NR548 Exam 4 Actual Exam Style V3 | NR
548 Psychiatric Assessment for
Psychiatric-Mental Health Nurse
Practitioner Chamberlain
1. When assessing a patient for Bipolar I Disorder, which clinical finding is mandatory for the
diagnosis?
A. At least one hypomanic episode and one major depressive episode
B. At least one manic episode lasting at least one week or requiring hospitalization
C. Persistent depressive symptoms for at least two years without mania
D. Cyclical mood swings that do not meet the full criteria for mania
Correct Answer: B
Expert Explanation: The diagnostic hallmark of Bipolar I Disorder is the presence of at
least one manic episode in the patient’s lifetime. While depressive episodes are common,
they are not strictly required for a Bipolar I diagnosis according to the DSM-5-TR.
Distinguishing between mania and hypomania is essential for correct classification and
treatment planning in psychiatric practice.
2. A patient presents with a PHQ-9 score of 18. What is the most appropriate clinical
interpretation of this score?
A. Mild depression requiring monitoring
B. Moderate depression requiring psychotherapy only
,C. Severe depression requiring immediate hospitalization
D. Moderately severe depression requiring treatment intervention
Correct Answer: D
Expert Explanation: A PHQ-9 score between 15 and 19 indicates moderately severe
depression, which typically warrants pharmacological and/or psychotherapeutic
intervention. Scoring 20 or higher would indicate severe depression, while scores below 10
are generally considered mild. The practitioner must also specifically evaluate the answer
to question 9 regarding suicidal ideation regardless of the total score.
3. During a Mental Status Examination (MSE), the PMHNP notes the patient is using rhyming
words and sounds rather than meaningful phrases. This is documented as:
A. Neologisms
B. Clang associations
C. Word salad
D. Echolalia
Correct Answer: B
Expert Explanation: Clang associations are a thought process abnormality where word
choice is governed by the sound of the words, often involving rhyming or punning. This is
frequently observed in patients experiencing a manic episode or schizophrenia. Proper
documentation of thought process helps in differentiating between various psychotic and
mood disorders.
,4. Which screening tool is most appropriate for a PMHNP to use when screening an adult
patient for Bipolar Spectrum Disorder?
A. GAD-7
B. MDQ
C. PHQ-9
D. CAGE
Correct Answer: B
Expert Explanation: The Mood Disorder Questionnaire (MDQ) is a validated screening
tool specifically designed to identify symptoms associated with Bipolar I, II, and Not
Otherwise Specified disorders. While it is not a diagnostic tool on its own, a positive screen
necessitates a more thorough clinical interview. It helps practitioners identify mania or
hypomania history in patients presenting with depression.
5. A 24-year-old female reports fear of being in open spaces, using public transportation, or
being in a crowd because escape might be difficult. What is the most likely diagnosis?
A. Social Anxiety Disorder
B. Agoraphobia
C. Panic Disorder
D. Generalized Anxiety Disorder
Correct Answer: B
, Expert Explanation: Agoraphobia involves intense fear or anxiety triggered by real or
anticipated exposure to a wide range of situations, such as public transit or open spaces.
The core of the fear is the concern that escape might be difficult or help unavailable if panic
symptoms occur. It is often comorbid with Panic Disorder but is diagnosed as a distinct
entity in the DSM-5-TR.
6. What is the minimum duration of symptoms required to diagnose an adult with
Generalized Anxiety Disorder (GAD)?
A. 1 month
B. 6 months
C. 3 months
D. 12 months
Correct Answer: B
Expert Explanation: According to DSM-5-TR criteria, symptoms of excessive anxiety and
worry must occur more days than not for at least 6 months. These symptoms must involve
multiple activities or events and be difficult for the individual to control. Shorter durations
of anxiety might suggest an Adjustment Disorder or an Unspecified Anxiety Disorder.
7. In the assessment of a child with suspected ADHD, which criterion regarding the setting of
symptoms is necessary?
A. Symptoms must be present only in the classroom
B. Symptoms must occur only during structured activities
548 Psychiatric Assessment for
Psychiatric-Mental Health Nurse
Practitioner Chamberlain
1. When assessing a patient for Bipolar I Disorder, which clinical finding is mandatory for the
diagnosis?
A. At least one hypomanic episode and one major depressive episode
B. At least one manic episode lasting at least one week or requiring hospitalization
C. Persistent depressive symptoms for at least two years without mania
D. Cyclical mood swings that do not meet the full criteria for mania
Correct Answer: B
Expert Explanation: The diagnostic hallmark of Bipolar I Disorder is the presence of at
least one manic episode in the patient’s lifetime. While depressive episodes are common,
they are not strictly required for a Bipolar I diagnosis according to the DSM-5-TR.
Distinguishing between mania and hypomania is essential for correct classification and
treatment planning in psychiatric practice.
2. A patient presents with a PHQ-9 score of 18. What is the most appropriate clinical
interpretation of this score?
A. Mild depression requiring monitoring
B. Moderate depression requiring psychotherapy only
,C. Severe depression requiring immediate hospitalization
D. Moderately severe depression requiring treatment intervention
Correct Answer: D
Expert Explanation: A PHQ-9 score between 15 and 19 indicates moderately severe
depression, which typically warrants pharmacological and/or psychotherapeutic
intervention. Scoring 20 or higher would indicate severe depression, while scores below 10
are generally considered mild. The practitioner must also specifically evaluate the answer
to question 9 regarding suicidal ideation regardless of the total score.
3. During a Mental Status Examination (MSE), the PMHNP notes the patient is using rhyming
words and sounds rather than meaningful phrases. This is documented as:
A. Neologisms
B. Clang associations
C. Word salad
D. Echolalia
Correct Answer: B
Expert Explanation: Clang associations are a thought process abnormality where word
choice is governed by the sound of the words, often involving rhyming or punning. This is
frequently observed in patients experiencing a manic episode or schizophrenia. Proper
documentation of thought process helps in differentiating between various psychotic and
mood disorders.
,4. Which screening tool is most appropriate for a PMHNP to use when screening an adult
patient for Bipolar Spectrum Disorder?
A. GAD-7
B. MDQ
C. PHQ-9
D. CAGE
Correct Answer: B
Expert Explanation: The Mood Disorder Questionnaire (MDQ) is a validated screening
tool specifically designed to identify symptoms associated with Bipolar I, II, and Not
Otherwise Specified disorders. While it is not a diagnostic tool on its own, a positive screen
necessitates a more thorough clinical interview. It helps practitioners identify mania or
hypomania history in patients presenting with depression.
5. A 24-year-old female reports fear of being in open spaces, using public transportation, or
being in a crowd because escape might be difficult. What is the most likely diagnosis?
A. Social Anxiety Disorder
B. Agoraphobia
C. Panic Disorder
D. Generalized Anxiety Disorder
Correct Answer: B
, Expert Explanation: Agoraphobia involves intense fear or anxiety triggered by real or
anticipated exposure to a wide range of situations, such as public transit or open spaces.
The core of the fear is the concern that escape might be difficult or help unavailable if panic
symptoms occur. It is often comorbid with Panic Disorder but is diagnosed as a distinct
entity in the DSM-5-TR.
6. What is the minimum duration of symptoms required to diagnose an adult with
Generalized Anxiety Disorder (GAD)?
A. 1 month
B. 6 months
C. 3 months
D. 12 months
Correct Answer: B
Expert Explanation: According to DSM-5-TR criteria, symptoms of excessive anxiety and
worry must occur more days than not for at least 6 months. These symptoms must involve
multiple activities or events and be difficult for the individual to control. Shorter durations
of anxiety might suggest an Adjustment Disorder or an Unspecified Anxiety Disorder.
7. In the assessment of a child with suspected ADHD, which criterion regarding the setting of
symptoms is necessary?
A. Symptoms must be present only in the classroom
B. Symptoms must occur only during structured activities
