NRNP 6635 PSYCHOPATHOLOGY AND DIAGNOSTIC
REASONING MIDTERM EXAM 2026/2027 | Latest Walden
University Guide | Pass Guaranteed - A+ Graded
Domain 1: Foundations of Psychopathology & Diagnostic Process (10 Questions)
Q1: A 34-year-old patient presents for psychiatric evaluation stating, "I've been told I
have bipolar disorder, but I don't think that's right." History reveals three episodes of
major depression, one hypomanic episode lasting 5 days with decreased sleep and
increased goal-directed activity, and one manic episode lasting 10 days with psychotic
features requiring hospitalization. The patient asks for clarification about their
diagnosis. Which diagnosis is most accurate according to DSM-5-TR criteria?
A. Bipolar II Disorder, based on the history of hypomanic episodes and major depressive
episodes
B. Bipolar I Disorder, as there is documented history of at least one manic episode
[CORRECT]
C. Major Depressive Disorder with psychotic features, as the psychosis only occurred
during mood episodes
D. Cyclothymic Disorder, given the fluctuating mood patterns over time
Correct Answer: B
,Rationale: According to DSM-5-TR criteria, Bipolar I Disorder requires only one lifetime
manic episode for diagnosis (Criterion A), regardless of the presence or absence of
hypomanic or major depressive episodes. This patient clearly meets criteria for a manic
episode (abnormally elevated/expansive/irritable mood lasting ≥1 week, hospitalized,
with psychotic features). Once a manic episode has occurred, the diagnosis is Bipolar I
Disorder, even if hypomanic and depressive episodes are also present.
Why A is incorrect: While the patient does have hypomanic and major depressive
episodes that would suggest Bipolar II, the presence of even one full manic episode
supersedes Bipolar II diagnosis and establishes Bipolar I Disorder.
Why C is incorrect: Although the patient has experienced psychotic features during
mood episodes, the presence of distinct manic and hypomanic episodes indicates a
bipolar spectrum disorder rather than unipolar depression with psychotic features.
Why D is incorrect: Cyclothymic Disorder requires numerous periods of hypomanic and
depressive symptoms (not meeting full episode criteria) for at least 2 years, without any
manic, major depressive, or mixed episodes. This patient has had full syndromal
episodes.
Q2: A psychiatric-mental health nurse practitioner is conducting a diagnostic interview
with a 28-year-old woman who reports "feeling anxious and on edge" for the past 8
months. She describes persistent worry about multiple domains including work
performance, finances, her parents' health, and potential accidents. She reports
difficulty controlling the worry, muscle tension, fatigue, and sleep disturbance. She
,denies panic attacks, specific phobias, or trauma history. Which diagnostic
consideration is most critical before establishing a primary anxiety disorder diagnosis?
A. Determining if the anxiety symptoms are better explained by the physiological effects
of a substance
B. Assessing whether the worry and anxiety symptoms occur exclusively during major
depressive episodes
C. Evaluating for the presence of obsessions or compulsions that might indicate OCD
D. Ruling out medical conditions such as hyperthyroidism that could mimic anxiety
symptoms [CORRECT]
Correct Answer: D
Rationale: The clinical presentation is highly consistent with Generalized Anxiety
Disorder (GAD): excessive anxiety/worry occurring more days than not for ≥6 months
about multiple domains, difficulty controlling worry, and associated symptoms (muscle
tension, fatigue, sleep disturbance). However, DSM-5-TR diagnostic principles require
ruling out medical causes before establishing psychiatric diagnoses. Medical
conditions (hyperthyroidism, pheochromocytoma, cardiac arrhythmias, medication
effects) can produce identical symptom profiles. The diagnostic hierarchy prioritizes
medical etiologies.
Why A is incorrect: While substance-induced anxiety must be ruled out, this is part of
the comprehensive medical workup. The question emphasizes the most critical
, consideration, and medical conditions are statistically more prevalent mimics of anxiety
than substance-induced disorders in this demographic.
Why B is incorrect: Although GAD should not be diagnosed if symptoms occur
exclusively during major depressive episodes, the 8-month duration with multiple worry
domains suggests an independent anxiety disorder rather than depression-associated
anxiety.
Why C is incorrect: The absence of ego-dystonic intrusive thoughts, repetitive behaviors,
or mental acts makes OCD unlikely. The worry content is realistic (work, finances,
health) rather than the inappropriate intrusive thoughts characteristic of OCD.
Q3: During a cultural formulation interview, a 42-year-old Vietnamese-American patient
describes experiencing "taijin kyofusho" - intense fear of offending others through one's
appearance or behavior in social situations, distinct from typical social anxiety focused
on embarrassing oneself. Which DSM-5-TR cultural concept of distress does this
presentation most closely align with?
A. Ataque de nervios
B. Taijin kyofusho as a culturally specific manifestation within Social Anxiety Disorder
framework [CORRECT]
C. Hwa-byung
D. Shenjing shuairuo
REASONING MIDTERM EXAM 2026/2027 | Latest Walden
University Guide | Pass Guaranteed - A+ Graded
Domain 1: Foundations of Psychopathology & Diagnostic Process (10 Questions)
Q1: A 34-year-old patient presents for psychiatric evaluation stating, "I've been told I
have bipolar disorder, but I don't think that's right." History reveals three episodes of
major depression, one hypomanic episode lasting 5 days with decreased sleep and
increased goal-directed activity, and one manic episode lasting 10 days with psychotic
features requiring hospitalization. The patient asks for clarification about their
diagnosis. Which diagnosis is most accurate according to DSM-5-TR criteria?
A. Bipolar II Disorder, based on the history of hypomanic episodes and major depressive
episodes
B. Bipolar I Disorder, as there is documented history of at least one manic episode
[CORRECT]
C. Major Depressive Disorder with psychotic features, as the psychosis only occurred
during mood episodes
D. Cyclothymic Disorder, given the fluctuating mood patterns over time
Correct Answer: B
,Rationale: According to DSM-5-TR criteria, Bipolar I Disorder requires only one lifetime
manic episode for diagnosis (Criterion A), regardless of the presence or absence of
hypomanic or major depressive episodes. This patient clearly meets criteria for a manic
episode (abnormally elevated/expansive/irritable mood lasting ≥1 week, hospitalized,
with psychotic features). Once a manic episode has occurred, the diagnosis is Bipolar I
Disorder, even if hypomanic and depressive episodes are also present.
Why A is incorrect: While the patient does have hypomanic and major depressive
episodes that would suggest Bipolar II, the presence of even one full manic episode
supersedes Bipolar II diagnosis and establishes Bipolar I Disorder.
Why C is incorrect: Although the patient has experienced psychotic features during
mood episodes, the presence of distinct manic and hypomanic episodes indicates a
bipolar spectrum disorder rather than unipolar depression with psychotic features.
Why D is incorrect: Cyclothymic Disorder requires numerous periods of hypomanic and
depressive symptoms (not meeting full episode criteria) for at least 2 years, without any
manic, major depressive, or mixed episodes. This patient has had full syndromal
episodes.
Q2: A psychiatric-mental health nurse practitioner is conducting a diagnostic interview
with a 28-year-old woman who reports "feeling anxious and on edge" for the past 8
months. She describes persistent worry about multiple domains including work
performance, finances, her parents' health, and potential accidents. She reports
difficulty controlling the worry, muscle tension, fatigue, and sleep disturbance. She
,denies panic attacks, specific phobias, or trauma history. Which diagnostic
consideration is most critical before establishing a primary anxiety disorder diagnosis?
A. Determining if the anxiety symptoms are better explained by the physiological effects
of a substance
B. Assessing whether the worry and anxiety symptoms occur exclusively during major
depressive episodes
C. Evaluating for the presence of obsessions or compulsions that might indicate OCD
D. Ruling out medical conditions such as hyperthyroidism that could mimic anxiety
symptoms [CORRECT]
Correct Answer: D
Rationale: The clinical presentation is highly consistent with Generalized Anxiety
Disorder (GAD): excessive anxiety/worry occurring more days than not for ≥6 months
about multiple domains, difficulty controlling worry, and associated symptoms (muscle
tension, fatigue, sleep disturbance). However, DSM-5-TR diagnostic principles require
ruling out medical causes before establishing psychiatric diagnoses. Medical
conditions (hyperthyroidism, pheochromocytoma, cardiac arrhythmias, medication
effects) can produce identical symptom profiles. The diagnostic hierarchy prioritizes
medical etiologies.
Why A is incorrect: While substance-induced anxiety must be ruled out, this is part of
the comprehensive medical workup. The question emphasizes the most critical
, consideration, and medical conditions are statistically more prevalent mimics of anxiety
than substance-induced disorders in this demographic.
Why B is incorrect: Although GAD should not be diagnosed if symptoms occur
exclusively during major depressive episodes, the 8-month duration with multiple worry
domains suggests an independent anxiety disorder rather than depression-associated
anxiety.
Why C is incorrect: The absence of ego-dystonic intrusive thoughts, repetitive behaviors,
or mental acts makes OCD unlikely. The worry content is realistic (work, finances,
health) rather than the inappropriate intrusive thoughts characteristic of OCD.
Q3: During a cultural formulation interview, a 42-year-old Vietnamese-American patient
describes experiencing "taijin kyofusho" - intense fear of offending others through one's
appearance or behavior in social situations, distinct from typical social anxiety focused
on embarrassing oneself. Which DSM-5-TR cultural concept of distress does this
presentation most closely align with?
A. Ataque de nervios
B. Taijin kyofusho as a culturally specific manifestation within Social Anxiety Disorder
framework [CORRECT]
C. Hwa-byung
D. Shenjing shuairuo
