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NR668 PMHNP Final Diagnostic Exam

Question 1

Which personality disorder is most commonly associated with brief, stress-related paranoid ideation or severe dissociative symptoms?

1. Borderline personality disorder ✅
2. Paranoid personality disorder
3. Schizoid personality disorder
4. Schizotypal personality disorder

Question 2

A 35-year-old woman has a well-established history of recurrent major depressive disorder and opioid use disorder. During periods of opioid abstinence, she continues to experience major depressive episodes that meet full MDD criteria. Which diagnostic formulation is most appropriate?

1. Opioid-induced depressive disorder
2. Major depressive disorder caused by methadone
3. Opioid use disorder with comorbid major depressive disorder ✅
4. No depressive diagnosis can be made until opioid use disorder fully remits

Question 3

An 8 year old child is given 2 apples. 1 of the apples is cut into 3 pieces. The child recognizes that the chopped apple contains the same amount of apple as the intact apple. This is known as conservation. Which stage in Piaget’s theory of cognitive development does a child develop conservation?

1. Concrete Operations ✅
2. Formal Operations
3. Sensorimotor
4. Preoperational

Question 4

A therapist meets with parents who are struggling to accept their child’s gender identity. The therapist provides information about gender identity, corrects misconceptions, and teaches supportive communication strategies. Which intervention is the therapist primarily using?

1. Interpersonal therapy
2. Cognitive-behavioral therapy
3. Structural family therapy
4. Psychoeducational approach ✅

Question 5

This lobe empowers one to know the difference in how one should act at a wedding vs. a funeral?

1. Frontal ✅
2. Temporal
3. Occipital
4. Parietal

Question 6

Which of the following medications may contribute to REM sleep behavior disorder?

1. Serotonin Norepinephrine Reuptake Inhibitors
2. All of these contribute to REM sleep behavior disorder. ✅
3. Beta blockers
4. Selective Serotonin Reuptake Inhibitors

Question 7

A 19-year-old woman with rapid-cycling bipolar I disorder (four or more mood episodes in the past 12 months, with depressive episodes predominating) has had an inadequate response to lamotrigine and is now in a moderate depressive episode. She uses a long-acting reversible contraceptive (levonorgestrel IUD) and is not planning pregnancy. Her thyroid and renal function are normal, and she is taking no antidepressants or stimulants. Which of the following is the most appropriate medication to add?

1. Aripiprazole
2. Bupropion
3. Lithium ✅
4. Valproate

Question 8

Which of the following statements is true?

1. Insecure attachment avoidant type is associated with helicopter parenting.
2. A secure pattern of attachment is associated with mild to moderate sleep disorders.
3. Insecure attachment ambivalent type is associated with nicotine addiction.
4. Insecure attachment disorganized type is associated with maltreatment. ✅

Question 9

Jamie is a 28 year old female who for the last 7 months has been overly concerned that she has been infected with the Covid-19 virus. Her mother had the virus 5 months ago. Jamie is anxious that she is now ill. She checks her temperature 4 times a day. She has tested negative for Covid -19 10 times in the last 3 months. Jamie has no overt symptoms of the virus. She frequently visits her PCP and drug store clinic asking for repeated testing. Two years ago, she had fears of the Zika virus and displayed similar behavior and repeated medical care visits. What is the most likely diagnosis here?

1. Factitious disorder by proxy
2. Illness anxiety disorder ✅
3. Panic disorder
4. Somatic symptom disorder

Question 10

A 51 year old male presents to you after agreeing with his partner’s request to obtain help. He notes that he collects baseball cards and feels strongly that this growing collection is an investment in the future. He offers that he never sells the cards and “cannot part with them”. He has marked distress associated with discarding any items. He admits that the condominium is running out of walkable hallway space to store all of the cards. Despite this, he continues to purchase more cards each week. His partner is concerned about both the cost of the baseball cards and the remaining space left in their home to store these items. What is the best diagnosis?

1. Delusional disorder
2. Obsessive Compulsive Personality Disorder
3. Non pathological behavior
4. Hoarding disorder, with excessive acquisition ✅

Question 11

A phenomenon in which a markedly increased dose of a substance is required to achieve the desired effect or a markedly reduced effect is experienced when the usual (original) dose is consumed is better known as what?

1. Addiction
2. Tolerance ✅
3. Dependence
4. Withdrawal

Question 12

Which section of the Mental Status exam would one document gait, tics and hand wringing?

1. Motor activity ✅
2. Thought process
3. Speech
4. Extracorporeal findings

Question 13

The Patient Self-Determination Act of 1990 applies to all health care institutions that receive Medicare or Medicaid funds. Which of the following best describes what the Act requires of these institutions?

1. Obtain informed consent before performing any health care intervention on a patient
2. At the time of admission, provide each adult patient with written information about their rights to make health care decisions and to formulate advance directives, document whether the patient has an advance directive, and neither condition care on nor discriminate based on whether a directive exists ✅
3. Guarantee that every patient’s advance directive carries binding legal force in any state in which the patient receives care
4. Petition for a court-appointed guardian whenever a patient lacks decision-making capacity

Question 14

Which of the following is NOT a symptom of Alcohol Withdrawal as listed in the Criterion B of the DSM-5?

1. Increased hand tremor
2. Hypothermia ✅
3. Generalized Tonic-clonic seizures
4. Pulse greater than 100 bpm

Question 15

Felipe intentionally punctures his foot and contaminates the wound, then seeks medical treatment while falsely reporting that the injury occurred accidentally. No external reward, financial incentive, avoidance of responsibility, or other secondary gain is evident. Which diagnosis best fits this behavior?

1. Malingering
2. Somatic symptom disorder
3. Conversion disorder
4. Factitious disorder imposed on self ✅

Question 16

A patient diagnosed with schizophrenia suddenly stops mid-sentence and loses her train of thought. She struggles to articulate her own thoughts or complete sentences, often staring and appearing confused. Which term best describes this phenomenon in the MSE?

1. Flight of Ideas
2. Word salad
3. Thought blocking ✅
4. Loose Associations

Question 17

Which of the following is least appropriate for managing bruxism that emerges after starting an SSRI?

1. Adding buspirone
2. Low dose Haloperidol ✅
3. Reducing the SSRI dose
4. Switching to a alternative antidepressant

Question 18

A 3-year-old child occasionally bites her hand when frustrated but has normal development, no tissue injury, and no other repetitive or concerning behaviors. What is the most appropriate initial approach?

1. Assess the behavior, triggers, developmental context, and safety; provide parental guidance and monitor ✅
2. Refer immediately for pediatric DBT
3. Diagnose stereotypic movement disorder
4. Begin a second-generation antipsychotic

Question 19

A 35-year-old woman, eight weeks postpartum, presents with low mood, difficulty sleeping even when the baby is asleep, and passive suicidal thoughts. She is open to treatment but asks if she should consider stopping breastfeeding if she starts medication. What should the PMHNP prioritize in her treatment planning?

1. Suggest stopping breastfeeding to simplify pharmacologic options
2. Begin fluoxetine immediately, as it is effective for postpartum depression
3. Administer a suicide risk assessment and safety planning. Discuss options for medication safe in breastfeeding, such as sertraline, and consider psychotherapy ✅
4. Refer her for electroconvulsive therapy (ECT) due to her suicidal thoughts

Question 20

Ron, a 34-year-old man, presents urgently with 5 days of bilateral hand tingling and a sense that his hands are “weak.” Symptoms began the day after his partner abruptly ended their 3-year relationship. He rarely sees his primary care provider, denies injury, and has no other complaints. On examination, grip strength is “give-way” rather than consistently reduced, and full power returns momentarily when he is distracted. The sensory loss stops abruptly at the wrists in a non-anatomic “glove” distribution that does not correspond to any peripheral nerve or dermatome. Reflexes are normal and symmetric. Which of the following is the most likely diagnosis?

1. Somatic Symptom Disorder
2. Conversion disorder ✅
3. Factitious disorder
4. Body dysmorphic Disorder

Question 21

Which disorder is associated with higher rates of ADHD, enlarged testes after puberty, prominent ears, a long narrow face, hypotonia and short stature?

1. Asperger’s syndrome
2. Prader-Willi syndrome
3. Fragile X ✅
4. PKU

Question 22

Delirium and dementia may at times have overlapping characteristics. However, which of the following are readily associated with delirium?

1. Insidious onset
2. Bipolar onset
3. Sudden Onset ✅
4. Delayed onset

Question 23

The recurrent pulling out of one’s own hair, resulting in hair loss with repeated attempts to stop and related distress is known as what disorder?

1. Trichotillomania ✅
2. Body dysmorphic disorder
3. Kleptomania
4. Delusional disorder

Question 24

A child with an anxiety disorder is experiencing academic struggles. Which intervention would address both academic and mental health needs?

1. Coordination of school supports and mental health care ✅
2. Referral for special education evaluation
3. Individual counseling
4. Parental counseling

Question 25

A patient tells the PMHNP that religious beliefs strongly influence how they understand depression and which treatments they are willing to consider. What is the most culturally responsive response?

1. Avoid discussing religion unless the patient refuses medication
2. “Religious beliefs should be kept separate from medical decisions.”
3. “Tell me how your beliefs shape your understanding of what is happening and what treatments would feel acceptable to you.” ✅
4. “It is best to follow the treatment plan even when it conflicts with your beliefs.”

Question 26

A 30-year-old woman develops persistent depressed mood, anhedonia, guilt, insomnia, and impaired functioning beginning 3 weeks after giving birth. Which statement best describes the DSM-5-TR diagnosis?

1. The symptoms may meet criteria for a major depressive episode with peripartum onset if full MDD criteria are met ✅
2. Psychotic symptoms are required for the peripartum-onset specifier
3. Thoughts of harming the infant are required for the diagnosis
4. The symptoms cannot represent major depression until 6 months postpartum

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