Western Governors University
CCN: NURS 6437
Course Number: D344
Course Title: Assessment & Diagnostic Process
Credit Hours:3.0
Exam: Objective Assessment
Date:2026
Question: A PMHNP is conducting a psychiatric interview with a patient who is guarded and
provides vague answers. The NP decides to use "open-ended" questions followed by "focused"
questions to narrow the differential. This systematic approach to narrowing down a diagnosis based
on clinical data is known as:
• A. Pattern Recognition.
• B. Deductive Reasoning.
• C. Intuitive Heuristics.
• D. Anchoring Bias.
Answer: B.
Rationale: Deductive reasoning in the diagnostic process involves moving from a broad set of
symptoms (general) to a specific diagnosis (particular) by systematically ruling out competing
hypotheses.
Question (True/False): In the diagnostic process, "Diagnostic Overshadowing" occurs when a
clinician wrongly attributes a patient’s physical symptoms to their known psychiatric disorder,
leading to a missed medical diagnosis.
Answer: True.
Rationale: This is a significant risk in PMHNP practice; for example, attributing a patient’s
tachycardia to "anxiety" when they actually have a pulmonary embolism.
Question (Fill in the blank): The clinical phenomenon where a clinician’s initial impression of a
patient (e.g., "this patient looks depressed") prevents them from considering contradictory evidence
later in the interview is a cognitive bias known as __________.
1
,Answer: Anchoring Bias (or Focalism).
Rationale: Anchoring bias occurs when the practitioner relies too heavily on the first piece of
information encountered.
Question: When formulating a diagnosis, the PMHNP utilizes the "Biopsychosocial Model."
Which of the following is considered a "Social" factor in the assessment of a patient with Alcohol
Use Disorder?
• A. Genetic predisposition to addiction.
• B. Impaired executive functioning in the prefrontal cortex.
• C. Lack of stable housing and a peer group that heavily uses substances.
• D. Low self-esteem and maladaptive coping mechanisms.
Answer: C.
Rationale: Social factors include environment, housing, support systems, and cultural influences.
Choice A and B are Biological; Choice D is Psychological.
Question: A patient presents with "anhedonia." To meet the DSM-5-TR diagnostic criteria for a
Major Depressive Episode, this symptom must be present for at least:
• A. One week.
• B. Two weeks.
• C. One month.
• D. Six months.
Answer: B.
Rationale: A Major Depressive Episode requires at least five symptoms (including depressed
mood or anhedonia) to be present for a minimum of a two-week period.
Differential Diagnosis: Medical Mimics & Labs
Question: A 55-year-old female with no prior psychiatric history presents with acute onset of
severe anxiety, palpitations, and weight loss. On physical exam, the PMHNP notes a fine tremor
and exophthalmos. What is the most appropriate next step in the diagnostic process?
• A. Initiate a trial of a Selective Serotonin Reuptake Inhibitor (SSRI).
• B. Administer the GAD-7 screening tool.
• C. Order a Serum TSH and Free T4.
• D. Refer the patient for Cognitive Behavioral Therapy (CBT).
Answer: C.
Rationale: New-onset anxiety in an older adult without a prior history warrants a search for
medical causes. The physical signs (tremor, exophthalmos) strongly suggest hyperthyroidism.
2
, Question (True/False): When assessing a patient for a "Substance-Induced Depressive Disorder,"
the clinician must determine that the symptoms developed during or soon after substance
intoxication or withdrawal.
Answer: True.
Rationale: Per DSM-5-TR, the timing of symptom onset in relation to substance use is the primary
factor in distinguishing it from a primary depressive disorder.
Question (Fill in the blank): A PMHNP is evaluating an elderly patient for "Pseudo-dementia." If
the patient’s cognitive deficits are secondary to Major Depressive Disorder, their performance on a
cognitive screen (like the MoCA) will often improve with __________.
Answer: Encouragement (or "Treatment of the underlying depression").
Rationale: Unlike true dementia, patients with "depressive pseudo-dementia" often put forth little
effort ("I don't know") but can perform better when prompted or once their mood is stabilized.
Question: Which laboratory finding would most likely lead a PMHNP to consider a differential
diagnosis of Vitamin B12 deficiency in a patient presenting with cognitive decline and paresthesia?
• A. Microcytic anemia.
• B. Macrocytic anemia (Elevated MCV).
• C. Hypokalemia.
• D. Elevated Liver Function Tests (LFTs).
Answer: B.
Rationale: Vitamin B12 deficiency causes megaloblastic (macrocytic) anemia and can present
with significant neuropsychiatric symptoms, including psychosis and dementia.
Question: A patient presents with symptoms of mania. During the assessment, you discover they
were recently prescribed high-dose Prednisone for an asthma exacerbation. The correct DSM-5-TR
diagnosis would be:
• A. Bipolar I Disorder, Manic Episode.
• B. Bipolar II Disorder, Hypomanic Episode.
• C. Mood Disorder Due to Another Medical Condition.
• D. Substance/Medication-Induced Bipolar and Related Disorder.
Answer: D.
Rationale: Because the manic symptoms are a direct physiological consequence of a medication
(Prednisone), it is classified as medication-induced.
Screening Tools & Measurement-Based Care
3
CCN: NURS 6437
Course Number: D344
Course Title: Assessment & Diagnostic Process
Credit Hours:3.0
Exam: Objective Assessment
Date:2026
Question: A PMHNP is conducting a psychiatric interview with a patient who is guarded and
provides vague answers. The NP decides to use "open-ended" questions followed by "focused"
questions to narrow the differential. This systematic approach to narrowing down a diagnosis based
on clinical data is known as:
• A. Pattern Recognition.
• B. Deductive Reasoning.
• C. Intuitive Heuristics.
• D. Anchoring Bias.
Answer: B.
Rationale: Deductive reasoning in the diagnostic process involves moving from a broad set of
symptoms (general) to a specific diagnosis (particular) by systematically ruling out competing
hypotheses.
Question (True/False): In the diagnostic process, "Diagnostic Overshadowing" occurs when a
clinician wrongly attributes a patient’s physical symptoms to their known psychiatric disorder,
leading to a missed medical diagnosis.
Answer: True.
Rationale: This is a significant risk in PMHNP practice; for example, attributing a patient’s
tachycardia to "anxiety" when they actually have a pulmonary embolism.
Question (Fill in the blank): The clinical phenomenon where a clinician’s initial impression of a
patient (e.g., "this patient looks depressed") prevents them from considering contradictory evidence
later in the interview is a cognitive bias known as __________.
1
,Answer: Anchoring Bias (or Focalism).
Rationale: Anchoring bias occurs when the practitioner relies too heavily on the first piece of
information encountered.
Question: When formulating a diagnosis, the PMHNP utilizes the "Biopsychosocial Model."
Which of the following is considered a "Social" factor in the assessment of a patient with Alcohol
Use Disorder?
• A. Genetic predisposition to addiction.
• B. Impaired executive functioning in the prefrontal cortex.
• C. Lack of stable housing and a peer group that heavily uses substances.
• D. Low self-esteem and maladaptive coping mechanisms.
Answer: C.
Rationale: Social factors include environment, housing, support systems, and cultural influences.
Choice A and B are Biological; Choice D is Psychological.
Question: A patient presents with "anhedonia." To meet the DSM-5-TR diagnostic criteria for a
Major Depressive Episode, this symptom must be present for at least:
• A. One week.
• B. Two weeks.
• C. One month.
• D. Six months.
Answer: B.
Rationale: A Major Depressive Episode requires at least five symptoms (including depressed
mood or anhedonia) to be present for a minimum of a two-week period.
Differential Diagnosis: Medical Mimics & Labs
Question: A 55-year-old female with no prior psychiatric history presents with acute onset of
severe anxiety, palpitations, and weight loss. On physical exam, the PMHNP notes a fine tremor
and exophthalmos. What is the most appropriate next step in the diagnostic process?
• A. Initiate a trial of a Selective Serotonin Reuptake Inhibitor (SSRI).
• B. Administer the GAD-7 screening tool.
• C. Order a Serum TSH and Free T4.
• D. Refer the patient for Cognitive Behavioral Therapy (CBT).
Answer: C.
Rationale: New-onset anxiety in an older adult without a prior history warrants a search for
medical causes. The physical signs (tremor, exophthalmos) strongly suggest hyperthyroidism.
2
, Question (True/False): When assessing a patient for a "Substance-Induced Depressive Disorder,"
the clinician must determine that the symptoms developed during or soon after substance
intoxication or withdrawal.
Answer: True.
Rationale: Per DSM-5-TR, the timing of symptom onset in relation to substance use is the primary
factor in distinguishing it from a primary depressive disorder.
Question (Fill in the blank): A PMHNP is evaluating an elderly patient for "Pseudo-dementia." If
the patient’s cognitive deficits are secondary to Major Depressive Disorder, their performance on a
cognitive screen (like the MoCA) will often improve with __________.
Answer: Encouragement (or "Treatment of the underlying depression").
Rationale: Unlike true dementia, patients with "depressive pseudo-dementia" often put forth little
effort ("I don't know") but can perform better when prompted or once their mood is stabilized.
Question: Which laboratory finding would most likely lead a PMHNP to consider a differential
diagnosis of Vitamin B12 deficiency in a patient presenting with cognitive decline and paresthesia?
• A. Microcytic anemia.
• B. Macrocytic anemia (Elevated MCV).
• C. Hypokalemia.
• D. Elevated Liver Function Tests (LFTs).
Answer: B.
Rationale: Vitamin B12 deficiency causes megaloblastic (macrocytic) anemia and can present
with significant neuropsychiatric symptoms, including psychosis and dementia.
Question: A patient presents with symptoms of mania. During the assessment, you discover they
were recently prescribed high-dose Prednisone for an asthma exacerbation. The correct DSM-5-TR
diagnosis would be:
• A. Bipolar I Disorder, Manic Episode.
• B. Bipolar II Disorder, Hypomanic Episode.
• C. Mood Disorder Due to Another Medical Condition.
• D. Substance/Medication-Induced Bipolar and Related Disorder.
Answer: D.
Rationale: Because the manic symptoms are a direct physiological consequence of a medication
(Prednisone), it is classified as medication-induced.
Screening Tools & Measurement-Based Care
3
