Walden University NRNP 6635 Psychopathology and
Diagnostic Reasoning – NRNP 6635 Study Guide, Original
Practice Questions & Answers, Comprehensive PMHNP
Exam Preparation, Psychopathology Review, Psychiatric
Assessment, Mental Status Examination, DSM-5-TR,
Diagnostic Reasoning, Differential Diagnosis, Diagnostic
Formulation, Neurobiology, Mood Disorders, Anxiety
Disorders, Psychotic Disorders, Trauma-Related Disorders,
Substance Use Disorders, Neurodevelopmental Disorders,
Neurocognitive Disorders, Personality Disorders & Clinical
Decision-Making
Question 1: A 32-year-old patient presents with a 4-week history of depressed
mood, anhedonia, significant weight loss, and insomnia. Which additional
symptom is required to meet the DSM-5-TR criteria for a Major Depressive Episode?
A. Elevated or expansive mood
B. Feelings of worthlessness or excessive guilt
C. A history of a manic episode
D. Substance-induced physiological effects
CORRECT ANSWER: B. Feelings of worthlessness or excessive guilt
Rationale: A Major Depressive Episode in DSM-5-TR requires five or more symptoms
during the same two-week period, including at least one of depressed mood or
anhedonia. The other symptoms include significant weight change, insomnia or
hypersomnia, psychomotor changes, fatigue, feelings of worthlessness or guilt,
diminished concentration, and recurrent thoughts of death. Therefore, "feelings of
worthlessness or excessive guilt" is one of the possible required symptoms .
Question 2: Which neurobiological mechanism is most strongly implicated in the
pathophysiology of anxiety disorders?
A. Hyperactivity of the dopaminergic mesolimbic pathway
B. Dysregulation of the gamma-aminobutyric acid (GABA) system
C. Degeneration of cholinergic neurons in the basal forebrain
D. Excess of glutamatergic activity in the prefrontal cortex
CORRECT ANSWER: B. Dysregulation of the gamma-aminobutyric acid (GABA)
system
Rationale: The GABA system is the primary inhibitory neurotransmitter system in the
brain, and its dysfunction is heavily implicated in the pathophysiology of anxiety
disorders. Reduced GABAergic tone leads to heightened neuronal excitability, which is
associated with increased anxiety .
Question 3: A 55-year-old male patient with a history of schizophrenia has been on
long-term antipsychotic therapy. During a routine visit, you observe involuntary,
,repetitive, and choreiform movements of the tongue and facial muscles. Which
assessment scale is most appropriate for monitoring this patient's condition?
A. Hamilton Depression Rating Scale (HAM-D)
B. Abnormal Involuntary Movement Scale (AIMS)
C. Young Mania Rating Scale (YMRS)
D. Positive and Negative Syndrome Scale (PANSS)
CORRECT ANSWER: B. Abnormal Involuntary Movement Scale (AIMS)
Rationale: The AIMS is a standardized rating scale specifically designed to assess and
monitor tardive dyskinesia and other medication-induced movement disorders. The
patient's symptoms are classic signs of tardive dyskinesia, a potentially irreversible side
effect of long-term antipsychotic use .
Question 4: In the DSM-5-TR, the diagnosis of "Unspecified" disorders is used in
which of the following circumstances?
A. The clinician has insufficient information to make a specific diagnosis.
B. The patient's symptoms are intentionally produced or feigned.
C. The patient's symptoms are entirely due to a general medical condition.
D. The patient has a subclinical presentation that does not cause distress.
CORRECT ANSWER: A. The clinician has insufficient information to make a specific
diagnosis.
Rationale: The "unspecified" category in DSM-5-TR is used when the clinician chooses
not to specify the reason the criteria for a specific disorder are not met. This is often
because there is insufficient information to make a more specific diagnosis, such as in
an emergency department setting .
Question 5: A 26-year-old patient is brought to the ER by police after being found
running naked in the street. The patient is agitated, exhibiting rapid and pressured
speech, and claims to have a special relationship with God. The patient reports
sleeping only 3 hours a night for the past week but feeling energetic. What is the
most likely diagnosis?
A. Schizophrenia
B. Major Depressive Disorder with Psychotic Features
C. Manic Episode
D. Substance-Induced Psychotic Disorder
CORRECT ANSWER: C. Manic Episode
Rationale: The patient's presentation includes a distinct period of abnormally and
persistently elevated, expansive, or irritable mood and increased goal-directed
activity/energy lasting at least one week. The symptoms of decreased need for sleep,
grandiosity, and pressured speech are classic criteria for a manic episode .
,Question 6: Which of the following is a core deficit in Autism Spectrum Disorder
(ASD) according to DSM-5-TR?
A. Persistent deficits in social communication and interaction
B. Restricted, repetitive patterns of behavior and interests
C. Both A and B are core deficits
D. Hallucinations and delusions
CORRECT ANSWER: C. Both A and B are core deficits
Rationale: DSM-5-TR criteria for ASD require persistent deficits in social
communication and social interaction across multiple contexts, as well as restricted,
repetitive patterns of behavior, interests, or activities. Both are essential domains for
the diagnosis .
Question 7: According to the diathesis-stress model of psychopathology, the
development of a mental disorder is best understood as:
A. A direct consequence of a single genetic mutation.
B. An inevitable outcome of exposure to severe trauma.
C. An interaction between a pre-existing vulnerability and environmental stressors.
D. A result of maladaptive learned behaviors in childhood.
CORRECT ANSWER: C. An interaction between a pre-existing vulnerability and
environmental stressors.
Rationale: The diathesis-stress model posits that individuals possess a certain degree
of vulnerability (diathesis) for a disorder, which may be genetic, psychological, or
biological. A mental disorder develops only when this vulnerability is triggered by
significant environmental stress .
Question 8: A 42-year-old female has been taking fluoxetine for Major Depressive
Disorder for 3 months. She reports that her mood has improved but complains of
significant sexual dysfunction. This side effect is most likely due to the drug's
effect on which neurotransmitter?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. Acetylcholine
CORRECT ANSWER: C. Serotonin
Rationale: Sexual dysfunction, including decreased libido, anorgasmia, and erectile
dysfunction, is a common side effect of SSRIs like fluoxetine. This is attributed to the
increase in synaptic serotonin, which inhibits sexual arousal and orgasm .
Question 9: Which of the following is a positive symptom of schizophrenia?
, A. Flat affect
B. Alogia
C. Avolition
D. Hallucinations
CORRECT ANSWER: D. Hallucinations
Rationale: Positive symptoms of schizophrenia are psychotic behaviors not seen in
healthy individuals, such as hallucinations, delusions, and disorganized speech.
Negative symptoms, such as flat affect, alogia, and avolition, represent a decrease in
normal functioning .
Question 10: The biopsychosocial model, which is the predominant framework in
psychiatric mental health nursing, posits that mental disorders result from:
A. Biological factors only.
B. Psychological factors only.
C. Social factors only.
D. The complex interaction of biological, psychological, and social factors.
CORRECT ANSWER: D. The complex interaction of biological, psychological, and
social factors.
Rationale: The biopsychosocial model is a comprehensive framework that emphasizes
that health and illness are determined by the dynamic interplay of biological (e.g.,
genetics, neurochemistry), psychological (e.g., mood, coping), and social (e.g., culture,
environment) factors. This is the foundational model for assessment and treatment in
psychiatry .
Question 11: A 19-year-old college student is brought to the clinic by a roommate.
The patient has not left their room for a week, has stopped bathing, and has been
speaking in a disorganized manner. The patient's family history is significant for
schizophrenia. What is the most critical initial step in the diagnostic process?
A. Administering a personality inventory.
B. Ordering a complete blood count and toxicology screen.
C. Conducting a comprehensive psychiatric interview and mental status exam.
D. Performing an MRI of the brain.
CORRECT ANSWER: C. Conducting a comprehensive psychiatric interview and
mental status exam.
Rationale: The clinical interview and mental status exam are the cornerstones of
psychiatric assessment. They are essential for establishing rapport, gathering
information about the patient's history and symptoms, and forming a differential
diagnosis. It is the most critical first step in diagnostic reasoning .
Diagnostic Reasoning – NRNP 6635 Study Guide, Original
Practice Questions & Answers, Comprehensive PMHNP
Exam Preparation, Psychopathology Review, Psychiatric
Assessment, Mental Status Examination, DSM-5-TR,
Diagnostic Reasoning, Differential Diagnosis, Diagnostic
Formulation, Neurobiology, Mood Disorders, Anxiety
Disorders, Psychotic Disorders, Trauma-Related Disorders,
Substance Use Disorders, Neurodevelopmental Disorders,
Neurocognitive Disorders, Personality Disorders & Clinical
Decision-Making
Question 1: A 32-year-old patient presents with a 4-week history of depressed
mood, anhedonia, significant weight loss, and insomnia. Which additional
symptom is required to meet the DSM-5-TR criteria for a Major Depressive Episode?
A. Elevated or expansive mood
B. Feelings of worthlessness or excessive guilt
C. A history of a manic episode
D. Substance-induced physiological effects
CORRECT ANSWER: B. Feelings of worthlessness or excessive guilt
Rationale: A Major Depressive Episode in DSM-5-TR requires five or more symptoms
during the same two-week period, including at least one of depressed mood or
anhedonia. The other symptoms include significant weight change, insomnia or
hypersomnia, psychomotor changes, fatigue, feelings of worthlessness or guilt,
diminished concentration, and recurrent thoughts of death. Therefore, "feelings of
worthlessness or excessive guilt" is one of the possible required symptoms .
Question 2: Which neurobiological mechanism is most strongly implicated in the
pathophysiology of anxiety disorders?
A. Hyperactivity of the dopaminergic mesolimbic pathway
B. Dysregulation of the gamma-aminobutyric acid (GABA) system
C. Degeneration of cholinergic neurons in the basal forebrain
D. Excess of glutamatergic activity in the prefrontal cortex
CORRECT ANSWER: B. Dysregulation of the gamma-aminobutyric acid (GABA)
system
Rationale: The GABA system is the primary inhibitory neurotransmitter system in the
brain, and its dysfunction is heavily implicated in the pathophysiology of anxiety
disorders. Reduced GABAergic tone leads to heightened neuronal excitability, which is
associated with increased anxiety .
Question 3: A 55-year-old male patient with a history of schizophrenia has been on
long-term antipsychotic therapy. During a routine visit, you observe involuntary,
,repetitive, and choreiform movements of the tongue and facial muscles. Which
assessment scale is most appropriate for monitoring this patient's condition?
A. Hamilton Depression Rating Scale (HAM-D)
B. Abnormal Involuntary Movement Scale (AIMS)
C. Young Mania Rating Scale (YMRS)
D. Positive and Negative Syndrome Scale (PANSS)
CORRECT ANSWER: B. Abnormal Involuntary Movement Scale (AIMS)
Rationale: The AIMS is a standardized rating scale specifically designed to assess and
monitor tardive dyskinesia and other medication-induced movement disorders. The
patient's symptoms are classic signs of tardive dyskinesia, a potentially irreversible side
effect of long-term antipsychotic use .
Question 4: In the DSM-5-TR, the diagnosis of "Unspecified" disorders is used in
which of the following circumstances?
A. The clinician has insufficient information to make a specific diagnosis.
B. The patient's symptoms are intentionally produced or feigned.
C. The patient's symptoms are entirely due to a general medical condition.
D. The patient has a subclinical presentation that does not cause distress.
CORRECT ANSWER: A. The clinician has insufficient information to make a specific
diagnosis.
Rationale: The "unspecified" category in DSM-5-TR is used when the clinician chooses
not to specify the reason the criteria for a specific disorder are not met. This is often
because there is insufficient information to make a more specific diagnosis, such as in
an emergency department setting .
Question 5: A 26-year-old patient is brought to the ER by police after being found
running naked in the street. The patient is agitated, exhibiting rapid and pressured
speech, and claims to have a special relationship with God. The patient reports
sleeping only 3 hours a night for the past week but feeling energetic. What is the
most likely diagnosis?
A. Schizophrenia
B. Major Depressive Disorder with Psychotic Features
C. Manic Episode
D. Substance-Induced Psychotic Disorder
CORRECT ANSWER: C. Manic Episode
Rationale: The patient's presentation includes a distinct period of abnormally and
persistently elevated, expansive, or irritable mood and increased goal-directed
activity/energy lasting at least one week. The symptoms of decreased need for sleep,
grandiosity, and pressured speech are classic criteria for a manic episode .
,Question 6: Which of the following is a core deficit in Autism Spectrum Disorder
(ASD) according to DSM-5-TR?
A. Persistent deficits in social communication and interaction
B. Restricted, repetitive patterns of behavior and interests
C. Both A and B are core deficits
D. Hallucinations and delusions
CORRECT ANSWER: C. Both A and B are core deficits
Rationale: DSM-5-TR criteria for ASD require persistent deficits in social
communication and social interaction across multiple contexts, as well as restricted,
repetitive patterns of behavior, interests, or activities. Both are essential domains for
the diagnosis .
Question 7: According to the diathesis-stress model of psychopathology, the
development of a mental disorder is best understood as:
A. A direct consequence of a single genetic mutation.
B. An inevitable outcome of exposure to severe trauma.
C. An interaction between a pre-existing vulnerability and environmental stressors.
D. A result of maladaptive learned behaviors in childhood.
CORRECT ANSWER: C. An interaction between a pre-existing vulnerability and
environmental stressors.
Rationale: The diathesis-stress model posits that individuals possess a certain degree
of vulnerability (diathesis) for a disorder, which may be genetic, psychological, or
biological. A mental disorder develops only when this vulnerability is triggered by
significant environmental stress .
Question 8: A 42-year-old female has been taking fluoxetine for Major Depressive
Disorder for 3 months. She reports that her mood has improved but complains of
significant sexual dysfunction. This side effect is most likely due to the drug's
effect on which neurotransmitter?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. Acetylcholine
CORRECT ANSWER: C. Serotonin
Rationale: Sexual dysfunction, including decreased libido, anorgasmia, and erectile
dysfunction, is a common side effect of SSRIs like fluoxetine. This is attributed to the
increase in synaptic serotonin, which inhibits sexual arousal and orgasm .
Question 9: Which of the following is a positive symptom of schizophrenia?
, A. Flat affect
B. Alogia
C. Avolition
D. Hallucinations
CORRECT ANSWER: D. Hallucinations
Rationale: Positive symptoms of schizophrenia are psychotic behaviors not seen in
healthy individuals, such as hallucinations, delusions, and disorganized speech.
Negative symptoms, such as flat affect, alogia, and avolition, represent a decrease in
normal functioning .
Question 10: The biopsychosocial model, which is the predominant framework in
psychiatric mental health nursing, posits that mental disorders result from:
A. Biological factors only.
B. Psychological factors only.
C. Social factors only.
D. The complex interaction of biological, psychological, and social factors.
CORRECT ANSWER: D. The complex interaction of biological, psychological, and
social factors.
Rationale: The biopsychosocial model is a comprehensive framework that emphasizes
that health and illness are determined by the dynamic interplay of biological (e.g.,
genetics, neurochemistry), psychological (e.g., mood, coping), and social (e.g., culture,
environment) factors. This is the foundational model for assessment and treatment in
psychiatry .
Question 11: A 19-year-old college student is brought to the clinic by a roommate.
The patient has not left their room for a week, has stopped bathing, and has been
speaking in a disorganized manner. The patient's family history is significant for
schizophrenia. What is the most critical initial step in the diagnostic process?
A. Administering a personality inventory.
B. Ordering a complete blood count and toxicology screen.
C. Conducting a comprehensive psychiatric interview and mental status exam.
D. Performing an MRI of the brain.
CORRECT ANSWER: C. Conducting a comprehensive psychiatric interview and
mental status exam.
Rationale: The clinical interview and mental status exam are the cornerstones of
psychiatric assessment. They are essential for establishing rapport, gathering
information about the patient's history and symptoms, and forming a differential
diagnosis. It is the most critical first step in diagnostic reasoning .
