NRNP 6635 FINAL EXAM 2026/2027 | Psychopathology and
Diagnostic Reasoning | Walden University | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1: NEURODEVELOPMENTAL, SCHIZOPHRENIA SPECTRUM
& PSYCHOTIC DISORDERS (Q1–15)
Q1. A 7-year-old boy presents with difficulty sustaining attention in school, frequent
interrupting, and inability to remain seated. Symptoms began at age 5, occur in multiple
settings, and cause significant academic impairment. His teacher reports similar
concerns. Which DSM-5-TR diagnosis is most appropriate?
A. Oppositional Defiant Disorder
B. Attention-Deficit/Hyperactivity Disorder, Combined Presentation
C. Autism Spectrum Disorder
D. Specific Learning Disorder
Correct Answer: B
Rationale: The presentation meets DSM-5-TR criteria for ADHD Combined Presentation:
≥6 symptoms of inattention (difficulty sustaining attention) and ≥6 symptoms of
hyperactivity-impulsivity (interrupting, inability to remain seated) present before age 12,
in multiple settings, with functional impairment. ODD (A) requires angry/irritable mood
and defiant behavior, not primarily attention deficits. ASD (C) requires social
communication deficits and restricted/repetitive behaviors. Specific Learning Disorder
(D) involves academic skill deficits, not attention/hyperactivity. Reference: DSM-5-TR
314.01 (F90.2).
,Q2. A 16-year-old female is referred for evaluation after two episodes of sudden,
unprovoked irritability and explosive verbal outbursts lasting 20–30 minutes, occurring
approximately three times per week for the past 8 months. Between episodes, her mood
is euthymic. She denies depressive symptoms, grandiosity, or sleep disturbance. Which
diagnosis best fits this presentation?
A. Disruptive Mood Dysregulation Disorder
B. Intermittent Explosive Disorder
C. Bipolar II Disorder
D. Major Depressive Disorder, With Irritable Mood
Correct Answer: B
Rationale: Intermittent Explosive Disorder requires recurrent behavioral outbursts
(verbal or physical) grossly out of proportion to provocation, not better explained by
another mental disorder. The euthymic baseline between episodes, absence of mood
symptoms, and specific pattern of explosive behavior distinguish this from DMDD (A),
which requires persistent irritability between outbursts. Bipolar II (C) requires
hypomanic and depressive episodes. MDD (D) requires persistent depressive
symptoms. Reference: DSM-5-TR 312.34 (F63.81).
Q3. A 22-year-old male is brought to the emergency department by police after being
found wandering traffic, stating that "the government has implanted a chip in my brain
to control my thoughts." He reports hearing a voice commenting on his actions for the
past 6 months. He has poor hygiene, flattened affect, and has withdrawn from all social
contacts. His mother reports gradual functional decline over 18 months. Which
diagnosis is most appropriate?
A. Brief Psychotic Disorder
B. Schizophreniform Disorder
,C. Schizophrenia
D. Delusional Disorder
Correct Answer: C
Rationale: Schizophrenia requires ≥2 of: delusions, hallucinations, disorganized speech,
grossly disorganized/catatonic behavior, negative symptoms; with at least one being
delusions/hallucinations/disorganized speech, present for ≥6 months with active
symptoms for ≥1 month, and functional decline. The 18-month course with gradual
decline, auditory hallucinations (commenting), persecutory delusions, negative
symptoms (flat affect, withdrawal), and functional impairment meet criteria. Brief
Psychotic Disorder (A) lasts <1 month. Schizophreniform (B) lasts 1–6 months without
functional decline requirement. Delusional Disorder (D) lacks the hallucinations and
negative symptoms. Reference: DSM-5-TR 295.90 (F20.9).
Q4. A 19-year-old college student presents with 3 weeks of disorganized speech,
inappropriate laughter, and visual hallucinations of "angels" following heavy cannabis
use. Urine drug screen is positive for THC. Symptoms began 2 days after cessation of
use. Which is the most appropriate diagnosis?
A. Schizophrenia
B. Cannabis-Induced Psychotic Disorder
C. Schizoaffective Disorder
D. Delusional Disorder
Correct Answer: B
Rationale: Cannabis-Induced Psychotic Disorder is diagnosed when psychotic
symptoms (delusions, hallucinations, disorganized speech) are attributable to cannabis
intoxication or withdrawal, with evidence from history/physical/lab. The temporal
relationship (symptoms began after heavy use and cessation), positive urine THC, and
, 3-week duration support this diagnosis. Schizophrenia (A) requires 6 months.
Schizoaffective (C) requires mood episode concurrent with psychosis. Delusional
Disorder (D) lacks hallucinations and disorganization. Reference: DSM-5-TR 292.9
(F12.259).
Q5. A 35-year-old woman reports that for the past 2 years, she has believed her
neighbor is poisoning her food, despite no evidence. She continues working and
maintaining relationships, though she is preoccupied with this belief. She denies
hallucinations or negative symptoms. Which diagnosis is most appropriate?
A. Schizophrenia
B. Schizoaffective Disorder
C. Delusional Disorder, Persecutory Type
D. Paranoid Personality Disorder
Correct Answer: C
Rationale: Delusional Disorder requires ≥1 delusion(s) for ≥1 month without other
psychotic symptoms (hallucinations, disorganized speech/behavior, negative
symptoms) and without functional impairment outside the delusion's impact. The
non-bizarre persecutory delusion (poisoning) with preserved functioning meets criteria.
Schizophrenia (A) and Schizoaffective (B) require additional psychotic symptoms.
Paranoid PD (D) involves pervasive distrust/suspiciousness, not fixed delusional beliefs.
Reference: DSM-5-TR 297.1 (F22).
Q6. A 4-year-old boy is referred for evaluation due to delayed language development,
lack of eye contact, repetitive hand-flapping, and intense distress when his daily routine
is changed. He lines up toys in exact order and becomes fixated on spinning wheels.
Which diagnosis is most appropriate?
Diagnostic Reasoning | Walden University | Verified Q&A |
Pass Guaranteed - A+ Graded
SECTION 1: NEURODEVELOPMENTAL, SCHIZOPHRENIA SPECTRUM
& PSYCHOTIC DISORDERS (Q1–15)
Q1. A 7-year-old boy presents with difficulty sustaining attention in school, frequent
interrupting, and inability to remain seated. Symptoms began at age 5, occur in multiple
settings, and cause significant academic impairment. His teacher reports similar
concerns. Which DSM-5-TR diagnosis is most appropriate?
A. Oppositional Defiant Disorder
B. Attention-Deficit/Hyperactivity Disorder, Combined Presentation
C. Autism Spectrum Disorder
D. Specific Learning Disorder
Correct Answer: B
Rationale: The presentation meets DSM-5-TR criteria for ADHD Combined Presentation:
≥6 symptoms of inattention (difficulty sustaining attention) and ≥6 symptoms of
hyperactivity-impulsivity (interrupting, inability to remain seated) present before age 12,
in multiple settings, with functional impairment. ODD (A) requires angry/irritable mood
and defiant behavior, not primarily attention deficits. ASD (C) requires social
communication deficits and restricted/repetitive behaviors. Specific Learning Disorder
(D) involves academic skill deficits, not attention/hyperactivity. Reference: DSM-5-TR
314.01 (F90.2).
,Q2. A 16-year-old female is referred for evaluation after two episodes of sudden,
unprovoked irritability and explosive verbal outbursts lasting 20–30 minutes, occurring
approximately three times per week for the past 8 months. Between episodes, her mood
is euthymic. She denies depressive symptoms, grandiosity, or sleep disturbance. Which
diagnosis best fits this presentation?
A. Disruptive Mood Dysregulation Disorder
B. Intermittent Explosive Disorder
C. Bipolar II Disorder
D. Major Depressive Disorder, With Irritable Mood
Correct Answer: B
Rationale: Intermittent Explosive Disorder requires recurrent behavioral outbursts
(verbal or physical) grossly out of proportion to provocation, not better explained by
another mental disorder. The euthymic baseline between episodes, absence of mood
symptoms, and specific pattern of explosive behavior distinguish this from DMDD (A),
which requires persistent irritability between outbursts. Bipolar II (C) requires
hypomanic and depressive episodes. MDD (D) requires persistent depressive
symptoms. Reference: DSM-5-TR 312.34 (F63.81).
Q3. A 22-year-old male is brought to the emergency department by police after being
found wandering traffic, stating that "the government has implanted a chip in my brain
to control my thoughts." He reports hearing a voice commenting on his actions for the
past 6 months. He has poor hygiene, flattened affect, and has withdrawn from all social
contacts. His mother reports gradual functional decline over 18 months. Which
diagnosis is most appropriate?
A. Brief Psychotic Disorder
B. Schizophreniform Disorder
,C. Schizophrenia
D. Delusional Disorder
Correct Answer: C
Rationale: Schizophrenia requires ≥2 of: delusions, hallucinations, disorganized speech,
grossly disorganized/catatonic behavior, negative symptoms; with at least one being
delusions/hallucinations/disorganized speech, present for ≥6 months with active
symptoms for ≥1 month, and functional decline. The 18-month course with gradual
decline, auditory hallucinations (commenting), persecutory delusions, negative
symptoms (flat affect, withdrawal), and functional impairment meet criteria. Brief
Psychotic Disorder (A) lasts <1 month. Schizophreniform (B) lasts 1–6 months without
functional decline requirement. Delusional Disorder (D) lacks the hallucinations and
negative symptoms. Reference: DSM-5-TR 295.90 (F20.9).
Q4. A 19-year-old college student presents with 3 weeks of disorganized speech,
inappropriate laughter, and visual hallucinations of "angels" following heavy cannabis
use. Urine drug screen is positive for THC. Symptoms began 2 days after cessation of
use. Which is the most appropriate diagnosis?
A. Schizophrenia
B. Cannabis-Induced Psychotic Disorder
C. Schizoaffective Disorder
D. Delusional Disorder
Correct Answer: B
Rationale: Cannabis-Induced Psychotic Disorder is diagnosed when psychotic
symptoms (delusions, hallucinations, disorganized speech) are attributable to cannabis
intoxication or withdrawal, with evidence from history/physical/lab. The temporal
relationship (symptoms began after heavy use and cessation), positive urine THC, and
, 3-week duration support this diagnosis. Schizophrenia (A) requires 6 months.
Schizoaffective (C) requires mood episode concurrent with psychosis. Delusional
Disorder (D) lacks hallucinations and disorganization. Reference: DSM-5-TR 292.9
(F12.259).
Q5. A 35-year-old woman reports that for the past 2 years, she has believed her
neighbor is poisoning her food, despite no evidence. She continues working and
maintaining relationships, though she is preoccupied with this belief. She denies
hallucinations or negative symptoms. Which diagnosis is most appropriate?
A. Schizophrenia
B. Schizoaffective Disorder
C. Delusional Disorder, Persecutory Type
D. Paranoid Personality Disorder
Correct Answer: C
Rationale: Delusional Disorder requires ≥1 delusion(s) for ≥1 month without other
psychotic symptoms (hallucinations, disorganized speech/behavior, negative
symptoms) and without functional impairment outside the delusion's impact. The
non-bizarre persecutory delusion (poisoning) with preserved functioning meets criteria.
Schizophrenia (A) and Schizoaffective (B) require additional psychotic symptoms.
Paranoid PD (D) involves pervasive distrust/suspiciousness, not fixed delusional beliefs.
Reference: DSM-5-TR 297.1 (F22).
Q6. A 4-year-old boy is referred for evaluation due to delayed language development,
lack of eye contact, repetitive hand-flapping, and intense distress when his daily routine
is changed. He lines up toys in exact order and becomes fixated on spinning wheels.
Which diagnosis is most appropriate?
