WGU D344 PMHNP Objective Assessment (OA) |
Questions and Answers | 2026 Update | 100%
Correct.
SECTION 1: PSYCHIATRIC ASSESSMENT & DIAGNOSIS (12 Questions)
Q1: A 34-year-old patient presents for psychiatric evaluation. During the Mental Status
Examination, the nurse practitioner observes that the patient maintains an unusual
posture with arms extended for several minutes without apparent discomfort. This
finding is most consistent with which catatonic feature?
A. Catalepsy
B. Waxy flexibility
C. Posturing
D. Negativism
Correct Answer: C
Rationale: Correct because posturing is defined as spontaneous maintenance of a
posture against gravity for an extended period, which matches the described
presentation. Per DSM-5-TR criteria for catatonia, posturing is a core diagnostic feature
distinct from catalepsy (maintenance of externally imposed posture) and waxy flexibility
(slight resistance to passive movement followed by maintenance of position).
Q2: During a psychiatric interview, a 28-year-old patient with schizophrenia states, "The
government is sending messages through the radio about my thoughts." The patient
believes others can hear their internal thoughts. This type of delusion is classified as:
A. Referential delusion
B. Thought broadcasting
C. Grandiose delusion
D. Persecutory delusion
Correct Answer: B
Rationale: Correct because thought broadcasting is the delusional belief that one's
thoughts are being transmitted and can be heard by others. Per DSM-5-TR, this is a first-
rank symptom of schizophrenia and is distinct from referential thinking (events have
special meaning for the individual) and persecutory delusions (being harmed or
conspired against).
Q3: A patient scores 18 on the Montreal Cognitive Assessment (MoCA). Based on
standard scoring interpretation, this result indicates:
A. Normal cognition
,B. Mild cognitive impairment
C. Moderate cognitive impairment
D. Severe cognitive impairment
Correct Answer: B
Rationale: Correct because the MoCA scoring criteria define scores of 18-25 as mild
cognitive impairment, ≥26 as normal, 10-17 as moderate, and <10 as severe. Standard
PMHNP practice requires this interpretation to guide further neuropsychological
evaluation and differential diagnosis for dementia versus delirium.
Q4: During a Mental Status Examination, a patient demonstrates speech with excessive
unnecessary detail that eventually reaches the point but takes a circuitous route. This
pattern of speech is best described as:
A. Tangentiality
B. Circumstantiality
C. Loosening of associations
D. Flight of ideas
Correct Answer: B
Rationale: Correct because circumstantiality is characterized by speech that includes
excessive detail and digressions but eventually returns to the original point. Per
standard psychiatric assessment terminology, this differs from tangentiality (never
returns to original point), loosening of associations (illogical connections between
ideas), and flight of ideas (rapid topic shifts with logical connections).
Q5: A 45-year-old patient reports, "I feel empty and hopeless all the time" (subjective
mood). During the interview, the nurse practitioner observes minimal facial expression,
decreased vocal inflection, and limited gesturing. The affect is best described as:
A. Flat
B. Blunted
C. Restricted
D. Inappropriate
Correct Answer: A
Rationale: Correct because flat affect represents the most severe reduction in emotional
expressiveness, with virtually absent facial expression, vocal inflection, and body
language. Per MSE standards, blunted affect shows significant but not complete
reduction, restricted affect shows mild reduction in range, and inappropriate affect is
discordant with the stated mood or context.
Q6: A psychiatric nurse practitioner is conducting a suicide risk assessment using the
Columbia-Suicide Severity Rating Scale (C-SSRS). The patient reports having a specific
, plan to overdose on medication and has obtained the pills but states they would not
actually go through with it. This corresponds to which C-SSRS ideation severity level?
A. Active suicidal thoughts with methods but no intent to act
B. Active suicidal thoughts with intent but no specific plan
C. Active suicidal thoughts with intent and specific plan
D. Non-specific active suicidal thoughts
Correct Answer: A
Rationale: Correct because the C-SSRS severity scale categorizes ideation into five
levels, with "active with methods but without intent to act" representing Level 3. The
patient has identified a method (overdose) and obtained means but denies intent,
distinguishing this from Level 4 (intent without plan) and Level 5 (intent with plan).
Q7: A 52-year-old patient with no prior psychiatric history presents with new-onset
anxiety, irritability, tremor, and heat intolerance. Laboratory studies reveal suppressed
TSH and elevated free T4. The most appropriate next step in management is:
A. Initiate SSRI for anxiety disorder
B. Initiate benzodiazepine for acute anxiety
C. Refer for endocrinology evaluation and treat hyperthyroidism
D. Initiate mood stabilizer for bipolar disorder
Correct Answer: C
Rationale: Correct because hyperthyroidism is a well-established medical cause of
anxiety symptoms and must be ruled out before diagnosing a primary anxiety disorder.
Standard PMHNP practice requires comprehensive medical workup including thyroid
function tests, as treating the underlying endocrine disorder typically resolves
psychiatric symptoms.
Q8: During the psychiatric history, a patient describes their depressive symptoms using
the PQRST format. They report the symptom quality as "a heavy, crushing weight on my
chest that makes it hard to breathe." The nurse practitioner recognizes this description
requires immediate attention because:
A. It may indicate panic disorder with somatic symptoms
B. It may indicate a medical emergency such as acute coronary syndrome
C. It represents a somatic symptom disorder conversion presentation
D. It is consistent with atypical depression features
Correct Answer: B
Rationale: Correct because chest pressure or crushing sensations can indicate life-
threatening medical conditions including acute coronary syndrome, pulmonary
Questions and Answers | 2026 Update | 100%
Correct.
SECTION 1: PSYCHIATRIC ASSESSMENT & DIAGNOSIS (12 Questions)
Q1: A 34-year-old patient presents for psychiatric evaluation. During the Mental Status
Examination, the nurse practitioner observes that the patient maintains an unusual
posture with arms extended for several minutes without apparent discomfort. This
finding is most consistent with which catatonic feature?
A. Catalepsy
B. Waxy flexibility
C. Posturing
D. Negativism
Correct Answer: C
Rationale: Correct because posturing is defined as spontaneous maintenance of a
posture against gravity for an extended period, which matches the described
presentation. Per DSM-5-TR criteria for catatonia, posturing is a core diagnostic feature
distinct from catalepsy (maintenance of externally imposed posture) and waxy flexibility
(slight resistance to passive movement followed by maintenance of position).
Q2: During a psychiatric interview, a 28-year-old patient with schizophrenia states, "The
government is sending messages through the radio about my thoughts." The patient
believes others can hear their internal thoughts. This type of delusion is classified as:
A. Referential delusion
B. Thought broadcasting
C. Grandiose delusion
D. Persecutory delusion
Correct Answer: B
Rationale: Correct because thought broadcasting is the delusional belief that one's
thoughts are being transmitted and can be heard by others. Per DSM-5-TR, this is a first-
rank symptom of schizophrenia and is distinct from referential thinking (events have
special meaning for the individual) and persecutory delusions (being harmed or
conspired against).
Q3: A patient scores 18 on the Montreal Cognitive Assessment (MoCA). Based on
standard scoring interpretation, this result indicates:
A. Normal cognition
,B. Mild cognitive impairment
C. Moderate cognitive impairment
D. Severe cognitive impairment
Correct Answer: B
Rationale: Correct because the MoCA scoring criteria define scores of 18-25 as mild
cognitive impairment, ≥26 as normal, 10-17 as moderate, and <10 as severe. Standard
PMHNP practice requires this interpretation to guide further neuropsychological
evaluation and differential diagnosis for dementia versus delirium.
Q4: During a Mental Status Examination, a patient demonstrates speech with excessive
unnecessary detail that eventually reaches the point but takes a circuitous route. This
pattern of speech is best described as:
A. Tangentiality
B. Circumstantiality
C. Loosening of associations
D. Flight of ideas
Correct Answer: B
Rationale: Correct because circumstantiality is characterized by speech that includes
excessive detail and digressions but eventually returns to the original point. Per
standard psychiatric assessment terminology, this differs from tangentiality (never
returns to original point), loosening of associations (illogical connections between
ideas), and flight of ideas (rapid topic shifts with logical connections).
Q5: A 45-year-old patient reports, "I feel empty and hopeless all the time" (subjective
mood). During the interview, the nurse practitioner observes minimal facial expression,
decreased vocal inflection, and limited gesturing. The affect is best described as:
A. Flat
B. Blunted
C. Restricted
D. Inappropriate
Correct Answer: A
Rationale: Correct because flat affect represents the most severe reduction in emotional
expressiveness, with virtually absent facial expression, vocal inflection, and body
language. Per MSE standards, blunted affect shows significant but not complete
reduction, restricted affect shows mild reduction in range, and inappropriate affect is
discordant with the stated mood or context.
Q6: A psychiatric nurse practitioner is conducting a suicide risk assessment using the
Columbia-Suicide Severity Rating Scale (C-SSRS). The patient reports having a specific
, plan to overdose on medication and has obtained the pills but states they would not
actually go through with it. This corresponds to which C-SSRS ideation severity level?
A. Active suicidal thoughts with methods but no intent to act
B. Active suicidal thoughts with intent but no specific plan
C. Active suicidal thoughts with intent and specific plan
D. Non-specific active suicidal thoughts
Correct Answer: A
Rationale: Correct because the C-SSRS severity scale categorizes ideation into five
levels, with "active with methods but without intent to act" representing Level 3. The
patient has identified a method (overdose) and obtained means but denies intent,
distinguishing this from Level 4 (intent without plan) and Level 5 (intent with plan).
Q7: A 52-year-old patient with no prior psychiatric history presents with new-onset
anxiety, irritability, tremor, and heat intolerance. Laboratory studies reveal suppressed
TSH and elevated free T4. The most appropriate next step in management is:
A. Initiate SSRI for anxiety disorder
B. Initiate benzodiazepine for acute anxiety
C. Refer for endocrinology evaluation and treat hyperthyroidism
D. Initiate mood stabilizer for bipolar disorder
Correct Answer: C
Rationale: Correct because hyperthyroidism is a well-established medical cause of
anxiety symptoms and must be ruled out before diagnosing a primary anxiety disorder.
Standard PMHNP practice requires comprehensive medical workup including thyroid
function tests, as treating the underlying endocrine disorder typically resolves
psychiatric symptoms.
Q8: During the psychiatric history, a patient describes their depressive symptoms using
the PQRST format. They report the symptom quality as "a heavy, crushing weight on my
chest that makes it hard to breathe." The nurse practitioner recognizes this description
requires immediate attention because:
A. It may indicate panic disorder with somatic symptoms
B. It may indicate a medical emergency such as acute coronary syndrome
C. It represents a somatic symptom disorder conversion presentation
D. It is consistent with atypical depression features
Correct Answer: B
Rationale: Correct because chest pressure or crushing sensations can indicate life-
threatening medical conditions including acute coronary syndrome, pulmonary
