NRNP 6635 PSYCHOPATHOLOGY AND DIAGNOSTIC
REASONING MIDTERM EXAM 2026/2027 | Latest Walden
University Complete Guide | Pass Guaranteed - A+ Graded
Domain 1: Foundations of Psychopathology & Diagnostic Process (10 Questions)
Q1: A 24-year-old graduate student presents for evaluation stating, "I think I'm losing my
mind. For the past three weeks, I've been unable to sleep more than 2 hours nightly, I
feel incredibly energetic, and I started three new business ventures yesterday. My
friends say I'm talking too fast and jumping between topics. I spent $8,000 on
cryptocurrency last night without thinking." The patient denies substance use and has
no prior psychiatric history. Family history is significant for bipolar disorder in an aunt.
Which diagnostic criterion from the DSM-5-TR is most critical to establish before
confirming a diagnosis?
A. Duration of symptoms exceeding 6 months
B. Presence of psychotic features during the episode
C. Marked impairment in social or occupational functioning [CORRECT]
D. History of childhood trauma
Correct Answer: C
,Rationale: The clinical presentation strongly suggests a manic episode
(elevated/expansive mood, decreased need for sleep, increased goal-directed activity,
excessive involvement in risky activities, pressured speech). Per DSM-5-TR criteria for a
manic episode, the symptoms must cause marked impairment in social or occupational
functioning, necessitate hospitalization to prevent harm, or include psychotic features
(Criterion C for Manic Episode). This functional impairment criterion is essential to
distinguish pathological mania from non-pathological elevated mood states. Option A is
incorrect—manic episodes require only 1 week duration (or any duration if hospitalized),
not 6 months. Option B (psychotic features) would qualify the episode as severe with
psychotic features, but their absence doesn't preclude diagnosis if functional
impairment exists. Option D, while relevant to overall case formulation, is not a
diagnostic criterion for bipolar disorder.
Q2: A PMHNP is conducting a diagnostic interview with a 19-year-old patient who
reports feeling "sad and empty" for the past two weeks, with difficulty concentrating and
insomnia. The patient mentions that their younger brother drowned six months ago
while they were supposed to be watching him. The patient states, "I keep replaying that
day in my mind—I should have been there, it's my fault." Which element of the diagnostic
formulation most specifically distinguishes between Major Depressive Disorder and
Persistent Complex Bereavement Disorder (now Prolonged Grief Disorder in DSM-5-TR)?
A. The presence of suicidal ideation
B. The intensity of grief reactions focused on the deceased and identity disruption
centered on the loss [CORRECT]
,C. The severity of sleep disturbance
D. The patient's age at the time of loss
Correct Answer: B
Rationale: Prolonged Grief Disorder (formerly Persistent Complex Bereavement Disorder
in DSM-5 Section III, now in DSM-5-TR) is distinguished from MDD by the centrality of
the loss to the individual's identity and the specific nature of grief reactions. Key
features include intense yearning/longing for the deceased, preoccupation with the
deceased, and identity disruption centered on the loss (e.g., feeling part of oneself
died). While MDD may occur after bereavement, the grief symptoms in PGD are
specifically tied to the deceased rather than generalized anhedonia or self-critical
thoughts. The patient's specific focus on guilt regarding the death and identity-based
rumination ("it's my fault") suggests grief-related pathology. Option A occurs in both
conditions. Option C is a non-specific symptom present in both. Option D is not a
diagnostic differentiator.
Q3: A 34-year-old patient presents with complaints of persistent worry about multiple
domains (work, health, family finances) for the past 8 months, difficulty controlling the
worry, restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and
sleep disturbance. The patient reports these symptoms cause significant distress but
has continued working full-time, stating "I push through it." Which diagnostic
consideration is most essential before assigning a diagnosis of Generalized Anxiety
Disorder?
, A. Whether the patient has panic attacks
B. Whether the anxiety is excessive for the actual likelihood or impact of the feared
events [CORRECT]
C. Whether the patient has taken any benzodiazepines in the past year
D. Whether the patient has a specific phobia
Correct Answer: B
Rationale: DSM-5-TR Criterion B for Generalized Anxiety Disorder requires that the
anxiety and worry be associated with three (or more) of six physical/cognitive
symptoms, which this patient meets (restlessness, fatigue, concentration difficulties,
irritability, muscle tension, sleep disturbance). However, Criterion A requires that the
worry be "excessive" (out of proportion to the actual likelihood or impact of the feared
events). The PMHNP must assess whether the patient's worry is disproportionate to
actual risks. The patient's ability to "push through" and maintain employment doesn't
preclude GAD, but the excessiveness of worry must be established. Option A (panic
attacks) may co-occur but aren't required. Option C (medication history) is relevant for
treatment planning but not diagnostic criteria. Option D (specific phobia) would involve
circumscribed fear, not multiple domains.
Q4: A child psychiatrist evaluates a 7-year-old boy whose parents report he "never stops
moving," talks constantly, interrupts others, has difficulty waiting his turn, and cannot
sustain attention during schoolwork or play. These behaviors have been present since
REASONING MIDTERM EXAM 2026/2027 | Latest Walden
University Complete Guide | Pass Guaranteed - A+ Graded
Domain 1: Foundations of Psychopathology & Diagnostic Process (10 Questions)
Q1: A 24-year-old graduate student presents for evaluation stating, "I think I'm losing my
mind. For the past three weeks, I've been unable to sleep more than 2 hours nightly, I
feel incredibly energetic, and I started three new business ventures yesterday. My
friends say I'm talking too fast and jumping between topics. I spent $8,000 on
cryptocurrency last night without thinking." The patient denies substance use and has
no prior psychiatric history. Family history is significant for bipolar disorder in an aunt.
Which diagnostic criterion from the DSM-5-TR is most critical to establish before
confirming a diagnosis?
A. Duration of symptoms exceeding 6 months
B. Presence of psychotic features during the episode
C. Marked impairment in social or occupational functioning [CORRECT]
D. History of childhood trauma
Correct Answer: C
,Rationale: The clinical presentation strongly suggests a manic episode
(elevated/expansive mood, decreased need for sleep, increased goal-directed activity,
excessive involvement in risky activities, pressured speech). Per DSM-5-TR criteria for a
manic episode, the symptoms must cause marked impairment in social or occupational
functioning, necessitate hospitalization to prevent harm, or include psychotic features
(Criterion C for Manic Episode). This functional impairment criterion is essential to
distinguish pathological mania from non-pathological elevated mood states. Option A is
incorrect—manic episodes require only 1 week duration (or any duration if hospitalized),
not 6 months. Option B (psychotic features) would qualify the episode as severe with
psychotic features, but their absence doesn't preclude diagnosis if functional
impairment exists. Option D, while relevant to overall case formulation, is not a
diagnostic criterion for bipolar disorder.
Q2: A PMHNP is conducting a diagnostic interview with a 19-year-old patient who
reports feeling "sad and empty" for the past two weeks, with difficulty concentrating and
insomnia. The patient mentions that their younger brother drowned six months ago
while they were supposed to be watching him. The patient states, "I keep replaying that
day in my mind—I should have been there, it's my fault." Which element of the diagnostic
formulation most specifically distinguishes between Major Depressive Disorder and
Persistent Complex Bereavement Disorder (now Prolonged Grief Disorder in DSM-5-TR)?
A. The presence of suicidal ideation
B. The intensity of grief reactions focused on the deceased and identity disruption
centered on the loss [CORRECT]
,C. The severity of sleep disturbance
D. The patient's age at the time of loss
Correct Answer: B
Rationale: Prolonged Grief Disorder (formerly Persistent Complex Bereavement Disorder
in DSM-5 Section III, now in DSM-5-TR) is distinguished from MDD by the centrality of
the loss to the individual's identity and the specific nature of grief reactions. Key
features include intense yearning/longing for the deceased, preoccupation with the
deceased, and identity disruption centered on the loss (e.g., feeling part of oneself
died). While MDD may occur after bereavement, the grief symptoms in PGD are
specifically tied to the deceased rather than generalized anhedonia or self-critical
thoughts. The patient's specific focus on guilt regarding the death and identity-based
rumination ("it's my fault") suggests grief-related pathology. Option A occurs in both
conditions. Option C is a non-specific symptom present in both. Option D is not a
diagnostic differentiator.
Q3: A 34-year-old patient presents with complaints of persistent worry about multiple
domains (work, health, family finances) for the past 8 months, difficulty controlling the
worry, restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and
sleep disturbance. The patient reports these symptoms cause significant distress but
has continued working full-time, stating "I push through it." Which diagnostic
consideration is most essential before assigning a diagnosis of Generalized Anxiety
Disorder?
, A. Whether the patient has panic attacks
B. Whether the anxiety is excessive for the actual likelihood or impact of the feared
events [CORRECT]
C. Whether the patient has taken any benzodiazepines in the past year
D. Whether the patient has a specific phobia
Correct Answer: B
Rationale: DSM-5-TR Criterion B for Generalized Anxiety Disorder requires that the
anxiety and worry be associated with three (or more) of six physical/cognitive
symptoms, which this patient meets (restlessness, fatigue, concentration difficulties,
irritability, muscle tension, sleep disturbance). However, Criterion A requires that the
worry be "excessive" (out of proportion to the actual likelihood or impact of the feared
events). The PMHNP must assess whether the patient's worry is disproportionate to
actual risks. The patient's ability to "push through" and maintain employment doesn't
preclude GAD, but the excessiveness of worry must be established. Option A (panic
attacks) may co-occur but aren't required. Option C (medication history) is relevant for
treatment planning but not diagnostic criteria. Option D (specific phobia) would involve
circumscribed fear, not multiple domains.
Q4: A child psychiatrist evaluates a 7-year-old boy whose parents report he "never stops
moving," talks constantly, interrupts others, has difficulty waiting his turn, and cannot
sustain attention during schoolwork or play. These behaviors have been present since
