NR548 Exam 1 Actual Exam Style V3 | NR
548 Psychiatric Assessment for
Psychiatric-Mental Health Nurse
Practitioner Chamberlain
1. During a Mental Status Examination (MSE), a patient provides excessive detail and many
unnecessary detours before finally reaching the point of their story. This thought process is
best documented as:
A. Tangentiality
B. Circumstantiality
C. Flight of ideas
D. Derailment
Correct Answer: B
Expert Explanation: Circumstantiality is characterized by an over-inclusion of details that
are often irrelevant but eventually lead back to the original point or answer. This differs
from tangentiality, where the patient never returns to the original topic. Recognizing these
patterns helps the PMHNP differentiate between normal anxiety and thought disorders like
schizophrenia.
2. When assessing a patient for suicide risk, which of the following is considered the strongest
predictor of a future suicide attempt?
A. Family history of completed suicide
,B. Access to lethal means such as firearms
C. The presence of a diagnosed mood disorder
D. A history of previous suicide attempts
Correct Answer: D
Expert Explanation: A prior history of suicide attempts is statistically the most significant
predictor of future attempts and completed suicide. While other factors like family history
and access to means increase risk, the patient’s own behavioral history provides the most
direct evidence of risk. The PMHNP must conduct a thorough safety assessment whenever
this history is present.
3. A 45-year-old patient presents with a PHQ-9 score of 18. According to standard
interpretation, this indicates which level of depression severity?
A. Moderately severe depression
B. Moderate depression
C. Mild depression
D. Severe depression
Correct Answer: A
Expert Explanation: The PHQ-9 score range of 15-19 corresponds to moderately severe
depression, while a score of 20 or higher is considered severe. This screening tool is
essential for quantifying symptoms and monitoring treatment progress over time. PMHNPs
,use these objective measurements to guide pharmacological and psychotherapeutic
interventions.
4. In the DSM-5-TR, which of the following symptoms must be present for a diagnosis of
Major Depressive Disorder (MDD)?
A. Psychomotor agitation or retardation
B. Anhedonia or depressed mood
C. Difficulty concentrating or indecisiveness
D. Significant weight loss or weight gain
Correct Answer: B
Expert Explanation: To meet the criteria for MDD, at least one of the five required
symptoms must be either a depressed mood or a loss of interest or pleasure (anhedonia).
These core symptoms ensure that the diagnosis captures the essential emotional
disturbances of the disorder. Other symptoms like psychomotor changes and weight
fluctuations are supporting criteria but not sufficient alone without a core symptom.
5. Which of the following is a legal requirement for a PMHNP under the ‘Duty to Warn’
(Tarasoff Rule) mandate?
A. Notifying the intended victim and law enforcement when a patient makes a credible
threat
B. Maintaining strict confidentiality even if a patient threatens a specific third party
C. Reporting any instance of past illegal activity shared during a session
, D. Institutionalizing any patient who expresses vague suicidal ideation
Correct Answer: A
Expert Explanation: The Duty to Warn arises when a patient makes a credible, specific
threat of harm against an identifiable third party. This legal precedent requires the
clinician to breach confidentiality to protect the potential victim and the public. PMHNPs
must balance patient privacy with the safety mandates established by state law and
professional ethics.
6. When assessing a pediatric patient, which acronym is commonly used to screen for
psychosocial risks and protective factors?
A. HEADSS
B. CAGE-AID
C. DIGFAST
D. SIGECAPS
Correct Answer: A
Expert Explanation: HEADSS stands for Home, Education/Employment, Activities, Drugs,
Sexuality, and Suicide/Safety, providing a comprehensive framework for adolescent
assessment. It helps clinicians systematically explore sensitive areas of a young person’s
life that impact mental health. Utilizing this structured approach ensures that no critical
psychosocial domain is overlooked during the interview.
548 Psychiatric Assessment for
Psychiatric-Mental Health Nurse
Practitioner Chamberlain
1. During a Mental Status Examination (MSE), a patient provides excessive detail and many
unnecessary detours before finally reaching the point of their story. This thought process is
best documented as:
A. Tangentiality
B. Circumstantiality
C. Flight of ideas
D. Derailment
Correct Answer: B
Expert Explanation: Circumstantiality is characterized by an over-inclusion of details that
are often irrelevant but eventually lead back to the original point or answer. This differs
from tangentiality, where the patient never returns to the original topic. Recognizing these
patterns helps the PMHNP differentiate between normal anxiety and thought disorders like
schizophrenia.
2. When assessing a patient for suicide risk, which of the following is considered the strongest
predictor of a future suicide attempt?
A. Family history of completed suicide
,B. Access to lethal means such as firearms
C. The presence of a diagnosed mood disorder
D. A history of previous suicide attempts
Correct Answer: D
Expert Explanation: A prior history of suicide attempts is statistically the most significant
predictor of future attempts and completed suicide. While other factors like family history
and access to means increase risk, the patient’s own behavioral history provides the most
direct evidence of risk. The PMHNP must conduct a thorough safety assessment whenever
this history is present.
3. A 45-year-old patient presents with a PHQ-9 score of 18. According to standard
interpretation, this indicates which level of depression severity?
A. Moderately severe depression
B. Moderate depression
C. Mild depression
D. Severe depression
Correct Answer: A
Expert Explanation: The PHQ-9 score range of 15-19 corresponds to moderately severe
depression, while a score of 20 or higher is considered severe. This screening tool is
essential for quantifying symptoms and monitoring treatment progress over time. PMHNPs
,use these objective measurements to guide pharmacological and psychotherapeutic
interventions.
4. In the DSM-5-TR, which of the following symptoms must be present for a diagnosis of
Major Depressive Disorder (MDD)?
A. Psychomotor agitation or retardation
B. Anhedonia or depressed mood
C. Difficulty concentrating or indecisiveness
D. Significant weight loss or weight gain
Correct Answer: B
Expert Explanation: To meet the criteria for MDD, at least one of the five required
symptoms must be either a depressed mood or a loss of interest or pleasure (anhedonia).
These core symptoms ensure that the diagnosis captures the essential emotional
disturbances of the disorder. Other symptoms like psychomotor changes and weight
fluctuations are supporting criteria but not sufficient alone without a core symptom.
5. Which of the following is a legal requirement for a PMHNP under the ‘Duty to Warn’
(Tarasoff Rule) mandate?
A. Notifying the intended victim and law enforcement when a patient makes a credible
threat
B. Maintaining strict confidentiality even if a patient threatens a specific third party
C. Reporting any instance of past illegal activity shared during a session
, D. Institutionalizing any patient who expresses vague suicidal ideation
Correct Answer: A
Expert Explanation: The Duty to Warn arises when a patient makes a credible, specific
threat of harm against an identifiable third party. This legal precedent requires the
clinician to breach confidentiality to protect the potential victim and the public. PMHNPs
must balance patient privacy with the safety mandates established by state law and
professional ethics.
6. When assessing a pediatric patient, which acronym is commonly used to screen for
psychosocial risks and protective factors?
A. HEADSS
B. CAGE-AID
C. DIGFAST
D. SIGECAPS
Correct Answer: A
Expert Explanation: HEADSS stands for Home, Education/Employment, Activities, Drugs,
Sexuality, and Suicide/Safety, providing a comprehensive framework for adolescent
assessment. It helps clinicians systematically explore sensitive areas of a young person’s
life that impact mental health. Utilizing this structured approach ensures that no critical
psychosocial domain is overlooked during the interview.
