NR 605 PMHNP Practicum Exam 2026/2027 | Psychiatric Diagnosis,
Treatment Planning & Clinical Management | 300 Questions &
Answers
Psychiatric Assessment & Diagnosis (1–40)
1. A patient reports depressed mood, loss of interest, fatigue, poor
concentration, and insomnia nearly every day for 3 weeks.
Which diagnosis is most consistent with this presentation?
A. Adjustment disorder
B. Major depressive disorder
C. Generalized anxiety disorder
D. Persistent depressive disorder
Answer: B
Rationale: Major depressive disorder requires a depressive episode
lasting at least 2 weeks with sufficient symptoms causing clinically
significant distress or impairment. The symptoms described meet
the general pattern of a major depressive episode.
2. Which symptom is considered a core symptom of a major
depressive episode?
A. Increased goal-directed activity
B. Elevated self-esteem
C. Anhedonia
D. Pressured speech
Answer: C
Rationale: Depressed mood and diminished interest or pleasure are
the two core depressive symptoms. Mania-related symptoms such
as increased goal-directed activity and pressured speech point
toward bipolar-spectrum illness.
3. A patient has excessive anxiety and worry about multiple areas
of life for more than 6 months and finds the worry difficult to
control. Which diagnosis is most likely?
A. Panic disorder
B. Generalized anxiety disorder
, C. Social anxiety disorder
D. Adjustment disorder
Answer: B
Rationale: Generalized anxiety disorder is characterized by excessive,
difficult-to-control worry about multiple domains occurring more
days than not for at least 6 months, accompanied by associated
physical or cognitive symptoms.
4. A patient experiences sudden episodes of intense fear
accompanied by palpitations, sweating, trembling, and fear of
dying. What should the PMHNP assess for first?
A. Whether the episodes are unexpected and recurrent
B. Whether the patient has hallucinations
C. Whether the patient has compulsions
D. Whether the patient has chronic insomnia
Answer: A
Rationale: Recurrent unexpected panic attacks are central to panic
disorder. The clinician should also determine whether medical
conditions or substances could be producing the symptoms.
5. Which finding most strongly supports a diagnosis of bipolar I
disorder?
A. Recurrent depressive episodes only
B. At least one manic episode
C. Chronic anxiety for 6 months
D. Hypomania without impairment
Answer: B
Rationale: Bipolar I disorder requires at least one manic episode. A
major depressive episode commonly occurs but is not required for
the diagnosis.
6. A patient has four days of elevated mood, increased energy,
decreased need for sleep, and increased talkativeness without
marked impairment or hospitalization. Which condition should
be considered?
, A. Hypomanic episode
B. Manic episode
C. Delirium
D. Schizophrenia
Answer: A
Rationale: Hypomania generally lasts at least 4 consecutive days and
does not cause the marked functional impairment, hospitalization,
or psychosis characteristic of mania.
7. Which feature distinguishes mania from hypomania?
A. Increased energy
B. Decreased need for sleep
C. Significant functional impairment or hospitalization
D. Increased talkativeness
Answer: C
Rationale: Mania produces marked impairment, hospitalization, or
psychotic features. Hypomania is a clearly observable change in
functioning but does not reach the severity of mania.
8. A patient reports hearing a voice speaking when nobody is
present. This is best described as:
A. Delusion
B. Illusion
C. Auditory hallucination
D. Obsession
Answer: C
Rationale: A hallucination is a perception-like experience without an
external stimulus. A voice heard without an external source is an
auditory hallucination.
9. A patient believes that strangers on television are
communicating secret messages specifically to them. This is
most consistent with:
A. Thought blocking
B. Delusion of reference
, C. Flight of ideas
D. Neologism
Answer: B
Rationale: A delusion of reference involves believing that otherwise
neutral events, people, or media contain special personal meaning
directed toward the patient.
10. Which finding is characteristic of delirium?
A. Stable attention over several months
B. Acute fluctuating disturbance in attention and awareness
C. Lifelong social communication deficits
D. Chronic fixed delusions
Answer: B
Rationale: Delirium develops acutely and is characterized
particularly by impaired attention and awareness with fluctuating
severity. It should prompt evaluation for an underlying medical,
medication-related, or substance-related cause.
11. A patient has chronic hallucinations and delusions for more
than 6 months with functional decline. Which disorder should
be considered?
A. Schizophrenia
B. Brief psychotic disorder
C. Adjustment disorder
D. Panic disorder
Answer: A
Rationale: Schizophrenia involves characteristic psychotic symptoms
with continuous signs of disturbance for at least 6 months and
associated functional impairment.
12. Which assessment is essential before diagnosing a primary
psychotic disorder?
A. Evaluation for substance and medical causes
B. Assessment of handwriting
Treatment Planning & Clinical Management | 300 Questions &
Answers
Psychiatric Assessment & Diagnosis (1–40)
1. A patient reports depressed mood, loss of interest, fatigue, poor
concentration, and insomnia nearly every day for 3 weeks.
Which diagnosis is most consistent with this presentation?
A. Adjustment disorder
B. Major depressive disorder
C. Generalized anxiety disorder
D. Persistent depressive disorder
Answer: B
Rationale: Major depressive disorder requires a depressive episode
lasting at least 2 weeks with sufficient symptoms causing clinically
significant distress or impairment. The symptoms described meet
the general pattern of a major depressive episode.
2. Which symptom is considered a core symptom of a major
depressive episode?
A. Increased goal-directed activity
B. Elevated self-esteem
C. Anhedonia
D. Pressured speech
Answer: C
Rationale: Depressed mood and diminished interest or pleasure are
the two core depressive symptoms. Mania-related symptoms such
as increased goal-directed activity and pressured speech point
toward bipolar-spectrum illness.
3. A patient has excessive anxiety and worry about multiple areas
of life for more than 6 months and finds the worry difficult to
control. Which diagnosis is most likely?
A. Panic disorder
B. Generalized anxiety disorder
, C. Social anxiety disorder
D. Adjustment disorder
Answer: B
Rationale: Generalized anxiety disorder is characterized by excessive,
difficult-to-control worry about multiple domains occurring more
days than not for at least 6 months, accompanied by associated
physical or cognitive symptoms.
4. A patient experiences sudden episodes of intense fear
accompanied by palpitations, sweating, trembling, and fear of
dying. What should the PMHNP assess for first?
A. Whether the episodes are unexpected and recurrent
B. Whether the patient has hallucinations
C. Whether the patient has compulsions
D. Whether the patient has chronic insomnia
Answer: A
Rationale: Recurrent unexpected panic attacks are central to panic
disorder. The clinician should also determine whether medical
conditions or substances could be producing the symptoms.
5. Which finding most strongly supports a diagnosis of bipolar I
disorder?
A. Recurrent depressive episodes only
B. At least one manic episode
C. Chronic anxiety for 6 months
D. Hypomania without impairment
Answer: B
Rationale: Bipolar I disorder requires at least one manic episode. A
major depressive episode commonly occurs but is not required for
the diagnosis.
6. A patient has four days of elevated mood, increased energy,
decreased need for sleep, and increased talkativeness without
marked impairment or hospitalization. Which condition should
be considered?
, A. Hypomanic episode
B. Manic episode
C. Delirium
D. Schizophrenia
Answer: A
Rationale: Hypomania generally lasts at least 4 consecutive days and
does not cause the marked functional impairment, hospitalization,
or psychosis characteristic of mania.
7. Which feature distinguishes mania from hypomania?
A. Increased energy
B. Decreased need for sleep
C. Significant functional impairment or hospitalization
D. Increased talkativeness
Answer: C
Rationale: Mania produces marked impairment, hospitalization, or
psychotic features. Hypomania is a clearly observable change in
functioning but does not reach the severity of mania.
8. A patient reports hearing a voice speaking when nobody is
present. This is best described as:
A. Delusion
B. Illusion
C. Auditory hallucination
D. Obsession
Answer: C
Rationale: A hallucination is a perception-like experience without an
external stimulus. A voice heard without an external source is an
auditory hallucination.
9. A patient believes that strangers on television are
communicating secret messages specifically to them. This is
most consistent with:
A. Thought blocking
B. Delusion of reference
, C. Flight of ideas
D. Neologism
Answer: B
Rationale: A delusion of reference involves believing that otherwise
neutral events, people, or media contain special personal meaning
directed toward the patient.
10. Which finding is characteristic of delirium?
A. Stable attention over several months
B. Acute fluctuating disturbance in attention and awareness
C. Lifelong social communication deficits
D. Chronic fixed delusions
Answer: B
Rationale: Delirium develops acutely and is characterized
particularly by impaired attention and awareness with fluctuating
severity. It should prompt evaluation for an underlying medical,
medication-related, or substance-related cause.
11. A patient has chronic hallucinations and delusions for more
than 6 months with functional decline. Which disorder should
be considered?
A. Schizophrenia
B. Brief psychotic disorder
C. Adjustment disorder
D. Panic disorder
Answer: A
Rationale: Schizophrenia involves characteristic psychotic symptoms
with continuous signs of disturbance for at least 6 months and
associated functional impairment.
12. Which assessment is essential before diagnosing a primary
psychotic disorder?
A. Evaluation for substance and medical causes
B. Assessment of handwriting
