenario-based clinical decision making; 20% direct knowledge
20% recall, 50% application, 30% analysis (clinical reasoning, differential
Cognitive mix
diagnosis, diagnostic formulation)
25 complex scenario presentations with multiple differentials; 20 DSM-5-TR
Special inclusions criteria and assessment-tool items; 15 medical mimic and substance-induced
condition items
Chamberlain University NR 548 syllabus; AACN Essentials of Master's Education;
Alignment
PMHNP competencies; psychiatric assessment standards (2026/2027 edition)
Chamberlain University | NR 548 Psychiatric Assessment 1
,FINAL EXAM: NR548 / NR 548 () PSYCHIATRIC ASSESSMENT FOR THE PMHNP
Section 1: Foundations of Psychiatric Assessment (Questions 1-15)
*Q1:* Which statement best describes the role of the DSM-5-TR in psychiatric assessment for
the PMHNP?
A. It provides standardized diagnostic criteria, prevalence data, and ICD-10-CM code
mapping to support reliable diagnosis and clinical communication. *[CORRECT]*
B. It assigns numeric severity scores that determine mandatory pharmacologic treatment for
each disorder.
C. It replaces the psychiatric interview as the primary assessment instrument.
D. It lists approved psychotropic medications with dosing guidelines for each diagnosis.
Correct Answer: A
Rationale: The DSM-5-TR is the official classification system that standardizes diagnostic criteria, adds
prevalence data and text revisions, and maps each diagnosis to ICD-10-CM codes for documentation and
billing. It guides, but never replaces, clinical interviewing, and it contains no medication guidelines. NR
548 emphasizes that criteria are diagnostic anchors, not treatment prescriptions.
*Q2:* A 34-year-old woman presents with 3 weeks of depressed mood, fatigue, and poor
concentration. Applying evidence-based diagnostic reasoning, what is the PMHNP's most
appropriate first step?
A. Count DSM-5-TR criteria for major depressive disorder and confirm the diagnosis
immediately.
B. Complete a full history, physical examination review, and targeted laboratory studies
(TSH, CBC, vitamin B12, metabolic panel) to exclude medical mimics before attributing
symptoms to a primary depressive disorder. *[CORRECT]*
C. Start an SSRI the same day and reassess the diagnosis only if symptoms persist after 8
weeks.
D. Refer the patient to psychiatry only after she has failed two adequate antidepressant
trials.
Correct Answer: B
Rationale: Diagnostic reasoning requires generating a broad differential and excluding medical mimics
(hypothyroidism, anemia, B12 deficiency, metabolic disturbances) before confirming a primary
psychiatric diagnosis. Premature criterion counting or immediate prescribing reflects premature closure,
a documented source of diagnostic error emphasized in NR 548. Delaying care until multiple failed trials
is also inconsistent with evidence-based practice.
*Q3:* A PMHNP documents a new episode of major depressive disorder, recurrent, moderate,
for an established patient. Which ICD-10-CM code correctly corresponds to this diagnosis?
A. F32.0, major depressive disorder, single episode, mild
B. F31.81, bipolar II disorder
C. F33.1, major depressive disorder, recurrent, moderate *[CORRECT]*
D. F41.9, unspecified anxiety disorder
Chamberlain University | NR 548 Psychiatric Assessment 2
,FINAL EXAM: NR548 / NR 548 () PSYCHIATRIC ASSESSMENT FOR THE PMHNP
Correct Answer: C
Rationale: In ICD-10-CM, the F32 series codes single-episode major depression and the F33 series
codes recurrent episodes, with the fourth character indicating severity (.1 = moderate). F31.81 denotes
bipolar II disorder and F41.9 denotes unspecified anxiety, neither of which matches a recurrent
moderate depressive episode. Accurate coding supports communication, reimbursement, and
epidemiologic tracking, a documentation standard taught in NR 548.
*Q4:* A PMHNP hears the word panic in a patient's opening statement, quickly diagnoses panic
disorder, and closes the evaluation without exploring the palpitations, heat intolerance, and
12-pound weight loss the patient also reports; thyroid studies later reveal Graves disease. Which
cognitive bias best describes this diagnostic error?
A. Availability bias, in which recently encountered cases dominate reasoning
B. Confirmation bias, in which evidence is selectively gathered to support a hypothesis
C. Diagnostic momentum, in which a label accepted from others gains traction
D. Premature closure, in which the diagnostic process is stopped before the differential is
sufficiently explored *[CORRECT]*
Correct Answer: D
Rationale: Premature closure is the most common cognitive error in clinical diagnosis and occurs when
the clinician accepts an early diagnosis and stops considering alternatives. In this case, classic
hyperthyroid symptoms were ignored after the panic label was applied. Availability and confirmation
biases involve recall of recent cases or selective evidence gathering, and diagnostic momentum involves
accepting a label from another clinician, none of which describes this presentation.
*Q5:* Which description best characterizes the Structured Clinical Interview for DSM-5
(SCID-5)?
A. A self-report symptom checklist completed by the patient before the visit
B. A clinician-administered, fully structured diagnostic interview that systematically maps
patient responses to DSM-5-TR criteria *[CORRECT]*
C. A projective personality test interpreting responses to ambiguous stimuli
D. A two-question depression screen designed for busy primary care settings
Correct Answer: B
Rationale: The SCID-5 is a semi-structured to structured clinician-administered interview considered a
gold standard for establishing DSM-5-TR diagnoses because it systematically probes each criterion with
specified follow-up questions. It is clinician-administered, not a self-report, projective, or ultra-brief
screening instrument. NR 548 presents structured interviews as instruments that improve diagnostic
reliability and reduce criterion misapplication.
Chamberlain University | NR 548 Psychiatric Assessment 3
, FINAL EXAM: NR548 / NR 548 () PSYCHIATRIC ASSESSMENT FOR THE PMHNP
*Q6:* A Puerto Rican patient describes episodes of screaming, trembling, and dissociative-like
behavior that family members call ataque de nervios. What is the PMHNP's most culturally
responsive action?
A. Use the DSM-5-TR Cultural Formulation Interview to elicit the patient's cultural
concepts of distress and integrate them into the diagnostic formulation. *[CORRECT]*
B. Document panic disorder immediately because the episodes resemble panic attacks.
C. Inform the patient that the episodes have no clinical significance and should be ignored.
D. Record the episodes as somatic symptom disorder because no medical cause was
identified.
Correct Answer: A
Rationale: The DSM-5-TR Cultural Formulation Interview (CFI) is a 16-item evidence-based guide for
eliciting cultural definitions of the problem, perceived causes, and coping preferences. Ataque de nervios
is a recognized cultural concept of distress, and understanding it prevents pathologizing culturally
normative expressions. Dismissing or mislabeling such idioms of distress is a common source of
diagnostic error and disengagement.
*Q7:* A 24-year-old graduate student reports 3 weeks of depressed mood, but on careful
questioning describes three prior 4-day periods of decreased need for sleep, racing thoughts, and
impulsive overspending with intact functioning. Before starting sertraline, the PMHNP's most
appropriate next step is to:
A. Refer for an exercise program and sleep hygiene counseling before any medication.
B. Start sertraline and reassess in 2 weeks because the mood symptoms are clearly unipolar.
C. Assess for bipolar spectrum illness using the Mood Disorder Questionnaire and a full
hypomania/mania history, because antidepressant monotherapy risks precipitating a mood
switch. *[CORRECT]*
D. Diagnose borderline personality disorder based on the impulsive spending episodes.
Correct Answer: C
Rationale: Historic hypomanic episodes (at least 4 days of elevated mood plus associated symptoms)
mandate ruling out bipolar II depression before antidepressant monotherapy, which can precipitate
mania or rapid cycling. The MDQ plus a detailed chronological mood history is the evidence-based
screening approach taught in NR 548. This complex presentation requires distinguishing bipolar
depression from unipolar depression and personality pathology before treatment selection.
*Q8:* A PMHNP wants a validated, patient-completed tool to monitor the severity of a patient's
depressive symptoms at each follow-up visit. Which instrument is most appropriate?
A. Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
B. Generalized Anxiety Disorder 7-item scale (GAD-7)
C. Young Mania Rating Scale (YMRS)
D. Patient Health Questionnaire 9-item scale (PHQ-9) *[CORRECT]*
Chamberlain University | NR 548 Psychiatric Assessment 4
FINAL EXAM: NR548 / NR 548 (LATEST UPDATE
)
PSYCHIATRIC ASSESSMENT FOR PSYCHIATRIC-MENTAL HEALTH
NURSE PRACTITIONER
QUESTIONS & ANSWERS | 100% CORRECT | GRADE A - CHAMBERLAIN
This comprehensive final examination evaluates the full NR 548 curriculum: diagnostic reasoning, DSM-5-TR
classification, structured interviewing, the mental status examination, evidence-based rating scales, suicide risk
assessment, differential diagnosis across psychiatric and medical etiologies, and lifespan and cultural
considerations. Each item provides the correct answer marked in place, the answer key line, and a rationale
grounded in NR 548 content, DSM-5-TR criteria, and evidence-based psychiatric assessment standards. The
examination is aligned with the Chamberlain University NR 548 course syllabus, the AACN Essentials of
Master's Education in Nursing, PMHNP competencies, and current psychiatric assessment standards.
Exam Overview Details
Total questions 150 (Q1 through Q150, sequential)
Content sections 9 sections mirroring the NR 548 module sequence
Item format Multiple choice, 4 options (A-D), exactly one correct answer with rationale
Item style 80% scenario-based clinical decision making; 20% direct knowledge
20% recall, 50% application, 30% analysis (clinical reasoning, differential
Cognitive mix
diagnosis, diagnostic formulation)
25 complex scenario presentations with multiple differentials; 20 DSM-5-TR
Special inclusions criteria and assessment-tool items; 15 medical mimic and substance-induced
condition items
Chamberlain University NR 548 syllabus; AACN Essentials of Master's Education;
Alignment
PMHNP competencies; psychiatric assessment standards (2026/2027 edition)
Chamberlain University | NR 548 Psychiatric Assessment 1
,FINAL EXAM: NR548 / NR 548 () PSYCHIATRIC ASSESSMENT FOR THE PMHNP
Section 1: Foundations of Psychiatric Assessment (Questions 1-15)
*Q1:* Which statement best describes the role of the DSM-5-TR in psychiatric assessment for
the PMHNP?
A. It provides standardized diagnostic criteria, prevalence data, and ICD-10-CM code
mapping to support reliable diagnosis and clinical communication. *[CORRECT]*
B. It assigns numeric severity scores that determine mandatory pharmacologic treatment for
each disorder.
C. It replaces the psychiatric interview as the primary assessment instrument.
D. It lists approved psychotropic medications with dosing guidelines for each diagnosis.
Correct Answer: A
Rationale: The DSM-5-TR is the official classification system that standardizes diagnostic criteria, adds
prevalence data and text revisions, and maps each diagnosis to ICD-10-CM codes for documentation and
billing. It guides, but never replaces, clinical interviewing, and it contains no medication guidelines. NR
548 emphasizes that criteria are diagnostic anchors, not treatment prescriptions.
*Q2:* A 34-year-old woman presents with 3 weeks of depressed mood, fatigue, and poor
concentration. Applying evidence-based diagnostic reasoning, what is the PMHNP's most
appropriate first step?
A. Count DSM-5-TR criteria for major depressive disorder and confirm the diagnosis
immediately.
B. Complete a full history, physical examination review, and targeted laboratory studies
(TSH, CBC, vitamin B12, metabolic panel) to exclude medical mimics before attributing
symptoms to a primary depressive disorder. *[CORRECT]*
C. Start an SSRI the same day and reassess the diagnosis only if symptoms persist after 8
weeks.
D. Refer the patient to psychiatry only after she has failed two adequate antidepressant
trials.
Correct Answer: B
Rationale: Diagnostic reasoning requires generating a broad differential and excluding medical mimics
(hypothyroidism, anemia, B12 deficiency, metabolic disturbances) before confirming a primary
psychiatric diagnosis. Premature criterion counting or immediate prescribing reflects premature closure,
a documented source of diagnostic error emphasized in NR 548. Delaying care until multiple failed trials
is also inconsistent with evidence-based practice.
*Q3:* A PMHNP documents a new episode of major depressive disorder, recurrent, moderate,
for an established patient. Which ICD-10-CM code correctly corresponds to this diagnosis?
A. F32.0, major depressive disorder, single episode, mild
B. F31.81, bipolar II disorder
C. F33.1, major depressive disorder, recurrent, moderate *[CORRECT]*
D. F41.9, unspecified anxiety disorder
Chamberlain University | NR 548 Psychiatric Assessment 2
,FINAL EXAM: NR548 / NR 548 () PSYCHIATRIC ASSESSMENT FOR THE PMHNP
Correct Answer: C
Rationale: In ICD-10-CM, the F32 series codes single-episode major depression and the F33 series
codes recurrent episodes, with the fourth character indicating severity (.1 = moderate). F31.81 denotes
bipolar II disorder and F41.9 denotes unspecified anxiety, neither of which matches a recurrent
moderate depressive episode. Accurate coding supports communication, reimbursement, and
epidemiologic tracking, a documentation standard taught in NR 548.
*Q4:* A PMHNP hears the word panic in a patient's opening statement, quickly diagnoses panic
disorder, and closes the evaluation without exploring the palpitations, heat intolerance, and
12-pound weight loss the patient also reports; thyroid studies later reveal Graves disease. Which
cognitive bias best describes this diagnostic error?
A. Availability bias, in which recently encountered cases dominate reasoning
B. Confirmation bias, in which evidence is selectively gathered to support a hypothesis
C. Diagnostic momentum, in which a label accepted from others gains traction
D. Premature closure, in which the diagnostic process is stopped before the differential is
sufficiently explored *[CORRECT]*
Correct Answer: D
Rationale: Premature closure is the most common cognitive error in clinical diagnosis and occurs when
the clinician accepts an early diagnosis and stops considering alternatives. In this case, classic
hyperthyroid symptoms were ignored after the panic label was applied. Availability and confirmation
biases involve recall of recent cases or selective evidence gathering, and diagnostic momentum involves
accepting a label from another clinician, none of which describes this presentation.
*Q5:* Which description best characterizes the Structured Clinical Interview for DSM-5
(SCID-5)?
A. A self-report symptom checklist completed by the patient before the visit
B. A clinician-administered, fully structured diagnostic interview that systematically maps
patient responses to DSM-5-TR criteria *[CORRECT]*
C. A projective personality test interpreting responses to ambiguous stimuli
D. A two-question depression screen designed for busy primary care settings
Correct Answer: B
Rationale: The SCID-5 is a semi-structured to structured clinician-administered interview considered a
gold standard for establishing DSM-5-TR diagnoses because it systematically probes each criterion with
specified follow-up questions. It is clinician-administered, not a self-report, projective, or ultra-brief
screening instrument. NR 548 presents structured interviews as instruments that improve diagnostic
reliability and reduce criterion misapplication.
Chamberlain University | NR 548 Psychiatric Assessment 3
, FINAL EXAM: NR548 / NR 548 () PSYCHIATRIC ASSESSMENT FOR THE PMHNP
*Q6:* A Puerto Rican patient describes episodes of screaming, trembling, and dissociative-like
behavior that family members call ataque de nervios. What is the PMHNP's most culturally
responsive action?
A. Use the DSM-5-TR Cultural Formulation Interview to elicit the patient's cultural
concepts of distress and integrate them into the diagnostic formulation. *[CORRECT]*
B. Document panic disorder immediately because the episodes resemble panic attacks.
C. Inform the patient that the episodes have no clinical significance and should be ignored.
D. Record the episodes as somatic symptom disorder because no medical cause was
identified.
Correct Answer: A
Rationale: The DSM-5-TR Cultural Formulation Interview (CFI) is a 16-item evidence-based guide for
eliciting cultural definitions of the problem, perceived causes, and coping preferences. Ataque de nervios
is a recognized cultural concept of distress, and understanding it prevents pathologizing culturally
normative expressions. Dismissing or mislabeling such idioms of distress is a common source of
diagnostic error and disengagement.
*Q7:* A 24-year-old graduate student reports 3 weeks of depressed mood, but on careful
questioning describes three prior 4-day periods of decreased need for sleep, racing thoughts, and
impulsive overspending with intact functioning. Before starting sertraline, the PMHNP's most
appropriate next step is to:
A. Refer for an exercise program and sleep hygiene counseling before any medication.
B. Start sertraline and reassess in 2 weeks because the mood symptoms are clearly unipolar.
C. Assess for bipolar spectrum illness using the Mood Disorder Questionnaire and a full
hypomania/mania history, because antidepressant monotherapy risks precipitating a mood
switch. *[CORRECT]*
D. Diagnose borderline personality disorder based on the impulsive spending episodes.
Correct Answer: C
Rationale: Historic hypomanic episodes (at least 4 days of elevated mood plus associated symptoms)
mandate ruling out bipolar II depression before antidepressant monotherapy, which can precipitate
mania or rapid cycling. The MDQ plus a detailed chronological mood history is the evidence-based
screening approach taught in NR 548. This complex presentation requires distinguishing bipolar
depression from unipolar depression and personality pathology before treatment selection.
*Q8:* A PMHNP wants a validated, patient-completed tool to monitor the severity of a patient's
depressive symptoms at each follow-up visit. Which instrument is most appropriate?
A. Yale-Brown Obsessive Compulsive Scale (Y-BOCS)
B. Generalized Anxiety Disorder 7-item scale (GAD-7)
C. Young Mania Rating Scale (YMRS)
D. Patient Health Questionnaire 9-item scale (PHQ-9) *[CORRECT]*
Chamberlain University | NR 548 Psychiatric Assessment 4
