NR548 Exam 2 Actual Exam Style V3 | NR
548 Psychiatric Assessment for
Psychiatric-Mental Health Nurse
Practitioner Chamberlain
1. During a mental status examination (MSE), a patient reports feeling extremely sad and
hopeless. However, the clinician observes the patient laughing while discussing these
feelings. How should the clinician document this finding?
A. The patient’s mood is incongruent with their affect.
B. The patient’s mood is congruent with their affect.
C. The patient is experiencing a flat affect.
D. The patient’s thought process is tangential.
Correct Answer: A
Expert Explanation: Mood refers to the patient’s internal emotional state, while affect
refers to the external expression of emotion observed by the clinician. When the patient’s
reported feelings do not match their observable emotional expression, it is documented as
incongruent. This distinction is vital for identifying potential diagnostic indicators such as
mania or personality disorders.
2. When conducting a suicide risk assessment, which factor represents the highest level of
immediate lethality?
A. A history of multiple past suicide attempts.
,B. A diagnosis of Major Depressive Disorder.
C. A specific plan with access to a firearm.
D. Living alone in a rural area with limited support.
Correct Answer: C
Expert Explanation: While all listed options are risk factors, the presence of a specific plan
combined with the immediate means to carry it out represents the highest acute risk.
Lethality is assessed by evaluating the speed and certainty of the method chosen by the
patient. Clinicians must prioritize safety planning and potentially involuntary
hospitalization when means are readily available.
3. In the assessment of a child for Attention-Deficit/Hyperactivity Disorder (ADHD), which of
the following is required for a DSM-5-TR diagnosis?
A. Symptoms must be present in only the school environment.
B. The child must display aggressive behavior toward peers.
C. The child must be older than 12 years of age for diagnosis.
D. Symptoms must be present in two or more settings.
Correct Answer: D
Expert Explanation: DSM-5-TR criteria for ADHD require that symptoms of inattention or
hyperactivity-impulsivity be present in at least two different settings, such as home and
school. This ensures that the symptoms are a pervasive neurodevelopmental issue rather
,than a reaction to a specific environment. Information from multiple informants, such as
parents and teachers, is essential for a comprehensive evaluation.
4. An 80-year-old patient presents with sudden onset confusion, fluctuating levels of
consciousness, and visual hallucinations. What is the most likely initial diagnosis?
A. Delirium
B. Vascular Dementia
C. Alzheimer’s Disease
D. Major Depressive Disorder with Psychosis
Correct Answer: A
Expert Explanation: Delirium is characterized by an acute onset, a fluctuating course, and
disturbances in attention and awareness. It is often caused by underlying medical
conditions, such as infections or medication side effects, particularly in geriatric
populations. Unlike dementia, which is progressive and chronic, delirium is typically
reversible once the underlying cause is addressed.
5. Which component of the Cultural Formulation Interview (CFI) focuses on the patient’s
perspective of their own illness?
A. Cultural Definition of the Problem
B. Cultural Perceptions of Cause, Context, and Support
C. Cultural Factors Affecting Self-Coping and Help-Seeking
, D. Cultural Factors Affecting Current Help-Seeking
Correct Answer: A
Expert Explanation: The Cultural Definition of the Problem component allows the patient
to describe their experience in their own words. This helps the PMHNP understand the
patient’s unique framework for their symptoms and distress. Incorporating these cultural
insights is necessary for building a therapeutic alliance and creating a culturally sensitive
treatment plan.
6. The PMHNP is evaluating a patient who makes a specific threat to harm a named
individual. Based on the Tarasoff ruling, what is the clinician’s primary legal obligation?
A. Maintain patient confidentiality at all costs.
B. Increase the dose of the patient’s antipsychotic medication.
C. Refer the patient to a different provider for a second opinion.
D. Duty to warn the intended victim and notify law enforcement.
Correct Answer: D
Expert Explanation: The Tarasoff rule establishes that mental health professionals have a
‘duty to warn’ or protect third parties who are specifically threatened by a patient.
Confidentiality is legally breached in these instances to ensure public safety and the safety
of the individual at risk. Documentation of the threat and the clinician’s subsequent actions
is critical for legal and ethical compliance.
548 Psychiatric Assessment for
Psychiatric-Mental Health Nurse
Practitioner Chamberlain
1. During a mental status examination (MSE), a patient reports feeling extremely sad and
hopeless. However, the clinician observes the patient laughing while discussing these
feelings. How should the clinician document this finding?
A. The patient’s mood is incongruent with their affect.
B. The patient’s mood is congruent with their affect.
C. The patient is experiencing a flat affect.
D. The patient’s thought process is tangential.
Correct Answer: A
Expert Explanation: Mood refers to the patient’s internal emotional state, while affect
refers to the external expression of emotion observed by the clinician. When the patient’s
reported feelings do not match their observable emotional expression, it is documented as
incongruent. This distinction is vital for identifying potential diagnostic indicators such as
mania or personality disorders.
2. When conducting a suicide risk assessment, which factor represents the highest level of
immediate lethality?
A. A history of multiple past suicide attempts.
,B. A diagnosis of Major Depressive Disorder.
C. A specific plan with access to a firearm.
D. Living alone in a rural area with limited support.
Correct Answer: C
Expert Explanation: While all listed options are risk factors, the presence of a specific plan
combined with the immediate means to carry it out represents the highest acute risk.
Lethality is assessed by evaluating the speed and certainty of the method chosen by the
patient. Clinicians must prioritize safety planning and potentially involuntary
hospitalization when means are readily available.
3. In the assessment of a child for Attention-Deficit/Hyperactivity Disorder (ADHD), which of
the following is required for a DSM-5-TR diagnosis?
A. Symptoms must be present in only the school environment.
B. The child must display aggressive behavior toward peers.
C. The child must be older than 12 years of age for diagnosis.
D. Symptoms must be present in two or more settings.
Correct Answer: D
Expert Explanation: DSM-5-TR criteria for ADHD require that symptoms of inattention or
hyperactivity-impulsivity be present in at least two different settings, such as home and
school. This ensures that the symptoms are a pervasive neurodevelopmental issue rather
,than a reaction to a specific environment. Information from multiple informants, such as
parents and teachers, is essential for a comprehensive evaluation.
4. An 80-year-old patient presents with sudden onset confusion, fluctuating levels of
consciousness, and visual hallucinations. What is the most likely initial diagnosis?
A. Delirium
B. Vascular Dementia
C. Alzheimer’s Disease
D. Major Depressive Disorder with Psychosis
Correct Answer: A
Expert Explanation: Delirium is characterized by an acute onset, a fluctuating course, and
disturbances in attention and awareness. It is often caused by underlying medical
conditions, such as infections or medication side effects, particularly in geriatric
populations. Unlike dementia, which is progressive and chronic, delirium is typically
reversible once the underlying cause is addressed.
5. Which component of the Cultural Formulation Interview (CFI) focuses on the patient’s
perspective of their own illness?
A. Cultural Definition of the Problem
B. Cultural Perceptions of Cause, Context, and Support
C. Cultural Factors Affecting Self-Coping and Help-Seeking
, D. Cultural Factors Affecting Current Help-Seeking
Correct Answer: A
Expert Explanation: The Cultural Definition of the Problem component allows the patient
to describe their experience in their own words. This helps the PMHNP understand the
patient’s unique framework for their symptoms and distress. Incorporating these cultural
insights is necessary for building a therapeutic alliance and creating a culturally sensitive
treatment plan.
6. The PMHNP is evaluating a patient who makes a specific threat to harm a named
individual. Based on the Tarasoff ruling, what is the clinician’s primary legal obligation?
A. Maintain patient confidentiality at all costs.
B. Increase the dose of the patient’s antipsychotic medication.
C. Refer the patient to a different provider for a second opinion.
D. Duty to warn the intended victim and notify law enforcement.
Correct Answer: D
Expert Explanation: The Tarasoff rule establishes that mental health professionals have a
‘duty to warn’ or protect third parties who are specifically threatened by a patient.
Confidentiality is legally breached in these instances to ensure public safety and the safety
of the individual at risk. Documentation of the threat and the clinician’s subsequent actions
is critical for legal and ethical compliance.
