NR 605 DIAGNOSIS AND MANAGEMENT IN PSYCHIATRIC-MENTAL HEALTH FINAL EXAM
2026/2027 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026
Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Psychiatric Assessment and Mental Status Examination
DSM-5-TR Diagnostic Criteria and Differential Diagnosis
Mood Disorders and Suicide Risk Assessment
Anxiety, Trauma, and Obsessive-Compulsive Disorders
Psychotic Disorders and Schizophrenia Spectrum
Personality Disorders and Substance Use Disorders
Psychopharmacology and Somatic Treatments
Psychotherapy and Therapeutic Modalities
Ethical, Legal, and Cultural Considerations
Introduction
This comprehensive examination assesses advanced knowledge in psychiatric-mental health diagnosis
and management across the lifespan. It evaluates competency in psychiatric assessment, mental status
examination, DSM-5-TR diagnostic criteria, differential diagnosis, psychopharmacology, psychotherapy,
and ethical-legal frameworks. Multiple-choice and scenario-based questions require clinical application
and decision-making. Emphasis is placed on evidence-based prescribing, risk assessment, and holistic
patient-centered care. Successful performance demonstrates readiness for autonomous psychiatric-
mental health nurse practitioner practice.
Section One: Questions 1–150
1. A 19-year-old college student is brought to the emergency department by campus security after
being found wandering outside in winter without a coat. The patient states, "I don't need a coat
because the voices told me my skin is made of fire and cannot burn." Mental status exam reveals
disorganized speech, flat affect, and poor eye contact. The patient admits to hearing commanding
voices for the past 3 months but has been hiding this from family. Which diagnosis is most
appropriate?
A. Brief Psychotic Disorder
B. Schizophrenia
C. Schizoaffective Disorder
D. Delusional Disorder
🟢 B. Schizophrenia
🔴 RATIONALE: Schizophrenia is diagnosed when characteristic symptoms including delusions,
hallucinations, disorganized speech, and negative symptoms are present for a significant portion of
time during a 1-month period, with continuous signs of disturbance persisting for at least 6 months.
This patient has auditory hallucinations (3 months), disorganized speech, and flat affect, meeting
criteria.
,2. A 7-year-old boy is referred by his teacher for evaluation. Parents report, "He's constantly
moving, cannot finish tasks, and blurts out answers before questions are completed." Symptoms
began at age 5 and occur in both school and home settings. The child has no history of trauma or
medical problems. Which assessment tool is considered gold standard for aiding in the diagnosis of
this condition?
A. Conners' Rating Scales
B. Beck Depression Inventory-II
C. Hamilton Anxiety Rating Scale
D. Positive and Negative Syndrome Scale (PANSS)
🟢 A. Conners' Rating Scales
🔴 RATIONALE: The Conners' Rating Scales are widely used and considered a gold standard
assessment tool for ADHD, gathering information from parents, teachers, and the child about
symptoms across settings.
3. During a psychiatric interview, a 45-year-old patient with depression states, "I don't see the point
in anything anymore. My family would be better off without me. I have a plan to use my father's
gun." Which is the priority nursing action?
A. Complete a full mental status examination
B. Assess the patient's insight and judgment
C. Initiate immediate suicide precautions and remove means
D. Schedule outpatient follow-up within one week
🟢 C. Initiate immediate suicide precautions and remove means
🔴 RATIONALE: The patient has suicidal ideation with a specific plan and access to lethal means.
Immediate safety interventions including suicide precautions and means restriction take priority over
all other assessment activities.
4. A 68-year-old widow presents with 6 weeks of depressed mood, anhedonia, early morning
awakening, and poor appetite following her husband's death. She states, "I just miss him so much,
but I know he'd want me to keep going." She denies suicidal ideation and maintains social
connections. Which is the most appropriate diagnosis?
A. Major Depressive Disorder, Single Episode
B. Persistent Depressive Disorder (Dysthymia)
C. Adjustment Disorder with Depressed Mood
D. No diagnosis; normal bereavement
🟢 D. No diagnosis; normal bereavement
🔴 RATIONALE: The patient's symptoms are consistent with normal grief following the death of a
spouse. The DSM-5-TR specifies that normal bereavement typically resolves within 2 months and does
not require a diagnosis unless symptoms are severe or prolonged.
,5. A PMHNP is conducting a mental status examination. The patient demonstrates inability to recall
three unrelated words after 5 minutes despite being able to register them initially. This finding
indicates impairment in which cognitive domain?
A. Attention
B. Immediate memory
C. Recent memory
D. Remote memory
🟢 C. Recent memory
🔴 RATIONALE: Recent memory refers to the ability to recall information after a short delay (typically
3-5 minutes). The patient could register the words initially (intact immediate memory) but could not
recall them after 5 minutes, indicating recent memory impairment.
6. A 16-year-old female is brought in by her mother who reports the patient has lost 20 pounds in 2
months, exercises excessively, and has amenorrhea. The patient states, "I'm still too fat. I can't eat
that or I'll blow up like a balloon." She is bradycardic with a BMI of 16.5. Which laboratory finding
requires immediate attention?
A. Elevated thyroid-stimulating hormone (TSH)
B. QTc prolongation on ECG
C. Elevated liver enzymes
D. Leukocytosis
🟢 B. QTc prolongation on ECG
🔴 RATIONALE: In severe anorexia nervosa, electrolyte imbalances (especially hypokalemia and
hypomagnesemia) can cause QTc prolongation, which predisposes to life-threatening ventricular
arrhythmias including torsades de pointes.
7. A 34-year-old veteran presents for evaluation. He reports, "Every time I hear a car backfire, I'm
right back in combat. I can't sleep, and I avoid crowds because I feel like I'm going to be attacked."
Symptoms have persisted for 8 months since leaving active duty. Which diagnosis best fits this
presentation?
A. Acute Stress Disorder
B. Post-Traumatic Stress Disorder
C. Generalized Anxiety Disorder
D. Panic Disorder
🟢 B. Post-Traumatic Stress Disorder
🔴 RATIONALE: PTSD is diagnosed when symptoms of intrusion, avoidance, negative alterations in
cognitions and mood, and alterations in arousal and reactivity persist for more than 1 month following
exposure to trauma. The veteran's symptoms have lasted 8 months and include flashbacks,
hypervigilance, and avoidance.
, 8. A PMHNP is assessing a 28-year-old client with new-onset depression. Which theoretical
framework BEST guides the integration of biological, psychological, and social factors in psychiatric
assessment?
A. Psychoanalytic theory
B. Biopsychosocial model
C. Behavioral theory
D. Cognitive theory
🟢 B. Biopsychosocial model
🔴 RATIONALE: The biopsychosocial model integrates biological, psychological, and social factors in
understanding mental health, providing a comprehensive framework for psychiatric assessment and
treatment planning.
9. A client with major depressive disorder is started on sertraline. Which patient education is MOST
important for the PMHNP to provide regarding the therapeutic timeline?
A. "You will feel better within 2-3 days."
B. "Full therapeutic effects may take 4-6 weeks."
C. "The medication works immediately."
D. "You should stop the medication if you don't feel better in one week."
🟢 B. "Full therapeutic effects may take 4-6 weeks."
🔴 RATIONALE: SSRIs like sertraline typically require 4-6 weeks to achieve full therapeutic effect.
Patients should be educated to continue the medication as prescribed and report any concerning side
effects.
10. A 24-year-old patient with schizophrenia has been stable on olanzapine 15 mg at bedtime for
one year. He presents with a 20-pound weight gain, fasting glucose of 145 mg/dL, and triglycerides
of 320 mg/dL. What is the most appropriate next step?
A. Continue olanzapine and monitor
B. Switch to aripiprazole
C. Add metformin
D. Discontinue all antipsychotics
🟢 B. Switch to aripiprazole
🔴 RATIONALE: Olanzapine has a high risk of metabolic side effects including weight gain,
hyperglycemia, and hyperlipidemia. Switching to aripiprazole, which has a more favorable metabolic
profile, is recommended while continuing to monitor the patient's psychiatric stability.
11. A patient asks the PMHNP, "Have you ever experienced depression yourself?" According to
therapeutic self-disclosure guidelines, which response demonstrates the MOST appropriate use of
self-disclosure?
2026/2027 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026
Q&A | INSTANT DOWNLOAD PDF.
Core Domains
Psychiatric Assessment and Mental Status Examination
DSM-5-TR Diagnostic Criteria and Differential Diagnosis
Mood Disorders and Suicide Risk Assessment
Anxiety, Trauma, and Obsessive-Compulsive Disorders
Psychotic Disorders and Schizophrenia Spectrum
Personality Disorders and Substance Use Disorders
Psychopharmacology and Somatic Treatments
Psychotherapy and Therapeutic Modalities
Ethical, Legal, and Cultural Considerations
Introduction
This comprehensive examination assesses advanced knowledge in psychiatric-mental health diagnosis
and management across the lifespan. It evaluates competency in psychiatric assessment, mental status
examination, DSM-5-TR diagnostic criteria, differential diagnosis, psychopharmacology, psychotherapy,
and ethical-legal frameworks. Multiple-choice and scenario-based questions require clinical application
and decision-making. Emphasis is placed on evidence-based prescribing, risk assessment, and holistic
patient-centered care. Successful performance demonstrates readiness for autonomous psychiatric-
mental health nurse practitioner practice.
Section One: Questions 1–150
1. A 19-year-old college student is brought to the emergency department by campus security after
being found wandering outside in winter without a coat. The patient states, "I don't need a coat
because the voices told me my skin is made of fire and cannot burn." Mental status exam reveals
disorganized speech, flat affect, and poor eye contact. The patient admits to hearing commanding
voices for the past 3 months but has been hiding this from family. Which diagnosis is most
appropriate?
A. Brief Psychotic Disorder
B. Schizophrenia
C. Schizoaffective Disorder
D. Delusional Disorder
🟢 B. Schizophrenia
🔴 RATIONALE: Schizophrenia is diagnosed when characteristic symptoms including delusions,
hallucinations, disorganized speech, and negative symptoms are present for a significant portion of
time during a 1-month period, with continuous signs of disturbance persisting for at least 6 months.
This patient has auditory hallucinations (3 months), disorganized speech, and flat affect, meeting
criteria.
,2. A 7-year-old boy is referred by his teacher for evaluation. Parents report, "He's constantly
moving, cannot finish tasks, and blurts out answers before questions are completed." Symptoms
began at age 5 and occur in both school and home settings. The child has no history of trauma or
medical problems. Which assessment tool is considered gold standard for aiding in the diagnosis of
this condition?
A. Conners' Rating Scales
B. Beck Depression Inventory-II
C. Hamilton Anxiety Rating Scale
D. Positive and Negative Syndrome Scale (PANSS)
🟢 A. Conners' Rating Scales
🔴 RATIONALE: The Conners' Rating Scales are widely used and considered a gold standard
assessment tool for ADHD, gathering information from parents, teachers, and the child about
symptoms across settings.
3. During a psychiatric interview, a 45-year-old patient with depression states, "I don't see the point
in anything anymore. My family would be better off without me. I have a plan to use my father's
gun." Which is the priority nursing action?
A. Complete a full mental status examination
B. Assess the patient's insight and judgment
C. Initiate immediate suicide precautions and remove means
D. Schedule outpatient follow-up within one week
🟢 C. Initiate immediate suicide precautions and remove means
🔴 RATIONALE: The patient has suicidal ideation with a specific plan and access to lethal means.
Immediate safety interventions including suicide precautions and means restriction take priority over
all other assessment activities.
4. A 68-year-old widow presents with 6 weeks of depressed mood, anhedonia, early morning
awakening, and poor appetite following her husband's death. She states, "I just miss him so much,
but I know he'd want me to keep going." She denies suicidal ideation and maintains social
connections. Which is the most appropriate diagnosis?
A. Major Depressive Disorder, Single Episode
B. Persistent Depressive Disorder (Dysthymia)
C. Adjustment Disorder with Depressed Mood
D. No diagnosis; normal bereavement
🟢 D. No diagnosis; normal bereavement
🔴 RATIONALE: The patient's symptoms are consistent with normal grief following the death of a
spouse. The DSM-5-TR specifies that normal bereavement typically resolves within 2 months and does
not require a diagnosis unless symptoms are severe or prolonged.
,5. A PMHNP is conducting a mental status examination. The patient demonstrates inability to recall
three unrelated words after 5 minutes despite being able to register them initially. This finding
indicates impairment in which cognitive domain?
A. Attention
B. Immediate memory
C. Recent memory
D. Remote memory
🟢 C. Recent memory
🔴 RATIONALE: Recent memory refers to the ability to recall information after a short delay (typically
3-5 minutes). The patient could register the words initially (intact immediate memory) but could not
recall them after 5 minutes, indicating recent memory impairment.
6. A 16-year-old female is brought in by her mother who reports the patient has lost 20 pounds in 2
months, exercises excessively, and has amenorrhea. The patient states, "I'm still too fat. I can't eat
that or I'll blow up like a balloon." She is bradycardic with a BMI of 16.5. Which laboratory finding
requires immediate attention?
A. Elevated thyroid-stimulating hormone (TSH)
B. QTc prolongation on ECG
C. Elevated liver enzymes
D. Leukocytosis
🟢 B. QTc prolongation on ECG
🔴 RATIONALE: In severe anorexia nervosa, electrolyte imbalances (especially hypokalemia and
hypomagnesemia) can cause QTc prolongation, which predisposes to life-threatening ventricular
arrhythmias including torsades de pointes.
7. A 34-year-old veteran presents for evaluation. He reports, "Every time I hear a car backfire, I'm
right back in combat. I can't sleep, and I avoid crowds because I feel like I'm going to be attacked."
Symptoms have persisted for 8 months since leaving active duty. Which diagnosis best fits this
presentation?
A. Acute Stress Disorder
B. Post-Traumatic Stress Disorder
C. Generalized Anxiety Disorder
D. Panic Disorder
🟢 B. Post-Traumatic Stress Disorder
🔴 RATIONALE: PTSD is diagnosed when symptoms of intrusion, avoidance, negative alterations in
cognitions and mood, and alterations in arousal and reactivity persist for more than 1 month following
exposure to trauma. The veteran's symptoms have lasted 8 months and include flashbacks,
hypervigilance, and avoidance.
, 8. A PMHNP is assessing a 28-year-old client with new-onset depression. Which theoretical
framework BEST guides the integration of biological, psychological, and social factors in psychiatric
assessment?
A. Psychoanalytic theory
B. Biopsychosocial model
C. Behavioral theory
D. Cognitive theory
🟢 B. Biopsychosocial model
🔴 RATIONALE: The biopsychosocial model integrates biological, psychological, and social factors in
understanding mental health, providing a comprehensive framework for psychiatric assessment and
treatment planning.
9. A client with major depressive disorder is started on sertraline. Which patient education is MOST
important for the PMHNP to provide regarding the therapeutic timeline?
A. "You will feel better within 2-3 days."
B. "Full therapeutic effects may take 4-6 weeks."
C. "The medication works immediately."
D. "You should stop the medication if you don't feel better in one week."
🟢 B. "Full therapeutic effects may take 4-6 weeks."
🔴 RATIONALE: SSRIs like sertraline typically require 4-6 weeks to achieve full therapeutic effect.
Patients should be educated to continue the medication as prescribed and report any concerning side
effects.
10. A 24-year-old patient with schizophrenia has been stable on olanzapine 15 mg at bedtime for
one year. He presents with a 20-pound weight gain, fasting glucose of 145 mg/dL, and triglycerides
of 320 mg/dL. What is the most appropriate next step?
A. Continue olanzapine and monitor
B. Switch to aripiprazole
C. Add metformin
D. Discontinue all antipsychotics
🟢 B. Switch to aripiprazole
🔴 RATIONALE: Olanzapine has a high risk of metabolic side effects including weight gain,
hyperglycemia, and hyperlipidemia. Switching to aripiprazole, which has a more favorable metabolic
profile, is recommended while continuing to monitor the patient's psychiatric stability.
11. A patient asks the PMHNP, "Have you ever experienced depression yourself?" According to
therapeutic self-disclosure guidelines, which response demonstrates the MOST appropriate use of
self-disclosure?
