NR605 Midterm Exam | Chamberlain University | Weeks 1-4 Page 1
NR605 / NR 605 Midterm Exam (Latest Update 2026/2027)
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum
Chamberlain University | Weeks 1 - 4 Covered | Questions and Verified Answers | 100% Correct
Aligned with AACN Essentials of Master's Education & Psychiatric-Mental Health Nurse Practitioner Competencies (2026/2027 Edition)
120 Questions | 8 Sections | Cognitive Distribution: 20% Recall, 50% Application, 30% Analysis
Special Inclusions: 20 Clinical Reasoning Scenarios | 15 Psychopharmacology Items | 10 Risk Assessment Items
Section 1: Foundations of Psychiatric-Mental Health Assessment
Q1: A PMHNP is completing an initial psychiatric evaluation on a 42-year-old patient with new-onset depression.
Which theoretical framework BEST guides the integration of biological, psychological, and social domains into the
diagnostic formulation and treatment plan?
A. The biomedical model, which prioritizes neurochemical etiology and pharmacologic intervention
B. The biopsychosocial-spiritual model, which integrates genetic, cognitive, interpersonal, cultural, and spiritual
factors *[CORRECT]*
C. The diathesis-stress model, which considers genetic vulnerability exclusively
D. The recovery model, which focuses solely on patient-defined outcomes
Correct Answer: B
Rationale: The biopsychosocial-spiritual model (Engel, 1977; expanded by subsequent PMHNP competencies) is the
foundational framework taught in NR605 Weeks 1-2; it requires the PMHNP to actively integrate genetic predisposition,
cognitive/affective functioning, interpersonal context, cultural identity, and spiritual meaning. The biomedical model (A) is
reductionist and inconsistent with AACN Essentials. The diathesis-stress model (C) addresses etiology but not holistic
assessment. The recovery model (D) is a treatment philosophy, not an assessment framework.
Q2: Which component is part of the DSM-5 Cultural Formulation Interview (CFI) and is REQUIRED for competent
cross-cultural psychiatric assessment?
A. Cultural primacy of biomedical explanations over patient explanatory models
B. Cultural identity, cultural explanations of illness, cultural stressors and supports, and cultural elements of the
clinician-patient relationship *[CORRECT]*
C. Standardized translation of Western symptom checklists into the patient's primary language
D. Cultural diagnosis assignment using culture-bound syndrome taxonomies only
Correct Answer: B
Rationale: The DSM-5 CFI (NR 605 Week 1) consists of four domains: cultural identity, cultural explanations of the
individual's illness, cultural stressors and supports, and cultural elements of the clinician-patient relationship. Option A
violates patient-centered care; (C) ignores the patient's own explanatory model; (D) is incorrect because culture-bound
syndromes are appendicular, not the primary assessment vehicle. AACN Essentials and PMHNP Competencies (2026) require
culturally responsive assessment as a core competency.
Q3: A patient with a history of severe childhood sexual abuse presents for treatment of PTSD. Which principle of
trauma-informed care (TIC) should the PMHNP prioritize during the initial interview?
A. Obtain a comprehensive trauma narrative during the first session to confirm the diagnosis
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum | Latest Update 2026/2027 | 100% Correct Answers
,NR605 Midterm Exam | Chamberlain University | Weeks 1-4 Page 2
B. Emphasize safety, trustworthiness, choice, collaboration, and empowerment throughout the encounter
*[CORRECT]*
C. Limit trauma inquiry to standardized checklists to avoid triggering content
D. Recommend immediate exposure therapy to demonstrate clinical competence
Correct Answer: B
Rationale: SAMHSA's six trauma-informed principles (safety; trustworthiness and transparency; peer support; collaboration
and mutuality; empowerment, voice, and choice; cultural issues) frame competent trauma-integrated care (NR 605 Week 3).
Forcing a trauma narrative (A) risks re-traumatization; avoiding inquiry (C) undermines assessment; immediate exposure (D)
without stabilization contraindicates evidence-based staging. TIC prioritizes the patient's sense of control throughout.
Q4: Which statement BEST reflects the recovery-oriented approach mandated by the AACN Essentials and SAMHSA
for PMHNP practice?
A. Recovery is defined as complete symptom remission and return to premorbid functioning
B. Recovery is a personal journey of living a satisfying, hopeful, and contributing life, with or without symptom
resolution *[CORRECT]*
C. Recovery is achieved only when the patient complies fully with prescribed pharmacologic treatment
D. Recovery requires hospitalization to stabilize symptoms before outpatient treatment
Correct Answer: B
Rationale: SAMHSA defines recovery as 'a process of change through which individuals improve their health and wellness, live
a self-directed life, and strive to reach their full potential' (NR 605 Week 1). Symptom remission (A) is a clinical outcome but
not equivalent to recovery. Compliance-based definitions (C) violate patient autonomy. Hospitalization (D) is unnecessary for
most recovery journeys. Recovery orientation centers on hope, identity, meaning, and empowerment.
Q5: A 35-year-old patient with schizoaffective disorder is being assessed for ongoing care. The PMHNP uses a
strengths-based assessment approach. Which interview question BEST exemplifies this approach?
A. What symptoms are most distressing to you today?
B. Tell me about times when you felt your symptoms were more manageable and what you were doing then
*[CORRECT]*
C. How many psychiatric hospitalizations have you had in the past five years?
D. What medications have failed to control your symptoms in the past?
Correct Answer: B
Rationale: Strengths-based assessment (NR 605 Week 2) elicits patient resources, coping, and exception moments when
symptoms were less impairing; this supports recovery-oriented care. Options (A), (C), and (D) are deficit-focused. Per PMHNP
Competencies (2026), assessment must identify protective factors and resilience alongside pathology to inform collaborative
treatment planning.
Q6: A patient with borderline personality disorder repeatedly tells the PMHNP, 'You remind me of my mother - the
only person who ever really understood me.' This phenomenon is BEST described as:
A. Countertransference, requiring immediate referral to another provider
B. Transference, in which unconscious feelings from past relationships are projected onto the clinician
*[CORRECT]*
C. Therapeutic alliance, indicating strong engagement in treatment
D. Splitting, requiring limit-setting in the treatment contract
Correct Answer: B
Rationale: Transference (NR 605 Week 1) involves the unconscious redirection of feelings from significant early relationships
onto the clinician. Recognizing and working with transference strengthens the therapeutic alliance. Countertransference (A)
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum | Latest Update 2026/2027 | 100% Correct Answers
,NR605 Midterm Exam | Chamberlain University | Weeks 1-4 Page 3
refers to the clinician's emotional reactions to the patient. While (C) signals engagement, labeling it 'therapeutic alliance'
misses the dynamic. Splitting (D) is a different defense mechanism involving polarization of people into all-good or all-bad.
Q7: A PMHNP finds herself feeling unusually irritated and dismissive toward a patient with antisocial personality
disorder during a session. She recognizes this as countertransference. What is the MOST appropriate next step
according to PMHNP professional standards?
A. Terminate the patient from the practice immediately to ensure clinical safety
B. Reflect on the affective response, seek supervision, and use the awareness to inform the therapeutic work
without acting on the feelings *[CORRECT]*
C. Confront the patient about their behavior that triggered the clinician's irritation
D. Prescribe a PRN benzodiazepine to the patient to reduce their distressing behaviors
Correct Answer: B
Rationale: Countertransference (NR 605 Week 1) is a clinically valuable signal that requires reflection, supervision, and
conscious management - not action toward the patient. Termination (A) is premature and unethical. Confrontation (C) risks
harming the alliance and inappropriately centers the clinician's feelings. Medication (D) does not address the dynamic.
PMHNP Competencies (2026) require self-awareness and use-of-self as core competencies.
Q8: During a mental status examination, the PMHNP notes that a patient's speech is loud, pressured, and difficult to
interrupt. The patient reports feeling 'on top of the world.' Which MSE domain is being described?
A. Affect and mood
B. Thought process and thought content
C. Speech, motor behavior, and mood *[CORRECT]*
D. Perception and insight
Correct Answer: C
Rationale: The MSE (NR 605 Week 1) is organized into domains: appearance and behavior, speech, mood and affect, thought
process, thought content, perception, cognition, insight, and judgment. Pressured loud speech reflects the speech domain; 'on
top of the world' reflects mood. Motor behavior is also implicated if agitation is present. The correct answer integrates the three
domains. (A), (B), and (D) capture only partial information.
Q9: A patient reports that the CIA is monitoring their thoughts through a microchip implanted in their tooth. This
symptom is BEST categorized within which MSE domain?
A. Thought process
B. Thought content - persecutory delusion *[CORRECT]*
C. Perception - auditory hallucination
D. Cognition - confabulation
Correct Answer: B
Rationale: Fixed false beliefs (delusions) with intact logic represent thought content (NR 605 Week 1). Persecutory delusions
are common in psychotic disorders. Thought process (A) refers to form (e.g., loose associations). Perception (C) involves
sensory experiences (hallucinations). Confabulation (D) is a memory-related phenomenon. PMHNP assessment must
distinguish thought form from thought content.
Q10: Which domains are MANDATORY components of a comprehensive psychiatric risk assessment according to
PMHNP Competencies (2026)?
A. Suicide risk only
B. Suicide, homicide/violence, self-neglect, and vulnerability to exploitation *[CORRECT]*
C. Substance use only
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum | Latest Update 2026/2027 | 100% Correct Answers
, NR605 Midterm Exam | Chamberlain University | Weeks 1-4 Page 4
D. Danger to self only; danger to others is assessed only if the patient discloses homicidal ideation
Correct Answer: B
Rationale: Comprehensive risk assessment (NR 605 Week 2; PMHNP Competencies 2026) must include suicide risk,
homicide/violence risk, self-neglect (e.g., inability to provide for basic needs), and vulnerability to exploitation (especially in
elderly, pediatric, and cognitively impaired populations). Single-domain assessment (A, C, D) violates standards of practice
and exposes the clinician to liability for inadequate assessment.
Q11: A PMHNP evaluates a patient in the emergency department for suicidal ideation and decides to hospitalize
involuntarily. Which documentation element is MOST critical for legal and regulatory compliance?
A. The patient's insurance information and primary care provider contact
B. Specific risk factors, protective factors, the risk formulation (clinical judgment of imminent danger), the
least-restrictive alternative considered, and the rationale for involuntary commitment *[CORRECT]*
C. The patient's family psychiatric history
D. The PMHNP's personal emotional response to the patient
Correct Answer: B
Rationale: Documentation of risk (NR 605 Week 2) must demonstrate the clinical reasoning supporting the disposition -
specific risk factors, protective factors, the formulation (synthesis, not just list), alternatives considered, and rationale. This
protects the patient, supports treatment planning, and provides legal protection. Insurance (A) and family history (C) are
important but not the priority. Subjective clinician feelings (D) belong in supervision, not the clinical record.
Q12: A patient with treatment-resistant depression has a PHQ-9 of 18, comorbid hypothyroidism, and ongoing alcohol
misuse. Which collaboration is MOST appropriate for the PMHNP to initiate?
A. Refer only to a 12-step program; defer all other care until sobriety is achieved
B. Coordinate with the patient's primary care provider for thyroid optimization, addiction medicine for substance
use, and ongoing psychiatric management - while maintaining one unified treatment plan *[CORRECT]*
C. Defer psychiatric treatment until hypothyroidism is corrected
D. Refer the patient to a social worker for case management and step back from direct psychiatric care
Correct Answer: B
Rationale: Interdisciplinary collaboration (NR 605 Week 2; AACN Essentials) requires the PMHNP to coordinate care across
medical, addiction, and psychiatric domains while maintaining a unified plan. Sequential treatment (A, C) ignores the
bidirectional impact of these conditions. Deferring psychiatric care (D) abandons the patient. The PMHNP remains the
psychiatric lead while collaborating with appropriate specialists.
Q13: A 28-year-old presents with 2 weeks of depressed mood, anhedonia, insomnia, fatigue, and recurrent thoughts of
death (without plan or intent). Symptoms cause clinically significant distress and impairment. What is the MOST
appropriate DSM-5 diagnostic formulation?
A. Major depressive disorder, recurrent, moderate, without suicidal ideation
B. Major depressive disorder, single episode, moderate, with anxious distress, recurrent thoughts of death
without intent *[CORRECT]*
C. Persistent depressive disorder (dysthymia), early onset
D. Adjustment disorder with depressed mood
Correct Answer: B
Rationale: DSM-5 MDD requires 5+ symptoms in 2 weeks including at least depressed mood or anhedonia, with clinically
significant distress/impairment (NR 605 Week 3). 'Single episode' (vs. recurrent) is appropriate for first presentation. 'Recurrent
thoughts of death' (not just suicidal ideation) is a specifiable symptom. Specifier 'with anxious distress' is appropriate when
anxiety symptoms are prominent. Persistent depressive disorder (C) requires 2-year duration. Adjustment disorder (D) requires
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum | Latest Update 2026/2027 | 100% Correct Answers
NR605 / NR 605 Midterm Exam (Latest Update 2026/2027)
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum
Chamberlain University | Weeks 1 - 4 Covered | Questions and Verified Answers | 100% Correct
Aligned with AACN Essentials of Master's Education & Psychiatric-Mental Health Nurse Practitioner Competencies (2026/2027 Edition)
120 Questions | 8 Sections | Cognitive Distribution: 20% Recall, 50% Application, 30% Analysis
Special Inclusions: 20 Clinical Reasoning Scenarios | 15 Psychopharmacology Items | 10 Risk Assessment Items
Section 1: Foundations of Psychiatric-Mental Health Assessment
Q1: A PMHNP is completing an initial psychiatric evaluation on a 42-year-old patient with new-onset depression.
Which theoretical framework BEST guides the integration of biological, psychological, and social domains into the
diagnostic formulation and treatment plan?
A. The biomedical model, which prioritizes neurochemical etiology and pharmacologic intervention
B. The biopsychosocial-spiritual model, which integrates genetic, cognitive, interpersonal, cultural, and spiritual
factors *[CORRECT]*
C. The diathesis-stress model, which considers genetic vulnerability exclusively
D. The recovery model, which focuses solely on patient-defined outcomes
Correct Answer: B
Rationale: The biopsychosocial-spiritual model (Engel, 1977; expanded by subsequent PMHNP competencies) is the
foundational framework taught in NR605 Weeks 1-2; it requires the PMHNP to actively integrate genetic predisposition,
cognitive/affective functioning, interpersonal context, cultural identity, and spiritual meaning. The biomedical model (A) is
reductionist and inconsistent with AACN Essentials. The diathesis-stress model (C) addresses etiology but not holistic
assessment. The recovery model (D) is a treatment philosophy, not an assessment framework.
Q2: Which component is part of the DSM-5 Cultural Formulation Interview (CFI) and is REQUIRED for competent
cross-cultural psychiatric assessment?
A. Cultural primacy of biomedical explanations over patient explanatory models
B. Cultural identity, cultural explanations of illness, cultural stressors and supports, and cultural elements of the
clinician-patient relationship *[CORRECT]*
C. Standardized translation of Western symptom checklists into the patient's primary language
D. Cultural diagnosis assignment using culture-bound syndrome taxonomies only
Correct Answer: B
Rationale: The DSM-5 CFI (NR 605 Week 1) consists of four domains: cultural identity, cultural explanations of the
individual's illness, cultural stressors and supports, and cultural elements of the clinician-patient relationship. Option A
violates patient-centered care; (C) ignores the patient's own explanatory model; (D) is incorrect because culture-bound
syndromes are appendicular, not the primary assessment vehicle. AACN Essentials and PMHNP Competencies (2026) require
culturally responsive assessment as a core competency.
Q3: A patient with a history of severe childhood sexual abuse presents for treatment of PTSD. Which principle of
trauma-informed care (TIC) should the PMHNP prioritize during the initial interview?
A. Obtain a comprehensive trauma narrative during the first session to confirm the diagnosis
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum | Latest Update 2026/2027 | 100% Correct Answers
,NR605 Midterm Exam | Chamberlain University | Weeks 1-4 Page 2
B. Emphasize safety, trustworthiness, choice, collaboration, and empowerment throughout the encounter
*[CORRECT]*
C. Limit trauma inquiry to standardized checklists to avoid triggering content
D. Recommend immediate exposure therapy to demonstrate clinical competence
Correct Answer: B
Rationale: SAMHSA's six trauma-informed principles (safety; trustworthiness and transparency; peer support; collaboration
and mutuality; empowerment, voice, and choice; cultural issues) frame competent trauma-integrated care (NR 605 Week 3).
Forcing a trauma narrative (A) risks re-traumatization; avoiding inquiry (C) undermines assessment; immediate exposure (D)
without stabilization contraindicates evidence-based staging. TIC prioritizes the patient's sense of control throughout.
Q4: Which statement BEST reflects the recovery-oriented approach mandated by the AACN Essentials and SAMHSA
for PMHNP practice?
A. Recovery is defined as complete symptom remission and return to premorbid functioning
B. Recovery is a personal journey of living a satisfying, hopeful, and contributing life, with or without symptom
resolution *[CORRECT]*
C. Recovery is achieved only when the patient complies fully with prescribed pharmacologic treatment
D. Recovery requires hospitalization to stabilize symptoms before outpatient treatment
Correct Answer: B
Rationale: SAMHSA defines recovery as 'a process of change through which individuals improve their health and wellness, live
a self-directed life, and strive to reach their full potential' (NR 605 Week 1). Symptom remission (A) is a clinical outcome but
not equivalent to recovery. Compliance-based definitions (C) violate patient autonomy. Hospitalization (D) is unnecessary for
most recovery journeys. Recovery orientation centers on hope, identity, meaning, and empowerment.
Q5: A 35-year-old patient with schizoaffective disorder is being assessed for ongoing care. The PMHNP uses a
strengths-based assessment approach. Which interview question BEST exemplifies this approach?
A. What symptoms are most distressing to you today?
B. Tell me about times when you felt your symptoms were more manageable and what you were doing then
*[CORRECT]*
C. How many psychiatric hospitalizations have you had in the past five years?
D. What medications have failed to control your symptoms in the past?
Correct Answer: B
Rationale: Strengths-based assessment (NR 605 Week 2) elicits patient resources, coping, and exception moments when
symptoms were less impairing; this supports recovery-oriented care. Options (A), (C), and (D) are deficit-focused. Per PMHNP
Competencies (2026), assessment must identify protective factors and resilience alongside pathology to inform collaborative
treatment planning.
Q6: A patient with borderline personality disorder repeatedly tells the PMHNP, 'You remind me of my mother - the
only person who ever really understood me.' This phenomenon is BEST described as:
A. Countertransference, requiring immediate referral to another provider
B. Transference, in which unconscious feelings from past relationships are projected onto the clinician
*[CORRECT]*
C. Therapeutic alliance, indicating strong engagement in treatment
D. Splitting, requiring limit-setting in the treatment contract
Correct Answer: B
Rationale: Transference (NR 605 Week 1) involves the unconscious redirection of feelings from significant early relationships
onto the clinician. Recognizing and working with transference strengthens the therapeutic alliance. Countertransference (A)
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum | Latest Update 2026/2027 | 100% Correct Answers
,NR605 Midterm Exam | Chamberlain University | Weeks 1-4 Page 3
refers to the clinician's emotional reactions to the patient. While (C) signals engagement, labeling it 'therapeutic alliance'
misses the dynamic. Splitting (D) is a different defense mechanism involving polarization of people into all-good or all-bad.
Q7: A PMHNP finds herself feeling unusually irritated and dismissive toward a patient with antisocial personality
disorder during a session. She recognizes this as countertransference. What is the MOST appropriate next step
according to PMHNP professional standards?
A. Terminate the patient from the practice immediately to ensure clinical safety
B. Reflect on the affective response, seek supervision, and use the awareness to inform the therapeutic work
without acting on the feelings *[CORRECT]*
C. Confront the patient about their behavior that triggered the clinician's irritation
D. Prescribe a PRN benzodiazepine to the patient to reduce their distressing behaviors
Correct Answer: B
Rationale: Countertransference (NR 605 Week 1) is a clinically valuable signal that requires reflection, supervision, and
conscious management - not action toward the patient. Termination (A) is premature and unethical. Confrontation (C) risks
harming the alliance and inappropriately centers the clinician's feelings. Medication (D) does not address the dynamic.
PMHNP Competencies (2026) require self-awareness and use-of-self as core competencies.
Q8: During a mental status examination, the PMHNP notes that a patient's speech is loud, pressured, and difficult to
interrupt. The patient reports feeling 'on top of the world.' Which MSE domain is being described?
A. Affect and mood
B. Thought process and thought content
C. Speech, motor behavior, and mood *[CORRECT]*
D. Perception and insight
Correct Answer: C
Rationale: The MSE (NR 605 Week 1) is organized into domains: appearance and behavior, speech, mood and affect, thought
process, thought content, perception, cognition, insight, and judgment. Pressured loud speech reflects the speech domain; 'on
top of the world' reflects mood. Motor behavior is also implicated if agitation is present. The correct answer integrates the three
domains. (A), (B), and (D) capture only partial information.
Q9: A patient reports that the CIA is monitoring their thoughts through a microchip implanted in their tooth. This
symptom is BEST categorized within which MSE domain?
A. Thought process
B. Thought content - persecutory delusion *[CORRECT]*
C. Perception - auditory hallucination
D. Cognition - confabulation
Correct Answer: B
Rationale: Fixed false beliefs (delusions) with intact logic represent thought content (NR 605 Week 1). Persecutory delusions
are common in psychotic disorders. Thought process (A) refers to form (e.g., loose associations). Perception (C) involves
sensory experiences (hallucinations). Confabulation (D) is a memory-related phenomenon. PMHNP assessment must
distinguish thought form from thought content.
Q10: Which domains are MANDATORY components of a comprehensive psychiatric risk assessment according to
PMHNP Competencies (2026)?
A. Suicide risk only
B. Suicide, homicide/violence, self-neglect, and vulnerability to exploitation *[CORRECT]*
C. Substance use only
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum | Latest Update 2026/2027 | 100% Correct Answers
, NR605 Midterm Exam | Chamberlain University | Weeks 1-4 Page 4
D. Danger to self only; danger to others is assessed only if the patient discloses homicidal ideation
Correct Answer: B
Rationale: Comprehensive risk assessment (NR 605 Week 2; PMHNP Competencies 2026) must include suicide risk,
homicide/violence risk, self-neglect (e.g., inability to provide for basic needs), and vulnerability to exploitation (especially in
elderly, pediatric, and cognitively impaired populations). Single-domain assessment (A, C, D) violates standards of practice
and exposes the clinician to liability for inadequate assessment.
Q11: A PMHNP evaluates a patient in the emergency department for suicidal ideation and decides to hospitalize
involuntarily. Which documentation element is MOST critical for legal and regulatory compliance?
A. The patient's insurance information and primary care provider contact
B. Specific risk factors, protective factors, the risk formulation (clinical judgment of imminent danger), the
least-restrictive alternative considered, and the rationale for involuntary commitment *[CORRECT]*
C. The patient's family psychiatric history
D. The PMHNP's personal emotional response to the patient
Correct Answer: B
Rationale: Documentation of risk (NR 605 Week 2) must demonstrate the clinical reasoning supporting the disposition -
specific risk factors, protective factors, the formulation (synthesis, not just list), alternatives considered, and rationale. This
protects the patient, supports treatment planning, and provides legal protection. Insurance (A) and family history (C) are
important but not the priority. Subjective clinician feelings (D) belong in supervision, not the clinical record.
Q12: A patient with treatment-resistant depression has a PHQ-9 of 18, comorbid hypothyroidism, and ongoing alcohol
misuse. Which collaboration is MOST appropriate for the PMHNP to initiate?
A. Refer only to a 12-step program; defer all other care until sobriety is achieved
B. Coordinate with the patient's primary care provider for thyroid optimization, addiction medicine for substance
use, and ongoing psychiatric management - while maintaining one unified treatment plan *[CORRECT]*
C. Defer psychiatric treatment until hypothyroidism is corrected
D. Refer the patient to a social worker for case management and step back from direct psychiatric care
Correct Answer: B
Rationale: Interdisciplinary collaboration (NR 605 Week 2; AACN Essentials) requires the PMHNP to coordinate care across
medical, addiction, and psychiatric domains while maintaining a unified plan. Sequential treatment (A, C) ignores the
bidirectional impact of these conditions. Deferring psychiatric care (D) abandons the patient. The PMHNP remains the
psychiatric lead while collaborating with appropriate specialists.
Q13: A 28-year-old presents with 2 weeks of depressed mood, anhedonia, insomnia, fatigue, and recurrent thoughts of
death (without plan or intent). Symptoms cause clinically significant distress and impairment. What is the MOST
appropriate DSM-5 diagnostic formulation?
A. Major depressive disorder, recurrent, moderate, without suicidal ideation
B. Major depressive disorder, single episode, moderate, with anxious distress, recurrent thoughts of death
without intent *[CORRECT]*
C. Persistent depressive disorder (dysthymia), early onset
D. Adjustment disorder with depressed mood
Correct Answer: B
Rationale: DSM-5 MDD requires 5+ symptoms in 2 weeks including at least depressed mood or anhedonia, with clinically
significant distress/impairment (NR 605 Week 3). 'Single episode' (vs. recurrent) is appropriate for first presentation. 'Recurrent
thoughts of death' (not just suicidal ideation) is a specifiable symptom. Specifier 'with anxious distress' is appropriate when
anxiety symptoms are prominent. Persistent depressive disorder (C) requires 2-year duration. Adjustment disorder (D) requires
Diagnosis & Management in Psychiatric-Mental Health across the Lifespan I Practicum | Latest Update 2026/2027 | 100% Correct Answers
