WGU D344 PMHNP Objective Assessment (OA) – Comprehensive Full Questions, Correct Answers, and Worked Solutions | 2026 Update | 100% Correct.

1. A 32-year-old female presents with a 6-month history of persistent worry about her health, job performance, and family relationships. She reports muscle tension, fatigue, and difficulty sleeping. She finds the worry difficult to control. What is the most likely diagnosis? A) Panic Disorder B) Generalized Anxiety Disorder (GAD) C) Social Anxiety Disorder D) Obsessive-Compulsive Disorder (OCD) Answer: B. The patient’s symptoms of excessive, uncontrollable worry occurring more days than not for at least 6 months, along with associated physical symptoms (muscle tension, fatigue, sleep disturbance), are classic for GAD. 2. A 45-year-old male with a history of alcohol use disorder is started on disulfiram. What is the most critical patient education point regarding this medication? A) It can cause severe hypertension if combined with tyramine-rich foods. B) It will cause a severe adverse reaction if any alcohol is consumed. C) It is highly addictive and requires careful monitoring. D) It may cause significant weight gain. Answer: B. Disulfiram works by inhibiting aldehyde dehydrogenase, leading to a buildup of acetaldehyde if alcohol is consumed. This causes a severe reaction characterized by flushing, nausea, vomiting, and hypotension. Avoiding alcohol in all forms (including cough syrups and mouthwash) is crucial. 3. A patient with Major Depressive Disorder (MDD) is started on fluoxetine. After three weeks, she reports feeling "much better" but also states she has "a lot more energy." What is the most important assessment for the PMHNP to make at this time? A) Assess for signs of serotonin syndrome. B) Assess for activation or hypomania. C) Assess for orthostatic hypotension. D) Assess for gastrointestinal bleeding. Answer: B. While an antidepressant can improve energy before mood, a significant increase in energy accompanied by elevated mood, decreased need for sleep, or risky behavior could indicate a switch to a hypomanic or manic episode, especially in patients with underlying Bipolar Disorder. This is a crucial differential. 4. Which of the following is an FDA-approved indication for clozapine? A) Treatment-resistant depression B) Treatment-resistant schizophrenia C) Acute bipolar mania D) Generalized anxiety disorder Answer: B. Clozapine is the gold-standard medication for treatment-resistant schizophrenia. It is also indicated for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder. 5. A patient is brought to the ED by police for erratic behavior. He is disoriented, agitated, and picking at the air. His vitals are HR 120, BP 150/90, Temp 101.2°F. Pupils are dilated. Which of the following is the most likely cause? A) Alcohol intoxication B) Opioid withdrawal C) Anticholinergic toxicity D) Serotonin syndrome Answer: C. The classic triad of anticholinergic toxicity is "mad as a hatter" (delirium/agitation), "blind as a bat" (mydriasis), "red as a beet" (flushed skin), "hot as a hare" (hyperthermia), and "dry as a bone" (dry mouth, absent sweating). This presentation fits this toxidrome. 6. In Motivational Interviewing, the term "OARS" stands for: A) Open-ended questions, Affirmations, Reflections, Summaries B) Objective Assessment, Rationalization, Support, Summaries C) Openness, Acceptance, Respect, Support D) Observation, Analysis, Reflection, Strategy Answer: A. OARS are the core communication skills used in Motivational Interviewing to elicit change talk and strengthen the patient's own motivation for change. 7. A patient with Bipolar I disorder is stabilized on lithium. Which of the following is a sign of early lithium toxicity? A) Hyperreflexia and tremor B) Coarse tremor, nausea, and vomiting C) Ataxia and confusion D) Polyuria and polydipsia Answer: B. While polyuria and polydipsia are common side effects of lithium, not toxicity, coarse tremor, nausea, vomiting, and diarrhea are early signs of toxicity. Ataxia, confusion, and seizures are signs of severe toxicity. 8. What is the first-line pharmacological treatment for ADHD in an adult with a history of substance use disorder? A) Methylphenidate (Ritalin) B) Mixed amphetamine salts (Adderall) C) Atomoxetine (Strattera) D) Lisdexamfetamine (Vyvanse) Answer: C. While stimulants are first-line for ADHD in general, in patients with a history of substance use disorder, the non-stimulant atomoxetine or other non-stimulants (viloxazine, guanfacine) are often preferred due to their lower abuse potential. Lisdexamfetamine has a lower potential than immediate-release stimulants but is still a schedule II drug. 9. Which of the following is a key characteristic of Delirium that helps distinguish it from Dementia? A) Gradual onset and progressive decline B) Impaired memory C) Fluctuating level of consciousness D) Irreversible cognitive impairment Answer: C. Delirium is characterized by an acute onset and a fluctuating course, meaning the level of consciousness and attention can change significantly throughout the day. Dementia has a gradual, progressive onset and generally stable level of consciousness. 10. A patient on phenelzine (an MAOI) presents to the emergency department with a severe headache, tachycardia, and hypertension after eating a meal. What is the most likely cause? A) Hypertensive crisis from dietary tyramine B) Serotonin syndrome C) Neuroleptic malignant syndrome D) Normal side effect of the medication Answer: A. MAOIs inhibit the breakdown of tyramine, found in aged cheeses, cured meats, and fermented foods. A buildup of tyramine can cause a hypertensive crisis, a medical emergency. The classic presentation includes a severe occipital headache, palpitations, and elevated blood pressure. 11. A 16-year-old male is brought in by his parents because he has been having episodes of intense fear that come on suddenly, accompanied by palpitations, sweating, and a feeling of impending doom. What is the most appropriate initial screening tool? A) Beck Depression Inventory (BDI) B) Columbia-Suicide Severity Rating Scale (C-SSRS) C) Generalized Anxiety Disorder-7 (GAD-7) D) The "SIGECAPS" mnemonic Answer: B. While panic disorder may be the eventual diagnosis, the PMHNP's immediate priority is to assess for suicide risk. The C-SSRS is a validated tool for assessing suicidal ideation and behavior across all age groups and is a critical part of any initial psychiatric assessment. 12. Which of the following long-acting injectable (LAI) antipsychotics is a second-generation agent? A) Haloperidol decanoate B) Fluphenazine decanoate C) Risperidone microspheres D) Chlorpromazine Answer: C. Risperidone microspheres (Risperdal Consta) and paliperidone palmitate (Invega Sustenna/Trinza) are second-generation (atypical) LAIs. Haloperidol and fluphenazine are first-generation (typical) LAIs.