NR 548 - Psychiatric Assessment
for the PMHNP Exam
1. During the mental status examination, a client describes feeling "empty and
hopeless," while the nurse practitioner observes a bright, smiling face. Which
terms correctly describe this finding?
A. Mood is euthymic and affect is flat
B. Mood is elevated and affect is labile
C. Mood is anxious and affect is blunted
D. Mood is depressed and affect is incongruent
Correct Answer: D. Mood is depressed and affect is incongruent
Rationale: Mood is the client's subjective, sustained emotional state; affect is the
observed expression. A smiling face with reported hopelessness is an incongruent
affect.
2. A client answering the question "How did you get here today?" gives a long,
detailed account of the bus route, driver, weather and fare before finally
answering. Which thought-process disturbance is described?
A. Tangentiality
B. Flight of ideas
C. Circumstantiality
D. Word salad
Correct Answer: C. Circumstantiality
Rationale: Circumstantiality includes excessive, unnecessary detail but the speaker
eventually returns to the point. In tangentiality, the goal is never reached.
,3. A client responds to every question with an answer that wanders further from
the topic and never reaches the point. What is this called?
A. Circumstantiality
B. Tangentiality
C. Perseveration
D. Thought blocking
Correct Answer: B. Tangentiality
Rationale: Tangential speech moves away from the question and does not return to
the original point.
4. A client speaks rapidly, jumping from topic to topic with understandable
connections based on rhyme and sound, such as "The sun is hot, I'm a lot,
that's a lot, got a pot." Which term best fits?
A. Echolalia
B. Clang associations
C. Neologisms
D. Thought insertion
Correct Answer: B. Clang associations
Rationale: Clang associations are word choices based on sound rather than meaning
and are common in mania.
5. A client states, "The television host is sending me secret messages about my
mission." Which type of thought content is this?
A. Illusion
B. Obsession
C. Delusion of reference
D. Overvalued idea
Correct Answer: C. Delusion of reference
Rationale: Delusions of reference involve the false belief that neutral events or media
have special personal meaning.
,6. Which finding best distinguishes an illusion from a hallucination?
A. An illusion occurs only in schizophrenia
B. An illusion is a misinterpretation of a real external stimulus
C. An illusion has no external stimulus
D. An illusion is always auditory
Correct Answer: B. An illusion is a misinterpretation of a real external stimulus
Rationale: A hallucination is a perception without an external stimulus, whereas an
illusion misperceives a real stimulus (e.g., a coat on a chair seen as a person).
7. Which type of hallucination most strongly suggests a medical or
neurological cause rather than a primary psychotic disorder?
A. Auditory hallucinations of a running commentary
B. Auditory hallucinations of two voices conversing
C. Command auditory hallucinations
D. Visual hallucinations
Correct Answer: D. Visual hallucinations
Rationale: Auditory hallucinations are most common in primary psychosis. New
visual, tactile or olfactory hallucinations should prompt a workup for delirium,
seizures, substances or neurodegenerative disease.
8. The practitioner asks a client to count backward from 100 by sevens. This
task primarily assesses which cognitive function?
A. Long-term memory
B. Attention and concentration
C. Abstract thinking
D. Insight
Correct Answer: B. Attention and concentration
Rationale: Serial sevens, spelling "world" backward and digit span test attention and
concentration.
, 9. A client is asked to interpret the proverb "A rolling stone gathers no moss"
and replies, "A rock that moves doesn't grow plants." Which finding is this?
A. Abstract thinking
B. Thought blocking
C. Flight of ideas
D. Concrete thinking
Correct Answer: D. Concrete thinking
Rationale: Literal interpretation of proverbs indicates concrete thinking, seen in
schizophrenia, intellectual disability and some neurocognitive disorders.
10. Which statement from a client demonstrates good insight?
A. "I think my hearing voices means my illness is getting worse and I need
treatment."
B. "The voices are real, and everyone else is lying."
C. "I do not have a problem, my family is overreacting."
D. "I'll agree to take the pills so you'll stop asking."
Correct Answer: A. "I think my hearing voices means my illness is getting
worse and I need treatment."
Rationale: Insight is recognition that one has an illness and needs treatment.
Judgment is the ability to make sound decisions.
11. A client is asked what they would do if they found a stamped, addressed
envelope on the street. The client says, "I'd open it and keep the money." Which
MSE domain is being evaluated?
A. Orientation
B. Memory
C. Affect
D. Judgment
Correct Answer: D. Judgment
Rationale: Hypothetical situations (stamped envelope, fire in a theater) are classic
ways to assess judgment.
for the PMHNP Exam
1. During the mental status examination, a client describes feeling "empty and
hopeless," while the nurse practitioner observes a bright, smiling face. Which
terms correctly describe this finding?
A. Mood is euthymic and affect is flat
B. Mood is elevated and affect is labile
C. Mood is anxious and affect is blunted
D. Mood is depressed and affect is incongruent
Correct Answer: D. Mood is depressed and affect is incongruent
Rationale: Mood is the client's subjective, sustained emotional state; affect is the
observed expression. A smiling face with reported hopelessness is an incongruent
affect.
2. A client answering the question "How did you get here today?" gives a long,
detailed account of the bus route, driver, weather and fare before finally
answering. Which thought-process disturbance is described?
A. Tangentiality
B. Flight of ideas
C. Circumstantiality
D. Word salad
Correct Answer: C. Circumstantiality
Rationale: Circumstantiality includes excessive, unnecessary detail but the speaker
eventually returns to the point. In tangentiality, the goal is never reached.
,3. A client responds to every question with an answer that wanders further from
the topic and never reaches the point. What is this called?
A. Circumstantiality
B. Tangentiality
C. Perseveration
D. Thought blocking
Correct Answer: B. Tangentiality
Rationale: Tangential speech moves away from the question and does not return to
the original point.
4. A client speaks rapidly, jumping from topic to topic with understandable
connections based on rhyme and sound, such as "The sun is hot, I'm a lot,
that's a lot, got a pot." Which term best fits?
A. Echolalia
B. Clang associations
C. Neologisms
D. Thought insertion
Correct Answer: B. Clang associations
Rationale: Clang associations are word choices based on sound rather than meaning
and are common in mania.
5. A client states, "The television host is sending me secret messages about my
mission." Which type of thought content is this?
A. Illusion
B. Obsession
C. Delusion of reference
D. Overvalued idea
Correct Answer: C. Delusion of reference
Rationale: Delusions of reference involve the false belief that neutral events or media
have special personal meaning.
,6. Which finding best distinguishes an illusion from a hallucination?
A. An illusion occurs only in schizophrenia
B. An illusion is a misinterpretation of a real external stimulus
C. An illusion has no external stimulus
D. An illusion is always auditory
Correct Answer: B. An illusion is a misinterpretation of a real external stimulus
Rationale: A hallucination is a perception without an external stimulus, whereas an
illusion misperceives a real stimulus (e.g., a coat on a chair seen as a person).
7. Which type of hallucination most strongly suggests a medical or
neurological cause rather than a primary psychotic disorder?
A. Auditory hallucinations of a running commentary
B. Auditory hallucinations of two voices conversing
C. Command auditory hallucinations
D. Visual hallucinations
Correct Answer: D. Visual hallucinations
Rationale: Auditory hallucinations are most common in primary psychosis. New
visual, tactile or olfactory hallucinations should prompt a workup for delirium,
seizures, substances or neurodegenerative disease.
8. The practitioner asks a client to count backward from 100 by sevens. This
task primarily assesses which cognitive function?
A. Long-term memory
B. Attention and concentration
C. Abstract thinking
D. Insight
Correct Answer: B. Attention and concentration
Rationale: Serial sevens, spelling "world" backward and digit span test attention and
concentration.
, 9. A client is asked to interpret the proverb "A rolling stone gathers no moss"
and replies, "A rock that moves doesn't grow plants." Which finding is this?
A. Abstract thinking
B. Thought blocking
C. Flight of ideas
D. Concrete thinking
Correct Answer: D. Concrete thinking
Rationale: Literal interpretation of proverbs indicates concrete thinking, seen in
schizophrenia, intellectual disability and some neurocognitive disorders.
10. Which statement from a client demonstrates good insight?
A. "I think my hearing voices means my illness is getting worse and I need
treatment."
B. "The voices are real, and everyone else is lying."
C. "I do not have a problem, my family is overreacting."
D. "I'll agree to take the pills so you'll stop asking."
Correct Answer: A. "I think my hearing voices means my illness is getting
worse and I need treatment."
Rationale: Insight is recognition that one has an illness and needs treatment.
Judgment is the ability to make sound decisions.
11. A client is asked what they would do if they found a stamped, addressed
envelope on the street. The client says, "I'd open it and keep the money." Which
MSE domain is being evaluated?
A. Orientation
B. Memory
C. Affect
D. Judgment
Correct Answer: D. Judgment
Rationale: Hypothetical situations (stamped envelope, fire in a theater) are classic
ways to assess judgment.
