NRNP 6665-01, Week 11 Final Exam Solutions 2026/2027 Advanced
PMHNP Care Across the Lifespan | Complex & Evolving Case Studies|
Actual Questions & Verified Solutions | Advanced Psychiatric-Mental
Health Nurse Practitioner | Pass Guarantee
CASE BLOCK 1: Pediatric Neurodevelopmental Complexity
Patient Profile: "Marcus Chen"
Age: 9 years, 3 months | Sex: Male | Presenting: Initial psychiatric evaluation
Referral Source: Pediatrician & school psychologist collaborative referral
Chief Concerns: Declining academic performance, emotional dysregulation, peer
rejection, "outbursts that seem disproportionate"
Background: Marcus is a third-grader previously identified as "gifted" in mathematics.
Over the past 18 months, teachers report increasing difficulty with transitions, repetitive
questioning, emotional meltdowns when routines change, and social isolation. Parents
describe intense interests in dinosaur taxonomy (knows 150+ species with Latin
names) but cannot engage in reciprocal play. Marcus becomes "hysterical" if his
morning routine is altered. He has started refusing school on days with field trips or
assemblies. Parents separated 8 months ago; Marcus lives primarily with mother, visits
father every other weekend.
,Developmental History: Motor milestones met on time. Language precocious—full
sentences by 18 months. No regression. History of sensory sensitivities (clothing tags,
food textures) since toddlerhood.
Medical: Generally healthy. No current medications. Allergies: penicillin.
Family Psychiatric History: Maternal uncle with bipolar I disorder; paternal grandfather
"eccentric, never diagnosed"; mother with generalized anxiety disorder.
Initial Observations: Marcus enters room with mother, avoids eye contact, immediately
identifies the diplodocus model on the shelf ("That should have 15 cervical vertebrae,
not 12"), becomes distressed when the session timer is visible ("I need to know exactly
when this ends").
Question 1
Marcus's presentation most strongly suggests which primary diagnostic formulation
requiring further evaluation?
A. Disruptive Mood Dysregulation Disorder (DMDD) with comorbid Specific Learning
Disorder
B. Autism Spectrum Disorder (ASD) Level 2, with consideration of comorbid Anxiety
Disorder
C. Early-onset Bipolar Disorder, mixed features, precipitated by parental separation
D. ADHD, Combined Presentation, with comorbid Oppositional Defiant Disorder
Correct Answer: B
,Rationale: Marcus presents with a classic constellation of ASD features:
restricted/repetitive interests (dinosaur taxonomy with exceptional detail), insistence on
sameness/routines (morning routine intolerance, need for precise session timing),
sensory sensitivities (clothing, food), social-communication challenges (lack of
reciprocal play, peer rejection), and atypical affective presentation (emotional
dysregulation linked to environmental changes rather than mood cycling).
The "hysterical" responses to routine changes represent meltdowns characteristic of
ASD, not mood episodes. His mathematical giftedness with social impairment suggests
the "twice-exceptional" profile common in ASD.
Why A is incorrect: While emotional dysregulation is present, the irritability is
context-specific (transitions, sensory issues) rather than the pervasive, severe irritability
of DMDD. The restricted interests and social deficits are not explained by DMDD.
Why C is incorrect: No evidence of episodic mood elevation, decreased need for sleep,
grandiosity, or goal-directed activity. The "outbursts" are reactive to environmental
stimuli, not spontaneous mood episodes. Family history alone doesn't justify this
diagnosis.
Why D is incorrect: While some ADHD features may co-occur, the core
social-communication deficits, restricted interests, and sensory issues are not
explained by ADHD. The emotional dysregulation is not oppositional but rather
distress-based.
Question 2
Given the diagnostic hypothesis, which assessment battery would provide the most
comprehensive, evidence-based evaluation?
, A. Conners-3, CBCL, and continuous performance testing only
B. ADOS-2, ADI-R, cognitive assessment (WISC-V), and sensory processing evaluation
C. K-SADS-PL, YMRS, and CDRS-R to rule out mood disorders first
D. Projective testing (Rorschach, TAT) and personality inventory (MMPI-A)
Correct Answer: B
Rationale: The gold standard ASD assessment requires structured observation
(ADOS-2) and developmental history (ADI-R). Cognitive assessment (WISC-V) is
essential to evaluate the "twice-exceptional" profile and identify any scatter between
verbal and nonverbal abilities. Sensory processing evaluation addresses the
documented sensory sensitivities that significantly impact functioning. This battery
follows DSM-5-TR and NICE guidelines for ASD assessment.
Why A is incorrect: Conners-3 and CPT assess ADHD, not ASD. While CBCL provides
broad behavioral data, they miss core ASD domains. This battery would inadequately
evaluate the primary diagnostic hypothesis.
Why C is incorrect: While mood disorders should be considered, K-SADS-PL and mood
rating scales are premature without first establishing whether symptoms are better
explained by ASD. The presentation doesn't suggest primary mood disorder.
Why D is incorrect: Projective testing lacks reliability and validity for ASD diagnosis.
MMPI-A is inappropriate for a 9-year-old and doesn't assess ASD features. This
approach is not evidence-based.
Question 3
PMHNP Care Across the Lifespan | Complex & Evolving Case Studies|
Actual Questions & Verified Solutions | Advanced Psychiatric-Mental
Health Nurse Practitioner | Pass Guarantee
CASE BLOCK 1: Pediatric Neurodevelopmental Complexity
Patient Profile: "Marcus Chen"
Age: 9 years, 3 months | Sex: Male | Presenting: Initial psychiatric evaluation
Referral Source: Pediatrician & school psychologist collaborative referral
Chief Concerns: Declining academic performance, emotional dysregulation, peer
rejection, "outbursts that seem disproportionate"
Background: Marcus is a third-grader previously identified as "gifted" in mathematics.
Over the past 18 months, teachers report increasing difficulty with transitions, repetitive
questioning, emotional meltdowns when routines change, and social isolation. Parents
describe intense interests in dinosaur taxonomy (knows 150+ species with Latin
names) but cannot engage in reciprocal play. Marcus becomes "hysterical" if his
morning routine is altered. He has started refusing school on days with field trips or
assemblies. Parents separated 8 months ago; Marcus lives primarily with mother, visits
father every other weekend.
,Developmental History: Motor milestones met on time. Language precocious—full
sentences by 18 months. No regression. History of sensory sensitivities (clothing tags,
food textures) since toddlerhood.
Medical: Generally healthy. No current medications. Allergies: penicillin.
Family Psychiatric History: Maternal uncle with bipolar I disorder; paternal grandfather
"eccentric, never diagnosed"; mother with generalized anxiety disorder.
Initial Observations: Marcus enters room with mother, avoids eye contact, immediately
identifies the diplodocus model on the shelf ("That should have 15 cervical vertebrae,
not 12"), becomes distressed when the session timer is visible ("I need to know exactly
when this ends").
Question 1
Marcus's presentation most strongly suggests which primary diagnostic formulation
requiring further evaluation?
A. Disruptive Mood Dysregulation Disorder (DMDD) with comorbid Specific Learning
Disorder
B. Autism Spectrum Disorder (ASD) Level 2, with consideration of comorbid Anxiety
Disorder
C. Early-onset Bipolar Disorder, mixed features, precipitated by parental separation
D. ADHD, Combined Presentation, with comorbid Oppositional Defiant Disorder
Correct Answer: B
,Rationale: Marcus presents with a classic constellation of ASD features:
restricted/repetitive interests (dinosaur taxonomy with exceptional detail), insistence on
sameness/routines (morning routine intolerance, need for precise session timing),
sensory sensitivities (clothing, food), social-communication challenges (lack of
reciprocal play, peer rejection), and atypical affective presentation (emotional
dysregulation linked to environmental changes rather than mood cycling).
The "hysterical" responses to routine changes represent meltdowns characteristic of
ASD, not mood episodes. His mathematical giftedness with social impairment suggests
the "twice-exceptional" profile common in ASD.
Why A is incorrect: While emotional dysregulation is present, the irritability is
context-specific (transitions, sensory issues) rather than the pervasive, severe irritability
of DMDD. The restricted interests and social deficits are not explained by DMDD.
Why C is incorrect: No evidence of episodic mood elevation, decreased need for sleep,
grandiosity, or goal-directed activity. The "outbursts" are reactive to environmental
stimuli, not spontaneous mood episodes. Family history alone doesn't justify this
diagnosis.
Why D is incorrect: While some ADHD features may co-occur, the core
social-communication deficits, restricted interests, and sensory issues are not
explained by ADHD. The emotional dysregulation is not oppositional but rather
distress-based.
Question 2
Given the diagnostic hypothesis, which assessment battery would provide the most
comprehensive, evidence-based evaluation?
, A. Conners-3, CBCL, and continuous performance testing only
B. ADOS-2, ADI-R, cognitive assessment (WISC-V), and sensory processing evaluation
C. K-SADS-PL, YMRS, and CDRS-R to rule out mood disorders first
D. Projective testing (Rorschach, TAT) and personality inventory (MMPI-A)
Correct Answer: B
Rationale: The gold standard ASD assessment requires structured observation
(ADOS-2) and developmental history (ADI-R). Cognitive assessment (WISC-V) is
essential to evaluate the "twice-exceptional" profile and identify any scatter between
verbal and nonverbal abilities. Sensory processing evaluation addresses the
documented sensory sensitivities that significantly impact functioning. This battery
follows DSM-5-TR and NICE guidelines for ASD assessment.
Why A is incorrect: Conners-3 and CPT assess ADHD, not ASD. While CBCL provides
broad behavioral data, they miss core ASD domains. This battery would inadequately
evaluate the primary diagnostic hypothesis.
Why C is incorrect: While mood disorders should be considered, K-SADS-PL and mood
rating scales are premature without first establishing whether symptoms are better
explained by ASD. The presentation doesn't suggest primary mood disorder.
Why D is incorrect: Projective testing lacks reliability and validity for ASD diagnosis.
MMPI-A is inappropriate for a 9-year-old and doesn't assess ASD features. This
approach is not evidence-based.
Question 3
