NRNP 6635 GRADE A MASTERY FINAL EXAM 2026/2027 |
Psychopathology and Diagnostic Reasoning | Walden
University | Verified Q&A | Pass Guaranteed - A+ Graded
Section 1: Neurodevelopmental & Psychotic Disorders - Advanced
Differential (Q1-18)
Q1. A 19-year-old college freshman is brought to the emergency department by campus
police after being found wandering outside at 3 AM, speaking to "the voices that control
the dormitory elevators." He reports that for the past 6 months, he has heard a male
voice commenting on his actions and occasionally commanding him to "check the
locks." He denies any mood symptoms, substance use, or trauma history. His mother
reports that he was a straight-A student until 8 months ago, when he gradually withdrew
from friends and began spending hours alone researching conspiracy theories about
government surveillance. Physical exam and urine drug screen are negative. Which
diagnosis is most appropriate?
A. Schizophreniform Disorder
B. Schizophrenia
C. Delusional Disorder
D. Brief Psychotic Disorder
B. Schizophrenia [CORRECT]
Rationale: The patient meets Criterion A with hallucinations (commenting and
commanding voices) and disorganized speech/behavior (wandering, conspiracy
preoccupation). Duration exceeds 6 months of continuous symptoms (including 2
months of active phase and 6 months of prodromal decline), meeting schizophrenia
duration requirement. Schizophreniform requires 1-6 months; this exceeds 6 months.
,Delusional Disorder lacks prominent hallucinations and functional decline. Brief
Psychotic Disorder requires <1 month.
Correct Answer: B
Q2. A 24-year-old woman presents with 3 weeks of auditory hallucinations, disorganized
speech, and grossly disorganized behavior following a traumatic sexual assault. She
has no prior psychiatric history. Urine toxicology is positive for cannabis. Her symptoms
have persisted daily since the assault without fluctuation. Which is the most appropriate
next step in diagnostic reasoning?
A. Diagnose Brief Psychotic Disorder
B. Diagnose Posttraumatic Stress Disorder with dissociative symptoms
C. First rule out substance/medication-induced psychotic disorder and psychotic
disorder due to another medical condition
D. Diagnose Schizophreniform Disorder
C. First rule out substance/medication-induced psychotic disorder and psychotic
disorder due to another medical condition [CORRECT]
Rationale: The DSM-5-TR hierarchical diagnostic rule requires ruling out
substance-induced and medical causes before diagnosing a primary psychotic disorder.
Cannabis use and acute trauma both represent potential etiological factors that must
be evaluated. The temporal relationship between cannabis use, trauma, and symptom
onset necessitates this step before assigning Brief Psychotic Disorder or
Schizophreniform Disorder. PTSD with dissociative symptoms does not typically include
prominent hallucinations and disorganized speech.
Correct Answer: C
Q3. A 7-year-old boy is referred by his teacher for evaluation. He frequently blurts out
answers before questions are completed, leaves his seat during instruction, and loses
materials necessary for tasks. At home, he interrupts conversations and has difficulty
waiting his turn during games. Symptoms began at age 5 and occur in both settings.
His pediatrician notes he is at the 95th percentile for height and weight. Which
,additional assessment is most critical before confirming ADHD, Combined
Presentation?
A. Intelligence testing to rule out intellectual disability
B. Sleep study to evaluate for obstructive sleep apnea
C. Thyroid function tests and comprehensive metabolic panel
D. Evaluation for specific learning disorder in reading
B. Sleep study to evaluate for obstructive sleep apnea [CORRECT]
Rationale: The patient's elevated BMI (95th percentile) significantly increases risk for
obstructive sleep apnea (OSA), which can mimic or exacerbate ADHD symptoms
through sleep fragmentation and daytime neurobehavioral impairment. DSM-5-TR
requires that symptoms are not better explained by another mental disorder or medical
condition. While other evaluations may be relevant, OSA represents the most immediate
and modifiable confound given his weight status. ADHD symptoms must not occur
exclusively during the course of another disorder.
Correct Answer: B
Q4. A 28-year-old man reports lifelong difficulty maintaining attention, chronic
disorganization, and forgetfulness in daily activities. He was never evaluated as a child
but describes consistent academic underachievement despite average intelligence. He
denies hyperactivity. His current job performance is jeopardized by missed deadlines
and careless errors. He consumes 4-5 cups of coffee daily and smokes half a pack of
cigarettes. Which diagnosis best fits?
A. ADHD, Predominantly Inattentive Presentation
B. ADHD, Combined Presentation
C. Generalized Anxiety Disorder
D. Major Depressive Disorder
A. ADHD, Predominantly Inattentive Presentation [CORRECT]
Rationale: The patient meets criteria for ADHD, Predominantly Inattentive Presentation:
≥6 inattention symptoms present since childhood, causing impairment in two settings
(academic, occupational), not better explained by another disorder. The absence of
, hyperactivity/impulsivity rules out Combined Presentation. His caffeine and nicotine use
are common self-medication strategies in undiagnosed adult ADHD. GAD and MDD may
coexist but do not account for the lifelong, pervasive inattention pattern.
Correct Answer: A
Q5. A 16-year-old girl is brought for evaluation after her parents discovered she has
been secretly restricting food intake, exercising compulsively for 2 hours daily, and has
lost 15 pounds in 3 months. She reports intense fear of gaining weight and believes she
is "fat" despite being underweight (BMI 16.5). She denies binge eating or purging. She
also reports that for the past year, she has had persistent difficulty falling asleep due to
racing thoughts about school performance and future college admissions. Which is the
primary diagnosis?
A. Anorexia Nervosa, Restricting Type; Insomnia Disorder as secondary
B. Insomnia Disorder; Anorexia Nervosa as secondary
C. Avoidant/Restrictive Food Intake Disorder
D. Anorexia Nervosa, Binge-Eating/Purging Type
A. Anorexia Nervosa, Restricting Type; Insomnia Disorder as secondary [CORRECT]
Rationale: The patient meets full criteria for Anorexia Nervosa: restriction of energy
intake leading to significantly low body weight, intense fear of gaining weight, and
disturbance in self-perceived weight/shape. The restricting subtype is correct as there
is no binge/purge behavior. The insomnia is likely secondary to malnutrition,
hyperarousal, and anxiety about the eating disorder. ARFID lacks the fear of weight gain
and body image disturbance. The hierarchical rule places Anorexia as primary when it
accounts for secondary symptoms.
Correct Answer: A
Q6. A 22-year-old man with a 4-year history of schizophrenia, paranoid type, treated with
risperidone 4 mg daily, presents with 2 months of worsening flat affect, avolition, and
social withdrawal. His mother reports he spends most days in bed and has stopped
attending his day program. He denies hallucinations or delusions. His medication
Psychopathology and Diagnostic Reasoning | Walden
University | Verified Q&A | Pass Guaranteed - A+ Graded
Section 1: Neurodevelopmental & Psychotic Disorders - Advanced
Differential (Q1-18)
Q1. A 19-year-old college freshman is brought to the emergency department by campus
police after being found wandering outside at 3 AM, speaking to "the voices that control
the dormitory elevators." He reports that for the past 6 months, he has heard a male
voice commenting on his actions and occasionally commanding him to "check the
locks." He denies any mood symptoms, substance use, or trauma history. His mother
reports that he was a straight-A student until 8 months ago, when he gradually withdrew
from friends and began spending hours alone researching conspiracy theories about
government surveillance. Physical exam and urine drug screen are negative. Which
diagnosis is most appropriate?
A. Schizophreniform Disorder
B. Schizophrenia
C. Delusional Disorder
D. Brief Psychotic Disorder
B. Schizophrenia [CORRECT]
Rationale: The patient meets Criterion A with hallucinations (commenting and
commanding voices) and disorganized speech/behavior (wandering, conspiracy
preoccupation). Duration exceeds 6 months of continuous symptoms (including 2
months of active phase and 6 months of prodromal decline), meeting schizophrenia
duration requirement. Schizophreniform requires 1-6 months; this exceeds 6 months.
,Delusional Disorder lacks prominent hallucinations and functional decline. Brief
Psychotic Disorder requires <1 month.
Correct Answer: B
Q2. A 24-year-old woman presents with 3 weeks of auditory hallucinations, disorganized
speech, and grossly disorganized behavior following a traumatic sexual assault. She
has no prior psychiatric history. Urine toxicology is positive for cannabis. Her symptoms
have persisted daily since the assault without fluctuation. Which is the most appropriate
next step in diagnostic reasoning?
A. Diagnose Brief Psychotic Disorder
B. Diagnose Posttraumatic Stress Disorder with dissociative symptoms
C. First rule out substance/medication-induced psychotic disorder and psychotic
disorder due to another medical condition
D. Diagnose Schizophreniform Disorder
C. First rule out substance/medication-induced psychotic disorder and psychotic
disorder due to another medical condition [CORRECT]
Rationale: The DSM-5-TR hierarchical diagnostic rule requires ruling out
substance-induced and medical causes before diagnosing a primary psychotic disorder.
Cannabis use and acute trauma both represent potential etiological factors that must
be evaluated. The temporal relationship between cannabis use, trauma, and symptom
onset necessitates this step before assigning Brief Psychotic Disorder or
Schizophreniform Disorder. PTSD with dissociative symptoms does not typically include
prominent hallucinations and disorganized speech.
Correct Answer: C
Q3. A 7-year-old boy is referred by his teacher for evaluation. He frequently blurts out
answers before questions are completed, leaves his seat during instruction, and loses
materials necessary for tasks. At home, he interrupts conversations and has difficulty
waiting his turn during games. Symptoms began at age 5 and occur in both settings.
His pediatrician notes he is at the 95th percentile for height and weight. Which
,additional assessment is most critical before confirming ADHD, Combined
Presentation?
A. Intelligence testing to rule out intellectual disability
B. Sleep study to evaluate for obstructive sleep apnea
C. Thyroid function tests and comprehensive metabolic panel
D. Evaluation for specific learning disorder in reading
B. Sleep study to evaluate for obstructive sleep apnea [CORRECT]
Rationale: The patient's elevated BMI (95th percentile) significantly increases risk for
obstructive sleep apnea (OSA), which can mimic or exacerbate ADHD symptoms
through sleep fragmentation and daytime neurobehavioral impairment. DSM-5-TR
requires that symptoms are not better explained by another mental disorder or medical
condition. While other evaluations may be relevant, OSA represents the most immediate
and modifiable confound given his weight status. ADHD symptoms must not occur
exclusively during the course of another disorder.
Correct Answer: B
Q4. A 28-year-old man reports lifelong difficulty maintaining attention, chronic
disorganization, and forgetfulness in daily activities. He was never evaluated as a child
but describes consistent academic underachievement despite average intelligence. He
denies hyperactivity. His current job performance is jeopardized by missed deadlines
and careless errors. He consumes 4-5 cups of coffee daily and smokes half a pack of
cigarettes. Which diagnosis best fits?
A. ADHD, Predominantly Inattentive Presentation
B. ADHD, Combined Presentation
C. Generalized Anxiety Disorder
D. Major Depressive Disorder
A. ADHD, Predominantly Inattentive Presentation [CORRECT]
Rationale: The patient meets criteria for ADHD, Predominantly Inattentive Presentation:
≥6 inattention symptoms present since childhood, causing impairment in two settings
(academic, occupational), not better explained by another disorder. The absence of
, hyperactivity/impulsivity rules out Combined Presentation. His caffeine and nicotine use
are common self-medication strategies in undiagnosed adult ADHD. GAD and MDD may
coexist but do not account for the lifelong, pervasive inattention pattern.
Correct Answer: A
Q5. A 16-year-old girl is brought for evaluation after her parents discovered she has
been secretly restricting food intake, exercising compulsively for 2 hours daily, and has
lost 15 pounds in 3 months. She reports intense fear of gaining weight and believes she
is "fat" despite being underweight (BMI 16.5). She denies binge eating or purging. She
also reports that for the past year, she has had persistent difficulty falling asleep due to
racing thoughts about school performance and future college admissions. Which is the
primary diagnosis?
A. Anorexia Nervosa, Restricting Type; Insomnia Disorder as secondary
B. Insomnia Disorder; Anorexia Nervosa as secondary
C. Avoidant/Restrictive Food Intake Disorder
D. Anorexia Nervosa, Binge-Eating/Purging Type
A. Anorexia Nervosa, Restricting Type; Insomnia Disorder as secondary [CORRECT]
Rationale: The patient meets full criteria for Anorexia Nervosa: restriction of energy
intake leading to significantly low body weight, intense fear of gaining weight, and
disturbance in self-perceived weight/shape. The restricting subtype is correct as there
is no binge/purge behavior. The insomnia is likely secondary to malnutrition,
hyperarousal, and anxiety about the eating disorder. ARFID lacks the fear of weight gain
and body image disturbance. The hierarchical rule places Anorexia as primary when it
accounts for secondary symptoms.
Correct Answer: A
Q6. A 22-year-old man with a 4-year history of schizophrenia, paranoid type, treated with
risperidone 4 mg daily, presents with 2 months of worsening flat affect, avolition, and
social withdrawal. His mother reports he spends most days in bed and has stopped
attending his day program. He denies hallucinations or delusions. His medication
