NRNP 6675 — PMHNP Across the Lifespan: Adults &
Older Adults |500 MCQ Exam Prep | Correct Answers
& Rationales
COMPREHENSIVE TOPIC SUMMARY
Section Focus Area Questions
1 Psychiatric Assessment & Diagnosis 1–15
2 Psychopharmacology: Antidepressants 16–30
3 Psychopharmacology: Mood Stabilizers 31–40
4 Psychopharmacology: Antipsychotics 41–50
5 Anxiolytics & Sedative-Hypnotics 51–55
6 ADHD & Stimulants 56–60
7 Geriatric Psychiatry 61–70
8 Substance Use Disorders 71–80
9 Psychotherapy & Treatment Modalities 81–90
10 Suicide Risk Assessment & Safety Planning 91–100
11 Special Populations & Cultural Considerations 101–105
12 Legal, Ethical & Professional Issues 106–115
13 Advanced Clinical Topics 116–130
14 Neurobiological Foundations 126–130
15 Comprehensive Clinical Practice 131–200
SECTION 1 — PSYCHIATRIC ASSESSMENT &
DIAGNOSIS
1. A 45-year-old male presents with a 6-month history of depressed mood, anhedonia,
hypersomnia, weight gain, and concentration difficulties. He denies suicidal ideation.
Which diagnosis is most appropriate?
A) Persistent depressive disorder (dysthymia) B) Major depressive disorder, single episode C)
Bipolar II disorder, depressive phase D) Adjustment disorder with depressed mood
B) Major depressive disorder, single episode (correct answer)
,Rationale: MDD requires at least 5 of 9 criteria (SIG E CAPS: Sleep, Interest, Guilt,
Energy, Concentration, Appetite, Psychomotor, Suicidality) present for ≥2 weeks with at
least one being depressed mood or anhedonia. This client has depressed mood, anhedonia,
hypersomnia, weight gain, and concentration difficulties — meeting MDD criteria. PDD
requires ≥2 years of depressed mood. Adjustment disorder requires an identifiable stressor
within 3 months.
2. A 68-year-old woman presents with a 3-week history of depressed mood, anergia, and
poor sleep following her husband's death 4 weeks ago. She occasionally "hears his voice"
calling her name. Which response is most appropriate?
A) Diagnose MDD and initiate antidepressant therapy B) Recognize this as normal bereavement
and provide supportive counseling; reassess in 4–6 weeks C) Diagnose complicated grief
disorder and initiate psychotherapy immediately D) Refer for inpatient psychiatric admission due
to auditory hallucinations
B) Recognize this as normal bereavement and provide supportive counseling; reassess in 4–
6 weeks (correct answer)
Rationale: Normal bereavement (grief) can include depressive symptoms and brief
auditory or visual hallucinations of the deceased — these are not pathological in the acute
grief period. DSM-5 removed the "bereavement exclusion" for MDD but cautions against
diagnosing MDD within weeks of loss unless symptoms are severe (suicidality, psychotic
features beyond brief hallucinations, functional impairment beyond expected). Watchful
waiting and support are appropriate initially.
3. Which tool is most appropriate for screening depression severity in adult psychiatric
outpatients?
A) Beck Anxiety Inventory (BAI) B) Patient Health Questionnaire-9 (PHQ-9) C) Columbia
Suicide Severity Rating Scale (C-SSRS) D) Brief Psychiatric Rating Scale (BPRS)
B) Patient Health Questionnaire-9 (PHQ-9) (correct answer)
Rationale: The PHQ-9 is a validated, widely used 9-item self-report tool that screens for
and rates depression severity based on DSM criteria. Scores: 0–4 (minimal), 5–9 (mild), 10–
14 (moderate), 15–19 (moderately severe), 20–27 (severe). It is ideal for outpatient
screening and monitoring treatment response. The BAI measures anxiety, C-SSRS
measures suicide risk, and BPRS assesses psychosis severity.
,4. A 52-year-old woman reports a 2-week period last year of elevated mood, decreased
sleep (feeling rested on 3 hours), increased goal-directed activity, and spending sprees —
but was able to work throughout. She now presents with depression. Which diagnosis is
most appropriate?
A) Bipolar I disorder, current episode depressed B) Bipolar II disorder, current episode
depressed C) Cyclothymic disorder D) Major depressive disorder with anxious distress
B) Bipolar II disorder, current episode depressed (correct answer)
Rationale: Bipolar II requires at least one hypomanic episode (≥4 days, with
elevated/irritable mood + 3–4 criteria, no psychosis, no hospitalization, functional change
noted by others but able to function) and at least one MDE. The described episode was
hypomanic (not manic — she remained functional). Bipolar I requires full manic episodes.
Cyclothymia requires 2+ years of hypomanic and depressive symptoms not meeting full
criteria.
5. A 38-year-old man reports persistent worry about multiple life domains for 3 years,
muscle tension, fatigue, irritability, sleep disturbance, and difficulty concentrating. He
recognizes the worry is excessive but cannot control it. Which diagnosis is most
appropriate?
A) Panic disorder B) Social anxiety disorder C) Generalized anxiety disorder (GAD) D)
Obsessive-compulsive disorder
C) Generalized anxiety disorder (GAD) (correct answer)
Rationale: GAD is characterized by excessive, uncontrollable worry about multiple
domains (not one specific focus) lasting ≥6 months, accompanied by ≥3 of 6 somatic
symptoms (restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep
disturbance). The worry is ego-dystonic (person recognizes it is excessive). It causes
significant distress or functional impairment.
6. A PMHNP is assessing a 29-year-old woman who reports recurrent unexpected panic
attacks followed by persistent worry about future attacks and avoidance of places where
attacks occurred. Which diagnosis is most appropriate?
A) Specific phobia B) Agoraphobia C) Panic disorder D) Panic disorder with agoraphobia
D) Panic disorder with agoraphobia (correct answer)
, Rationale: Panic disorder requires recurrent unexpected panic attacks + ≥1 month of
either persistent concern about attacks OR significant behavioral change (avoidance).
Agoraphobia is anxiety about situations where escape might be difficult during an attack,
leading to avoidance. When both criteria are met, both diagnoses are coded separately in
DSM-5. This client meets criteria for both panic disorder AND agoraphobia.
7. A 44-year-old man presents with a 6-month history of intrusive memories of a combat-
related trauma, nightmares, emotional numbing, hypervigilance, exaggerated startle
response, and avoidance of triggers. He served in combat 8 months ago. Which diagnosis is
most appropriate?
A) Acute stress disorder B) Adjustment disorder with anxiety C) PTSD D) Specific phobia
C) PTSD (correct answer)
Rationale: PTSD requires: exposure to actual or threatened trauma, intrusion symptoms
(flashbacks, nightmares), avoidance (of internal/external cues), negative alterations in
cognition/mood (emotional numbing), and alterations in arousal/reactivity (hypervigilance,
exaggerated startle) — lasting >1 month with significant impairment. Acute stress disorder
= 3 days to 1 month. This client's symptoms have been present 6+ months — meeting PTSD
criteria.
8. The PMHNP is evaluating a 55-year-old man with suspected OCD. Which assessment
tool is most appropriate for measuring OCD symptom severity?
A) Yale-Brown Obsessive Compulsive Scale (Y-BOCS) B) Hamilton Anxiety Rating Scale
(HAM-A) C) Obsessive-Compulsive Inventory (OCI) D) Beck Depression Inventory (BDI)
A) Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (correct answer)
Rationale: The Y-BOCS is the gold standard clinician-administered scale for measuring
OCD symptom severity. It separately rates obsessions and compulsions on time spent,
interference, distress, resistance, and control (0–4 each), yielding a total score of 0–40.
Scores: 0–7 (subclinical), 8–15 (mild), 16–23 (moderate), 24–31 (severe), 32–40 (extreme). It
guides treatment decisions and monitors response.
9. A 67-year-old woman reports a 2-year history of depressed mood present "more days
than not," low energy, low self-esteem, poor concentration, and feelings of hopelessness,
but she has never had a full MDE. Which diagnosis is most appropriate?
Older Adults |500 MCQ Exam Prep | Correct Answers
& Rationales
COMPREHENSIVE TOPIC SUMMARY
Section Focus Area Questions
1 Psychiatric Assessment & Diagnosis 1–15
2 Psychopharmacology: Antidepressants 16–30
3 Psychopharmacology: Mood Stabilizers 31–40
4 Psychopharmacology: Antipsychotics 41–50
5 Anxiolytics & Sedative-Hypnotics 51–55
6 ADHD & Stimulants 56–60
7 Geriatric Psychiatry 61–70
8 Substance Use Disorders 71–80
9 Psychotherapy & Treatment Modalities 81–90
10 Suicide Risk Assessment & Safety Planning 91–100
11 Special Populations & Cultural Considerations 101–105
12 Legal, Ethical & Professional Issues 106–115
13 Advanced Clinical Topics 116–130
14 Neurobiological Foundations 126–130
15 Comprehensive Clinical Practice 131–200
SECTION 1 — PSYCHIATRIC ASSESSMENT &
DIAGNOSIS
1. A 45-year-old male presents with a 6-month history of depressed mood, anhedonia,
hypersomnia, weight gain, and concentration difficulties. He denies suicidal ideation.
Which diagnosis is most appropriate?
A) Persistent depressive disorder (dysthymia) B) Major depressive disorder, single episode C)
Bipolar II disorder, depressive phase D) Adjustment disorder with depressed mood
B) Major depressive disorder, single episode (correct answer)
,Rationale: MDD requires at least 5 of 9 criteria (SIG E CAPS: Sleep, Interest, Guilt,
Energy, Concentration, Appetite, Psychomotor, Suicidality) present for ≥2 weeks with at
least one being depressed mood or anhedonia. This client has depressed mood, anhedonia,
hypersomnia, weight gain, and concentration difficulties — meeting MDD criteria. PDD
requires ≥2 years of depressed mood. Adjustment disorder requires an identifiable stressor
within 3 months.
2. A 68-year-old woman presents with a 3-week history of depressed mood, anergia, and
poor sleep following her husband's death 4 weeks ago. She occasionally "hears his voice"
calling her name. Which response is most appropriate?
A) Diagnose MDD and initiate antidepressant therapy B) Recognize this as normal bereavement
and provide supportive counseling; reassess in 4–6 weeks C) Diagnose complicated grief
disorder and initiate psychotherapy immediately D) Refer for inpatient psychiatric admission due
to auditory hallucinations
B) Recognize this as normal bereavement and provide supportive counseling; reassess in 4–
6 weeks (correct answer)
Rationale: Normal bereavement (grief) can include depressive symptoms and brief
auditory or visual hallucinations of the deceased — these are not pathological in the acute
grief period. DSM-5 removed the "bereavement exclusion" for MDD but cautions against
diagnosing MDD within weeks of loss unless symptoms are severe (suicidality, psychotic
features beyond brief hallucinations, functional impairment beyond expected). Watchful
waiting and support are appropriate initially.
3. Which tool is most appropriate for screening depression severity in adult psychiatric
outpatients?
A) Beck Anxiety Inventory (BAI) B) Patient Health Questionnaire-9 (PHQ-9) C) Columbia
Suicide Severity Rating Scale (C-SSRS) D) Brief Psychiatric Rating Scale (BPRS)
B) Patient Health Questionnaire-9 (PHQ-9) (correct answer)
Rationale: The PHQ-9 is a validated, widely used 9-item self-report tool that screens for
and rates depression severity based on DSM criteria. Scores: 0–4 (minimal), 5–9 (mild), 10–
14 (moderate), 15–19 (moderately severe), 20–27 (severe). It is ideal for outpatient
screening and monitoring treatment response. The BAI measures anxiety, C-SSRS
measures suicide risk, and BPRS assesses psychosis severity.
,4. A 52-year-old woman reports a 2-week period last year of elevated mood, decreased
sleep (feeling rested on 3 hours), increased goal-directed activity, and spending sprees —
but was able to work throughout. She now presents with depression. Which diagnosis is
most appropriate?
A) Bipolar I disorder, current episode depressed B) Bipolar II disorder, current episode
depressed C) Cyclothymic disorder D) Major depressive disorder with anxious distress
B) Bipolar II disorder, current episode depressed (correct answer)
Rationale: Bipolar II requires at least one hypomanic episode (≥4 days, with
elevated/irritable mood + 3–4 criteria, no psychosis, no hospitalization, functional change
noted by others but able to function) and at least one MDE. The described episode was
hypomanic (not manic — she remained functional). Bipolar I requires full manic episodes.
Cyclothymia requires 2+ years of hypomanic and depressive symptoms not meeting full
criteria.
5. A 38-year-old man reports persistent worry about multiple life domains for 3 years,
muscle tension, fatigue, irritability, sleep disturbance, and difficulty concentrating. He
recognizes the worry is excessive but cannot control it. Which diagnosis is most
appropriate?
A) Panic disorder B) Social anxiety disorder C) Generalized anxiety disorder (GAD) D)
Obsessive-compulsive disorder
C) Generalized anxiety disorder (GAD) (correct answer)
Rationale: GAD is characterized by excessive, uncontrollable worry about multiple
domains (not one specific focus) lasting ≥6 months, accompanied by ≥3 of 6 somatic
symptoms (restlessness, fatigue, concentration difficulty, irritability, muscle tension, sleep
disturbance). The worry is ego-dystonic (person recognizes it is excessive). It causes
significant distress or functional impairment.
6. A PMHNP is assessing a 29-year-old woman who reports recurrent unexpected panic
attacks followed by persistent worry about future attacks and avoidance of places where
attacks occurred. Which diagnosis is most appropriate?
A) Specific phobia B) Agoraphobia C) Panic disorder D) Panic disorder with agoraphobia
D) Panic disorder with agoraphobia (correct answer)
, Rationale: Panic disorder requires recurrent unexpected panic attacks + ≥1 month of
either persistent concern about attacks OR significant behavioral change (avoidance).
Agoraphobia is anxiety about situations where escape might be difficult during an attack,
leading to avoidance. When both criteria are met, both diagnoses are coded separately in
DSM-5. This client meets criteria for both panic disorder AND agoraphobia.
7. A 44-year-old man presents with a 6-month history of intrusive memories of a combat-
related trauma, nightmares, emotional numbing, hypervigilance, exaggerated startle
response, and avoidance of triggers. He served in combat 8 months ago. Which diagnosis is
most appropriate?
A) Acute stress disorder B) Adjustment disorder with anxiety C) PTSD D) Specific phobia
C) PTSD (correct answer)
Rationale: PTSD requires: exposure to actual or threatened trauma, intrusion symptoms
(flashbacks, nightmares), avoidance (of internal/external cues), negative alterations in
cognition/mood (emotional numbing), and alterations in arousal/reactivity (hypervigilance,
exaggerated startle) — lasting >1 month with significant impairment. Acute stress disorder
= 3 days to 1 month. This client's symptoms have been present 6+ months — meeting PTSD
criteria.
8. The PMHNP is evaluating a 55-year-old man with suspected OCD. Which assessment
tool is most appropriate for measuring OCD symptom severity?
A) Yale-Brown Obsessive Compulsive Scale (Y-BOCS) B) Hamilton Anxiety Rating Scale
(HAM-A) C) Obsessive-Compulsive Inventory (OCI) D) Beck Depression Inventory (BDI)
A) Yale-Brown Obsessive Compulsive Scale (Y-BOCS) (correct answer)
Rationale: The Y-BOCS is the gold standard clinician-administered scale for measuring
OCD symptom severity. It separately rates obsessions and compulsions on time spent,
interference, distress, resistance, and control (0–4 each), yielding a total score of 0–40.
Scores: 0–7 (subclinical), 8–15 (mild), 16–23 (moderate), 24–31 (severe), 32–40 (extreme). It
guides treatment decisions and monitors response.
9. A 67-year-old woman reports a 2-year history of depressed mood present "more days
than not," low energy, low self-esteem, poor concentration, and feelings of hopelessness,
but she has never had a full MDE. Which diagnosis is most appropriate?
