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. Traditional MCQ
A 17-year-old senior reports 6 weeks of nightly insomnia, 4 kg weight loss, and
writing a 200-page novel between 2–6 a.m. Parents note pressured speech and
purchasing $800 of skateboard gear. Physical exam: HR 106, BP 138/84, pupils 4
mm equal. Which is the most accurate diagnosis?
A. ADHD with insomnia
B. Major depressive episode with melancholic features
C. Bipolar I disorder, manic episode
D. Substance-induced hypomania (caffeine)
Correct Answer: C
Rationale: Classic manic symptoms: decreased need for sleep, pressured goal-directed
activity, excessive spending, and autonomic signs. Duration > 1 week and functional
impairment rule out hypomania. Caffeine does not produce expansive behavior of this
magnitude.
2. Traditional MCQ
Same patient. Urine tox negative, TSH normal, CBC normal. Parents prefer
non-pharmacologic first step. Which APA guideline-concordant recommendation
for adolescent mania is best?
A. Start lithium plus CBT-family focused therapy
B. Start quetiapine monotherapy
C. Omega-3 supplementation alone for 8 weeks
D. Hospitalize and start ECT
,Correct Answer: A
Rationale: APA 2024: combination of mood stabilizer + psychosocial intervention
(family-focused therapy or CBT) is first-line for manic adolescents. Monotherapy
antipsychotic acceptable but combo preferred. Omega-3 lacks efficacy for mania.
3. Traditional MCQ
After 4 weeks lithium 900 mg hs (serum 0.9 mmol/L), patient reports polyuria,
polydipsia, and 3 nocturnal enuresis episodes. BUN/Cr unchanged. Which
mechanism best explains these symptoms?
A. ADH antagonism in collecting duct → nephrogenic DI
B. Osmotic diuresis from glucose
C. SIADH from lithium
D. Acute lithium toxicity
Correct Answer: A
Rationale: Lithium inhibits ADH-sensitive adenylyl cyclase → decreased aquaporin-2
insertion → nephrogenic diabetes insipidus. Polyuria with normal glucose and stable
creatinine supports this.
4. Traditional MCQ
A 34-year-old woman at 16 weeks gestation with bipolar I (last manic episode 2
years ago, stable on lithium) asks about continuing lithium. Current serum level
0.7 mmol/L. Which evidence-based counseling is best?
A. Discontinue lithium immediately due to Ebstein risk
B. Taper lithium over 1 week and switch to valproate
C. Continue lithium with level-II ultrasounds; risk Ebstein 0.1 % vs relapse 30 %
D. Switch to lamotrigine because completely safe
Correct Answer: C
Rationale: Contemporary data show lithium teratogenicity is dose-related and lower
than historical estimates (Ebstein risk 0.1 % vs 30 % relapse risk). Level-II US monitors
,cardiac anatomy. Valproate has higher teratogenicity; lamotrigine is not “completely”
safe.
5. Traditional MCQ
A 6-year-old boy repeatedly lines up toy cars by color, becomes agitated when
order is changed, speaks only to request objects, and flaps hands when excited.
Teacher notes no peer interaction. Which assessment tool best confirms
diagnosis?
A. Conners 4th Edition
B. ADOS-2
C. CBCL
D. M-CHAT-R
Correct Answer: B
Rationale: Autism Diagnostic Observation Schedule-2 (ADOS-2) is gold-standard
play-based observation for autism. M-CHAT-R is screening, not diagnostic.
6. Traditional MCQ
Parents ask whether starting risperidone for irritability in autism will cause
obesity. Which strategy best mitigates metabolic risk?
A. Prescribe bedtime only dosing
B. Combine with low-dose metformin prophylaxis
C. Monitor BMI z-score monthly and switch to aripiprazole if > 5 % weight gain
D. Avoid antipsychotics entirely
Correct Answer: C
Rationale: AACAP 2022: monitor weight, BMI z-score, waist circumference monthly for
first 3 months; consider switch or metformin if gain > 5 %. Prophylactic metformin not
first-line.
7. Traditional MCQ
A 15-year-old girl with autism and moderate intellectual disability presents with
, 3-week history of daily 60-min screaming spells occurring only at 7 a.m. before
school bus. No medical issues. Functional assessment indicates escape from
school demand. Which behavioral intervention is best?
A. Differential reinforcement of incompatible behavior (DRI) with token system
B. Exposure + response prevention
C. Eye-movement desensitization
D. Holding therapy
Correct Answer: A
Rationale: ABA-based DRI reinforces quiet sitting (incompatible with screaming) and
tokens for compliance. ERP is for OCD; EMDR for trauma; holding therapy is unethical.
8. Traditional MCQ
A 26-year-old graduate student reports “brain fog,” losing 1 hour daily rechecking
door locks and stove knobs, causing tardiness. Yale-Brown Obsessive
Compulsive Scale = 20 (moderate). Which combined treatment has strongest
evidence?
A. Fluoxetine 40 mg + ERP
B. Clonazepam 2 mg BID
C. Risperidone augmentation
D. St. John’s wort
Correct Answer: A
Rationale: APA 2023: SSRIs (fluoxetine) plus exposure + response prevention (ERP) is
first-line for moderate OCD. Benzos lack efficacy; augmentation antipsychotics reserved
for refractory cases.
9. Traditional MCQ
After 8 weeks fluoxetine 40 mg + ERP, Yale-Brown decreases to 14 but plateaued.
Patient remains distressed. Which next step aligns with guidelines?
A. Increase fluoxetine to 80 mg
B. Add risperidone 0.5 mg
C. Switch to clomipramine 150 mg
D. Intensive ERP (2 h daily × 4 weeks)
WALDEN UNIVERSITY PMHNP Care Across the Lifespan |
Comprehensive Clinical Competency Assessment | Actual
Questions & Verified Answers | | Pass Guarantee
1. Traditional MCQ
A 17-year-old senior reports 6 weeks of nightly insomnia, 4 kg weight loss, and
writing a 200-page novel between 2–6 a.m. Parents note pressured speech and
purchasing $800 of skateboard gear. Physical exam: HR 106, BP 138/84, pupils 4
mm equal. Which is the most accurate diagnosis?
A. ADHD with insomnia
B. Major depressive episode with melancholic features
C. Bipolar I disorder, manic episode
D. Substance-induced hypomania (caffeine)
Correct Answer: C
Rationale: Classic manic symptoms: decreased need for sleep, pressured goal-directed
activity, excessive spending, and autonomic signs. Duration > 1 week and functional
impairment rule out hypomania. Caffeine does not produce expansive behavior of this
magnitude.
2. Traditional MCQ
Same patient. Urine tox negative, TSH normal, CBC normal. Parents prefer
non-pharmacologic first step. Which APA guideline-concordant recommendation
for adolescent mania is best?
A. Start lithium plus CBT-family focused therapy
B. Start quetiapine monotherapy
C. Omega-3 supplementation alone for 8 weeks
D. Hospitalize and start ECT
,Correct Answer: A
Rationale: APA 2024: combination of mood stabilizer + psychosocial intervention
(family-focused therapy or CBT) is first-line for manic adolescents. Monotherapy
antipsychotic acceptable but combo preferred. Omega-3 lacks efficacy for mania.
3. Traditional MCQ
After 4 weeks lithium 900 mg hs (serum 0.9 mmol/L), patient reports polyuria,
polydipsia, and 3 nocturnal enuresis episodes. BUN/Cr unchanged. Which
mechanism best explains these symptoms?
A. ADH antagonism in collecting duct → nephrogenic DI
B. Osmotic diuresis from glucose
C. SIADH from lithium
D. Acute lithium toxicity
Correct Answer: A
Rationale: Lithium inhibits ADH-sensitive adenylyl cyclase → decreased aquaporin-2
insertion → nephrogenic diabetes insipidus. Polyuria with normal glucose and stable
creatinine supports this.
4. Traditional MCQ
A 34-year-old woman at 16 weeks gestation with bipolar I (last manic episode 2
years ago, stable on lithium) asks about continuing lithium. Current serum level
0.7 mmol/L. Which evidence-based counseling is best?
A. Discontinue lithium immediately due to Ebstein risk
B. Taper lithium over 1 week and switch to valproate
C. Continue lithium with level-II ultrasounds; risk Ebstein 0.1 % vs relapse 30 %
D. Switch to lamotrigine because completely safe
Correct Answer: C
Rationale: Contemporary data show lithium teratogenicity is dose-related and lower
than historical estimates (Ebstein risk 0.1 % vs 30 % relapse risk). Level-II US monitors
,cardiac anatomy. Valproate has higher teratogenicity; lamotrigine is not “completely”
safe.
5. Traditional MCQ
A 6-year-old boy repeatedly lines up toy cars by color, becomes agitated when
order is changed, speaks only to request objects, and flaps hands when excited.
Teacher notes no peer interaction. Which assessment tool best confirms
diagnosis?
A. Conners 4th Edition
B. ADOS-2
C. CBCL
D. M-CHAT-R
Correct Answer: B
Rationale: Autism Diagnostic Observation Schedule-2 (ADOS-2) is gold-standard
play-based observation for autism. M-CHAT-R is screening, not diagnostic.
6. Traditional MCQ
Parents ask whether starting risperidone for irritability in autism will cause
obesity. Which strategy best mitigates metabolic risk?
A. Prescribe bedtime only dosing
B. Combine with low-dose metformin prophylaxis
C. Monitor BMI z-score monthly and switch to aripiprazole if > 5 % weight gain
D. Avoid antipsychotics entirely
Correct Answer: C
Rationale: AACAP 2022: monitor weight, BMI z-score, waist circumference monthly for
first 3 months; consider switch or metformin if gain > 5 %. Prophylactic metformin not
first-line.
7. Traditional MCQ
A 15-year-old girl with autism and moderate intellectual disability presents with
, 3-week history of daily 60-min screaming spells occurring only at 7 a.m. before
school bus. No medical issues. Functional assessment indicates escape from
school demand. Which behavioral intervention is best?
A. Differential reinforcement of incompatible behavior (DRI) with token system
B. Exposure + response prevention
C. Eye-movement desensitization
D. Holding therapy
Correct Answer: A
Rationale: ABA-based DRI reinforces quiet sitting (incompatible with screaming) and
tokens for compliance. ERP is for OCD; EMDR for trauma; holding therapy is unethical.
8. Traditional MCQ
A 26-year-old graduate student reports “brain fog,” losing 1 hour daily rechecking
door locks and stove knobs, causing tardiness. Yale-Brown Obsessive
Compulsive Scale = 20 (moderate). Which combined treatment has strongest
evidence?
A. Fluoxetine 40 mg + ERP
B. Clonazepam 2 mg BID
C. Risperidone augmentation
D. St. John’s wort
Correct Answer: A
Rationale: APA 2023: SSRIs (fluoxetine) plus exposure + response prevention (ERP) is
first-line for moderate OCD. Benzos lack efficacy; augmentation antipsychotics reserved
for refractory cases.
9. Traditional MCQ
After 8 weeks fluoxetine 40 mg + ERP, Yale-Brown decreases to 14 but plateaued.
Patient remains distressed. Which next step aligns with guidelines?
A. Increase fluoxetine to 80 mg
B. Add risperidone 0.5 mg
C. Switch to clomipramine 150 mg
D. Intensive ERP (2 h daily × 4 weeks)
