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Section 1: Assessment, Diagnosis & Differential Reasoning
(Questions 1-25)
Q1. A 34-year-old female presents with depressed mood, anhedonia, fatigue, and
insomnia for the past 3 weeks. She reports increased appetite with 8-lb weight gain,
psychomotor retardation, and feelings of worthlessness. She denies suicidal ideation.
Which diagnosis is most appropriate per DSM-5-TR criteria?
A. Major Depressive Disorder, single episode, moderate
B. Persistent Depressive Disorder (Dysthymia)
C. Adjustment Disorder with Depressed Mood
D. Bipolar II Disorder, current episode depressed
Correct Answer: A [CORRECT]
Rationale: The patient meets DSM-5-TR criteria for Major Depressive Disorder: ≥5
symptoms present during the same 2-week period, including depressed mood and
anhedonia, with clinically significant distress. Increased appetite and weight gain are
atypical features but still qualify for MDD. Duration is too short for Persistent
Depressive Disorder (B); symptoms exceed what would be expected for adjustment
disorder (C); no history of hypomania rules out Bipolar II (D). (ANCC Blueprint:
Domain 1 - Assessment & Diagnosis)
Q2. A 28-year-old male is brought to the emergency department by police after
running through traffic believing he is "saving the world from alien invasion." He has
not slept in 4 days, is hyperverbal, and displays grandiosity. His mother reports
,similar episodes lasting 5-7 days every 6 months for the past 3 years, interspersed
with periods of normal functioning. Which diagnosis is most appropriate?
A. Bipolar I Disorder, current episode manic
B. Bipolar II Disorder, current episode hypomanic
C. Cyclothymic Disorder
D. Schizoaffective Disorder, Bipolar Type
Correct Answer: A [CORRECT]
Rationale: The patient exhibits a full manic episode (≥7 days, psychosis, severe
impairment, hospitalization required) with history of recurrent episodes and inter-
episode recovery, meeting criteria for Bipolar I Disorder. Hypomania (B) does not
cause psychosis or require hospitalization; cyclothymia (C) involves subthreshold
symptoms without full manic episodes; schizoaffective (D) requires psychosis without
mood symptoms for ≥2 weeks, which is not described here. (ANCC Blueprint:
Domain 1 - Assessment & Diagnosis)
Q3. A 19-year-old college freshman presents with sudden onset of intense fear,
palpitations, sweating, trembling, and fear of dying. Episodes last 10-20 minutes and
have occurred 4 times in the past month. She is preoccupied with worry about future
attacks. Which is the most likely diagnosis?
A. Generalized Anxiety Disorder
B. Panic Disorder
C. Social Anxiety Disorder
D. Agoraphobia
Correct Answer: B [CORRECT]
Rationale: Panic Disorder requires recurrent unexpected panic attacks followed by ≥1
month of persistent concern about additional attacks or maladaptive behavioral
change. The sudden onset, crescendo intensity, and fear of dying are classic panic
attack features. GAD (A) involves chronic worry without discrete panic attacks; social
anxiety (C) requires social/performance triggers; agoraphobia (D) requires fear of
situations due to escape concerns. (ANCC Blueprint: Domain 1 - Assessment &
Diagnosis)
,Q4. A 42-year-old female reports intrusive thoughts of harming her infant, which
cause extreme anxiety. She spends 3 hours daily checking locks, washing hands, and
arranging items symmetrically to "prevent something bad from happening." She
recognizes these thoughts are her own and tries to resist them. Which diagnosis best
fits?
A. Obsessive-Compulsive Disorder
B. Obsessive-Compulsive Personality Disorder
C. Generalized Anxiety Disorder
D. Posttraumatic Stress Disorder
Correct Answer: A [CORRECT]
Rationale: OCD requires obsessions (intrusive thoughts causing anxiety) and
compulsions (repetitive behaviors reducing anxiety), consuming >1 hour daily and
causing impairment. Ego-dystonic nature (she resists them) distinguishes OCD from
psychosis. OCPD (B) involves egosyntonic preoccupation with orderliness without
true obsessions/compulsions; GAD (C) lacks specific intrusive thoughts and ritual
behaviors; PTSD (D) requires trauma history and re-experiencing symptoms. (ANCC
Blueprint: Domain 1 - Assessment & Diagnosis)
Q5. A 35-year-old veteran presents with nightmares, flashbacks, hypervigilance, and
emotional numbing following a combat deployment 8 months ago. He avoids
crowded places, startles easily, and reports difficulty concentrating. He denies
substance use. Which additional assessment is most critical before confirming PTSD?
A. Comprehensive metabolic panel
B. Trauma-focused cognitive processing therapy readiness
C. Rule out traumatic brain injury and substance use
D. Polysomnography for sleep apnea
Correct Answer: C [CORRECT]
Rationale: PTSD diagnosis requires ruling out medical mimics and substance-induced
symptoms. Traumatic brain injury (TBI) from blast exposure commonly co-occurs in
veterans and can mimic PTSD symptoms (irritability, concentration deficits, sleep
, disturbance). While CBT readiness (B) is important for treatment planning, medical
rule-out (C) is prerequisite for accurate diagnosis. Labs (A) and sleep studies (D) are
less critical than TBI/substance assessment. (ANCC Blueprint: Domain 1 - Assessment
& Diagnosis)
Q6. A 26-year-old female presents with chronic feelings of emptiness, unstable
intense relationships, impulsivity (binge eating, reckless driving), recurrent suicidal
gestures, and transient dissociative episodes under stress. She has a history of
childhood sexual abuse. Which diagnosis is most appropriate?
A. Bipolar II Disorder
B. Borderline Personality Disorder
C. Complex PTSD
D. Histrionic Personality Disorder
Correct Answer: B [CORRECT]
Rationale: The patient meets ≥5 DSM-5-TR criteria for Borderline Personality
Disorder: frantic efforts to avoid abandonment, unstable relationships, identity
disturbance, impulsivity, recurrent suicidal behavior, affective instability, chronic
emptiness, inappropriate anger, and transient stress-related dissociation. While C-
PTSD (C) shares features, the pervasive pattern of instability across relationships, self-
image, and affect since adolescence is characteristic of BPD. Bipolar II (A) requires
mood episodes; histrionic (D) lacks self-destructive behaviors and dissociation.
(ANCC Blueprint: Domain 1 - Assessment & Diagnosis)
Q7. A 52-year-old male with no psychiatric history presents with 3 weeks of
depressed mood, anhedonia, and psychomotor agitation. He has hypertension and
hyperlipidemia. Which medical condition should be ruled out first as a mimic of
depression?
A. Hypothyroidism
B. Vitamin B12 deficiency
2026/2027 | ANCC/AANP Exam Prep | Complete
Solutions | Pass Guaranteed - A+ Graded
Section 1: Assessment, Diagnosis & Differential Reasoning
(Questions 1-25)
Q1. A 34-year-old female presents with depressed mood, anhedonia, fatigue, and
insomnia for the past 3 weeks. She reports increased appetite with 8-lb weight gain,
psychomotor retardation, and feelings of worthlessness. She denies suicidal ideation.
Which diagnosis is most appropriate per DSM-5-TR criteria?
A. Major Depressive Disorder, single episode, moderate
B. Persistent Depressive Disorder (Dysthymia)
C. Adjustment Disorder with Depressed Mood
D. Bipolar II Disorder, current episode depressed
Correct Answer: A [CORRECT]
Rationale: The patient meets DSM-5-TR criteria for Major Depressive Disorder: ≥5
symptoms present during the same 2-week period, including depressed mood and
anhedonia, with clinically significant distress. Increased appetite and weight gain are
atypical features but still qualify for MDD. Duration is too short for Persistent
Depressive Disorder (B); symptoms exceed what would be expected for adjustment
disorder (C); no history of hypomania rules out Bipolar II (D). (ANCC Blueprint:
Domain 1 - Assessment & Diagnosis)
Q2. A 28-year-old male is brought to the emergency department by police after
running through traffic believing he is "saving the world from alien invasion." He has
not slept in 4 days, is hyperverbal, and displays grandiosity. His mother reports
,similar episodes lasting 5-7 days every 6 months for the past 3 years, interspersed
with periods of normal functioning. Which diagnosis is most appropriate?
A. Bipolar I Disorder, current episode manic
B. Bipolar II Disorder, current episode hypomanic
C. Cyclothymic Disorder
D. Schizoaffective Disorder, Bipolar Type
Correct Answer: A [CORRECT]
Rationale: The patient exhibits a full manic episode (≥7 days, psychosis, severe
impairment, hospitalization required) with history of recurrent episodes and inter-
episode recovery, meeting criteria for Bipolar I Disorder. Hypomania (B) does not
cause psychosis or require hospitalization; cyclothymia (C) involves subthreshold
symptoms without full manic episodes; schizoaffective (D) requires psychosis without
mood symptoms for ≥2 weeks, which is not described here. (ANCC Blueprint:
Domain 1 - Assessment & Diagnosis)
Q3. A 19-year-old college freshman presents with sudden onset of intense fear,
palpitations, sweating, trembling, and fear of dying. Episodes last 10-20 minutes and
have occurred 4 times in the past month. She is preoccupied with worry about future
attacks. Which is the most likely diagnosis?
A. Generalized Anxiety Disorder
B. Panic Disorder
C. Social Anxiety Disorder
D. Agoraphobia
Correct Answer: B [CORRECT]
Rationale: Panic Disorder requires recurrent unexpected panic attacks followed by ≥1
month of persistent concern about additional attacks or maladaptive behavioral
change. The sudden onset, crescendo intensity, and fear of dying are classic panic
attack features. GAD (A) involves chronic worry without discrete panic attacks; social
anxiety (C) requires social/performance triggers; agoraphobia (D) requires fear of
situations due to escape concerns. (ANCC Blueprint: Domain 1 - Assessment &
Diagnosis)
,Q4. A 42-year-old female reports intrusive thoughts of harming her infant, which
cause extreme anxiety. She spends 3 hours daily checking locks, washing hands, and
arranging items symmetrically to "prevent something bad from happening." She
recognizes these thoughts are her own and tries to resist them. Which diagnosis best
fits?
A. Obsessive-Compulsive Disorder
B. Obsessive-Compulsive Personality Disorder
C. Generalized Anxiety Disorder
D. Posttraumatic Stress Disorder
Correct Answer: A [CORRECT]
Rationale: OCD requires obsessions (intrusive thoughts causing anxiety) and
compulsions (repetitive behaviors reducing anxiety), consuming >1 hour daily and
causing impairment. Ego-dystonic nature (she resists them) distinguishes OCD from
psychosis. OCPD (B) involves egosyntonic preoccupation with orderliness without
true obsessions/compulsions; GAD (C) lacks specific intrusive thoughts and ritual
behaviors; PTSD (D) requires trauma history and re-experiencing symptoms. (ANCC
Blueprint: Domain 1 - Assessment & Diagnosis)
Q5. A 35-year-old veteran presents with nightmares, flashbacks, hypervigilance, and
emotional numbing following a combat deployment 8 months ago. He avoids
crowded places, startles easily, and reports difficulty concentrating. He denies
substance use. Which additional assessment is most critical before confirming PTSD?
A. Comprehensive metabolic panel
B. Trauma-focused cognitive processing therapy readiness
C. Rule out traumatic brain injury and substance use
D. Polysomnography for sleep apnea
Correct Answer: C [CORRECT]
Rationale: PTSD diagnosis requires ruling out medical mimics and substance-induced
symptoms. Traumatic brain injury (TBI) from blast exposure commonly co-occurs in
veterans and can mimic PTSD symptoms (irritability, concentration deficits, sleep
, disturbance). While CBT readiness (B) is important for treatment planning, medical
rule-out (C) is prerequisite for accurate diagnosis. Labs (A) and sleep studies (D) are
less critical than TBI/substance assessment. (ANCC Blueprint: Domain 1 - Assessment
& Diagnosis)
Q6. A 26-year-old female presents with chronic feelings of emptiness, unstable
intense relationships, impulsivity (binge eating, reckless driving), recurrent suicidal
gestures, and transient dissociative episodes under stress. She has a history of
childhood sexual abuse. Which diagnosis is most appropriate?
A. Bipolar II Disorder
B. Borderline Personality Disorder
C. Complex PTSD
D. Histrionic Personality Disorder
Correct Answer: B [CORRECT]
Rationale: The patient meets ≥5 DSM-5-TR criteria for Borderline Personality
Disorder: frantic efforts to avoid abandonment, unstable relationships, identity
disturbance, impulsivity, recurrent suicidal behavior, affective instability, chronic
emptiness, inappropriate anger, and transient stress-related dissociation. While C-
PTSD (C) shares features, the pervasive pattern of instability across relationships, self-
image, and affect since adolescence is characteristic of BPD. Bipolar II (A) requires
mood episodes; histrionic (D) lacks self-destructive behaviors and dissociation.
(ANCC Blueprint: Domain 1 - Assessment & Diagnosis)
Q7. A 52-year-old male with no psychiatric history presents with 3 weeks of
depressed mood, anhedonia, and psychomotor agitation. He has hypertension and
hyperlipidemia. Which medical condition should be ruled out first as a mimic of
depression?
A. Hypothyroidism
B. Vitamin B12 deficiency
