NRNP 6665 Final Exam Question and Answers 2026/2027 - WALDEN
UNIVERSITY PMHNP Care Across the Lifespan | Comprehensive
Clinical Competency Assessment | Actual Questions & Verified
Answers | | Pass Guarantee
1. A 17-year-old high-school junior is brought in by his mother after 4 months of irritable
mood, increased goal-directed social-media posting at 2 a.m., and a 15-lb weight gain.
Teachers note he is “hyper” but still earning A’s. Mother has bipolar I disorder. Urine drug
screen negative, TSH normal. YMRS = 18, CGI-BP = 4. Which diagnosis is most
accurate?
A. Bipolar I disorder, current episode manic
B. Bipolar II disorder, current episode hypomanic
C. ADHD, combined presentation, with caffeine intoxication
D. Disruptive mood dysregulation disorder
Correct Answer: B
Rationale: Symptoms are sub-syndromal for mania (no hospitalization/psychosis,
function preserved) and meet ≥4-day duration. Weight gain is common with atypical
antipsychotic treatment of bipolar disorder, not typically seen in pure ADHD. DMDD
requires onset <10 years and chronic irritability, not episodic.
2. A 7-year-old girl is evaluated for “constant worry” since starting first grade. She asks
daily, “What if you die?” and refuses sleepovers. She reads at grade level and has
,friends. GAD-7 (parent) = 12, SCARED = 25. Which first-line medication is FDA-approved
for her age?
A. Sertraline 25 mg daily
B. Fluoxetine 10 mg daily
C. Escitalopram 5 mg daily
D. Duloxetine 30 mg daily
Correct Answer: B
Rationale: Fluoxetine is FDA-approved for childhood MDD and has the largest pediatric
anxiety RCT database (TADS, CAMS). Sertraline and escitalopram are used off-label;
duloxetine is approved ≥7 years but data smaller.
3. A 29-year-old woman 32 weeks pregnant reports 6 weeks of sad mood, guilt,
insomnia, 5-lb weight loss, and passive suicidal ideation. PHQ-9 = 19. She discontinued
sertraline 100 mg at 6 weeks gestation. Obstetric history: one prior preterm birth on
sertraline. She prefers “no medications.” Which plan best balances risks?
A. Restart sertraline 50 mg with 4-week cardiac ultrasound
B. Begin IPT weekly ×12 weeks
C. Start bupropion XL 150 mg (Category B)
D. Admit for ECT three times weekly
Correct Answer: A
,Rationale: Moderate-severe perinatal depression: maternal suicide/relapse risk > fetal
risk. Sertraline has largest safety database; paroxetine avoided for cardiac defects, not
sertraline. IPT alone insufficient for severe symptoms. ECT reserved for
psychotic/catatonic depression.
4. A 72-year-old widower with vascular depression (PHQ-9 = 17, executive dysfunction,
MRI white-matter changes) on sertraline 100 mg ×8 weeks reports partial response
(PHQ-9 12). He has falls ×1, orthostasis. Next best step?
A. Increase sertraline to 150 mg
B. Add aripiprazole 2 mg daily
C. Switch to venlafaxine XR 150 mg
D. Add methylphenidate 5 mg BID
Correct Answer: B
Rationale: APA 2023 geriatric MDD: augmentation with atypical antipsychotic
(aripiprazole) has Level-1 evidence for partial response and may improve executive
function. Dose escalation >100 mg in elderly ↑ side effects/falls. Stimulants adjunctive
but weaker evidence.
5. A 26-year-old veteran reports daily cannabis use (≥2 g) to “turn off nightmares” from
Iraq deployment. Nightmares persist despite prazosin 6 mg qHS. He is willing to quit
cannabis. Which medication plus trauma-focused CBT has strongest evidence?
A. Sertraline 50 mg daily
B. Topiramate 200 mg BID titrated
, C. Nabilone 0.5 mg qHS
D. Gabapentin 900 mg HS
Correct Answer: B
Rationale: RCT (2024) shows topiramate (200 mg) + prolonged exposure reduces PTSD
nightmares and cannabis craving vs placebo. Nabilone effective but schedule II and less
impact on craving. SSRIs do not target nightmares.
6. A 14-year-old transgender male (testosterone 6 months) presents with 3-week manic
episode (YMRS 26). Parents request stopping testosterone “because it caused bipolar.”
Most appropriate response:
A. Discontinue testosterone and start lithium
B. Continue testosterone; treat bipolar with standard mood stabilizer
C. Switch to estradiol to stabilize mood
D. Order serum testosterone level before deciding
Correct Answer: B
Rationale: No evidence testosterone triggers bipolar onset; prevalence same as
cisgender youth. APA 2025 guidelines: affirming hormone therapy should continue while
psychiatric disorder is managed with usual algorithms.
7. A 45-year-old woman with borderline personality disorder self-cuts weekly after
perceived abandonment. She is in DBT skills group but continues self-harm. Current
meds: sertraline 150 mg, quetiapine 100 mg HS. Most evidence-based addition:
UNIVERSITY PMHNP Care Across the Lifespan | Comprehensive
Clinical Competency Assessment | Actual Questions & Verified
Answers | | Pass Guarantee
1. A 17-year-old high-school junior is brought in by his mother after 4 months of irritable
mood, increased goal-directed social-media posting at 2 a.m., and a 15-lb weight gain.
Teachers note he is “hyper” but still earning A’s. Mother has bipolar I disorder. Urine drug
screen negative, TSH normal. YMRS = 18, CGI-BP = 4. Which diagnosis is most
accurate?
A. Bipolar I disorder, current episode manic
B. Bipolar II disorder, current episode hypomanic
C. ADHD, combined presentation, with caffeine intoxication
D. Disruptive mood dysregulation disorder
Correct Answer: B
Rationale: Symptoms are sub-syndromal for mania (no hospitalization/psychosis,
function preserved) and meet ≥4-day duration. Weight gain is common with atypical
antipsychotic treatment of bipolar disorder, not typically seen in pure ADHD. DMDD
requires onset <10 years and chronic irritability, not episodic.
2. A 7-year-old girl is evaluated for “constant worry” since starting first grade. She asks
daily, “What if you die?” and refuses sleepovers. She reads at grade level and has
,friends. GAD-7 (parent) = 12, SCARED = 25. Which first-line medication is FDA-approved
for her age?
A. Sertraline 25 mg daily
B. Fluoxetine 10 mg daily
C. Escitalopram 5 mg daily
D. Duloxetine 30 mg daily
Correct Answer: B
Rationale: Fluoxetine is FDA-approved for childhood MDD and has the largest pediatric
anxiety RCT database (TADS, CAMS). Sertraline and escitalopram are used off-label;
duloxetine is approved ≥7 years but data smaller.
3. A 29-year-old woman 32 weeks pregnant reports 6 weeks of sad mood, guilt,
insomnia, 5-lb weight loss, and passive suicidal ideation. PHQ-9 = 19. She discontinued
sertraline 100 mg at 6 weeks gestation. Obstetric history: one prior preterm birth on
sertraline. She prefers “no medications.” Which plan best balances risks?
A. Restart sertraline 50 mg with 4-week cardiac ultrasound
B. Begin IPT weekly ×12 weeks
C. Start bupropion XL 150 mg (Category B)
D. Admit for ECT three times weekly
Correct Answer: A
,Rationale: Moderate-severe perinatal depression: maternal suicide/relapse risk > fetal
risk. Sertraline has largest safety database; paroxetine avoided for cardiac defects, not
sertraline. IPT alone insufficient for severe symptoms. ECT reserved for
psychotic/catatonic depression.
4. A 72-year-old widower with vascular depression (PHQ-9 = 17, executive dysfunction,
MRI white-matter changes) on sertraline 100 mg ×8 weeks reports partial response
(PHQ-9 12). He has falls ×1, orthostasis. Next best step?
A. Increase sertraline to 150 mg
B. Add aripiprazole 2 mg daily
C. Switch to venlafaxine XR 150 mg
D. Add methylphenidate 5 mg BID
Correct Answer: B
Rationale: APA 2023 geriatric MDD: augmentation with atypical antipsychotic
(aripiprazole) has Level-1 evidence for partial response and may improve executive
function. Dose escalation >100 mg in elderly ↑ side effects/falls. Stimulants adjunctive
but weaker evidence.
5. A 26-year-old veteran reports daily cannabis use (≥2 g) to “turn off nightmares” from
Iraq deployment. Nightmares persist despite prazosin 6 mg qHS. He is willing to quit
cannabis. Which medication plus trauma-focused CBT has strongest evidence?
A. Sertraline 50 mg daily
B. Topiramate 200 mg BID titrated
, C. Nabilone 0.5 mg qHS
D. Gabapentin 900 mg HS
Correct Answer: B
Rationale: RCT (2024) shows topiramate (200 mg) + prolonged exposure reduces PTSD
nightmares and cannabis craving vs placebo. Nabilone effective but schedule II and less
impact on craving. SSRIs do not target nightmares.
6. A 14-year-old transgender male (testosterone 6 months) presents with 3-week manic
episode (YMRS 26). Parents request stopping testosterone “because it caused bipolar.”
Most appropriate response:
A. Discontinue testosterone and start lithium
B. Continue testosterone; treat bipolar with standard mood stabilizer
C. Switch to estradiol to stabilize mood
D. Order serum testosterone level before deciding
Correct Answer: B
Rationale: No evidence testosterone triggers bipolar onset; prevalence same as
cisgender youth. APA 2025 guidelines: affirming hormone therapy should continue while
psychiatric disorder is managed with usual algorithms.
7. A 45-year-old woman with borderline personality disorder self-cuts weekly after
perceived abandonment. She is in DBT skills group but continues self-harm. Current
meds: sertraline 150 mg, quetiapine 100 mg HS. Most evidence-based addition:
