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PMHNP SCHIZOPHRENIA EXAM REVIEW
2026/2027: 100+ MCQS WITH RATIONALES –
HIGH YIELD STUDY GUIDE FOR ANCC & AANP
CERTIFICATION (LATEST DSM-5-TR)
Domain 1: Diagnosis & Differential (25 Questions)
**Q1.** A 22-year-old man has had auditory hallucinations and
delusions for 8 months, plus marked social withdrawal and flat affect.
He has never had a major depressive or manic episode. What is the most
likely diagnosis?
A. Schizophreniform disorder
B. Brief psychotic disorder
C. Schizophrenia
D. Schizoaffective disorder
**Rationale:** C – Symptoms >6 months with functional decline and no
mood episode criteria → Schizophrenia. Schizophreniform = 1–6
months.
**Q2.** A patient presents with delusions and hallucinations for 3
weeks after a major car accident, no prior psychiatric history. Symptoms
occur only at night when alone. What is the first step?
A. Diagnose brief psychotic disorder
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B. Order urine toxicology and brain imaging
C. Start olanzapine
D. Admit for ECT
**Rationale:** B – Rule out substance-induced (e.g., alcohol
withdrawal, stimulants) or medical (e.g., head trauma, delirium) causes
first.
**Q3.** Which symptom is most specific to schizophrenia compared to
other psychotic disorders?
A. Grandiose delusions
B. Thought broadcasting
C. Auditory command hallucinations
D. Negative symptoms (avolition, alogia)
**Rationale:** D – Negative symptoms are core to schizophrenia and
less common in mood disorders with psychosis.
**Q4.** A patient has had 2 weeks of hallucinations and disorganized
speech, with onset immediately following a urine cocaine positive.
Symptoms resolved fully after 4 days of abstinence. Diagnosis?
A. Schizophrenia
B. Cocaine-induced psychotic disorder
C. Brief psychotic disorder
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D. Schizophreniform disorder
**Rationale:** B – Substance-induced psychotic disorder; full
resolution with abstinence and short duration.
**Q5.** To differentiate schizoaffective disorder from schizophrenia,
you must find:
A. At least 2 weeks of delusions without mood symptoms
B. A major mood episode concurrent with psychotic symptoms and
present for majority of total illness duration
C. Absence of negative symptoms
D. Onset after age 30
**Rationale:** B – Schizoaffective requires mood episode for most of
illness, not just during psychosis.
**Q6.** Which feature rules out brief psychotic disorder?
A. Hallucinations
B. Disorganized behavior
C. Duration >1 month
D. Postpartum onset
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**Rationale:** C – Brief psychotic disorder lasts 1 day to 1 month; if >1
month, reclassify.
**Q7.** A patient reports hearing his thoughts spoken aloud. This is an
example of:
A. Thought insertion
B. Thought echo (Gedankenlautwerden)
C. Thought blocking
D. Magical thinking
**Rationale:** B – Thought echo = hearing one’s own thoughts aloud, a
first-rank Schneiderian symptom.
**Q8.** Which medical condition most commonly presents with new-
onset psychosis in an older adult?
A. Thyroid storm
B. UTI with delirium
C. Brain tumor
D. Wilson’s disease
**Rationale:** B – Delirium from infection (UTI, pneumonia) is most
common; always rule out in elderly.
PMHNP SCHIZOPHRENIA EXAM REVIEW
2026/2027: 100+ MCQS WITH RATIONALES –
HIGH YIELD STUDY GUIDE FOR ANCC & AANP
CERTIFICATION (LATEST DSM-5-TR)
Domain 1: Diagnosis & Differential (25 Questions)
**Q1.** A 22-year-old man has had auditory hallucinations and
delusions for 8 months, plus marked social withdrawal and flat affect.
He has never had a major depressive or manic episode. What is the most
likely diagnosis?
A. Schizophreniform disorder
B. Brief psychotic disorder
C. Schizophrenia
D. Schizoaffective disorder
**Rationale:** C – Symptoms >6 months with functional decline and no
mood episode criteria → Schizophrenia. Schizophreniform = 1–6
months.
**Q2.** A patient presents with delusions and hallucinations for 3
weeks after a major car accident, no prior psychiatric history. Symptoms
occur only at night when alone. What is the first step?
A. Diagnose brief psychotic disorder
,2|Page
B. Order urine toxicology and brain imaging
C. Start olanzapine
D. Admit for ECT
**Rationale:** B – Rule out substance-induced (e.g., alcohol
withdrawal, stimulants) or medical (e.g., head trauma, delirium) causes
first.
**Q3.** Which symptom is most specific to schizophrenia compared to
other psychotic disorders?
A. Grandiose delusions
B. Thought broadcasting
C. Auditory command hallucinations
D. Negative symptoms (avolition, alogia)
**Rationale:** D – Negative symptoms are core to schizophrenia and
less common in mood disorders with psychosis.
**Q4.** A patient has had 2 weeks of hallucinations and disorganized
speech, with onset immediately following a urine cocaine positive.
Symptoms resolved fully after 4 days of abstinence. Diagnosis?
A. Schizophrenia
B. Cocaine-induced psychotic disorder
C. Brief psychotic disorder
,3|Page
D. Schizophreniform disorder
**Rationale:** B – Substance-induced psychotic disorder; full
resolution with abstinence and short duration.
**Q5.** To differentiate schizoaffective disorder from schizophrenia,
you must find:
A. At least 2 weeks of delusions without mood symptoms
B. A major mood episode concurrent with psychotic symptoms and
present for majority of total illness duration
C. Absence of negative symptoms
D. Onset after age 30
**Rationale:** B – Schizoaffective requires mood episode for most of
illness, not just during psychosis.
**Q6.** Which feature rules out brief psychotic disorder?
A. Hallucinations
B. Disorganized behavior
C. Duration >1 month
D. Postpartum onset
, 4|Page
**Rationale:** C – Brief psychotic disorder lasts 1 day to 1 month; if >1
month, reclassify.
**Q7.** A patient reports hearing his thoughts spoken aloud. This is an
example of:
A. Thought insertion
B. Thought echo (Gedankenlautwerden)
C. Thought blocking
D. Magical thinking
**Rationale:** B – Thought echo = hearing one’s own thoughts aloud, a
first-rank Schneiderian symptom.
**Q8.** Which medical condition most commonly presents with new-
onset psychosis in an older adult?
A. Thyroid storm
B. UTI with delirium
C. Brain tumor
D. Wilson’s disease
**Rationale:** B – Delirium from infection (UTI, pneumonia) is most
common; always rule out in elderly.
