NR548 EXAM 2 LATEST 2026/2027 | Psychiatric
Assessment for PMHNP | Weeks 3-4 Covered |
Questions & Verified Answers 100% Correct |
Chamberlain | Pass Guaranteed - A+ Graded
Section 1: Mood Disorders – MDD & Bipolar Assessment (Q1-12)
Question 1
A 42-year-old female presents with depressed mood, anhedonia, fatigue, sleep
disturbance, feelings of worthlessness, difficulty concentrating, and psychomotor
retardation. Symptoms began 3 weeks ago and have occurred nearly every day. She
denies any history of elevated mood, decreased need for sleep, or increased energy. Her
PHQ-9 score is 18. What is the MOST likely diagnosis?
A. Adjustment disorder with depressed mood B. Major depressive disorder, single
episode, moderate C. Persistent depressive disorder (dysthymia) D. Bipolar II disorder
Correct Answer: B. Major depressive disorder, single episode, moderate [CORRECT]
Rationale: The patient meets DSM-5-TR criteria for MDD with ≥5 symptoms in the same
2-week period, including the required depressed mood and anhedonia, with clinically
significant distress. A PHQ-9 score of 15-19 indicates moderately severe depression,
though clinically this presents as moderate severity. Adjustment disorder (A) requires
symptoms within 3 months of an identifiable stressor and fewer symptoms than MDD.
Persistent depressive disorder (C) requires symptoms for ≥2 years. Bipolar II (D) is
ruled out by the absence of any history of hypomania or mania, which the PMHNP must
always assess for when evaluating depression per NR548 Week 3 curriculum.
,Question 2
A 28-year-old male is evaluated for depression. He reports depressed mood, anhedonia,
insomnia, poor concentration, and significant weight loss over the past month. During
the assessment, he mentions a period 2 years ago when he felt "unstoppable," slept only
2 hours nightly for 2 weeks, talked rapidly, and engaged in risky sexual behavior. He
was not hospitalized and denies psychosis. What is the CRITICAL next step in diagnostic
formulation?
A. Diagnose major depressive disorder and initiate SSRI therapy B. Screen for bipolar
disorder using the Mood Disorder Questionnaire (MDQ) C. Diagnose persistent
depressive disorder with anxious distress D. Prescribe a mood stabilizer immediately
without further assessment
Correct Answer: B. Screen for bipolar disorder using the Mood Disorder Questionnaire
(MDQ) [CORRECT]
Rationale: The history of a distinct period with decreased need for sleep, grandiosity
(feeling "unstoppable"), pressured speech, and high-risk activities lasting ≥4 days
without psychosis or hospitalization suggests a prior hypomanic episode. Per DSM-5-TR
and NR548 Week 3 bipolar assessment competencies, the PMHNP must rule out bipolar
disorder before diagnosing MDD, as antidepressant monotherapy in bipolar disorder
can induce mania. The MDQ is the validated screening tool for bipolar spectrum
disorders. Option A is dangerous without ruling out bipolarity. Option C ignores the
manic history. Option D violates evidence-based assessment protocols requiring
diagnostic confirmation before treatment.
Question 3
A 35-year-old woman presents with major depressive disorder. She reports that her
depression worsens every fall and winter, improves in spring, and has occurred for the
past 4 years. She experiences hypersomnia, carbohydrate craving, and weight gain
during these episodes. Which DSM-5-TR specifier applies?
A. With melancholic features B. With atypical features C. With seasonal pattern D. With
peripartum onset
,Correct Answer: C. With seasonal pattern [CORRECT]
Rationale: The specifier "with seasonal pattern" requires a regular temporal
relationship between onset of major depressive episodes and a particular time of year
(typically fall/winter), full remissions at a characteristic time of year, and in the last 2
years, two major depressive episodes demonstrating the temporal relationship with no
non-seasonal episodes. This patient's 4-year pattern of fall/winter onset with spring
remission meets criteria. Melancholic features (A) include early morning awakening and
anhedonia, not hypersomnia. Atypical features (B) include mood reactivity and
hypersomnia but lack the seasonal temporal pattern requirement. Peripartum onset (D)
applies to episodes occurring during pregnancy or within 4 weeks postpartum.
Question 4
A 52-year-old male with no prior psychiatric history presents with depressed mood,
fatigue, constipation, cold intolerance, and dry skin. Laboratory studies reveal elevated
TSH and low free T4. His PHQ-9 score is 12. What is the FIRST priority in the PMHNP's
differential diagnosis hierarchy?
A. Initiate SSRI therapy for moderate depression B. Refer for cognitive behavioral
therapy as first-line treatment C. Rule out medical etiology and treat hypothyroidism D.
Diagnose persistent depressive disorder and begin psychotherapy
Correct Answer: C. Rule out medical etiology and treat hypothyroidism [CORRECT]
Rationale: Per the NR548 Week 3-4 differential diagnosis hierarchy and DSM-5-TR
guidelines, the PMHNP must first rule out general medical conditions and substance-
induced causes before diagnosing a primary mental disorder. Hypothyroidism
classically presents with depressive symptoms, fatigue, cold intolerance, and
constipation. The elevated TSH with low T4 confirms primary hypothyroidism, which
requires endocrine treatment. Treating with an SSRI (A) without addressing the
underlying medical condition violates the "rule out medical first" principle.
Psychotherapy alone (B, D) will not correct the neuroendocrine dysfunction causing
these symptoms.
, Question 5
A 19-year-old college student presents with a 2-week history of elevated mood,
decreased need for sleep (2 hours nightly), grandiose beliefs about becoming a famous
musician, pressured speech, flight of ideas, and excessive spending on musical
equipment. His roommate reports he is "impossible to reason with" and campus
security was called twice for disruptive behavior. He has no prior psychiatric history.
Which diagnosis is MOST appropriate?
A. Bipolar II disorder B. Cyclothymic disorder C. Bipolar I disorder, current episode
manic D. Brief psychotic disorder
Correct Answer: C. Bipolar I disorder, current episode manic [CORRECT]
Rationale: This patient meets DSM-5-TR criteria for a manic episode: elevated mood
plus grandiosity, decreased need for sleep, pressured speech, flight of ideas, and
excessive goal-directed activity (buying equipment) lasting >1 week with marked
impairment requiring intervention (security called). The presence of marked
impairment distinguishes mania from hypomania, making Bipolar I (C) correct rather
than Bipolar II (A). Cyclothymic disorder (B) requires ≥2 years of numerous hypomanic
and depressive symptoms not meeting full episode criteria. Brief psychotic disorder (D)
requires psychotic symptoms lasting 1 day to 1 month without mood symptoms
predominating.
Question 6
A 31-year-old female presents 3 weeks postpartum with depressed mood, anhedonia,
severe anxiety about harming her baby, insomnia even when the baby sleeps, and guilt
about being a "bad mother." She had a similar episode after her first pregnancy 3 years
ago. What is the MOST appropriate DSM-5-TR specifier for her major depressive
episode?
A. With psychotic features B. With peripartum onset C. With anxious distress D. With
mixed features
Correct Answer: B. With peripartum onset [CORRECT]
Assessment for PMHNP | Weeks 3-4 Covered |
Questions & Verified Answers 100% Correct |
Chamberlain | Pass Guaranteed - A+ Graded
Section 1: Mood Disorders – MDD & Bipolar Assessment (Q1-12)
Question 1
A 42-year-old female presents with depressed mood, anhedonia, fatigue, sleep
disturbance, feelings of worthlessness, difficulty concentrating, and psychomotor
retardation. Symptoms began 3 weeks ago and have occurred nearly every day. She
denies any history of elevated mood, decreased need for sleep, or increased energy. Her
PHQ-9 score is 18. What is the MOST likely diagnosis?
A. Adjustment disorder with depressed mood B. Major depressive disorder, single
episode, moderate C. Persistent depressive disorder (dysthymia) D. Bipolar II disorder
Correct Answer: B. Major depressive disorder, single episode, moderate [CORRECT]
Rationale: The patient meets DSM-5-TR criteria for MDD with ≥5 symptoms in the same
2-week period, including the required depressed mood and anhedonia, with clinically
significant distress. A PHQ-9 score of 15-19 indicates moderately severe depression,
though clinically this presents as moderate severity. Adjustment disorder (A) requires
symptoms within 3 months of an identifiable stressor and fewer symptoms than MDD.
Persistent depressive disorder (C) requires symptoms for ≥2 years. Bipolar II (D) is
ruled out by the absence of any history of hypomania or mania, which the PMHNP must
always assess for when evaluating depression per NR548 Week 3 curriculum.
,Question 2
A 28-year-old male is evaluated for depression. He reports depressed mood, anhedonia,
insomnia, poor concentration, and significant weight loss over the past month. During
the assessment, he mentions a period 2 years ago when he felt "unstoppable," slept only
2 hours nightly for 2 weeks, talked rapidly, and engaged in risky sexual behavior. He
was not hospitalized and denies psychosis. What is the CRITICAL next step in diagnostic
formulation?
A. Diagnose major depressive disorder and initiate SSRI therapy B. Screen for bipolar
disorder using the Mood Disorder Questionnaire (MDQ) C. Diagnose persistent
depressive disorder with anxious distress D. Prescribe a mood stabilizer immediately
without further assessment
Correct Answer: B. Screen for bipolar disorder using the Mood Disorder Questionnaire
(MDQ) [CORRECT]
Rationale: The history of a distinct period with decreased need for sleep, grandiosity
(feeling "unstoppable"), pressured speech, and high-risk activities lasting ≥4 days
without psychosis or hospitalization suggests a prior hypomanic episode. Per DSM-5-TR
and NR548 Week 3 bipolar assessment competencies, the PMHNP must rule out bipolar
disorder before diagnosing MDD, as antidepressant monotherapy in bipolar disorder
can induce mania. The MDQ is the validated screening tool for bipolar spectrum
disorders. Option A is dangerous without ruling out bipolarity. Option C ignores the
manic history. Option D violates evidence-based assessment protocols requiring
diagnostic confirmation before treatment.
Question 3
A 35-year-old woman presents with major depressive disorder. She reports that her
depression worsens every fall and winter, improves in spring, and has occurred for the
past 4 years. She experiences hypersomnia, carbohydrate craving, and weight gain
during these episodes. Which DSM-5-TR specifier applies?
A. With melancholic features B. With atypical features C. With seasonal pattern D. With
peripartum onset
,Correct Answer: C. With seasonal pattern [CORRECT]
Rationale: The specifier "with seasonal pattern" requires a regular temporal
relationship between onset of major depressive episodes and a particular time of year
(typically fall/winter), full remissions at a characteristic time of year, and in the last 2
years, two major depressive episodes demonstrating the temporal relationship with no
non-seasonal episodes. This patient's 4-year pattern of fall/winter onset with spring
remission meets criteria. Melancholic features (A) include early morning awakening and
anhedonia, not hypersomnia. Atypical features (B) include mood reactivity and
hypersomnia but lack the seasonal temporal pattern requirement. Peripartum onset (D)
applies to episodes occurring during pregnancy or within 4 weeks postpartum.
Question 4
A 52-year-old male with no prior psychiatric history presents with depressed mood,
fatigue, constipation, cold intolerance, and dry skin. Laboratory studies reveal elevated
TSH and low free T4. His PHQ-9 score is 12. What is the FIRST priority in the PMHNP's
differential diagnosis hierarchy?
A. Initiate SSRI therapy for moderate depression B. Refer for cognitive behavioral
therapy as first-line treatment C. Rule out medical etiology and treat hypothyroidism D.
Diagnose persistent depressive disorder and begin psychotherapy
Correct Answer: C. Rule out medical etiology and treat hypothyroidism [CORRECT]
Rationale: Per the NR548 Week 3-4 differential diagnosis hierarchy and DSM-5-TR
guidelines, the PMHNP must first rule out general medical conditions and substance-
induced causes before diagnosing a primary mental disorder. Hypothyroidism
classically presents with depressive symptoms, fatigue, cold intolerance, and
constipation. The elevated TSH with low T4 confirms primary hypothyroidism, which
requires endocrine treatment. Treating with an SSRI (A) without addressing the
underlying medical condition violates the "rule out medical first" principle.
Psychotherapy alone (B, D) will not correct the neuroendocrine dysfunction causing
these symptoms.
, Question 5
A 19-year-old college student presents with a 2-week history of elevated mood,
decreased need for sleep (2 hours nightly), grandiose beliefs about becoming a famous
musician, pressured speech, flight of ideas, and excessive spending on musical
equipment. His roommate reports he is "impossible to reason with" and campus
security was called twice for disruptive behavior. He has no prior psychiatric history.
Which diagnosis is MOST appropriate?
A. Bipolar II disorder B. Cyclothymic disorder C. Bipolar I disorder, current episode
manic D. Brief psychotic disorder
Correct Answer: C. Bipolar I disorder, current episode manic [CORRECT]
Rationale: This patient meets DSM-5-TR criteria for a manic episode: elevated mood
plus grandiosity, decreased need for sleep, pressured speech, flight of ideas, and
excessive goal-directed activity (buying equipment) lasting >1 week with marked
impairment requiring intervention (security called). The presence of marked
impairment distinguishes mania from hypomania, making Bipolar I (C) correct rather
than Bipolar II (A). Cyclothymic disorder (B) requires ≥2 years of numerous hypomanic
and depressive symptoms not meeting full episode criteria. Brief psychotic disorder (D)
requires psychotic symptoms lasting 1 day to 1 month without mood symptoms
predominating.
Question 6
A 31-year-old female presents 3 weeks postpartum with depressed mood, anhedonia,
severe anxiety about harming her baby, insomnia even when the baby sleeps, and guilt
about being a "bad mother." She had a similar episode after her first pregnancy 3 years
ago. What is the MOST appropriate DSM-5-TR specifier for her major depressive
episode?
A. With psychotic features B. With peripartum onset C. With anxious distress D. With
mixed features
Correct Answer: B. With peripartum onset [CORRECT]
