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 &
Neurocognitive Disorders, Personality Disorders & Clinical
Decision-Making
Question 1: Which diagnostic criterion is essential for a diagnosis of Major
Depressive Disorder (MDD) according to the DSM-5-TR?
A. Depressed mood for at least one month
B. Psychotic symptoms such as delusions
C. Depressed mood or anhedonia for at least two weeks
D. A history of manic episodes
CORRECT ANSWER: C. Depressed mood or anhedonia for at least two weeks
Rationale: The DSM-5-TR requires the presence of either depressed mood or
anhedonia (loss of interest or pleasure) for at least two weeks, along with four additional
symptoms from a specified list (e.g., changes in sleep, appetite, energy, concentration, or
thoughts of death). Psychotic symptoms (A) are not required and suggest a specifier like
MDD with psychotic features. Manic episodes (D) would indicate a bipolar disorder
rather than MDD .
Question 2: A patient presents with auditory hallucinations and disorganized
speech. Which type of symptom is the patient exhibiting?
A. Negative symptom
B. Cognitive symptom
C. Positive symptom
D. Affective symptom
CORRECT ANSWER: C. Positive symptom
Rationale: Positive symptoms of schizophrenia represent an excess or distortion of
normal functions. Hallucinations and disorganized speech are classic examples of
positive symptoms, as they are additional experiences or behaviors not present in
healthy individuals . Negative symptoms (A), in contrast, involve a diminution or loss of
normal functions, such as flat affect or avolition .
,Question 3: What is the hallmark feature of Generalized Anxiety Disorder
(GAD) as defined by the DSM-5-TR?
A. Recurrent, unexpected panic attacks
B. Excessive anxiety and worry occurring more days than not for at least six months
C. Intrusive, repetitive thoughts and compulsive behaviors
D. Fear of social scrutiny and negative evaluation
CORRECT ANSWER: B. Excessive anxiety and worry occurring more days than
not for at least six months
Rationale: The core diagnostic feature of GAD is persistent and excessive worry about
various domains that is difficult to control and occurs more days than not for a minimum
of six months . This distinguishes it from transient anxiety. Panic attacks (A) are
characteristic of Panic Disorder, and social fear (D) is indicative of Social Anxiety
Disorder.
Question 4: According to the DSM-5-TR, what is the minimum duration
required for a hypomanic episode?
A. 1 week
B. 4 consecutive days
C. 2 weeks
D. 1 month
CORRECT ANSWER: B. 4 consecutive days
Rationale: The DSM-5-TR specifies that a hypomanic episode, which is a distinct
period of elevated, expansive, or irritable mood, must last for at least four consecutive
days . A full manic episode (A) requires a duration of at least one week.
Question 5: Which assessment tool is most commonly used to screen for
depression in primary care settings?
A. GAD-7
B. MMSE
C. CAGE Questionnaire
D. PHQ-9
CORRECT ANSWER: D. PHQ-9
Rationale: The Patient Health Questionnaire-9 (PHQ-9) is a widely used, validated
screening tool for depression. It assesses the nine DSM-5-TR criteria for Major
Depressive Disorder . The GAD-7 (A) screens for anxiety, the MMSE (B) assesses
cognitive impairment, and the CAGE (C) screens for alcohol use disorder.
,Question 6: A 25-year-old patient reports recurrent, unexpected panic attacks
followed by persistent worry about having another attack. What is the most
likely diagnosis?
A. Agoraphobia
B. Social Anxiety Disorder
C. Panic Disorder
D. Specific Phobia
CORRECT ANSWER: C. Panic Disorder
Rationale: Panic Disorder is characterized by recurrent, unexpected panic attacks and
at least one month of persistent concern or worry about additional attacks or their
consequences . Agoraphobia (A) involves fear of places where escape might be difficult.
Social Anxiety Disorder (B) involves fear of social scrutiny.
Question 7: Which neurotransmitter is most implicated in the pathophysiology
of the positive symptoms of schizophrenia?
A. Serotonin
B. Acetylcholine
C. Dopamine
D. GABA
CORRECT ANSWER: C. Dopamine
Rationale: The dopamine hypothesis of schizophrenia posits that hyperactivity of
dopamine in the mesolimbic pathway is primarily responsible for the positive symptoms
of schizophrenia, such as hallucinations and delusions . This is the rationale for using
dopamine D2 receptor antagonists as antipsychotic medications.
Question 8: A patient presents with a pervasive pattern of instability in
interpersonal relationships, self-image, and affects, along with marked
impulsivity. This clinical picture is most consistent with which personality
disorder?
A. Narcissistic Personality Disorder
B. Borderline Personality Disorder
C. Antisocial Personality Disorder
D. Avoidant Personality Disorder
CORRECT ANSWER: B. Borderline Personality Disorder
Rationale: Borderline Personality Disorder (BPD) is characterized by a pervasive
pattern of instability in interpersonal relationships, self-image, and emotions,
accompanied by significant impulsivity . This instability is often triggered by a fear of
abandonment .
, Question 9: What is the characteristic symptom required for a diagnosis of
Post-Traumatic Stress Disorder (PTSD)?
A. Excessive worry about various life events
B. Persistent, intrusive memories of a traumatic event
C. Recurrent, unexpected panic attacks
D. Distressing obsessions and compulsions
CORRECT ANSWER: B. Persistent, intrusive memories of a traumatic event
Rationale: A core symptom of PTSD is the presence of intrusion symptoms, which
include recurrent, involuntary, and distressing memories of the traumatic event . Other
symptom clusters include avoidance, negative alterations in cognition and mood, and
alterations in arousal and reactivity.
Question 10: Which medication class is considered a first-line pharmacologic
treatment for Obsessive-Compulsive Disorder (OCD)?
A. Benzodiazepines
B. Antipsychotics
C. Selective Serotonin Reuptake Inhibitors (SSRIs)
D. Mood Stabilizers
CORRECT ANSWER: C. Selective Serotonin Reuptake Inhibitors (SSRIs)
Rationale: SSRIs are the first-line pharmacologic treatment for OCD due to their
efficacy in modulating serotonergic pathways that are implicated in the disorder's
pathophysiology . Benzodiazepines (A) are not first-line and have a risk of dependence.
Antipsychotics (B) are often used as augmentation, not monotherapy.
Question 11: A 35-year-old patient reports intrusive thoughts about
contamination and repetitive handwashing that cause significant distress and
are time-consuming. According to DSM-5-TR, what is the most likely
diagnosis?
A. Generalized Anxiety Disorder
B. Post-Traumatic Stress Disorder
C. Obsessive-Compulsive Disorder
D. Specific Phobia
CORRECT ANSWER: C. Obsessive-Compulsive Disorder
Rationale: The presence of obsessions (e.g., contamination thoughts) and compulsions
(e.g., handwashing) that are time-consuming and cause significant distress is diagnostic
for Obsessive-Compulsive Disorder .
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 &
Neurocognitive Disorders, Personality Disorders & Clinical
Decision-Making
Question 1: Which diagnostic criterion is essential for a diagnosis of Major
Depressive Disorder (MDD) according to the DSM-5-TR?
A. Depressed mood for at least one month
B. Psychotic symptoms such as delusions
C. Depressed mood or anhedonia for at least two weeks
D. A history of manic episodes
CORRECT ANSWER: C. Depressed mood or anhedonia for at least two weeks
Rationale: The DSM-5-TR requires the presence of either depressed mood or
anhedonia (loss of interest or pleasure) for at least two weeks, along with four additional
symptoms from a specified list (e.g., changes in sleep, appetite, energy, concentration, or
thoughts of death). Psychotic symptoms (A) are not required and suggest a specifier like
MDD with psychotic features. Manic episodes (D) would indicate a bipolar disorder
rather than MDD .
Question 2: A patient presents with auditory hallucinations and disorganized
speech. Which type of symptom is the patient exhibiting?
A. Negative symptom
B. Cognitive symptom
C. Positive symptom
D. Affective symptom
CORRECT ANSWER: C. Positive symptom
Rationale: Positive symptoms of schizophrenia represent an excess or distortion of
normal functions. Hallucinations and disorganized speech are classic examples of
positive symptoms, as they are additional experiences or behaviors not present in
healthy individuals . Negative symptoms (A), in contrast, involve a diminution or loss of
normal functions, such as flat affect or avolition .
,Question 3: What is the hallmark feature of Generalized Anxiety Disorder
(GAD) as defined by the DSM-5-TR?
A. Recurrent, unexpected panic attacks
B. Excessive anxiety and worry occurring more days than not for at least six months
C. Intrusive, repetitive thoughts and compulsive behaviors
D. Fear of social scrutiny and negative evaluation
CORRECT ANSWER: B. Excessive anxiety and worry occurring more days than
not for at least six months
Rationale: The core diagnostic feature of GAD is persistent and excessive worry about
various domains that is difficult to control and occurs more days than not for a minimum
of six months . This distinguishes it from transient anxiety. Panic attacks (A) are
characteristic of Panic Disorder, and social fear (D) is indicative of Social Anxiety
Disorder.
Question 4: According to the DSM-5-TR, what is the minimum duration
required for a hypomanic episode?
A. 1 week
B. 4 consecutive days
C. 2 weeks
D. 1 month
CORRECT ANSWER: B. 4 consecutive days
Rationale: The DSM-5-TR specifies that a hypomanic episode, which is a distinct
period of elevated, expansive, or irritable mood, must last for at least four consecutive
days . A full manic episode (A) requires a duration of at least one week.
Question 5: Which assessment tool is most commonly used to screen for
depression in primary care settings?
A. GAD-7
B. MMSE
C. CAGE Questionnaire
D. PHQ-9
CORRECT ANSWER: D. PHQ-9
Rationale: The Patient Health Questionnaire-9 (PHQ-9) is a widely used, validated
screening tool for depression. It assesses the nine DSM-5-TR criteria for Major
Depressive Disorder . The GAD-7 (A) screens for anxiety, the MMSE (B) assesses
cognitive impairment, and the CAGE (C) screens for alcohol use disorder.
,Question 6: A 25-year-old patient reports recurrent, unexpected panic attacks
followed by persistent worry about having another attack. What is the most
likely diagnosis?
A. Agoraphobia
B. Social Anxiety Disorder
C. Panic Disorder
D. Specific Phobia
CORRECT ANSWER: C. Panic Disorder
Rationale: Panic Disorder is characterized by recurrent, unexpected panic attacks and
at least one month of persistent concern or worry about additional attacks or their
consequences . Agoraphobia (A) involves fear of places where escape might be difficult.
Social Anxiety Disorder (B) involves fear of social scrutiny.
Question 7: Which neurotransmitter is most implicated in the pathophysiology
of the positive symptoms of schizophrenia?
A. Serotonin
B. Acetylcholine
C. Dopamine
D. GABA
CORRECT ANSWER: C. Dopamine
Rationale: The dopamine hypothesis of schizophrenia posits that hyperactivity of
dopamine in the mesolimbic pathway is primarily responsible for the positive symptoms
of schizophrenia, such as hallucinations and delusions . This is the rationale for using
dopamine D2 receptor antagonists as antipsychotic medications.
Question 8: A patient presents with a pervasive pattern of instability in
interpersonal relationships, self-image, and affects, along with marked
impulsivity. This clinical picture is most consistent with which personality
disorder?
A. Narcissistic Personality Disorder
B. Borderline Personality Disorder
C. Antisocial Personality Disorder
D. Avoidant Personality Disorder
CORRECT ANSWER: B. Borderline Personality Disorder
Rationale: Borderline Personality Disorder (BPD) is characterized by a pervasive
pattern of instability in interpersonal relationships, self-image, and emotions,
accompanied by significant impulsivity . This instability is often triggered by a fear of
abandonment .
, Question 9: What is the characteristic symptom required for a diagnosis of
Post-Traumatic Stress Disorder (PTSD)?
A. Excessive worry about various life events
B. Persistent, intrusive memories of a traumatic event
C. Recurrent, unexpected panic attacks
D. Distressing obsessions and compulsions
CORRECT ANSWER: B. Persistent, intrusive memories of a traumatic event
Rationale: A core symptom of PTSD is the presence of intrusion symptoms, which
include recurrent, involuntary, and distressing memories of the traumatic event . Other
symptom clusters include avoidance, negative alterations in cognition and mood, and
alterations in arousal and reactivity.
Question 10: Which medication class is considered a first-line pharmacologic
treatment for Obsessive-Compulsive Disorder (OCD)?
A. Benzodiazepines
B. Antipsychotics
C. Selective Serotonin Reuptake Inhibitors (SSRIs)
D. Mood Stabilizers
CORRECT ANSWER: C. Selective Serotonin Reuptake Inhibitors (SSRIs)
Rationale: SSRIs are the first-line pharmacologic treatment for OCD due to their
efficacy in modulating serotonergic pathways that are implicated in the disorder's
pathophysiology . Benzodiazepines (A) are not first-line and have a risk of dependence.
Antipsychotics (B) are often used as augmentation, not monotherapy.
Question 11: A 35-year-old patient reports intrusive thoughts about
contamination and repetitive handwashing that cause significant distress and
are time-consuming. According to DSM-5-TR, what is the most likely
diagnosis?
A. Generalized Anxiety Disorder
B. Post-Traumatic Stress Disorder
C. Obsessive-Compulsive Disorder
D. Specific Phobia
CORRECT ANSWER: C. Obsessive-Compulsive Disorder
Rationale: The presence of obsessions (e.g., contamination thoughts) and compulsions
(e.g., handwashing) that are time-consuming and cause significant distress is diagnostic
for Obsessive-Compulsive Disorder .
