NRNP6665 FINAL EXAM 2026/2027 | Page 1 | Passing Score: 80%
NRNP PROGRAM
NRNP6665
FINAL EXAM
Official Comprehensive Final 2026/2027
100 80% One-Time Cert
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Comprehensive Psychiatric Evaluation & Diagnosis Q1-Q20
Section 2 Mood & Anxiety Disorders Management Q21-Q40
Section 3 Psychotic & Thought Disorders Q41-Q60
Section 4 Substance Use & Co-Occurring Disorders Q61-Q80
Section 5 Ethical, Legal & Professional Issues in Psychiatry Q81-Q100
Instructions: Select the single best answer for each question. This exam is the comprehensive final assessment for NRNP6665.
NRNP6665 FINAL EXAM - 2026/2027 | Passing Score: 80% | Page 1 of 52
,SECTION 1 | Comprehensive Psychiatric Evaluation & Diagnosis | Q1-Q20 | NRNP6665 FINAL EXAM 2026/2027
Q1 Question 1 of 100
A 34-year-old woman presents to the psychiatric clinic reporting persistent sadness,
anhedonia, and difficulty concentrating for the past six weeks. She denies any prior
psychiatric history. The PMHNP is conducting a comprehensive psychiatric evaluation. The
most important initial step in this evaluation is to:
A. refer the patient for neuropsychological testing to rule out cognitive impairment
B. prescribe an SSRI immediately given the clear depressive symptomatology
C. obtain a detailed psychiatric and medical history to identify potential causes and comorbidities
D. order a brain MRI to exclude structural causes before proceeding with treatment
Correct Answer: C
Rationale:
The foundation of any comprehensive psychiatric evaluation is a thorough history, including psychiatric,
medical, substance use, and family history. Premature prescribing or testing without adequate
history-gathering can lead to misdiagnosis. Neuropsychological testing and neuroimaging are reserved for
when clinical findings suggest specific underlying conditions.
Q2 Question 2 of 100
During a mental status examination, the PMHNP observes that a 45-year-old male patient
demonstrates tangential speech, pressured language, and flight of ideas. These findings are
most consistent with which type of thought disorder?
A. Thought blocking
B. Obsessive rumination
C. Formal thought disorder with loosening of associations
D. Perseveration
Correct Answer: C
Rationale:
Tangential speech, pressured language, and flight of ideas are hallmark features of a formal thought
disorder characterized by loosening of associations, commonly seen in manic episodes and schizophrenia.
Thought blocking involves sudden cessation of speech, perseveration involves repetition of the same
response, and rumination involves repetitive negative thinking.
NRNP6665 FINAL EXAM - 2026/2027 | Passing Score: 80% | Page 2 of 52
,SECTION 1 | Comprehensive Psychiatric Evaluation & Diagnosis | Q1-Q20 | NRNP6665 FINAL EXAM 2026/2027
Q3 Question 3 of 100
A 28-year-old patient is referred for psychiatric evaluation after being found wandering in
traffic. The patient appears disheveled, makes poor eye contact, and responds to internal
stimuli. The PMHNP should prioritize which assessment component first?
A. Administering the PHQ-9 for depression screening
B. Determining the patient's capacity to provide informed consent and assessing for safety
C. Completing a full personality inventory such as the MMPI-2
D. Obtaining collateral information from family about childhood development
Correct Answer: C
Rationale:
When a patient presents responding to internal stimuli and demonstrating impaired judgment, the priority is
assessing capacity and safety risk. While collateral information and standardized instruments are valuable,
the immediate concern is whether the patient can participate in their own care and whether they pose a
danger to themselves or others.
Q4 Question 4 of 100
A PMHNP is evaluating a 52-year-old man with new-onset panic attacks, diaphoresis, and
palpitations. His physical examination reveals a new heart murmur and elevated blood
pressure. The most appropriate next step is to:
A. initiate cognitive behavioral therapy for panic disorder
B. refer the patient to a cardiologist and defer any psychiatric treatment
C. start a benzodiazepine for immediate relief of panic symptoms
D. order laboratory tests including thyroid function, catecholamines, and an ECG before attributing
symptoms to a primary psychiatric etiology
Correct Answer: D
Rationale:
New-onset panic symptoms with physical findings such as a heart murmur and hypertension require medical
rule-out before assuming a primary psychiatric diagnosis. Pheochromocytoma, hyperthyroidism, and cardiac
arrhythmias can all mimic panic disorder. A benzodiazepine may be considered after medical causes are
excluded.
NRNP6665 FINAL EXAM - 2026/2027 | Passing Score: 80% | Page 3 of 52
, SECTION 1 | Comprehensive Psychiatric Evaluation & Diagnosis | Q1-Q20 | NRNP6665 FINAL EXAM 2026/2027
Q5 Question 5 of 100
A 19-year-old college student presents with a first episode of psychosis including auditory
hallucinations and paranoid delusions lasting three weeks. The PMHNP should include which
of the following in the differential diagnosis?
A. Brief psychotic disorder, schizophreniform disorder, substance-induced psychotic disorder, and
schizophrenia
B. Schizophrenia exclusively, as first-episode psychosis always indicates this diagnosis
C. Schizoaffective disorder and bipolar disorder only
D. Delusional disorder and malingering only
Correct Answer: A
Rationale:
First-episode psychosis requires a broad differential including brief psychotic disorder (if under one month),
schizophreniform disorder (one to six months), substance-induced psychosis, and schizophrenia (over six
months or with functional decline). Narrowing prematurely to one diagnosis is inappropriate without
longitudinal observation and substance use assessment.
Q6 Question 6 of 100
During a psychiatric interview, a 38-year-old woman describes hearing voices that comment
on her behavior and occasionally command her to harm herself. The PMHNP should first:
A. explore the content, frequency, and severity of command hallucinations and assess the
patient's ability to resist them
B. immediately initiate involuntary commitment proceedings
C. prescribe an antipsychotic medication and schedule follow-up in two weeks
D. refer the patient for electroconvulsive therapy evaluation
Correct Answer: A
Rationale:
Command hallucinations, particularly those involving self-harm, require careful exploration of their content,
frequency, and the patient's ability to resist acting on them. This assessment guides whether immediate
hospitalization is needed or outpatient management is appropriate. Involuntary commitment may become
necessary but requires a thorough risk assessment first.
NRNP6665 FINAL EXAM - 2026/2027 | Passing Score: 80% | Page 4 of 52
NRNP PROGRAM
NRNP6665
FINAL EXAM
Official Comprehensive Final 2026/2027
100 80% One-Time Cert
QUESTIONS PASSING SCORE RECERTIFICATION
TABLE OF CONTENTS
Section 1 Comprehensive Psychiatric Evaluation & Diagnosis Q1-Q20
Section 2 Mood & Anxiety Disorders Management Q21-Q40
Section 3 Psychotic & Thought Disorders Q41-Q60
Section 4 Substance Use & Co-Occurring Disorders Q61-Q80
Section 5 Ethical, Legal & Professional Issues in Psychiatry Q81-Q100
Instructions: Select the single best answer for each question. This exam is the comprehensive final assessment for NRNP6665.
NRNP6665 FINAL EXAM - 2026/2027 | Passing Score: 80% | Page 1 of 52
,SECTION 1 | Comprehensive Psychiatric Evaluation & Diagnosis | Q1-Q20 | NRNP6665 FINAL EXAM 2026/2027
Q1 Question 1 of 100
A 34-year-old woman presents to the psychiatric clinic reporting persistent sadness,
anhedonia, and difficulty concentrating for the past six weeks. She denies any prior
psychiatric history. The PMHNP is conducting a comprehensive psychiatric evaluation. The
most important initial step in this evaluation is to:
A. refer the patient for neuropsychological testing to rule out cognitive impairment
B. prescribe an SSRI immediately given the clear depressive symptomatology
C. obtain a detailed psychiatric and medical history to identify potential causes and comorbidities
D. order a brain MRI to exclude structural causes before proceeding with treatment
Correct Answer: C
Rationale:
The foundation of any comprehensive psychiatric evaluation is a thorough history, including psychiatric,
medical, substance use, and family history. Premature prescribing or testing without adequate
history-gathering can lead to misdiagnosis. Neuropsychological testing and neuroimaging are reserved for
when clinical findings suggest specific underlying conditions.
Q2 Question 2 of 100
During a mental status examination, the PMHNP observes that a 45-year-old male patient
demonstrates tangential speech, pressured language, and flight of ideas. These findings are
most consistent with which type of thought disorder?
A. Thought blocking
B. Obsessive rumination
C. Formal thought disorder with loosening of associations
D. Perseveration
Correct Answer: C
Rationale:
Tangential speech, pressured language, and flight of ideas are hallmark features of a formal thought
disorder characterized by loosening of associations, commonly seen in manic episodes and schizophrenia.
Thought blocking involves sudden cessation of speech, perseveration involves repetition of the same
response, and rumination involves repetitive negative thinking.
NRNP6665 FINAL EXAM - 2026/2027 | Passing Score: 80% | Page 2 of 52
,SECTION 1 | Comprehensive Psychiatric Evaluation & Diagnosis | Q1-Q20 | NRNP6665 FINAL EXAM 2026/2027
Q3 Question 3 of 100
A 28-year-old patient is referred for psychiatric evaluation after being found wandering in
traffic. The patient appears disheveled, makes poor eye contact, and responds to internal
stimuli. The PMHNP should prioritize which assessment component first?
A. Administering the PHQ-9 for depression screening
B. Determining the patient's capacity to provide informed consent and assessing for safety
C. Completing a full personality inventory such as the MMPI-2
D. Obtaining collateral information from family about childhood development
Correct Answer: C
Rationale:
When a patient presents responding to internal stimuli and demonstrating impaired judgment, the priority is
assessing capacity and safety risk. While collateral information and standardized instruments are valuable,
the immediate concern is whether the patient can participate in their own care and whether they pose a
danger to themselves or others.
Q4 Question 4 of 100
A PMHNP is evaluating a 52-year-old man with new-onset panic attacks, diaphoresis, and
palpitations. His physical examination reveals a new heart murmur and elevated blood
pressure. The most appropriate next step is to:
A. initiate cognitive behavioral therapy for panic disorder
B. refer the patient to a cardiologist and defer any psychiatric treatment
C. start a benzodiazepine for immediate relief of panic symptoms
D. order laboratory tests including thyroid function, catecholamines, and an ECG before attributing
symptoms to a primary psychiatric etiology
Correct Answer: D
Rationale:
New-onset panic symptoms with physical findings such as a heart murmur and hypertension require medical
rule-out before assuming a primary psychiatric diagnosis. Pheochromocytoma, hyperthyroidism, and cardiac
arrhythmias can all mimic panic disorder. A benzodiazepine may be considered after medical causes are
excluded.
NRNP6665 FINAL EXAM - 2026/2027 | Passing Score: 80% | Page 3 of 52
, SECTION 1 | Comprehensive Psychiatric Evaluation & Diagnosis | Q1-Q20 | NRNP6665 FINAL EXAM 2026/2027
Q5 Question 5 of 100
A 19-year-old college student presents with a first episode of psychosis including auditory
hallucinations and paranoid delusions lasting three weeks. The PMHNP should include which
of the following in the differential diagnosis?
A. Brief psychotic disorder, schizophreniform disorder, substance-induced psychotic disorder, and
schizophrenia
B. Schizophrenia exclusively, as first-episode psychosis always indicates this diagnosis
C. Schizoaffective disorder and bipolar disorder only
D. Delusional disorder and malingering only
Correct Answer: A
Rationale:
First-episode psychosis requires a broad differential including brief psychotic disorder (if under one month),
schizophreniform disorder (one to six months), substance-induced psychosis, and schizophrenia (over six
months or with functional decline). Narrowing prematurely to one diagnosis is inappropriate without
longitudinal observation and substance use assessment.
Q6 Question 6 of 100
During a psychiatric interview, a 38-year-old woman describes hearing voices that comment
on her behavior and occasionally command her to harm herself. The PMHNP should first:
A. explore the content, frequency, and severity of command hallucinations and assess the
patient's ability to resist them
B. immediately initiate involuntary commitment proceedings
C. prescribe an antipsychotic medication and schedule follow-up in two weeks
D. refer the patient for electroconvulsive therapy evaluation
Correct Answer: A
Rationale:
Command hallucinations, particularly those involving self-harm, require careful exploration of their content,
frequency, and the patient's ability to resist acting on them. This assessment guides whether immediate
hospitalization is needed or outpatient management is appropriate. Involuntary commitment may become
necessary but requires a thorough risk assessment first.
NRNP6665 FINAL EXAM - 2026/2027 | Passing Score: 80% | Page 4 of 52
