NRNP 6665 FINAL EXAM
LATEST VERSION 3 NEWEST 2026/2027
100 Questions and Correct Answers | 100% Correct Q & A
Walden University | PMHNP Care Across Lifespan I | BRAND NEW!!
Total Questions: 100 | Format: Multiple Choice (A-D) | Cognitive Levels: 30% Recall, 50% Application, 20% Analysis
Aligned with 2026-2027 Walden University NRNP 6665 Curriculum and PMHNP Certification Competencies
Section 1: Foundational Psychotherapy Theories and Applications
Questions 1-12
1. A PMHNP is treating a patient who unconsciously attributes their own unacceptable aggressive feelings toward their spouse.
The patient repeatedly accuses the spouse of being hostile and angry. Which defense mechanism is this patient demonstrating?
A. Denial
B. Projection
C. Rationalization
D. Displacement
Correct Answer: B
Rationale: Projection involves unconsciously attributing one's own unacceptable thoughts, feelings, or impulses to another person. This patient is
projecting their own aggressive feelings onto their spouse. Denial (A) is refusing to acknowledge reality. Rationalization (C) is creating logical but
false explanations for unacceptable behaviors. Displacement (D) is redirecting emotions from the original source to a less threatening target. Per
psychodynamic theory foundational to PMHNP practice, recognizing defense mechanisms is essential for case conceptualization and therapeutic
intervention.
2. According to Carl Rogers' person-centered therapy, which of the following is NOT one of the three core conditions necessary
for therapeutic change?
A. Empathy
B. Unconditional positive regard
C. Congruence (genuineness)
D. Transference interpretation
Correct Answer: D
Rationale: Rogers' person-centered therapy identifies three core conditions: empathy, unconditional positive regard, and congruence
(genuineness). Transference interpretation (D) is a technique from psychodynamic therapy, not a core condition of person-centered therapy. Per
Walden University PMHNP curriculum, understanding these foundational therapeutic conditions is critical for building effective therapeutic
relationships across all psychiatric treatment settings.
Psychiatric-Mental Health Nurse Practitioner Certification Preparation
,3. A PMHNP is working with a patient with borderline personality disorder using Dialectical Behavior Therapy (DBT). Which of
the following is one of the four primary skill modules taught in DBT skills groups?
A. Cognitive restructuring
B. Interpersonal effectiveness
C. Free association
D. Systematic desensitization
Correct Answer: B
Rationale: DBT, developed by Marsha Linehan, includes four primary skill modules: distress tolerance, emotional regulation, interpersonal
effectiveness, and mindfulness. Cognitive restructuring (A) is a CBT technique. Free association (C) is a psychoanalytic technique. Systematic
desensitization (D) is a behavioral therapy technique for phobias. Per PMHNP certification standards, DBT is the gold standard evidence-based
psychotherapy for borderline personality disorder.
4. A patient presenting with major depressive disorder consistently views experiences in extreme, all-or-nothing terms. For
example, the patient states, 'If I don't get a perfect score on this presentation, I am a total failure.' Which cognitive distortion
described by Aaron Beck is this patient demonstrating?
A. Mind reading
B. Catastrophizing
C. All-or-nothing (dichotomous) thinking
D. Personalization
Correct Answer: C
Rationale: All-or-nothing (dichotomous) thinking involves seeing things in absolute, black-or-white categories with no middle ground. This patient
views outcomes as either perfect or total failure. Mind reading (A) is assuming others are thinking negatively about you. Catastrophizing (B) is
anticipating the worst possible outcome. Personalization (D) is attributing external negative events to oneself. Per Beck's cognitive theory,
identifying cognitive distortions is the first step in cognitive restructuring within CBT, which is the most evidence-based psychotherapy for
multiple psychiatric disorders.
5. A PMHNP is using Motivational Interviewing (MI) techniques with a patient with alcohol use disorder who is ambivalent about
treatment. Which of the following is part of the OARS framework used in MI?
A. Observation, Assessment, Referral, and Supervision
B. Open-ended questions, Affirmations, Reflective listening, and Summaries
C. Orientation, Adaptation, Reassurance, and Support
D. Observation, Analysis, Response, and Strategy
Correct Answer: B
Rationale: OARS in Motivational Interviewing stands for Open-ended questions, Affirmations, Reflective listening, and Summaries. These are
core MI techniques used to elicit change talk and explore ambivalence. Options A, C, and D are not valid MI frameworks. Per PMHNP
curriculum standards, MI is an evidence-based approach particularly effective for substance use disorders and other conditions where
ambivalence about change is a primary treatment barrier.
6. A patient in psychoanalysis begins to direct feelings about their deceased parent toward the PMHNP, treating the PMHNP with
the same anger and resentment they felt toward the parent. This phenomenon is best described as:
A. Countertransference
B. Transference
C. Resistance
D. Projection
Correct Answer: B
Rationale: Transference is the unconscious redirection of feelings, desires, and expectations from significant figures in the patient's past onto the
therapist. This patient is transferring feelings about their deceased parent onto the PMHNP. Countertransference (A) is the therapist's emotional
reactions to the patient based on the therapist's own past experiences. Resistance (C) is unconscious opposition to the therapeutic process.
Projection (D) is attributing one's own feelings to others. Per psychodynamic theory, recognizing and managing transference is a core competency
for PMHNP practice.
NRNP 6665 Final Exam 2026/2027 | Page 2
,7. A PMHNP is using systematic desensitization to treat a patient with a specific phobia of spiders. This behavioral technique is
based on which learning principle?
A. Operant conditioning through negative reinforcement
B. Classical conditioning through reciprocal inhibition
C. Social learning through observational modeling
D. Cognitive restructuring through thought challenging
Correct Answer: B
Rationale: Systematic desensitization, developed by Joseph Wolpe, is based on classical conditioning through reciprocal inhibition. The patient is
gradually exposed to the feared stimulus while practicing relaxation techniques, and the relaxation response inhibits the anxiety response. Operant
conditioning (A) involves consequences modifying behavior. Social learning (C) involves learning through observation. Cognitive restructuring
(D) is a cognitive therapy technique. Per behavioral theory, systematic desensitization is an evidence-based treatment for specific phobias and
anxiety disorders.
8. Interpersonal Therapy (IPT) focuses on which of the following four primary problem areas?
A. Grief, Role disputes, Role transitions, and Interpersonal deficits
B. Childhood trauma, Attachment disruptions, Emotional dysregulation, and Identity confusion
C. Cognitive distortions, Behavioral patterns, Emotional avoidance, and Somatic complaints
D. Family conflict, Financial stress, Occupational problems, and Spiritual crisis
Correct Answer: A
Rationale: IPT, developed by Gerald Klerman and Myrna Weissman, focuses on four primary interpersonal problem areas: grief (complicated
bereavement), role disputes (conflicts with significant others), role transitions (difficulty adjusting to life changes), and interpersonal deficits
(social isolation and inadequate social support). Options B, C, and D describe areas addressed by other therapeutic modalities. Per PMHNP
certification standards, IPT is an evidence-based time-limited psychotherapy particularly effective for major depressive disorder.
9. A patient who was repeatedly criticized by their father now excessively pursues artistic achievements to compensate for feelings
of inadequacy. According to psychodynamic theory, which defense mechanism is this patient primarily using?
A. Sublimation
B. Compensation
C. Repression
D. Regression
Correct Answer: B
Rationale: Compensation is a defense mechanism in which a person overachieves in one area to offset real or perceived deficiencies in another
area. This patient is using artistic achievement to compensate for feelings of inadequacy stemming from paternal criticism. Sublimation (A)
involves channeling unacceptable impulses into socially acceptable activities (e.g., aggression into sports). Repression (C) is unconsciously
blocking unacceptable thoughts. Regression (D) is reverting to an earlier developmental stage under stress. Per psychodynamic theory, identifying
defense mechanisms helps PMHNPs understand the patient's unconscious psychological processes.
10. Which of the following best describes Ellis's Rational Emotive Behavior Therapy (REBT) approach to emotional disturbance?
A. Emotional disturbance is caused by unconscious conflicts from early childhood
B. Emotional disturbance is primarily caused by irrational beliefs about activating events
C. Emotional disturbance results from maladaptive reinforcement patterns
D. Emotional disturbance stems from distorted sensory processing of environmental stimuli
Correct Answer: B
Rationale: Albert Ellis's REBT posits that emotional disturbance is primarily caused by irrational beliefs (B) that a person holds about activating
events, not the events themselves. The A-B-C model: Activating event, Belief system (irrational beliefs), and Consequences (emotional and
behavioral). Unconscious conflicts (A) is the psychoanalytic view. Reinforcement patterns (C) is the behavioral view. Sensory processing (D) is
not a framework for emotional disturbance in any major psychotherapy model. Per PMHNP curriculum standards, understanding REBT
principles is important as it is a foundational cognitive therapy approach that influenced modern CBT.
NRNP 6665 Final Exam 2026/2027 | Page 3
, 11. A PMHNP is treating a patient with social anxiety disorder using exposure-based interventions. The PMHNP gradually
exposes the patient to increasingly anxiety-provoking social situations while the patient practices relaxation techniques. Which
behavioral principle underlies this approach?
A. Spontaneous recovery through extinction of conditioned responses
B. Habituation through sustained and graduated exposure to feared stimuli
C. Insight development through interpretation of unconscious conflicts
D. Reinforcement scheduling through variable-ratio reward patterns
Correct Answer: B
Rationale: Gradual exposure to feared stimuli leads to habituation, a process by which the anxiety response diminishes through repeated and
sustained contact with the anxiety-provoking stimulus. This is the core principle underlying exposure therapy. Spontaneous recovery (A) refers to
the reappearance of an extinguished response. Insight development (C) is a psychoanalytic concept. Reinforcement scheduling (D) is an operant
conditioning principle. Per behavioral theory and PMHNP certification standards, exposure therapy is among the most effective treatments for
anxiety disorders, with robust evidence supporting its efficacy.
12. According to B.F. Skinner's operant conditioning theory, which type of reinforcement schedule produces the highest rate of
response and the greatest resistance to extinction?
A. Fixed ratio schedule
B. Fixed interval schedule
C. Variable ratio schedule
D. Continuous reinforcement schedule
Correct Answer: C
Rationale: A variable ratio (VR) schedule, where reinforcement is delivered after an unpredictable number of responses, produces the highest and
most steady response rate and the greatest resistance to extinction. This principle explains why gambling behaviors are so persistent. Fixed ratio
(A) produces high but pausing-prone response rates. Fixed interval (B) produces a scalloped pattern of responding. Continuous reinforcement (D)
produces rapid acquisition but rapid extinction. Per behavioral theory foundational to PMHNP practice, understanding reinforcement schedules
informs the development of behavioral modification interventions in psychiatric care.
Section 2: DSM-5-TR Diagnostic Criteria and Differential Diagnosis
Questions 13-30
13. A 28-year-old patient presents with auditory hallucinations, persecutory delusions, and disorganized speech for the past 8
weeks. Symptoms began 6 months ago with a 2-month prodromal period of social withdrawal and eccentric behavior. What is the
most accurate diagnosis?
A. Brief Psychotic Disorder
B. Schizophrenia
C. Schizoaffective Disorder
D. Delusional Disorder
Correct Answer: B
Rationale: This patient meets DSM-5-TR criteria for schizophrenia: active-phase symptoms (hallucinations, delusions, disorganized speech)
lasting at least 1 month (8 weeks), with a total duration of at least 6 months including prodromal/residual symptoms. Brief Psychotic Disorder (A)
lasts less than 1 month. Schizoaffective Disorder (C) requires a concurrent major mood episode. Delusional Disorder (D) requires only delusions
without other prominent psychotic symptoms. Per DSM-5-TR, the 6-month total duration criterion distinguishes schizophrenia from brief
psychotic and schizoaffective disorders.
NRNP 6665 Final Exam 2026/2027 | Page 4
LATEST VERSION 3 NEWEST 2026/2027
100 Questions and Correct Answers | 100% Correct Q & A
Walden University | PMHNP Care Across Lifespan I | BRAND NEW!!
Total Questions: 100 | Format: Multiple Choice (A-D) | Cognitive Levels: 30% Recall, 50% Application, 20% Analysis
Aligned with 2026-2027 Walden University NRNP 6665 Curriculum and PMHNP Certification Competencies
Section 1: Foundational Psychotherapy Theories and Applications
Questions 1-12
1. A PMHNP is treating a patient who unconsciously attributes their own unacceptable aggressive feelings toward their spouse.
The patient repeatedly accuses the spouse of being hostile and angry. Which defense mechanism is this patient demonstrating?
A. Denial
B. Projection
C. Rationalization
D. Displacement
Correct Answer: B
Rationale: Projection involves unconsciously attributing one's own unacceptable thoughts, feelings, or impulses to another person. This patient is
projecting their own aggressive feelings onto their spouse. Denial (A) is refusing to acknowledge reality. Rationalization (C) is creating logical but
false explanations for unacceptable behaviors. Displacement (D) is redirecting emotions from the original source to a less threatening target. Per
psychodynamic theory foundational to PMHNP practice, recognizing defense mechanisms is essential for case conceptualization and therapeutic
intervention.
2. According to Carl Rogers' person-centered therapy, which of the following is NOT one of the three core conditions necessary
for therapeutic change?
A. Empathy
B. Unconditional positive regard
C. Congruence (genuineness)
D. Transference interpretation
Correct Answer: D
Rationale: Rogers' person-centered therapy identifies three core conditions: empathy, unconditional positive regard, and congruence
(genuineness). Transference interpretation (D) is a technique from psychodynamic therapy, not a core condition of person-centered therapy. Per
Walden University PMHNP curriculum, understanding these foundational therapeutic conditions is critical for building effective therapeutic
relationships across all psychiatric treatment settings.
Psychiatric-Mental Health Nurse Practitioner Certification Preparation
,3. A PMHNP is working with a patient with borderline personality disorder using Dialectical Behavior Therapy (DBT). Which of
the following is one of the four primary skill modules taught in DBT skills groups?
A. Cognitive restructuring
B. Interpersonal effectiveness
C. Free association
D. Systematic desensitization
Correct Answer: B
Rationale: DBT, developed by Marsha Linehan, includes four primary skill modules: distress tolerance, emotional regulation, interpersonal
effectiveness, and mindfulness. Cognitive restructuring (A) is a CBT technique. Free association (C) is a psychoanalytic technique. Systematic
desensitization (D) is a behavioral therapy technique for phobias. Per PMHNP certification standards, DBT is the gold standard evidence-based
psychotherapy for borderline personality disorder.
4. A patient presenting with major depressive disorder consistently views experiences in extreme, all-or-nothing terms. For
example, the patient states, 'If I don't get a perfect score on this presentation, I am a total failure.' Which cognitive distortion
described by Aaron Beck is this patient demonstrating?
A. Mind reading
B. Catastrophizing
C. All-or-nothing (dichotomous) thinking
D. Personalization
Correct Answer: C
Rationale: All-or-nothing (dichotomous) thinking involves seeing things in absolute, black-or-white categories with no middle ground. This patient
views outcomes as either perfect or total failure. Mind reading (A) is assuming others are thinking negatively about you. Catastrophizing (B) is
anticipating the worst possible outcome. Personalization (D) is attributing external negative events to oneself. Per Beck's cognitive theory,
identifying cognitive distortions is the first step in cognitive restructuring within CBT, which is the most evidence-based psychotherapy for
multiple psychiatric disorders.
5. A PMHNP is using Motivational Interviewing (MI) techniques with a patient with alcohol use disorder who is ambivalent about
treatment. Which of the following is part of the OARS framework used in MI?
A. Observation, Assessment, Referral, and Supervision
B. Open-ended questions, Affirmations, Reflective listening, and Summaries
C. Orientation, Adaptation, Reassurance, and Support
D. Observation, Analysis, Response, and Strategy
Correct Answer: B
Rationale: OARS in Motivational Interviewing stands for Open-ended questions, Affirmations, Reflective listening, and Summaries. These are
core MI techniques used to elicit change talk and explore ambivalence. Options A, C, and D are not valid MI frameworks. Per PMHNP
curriculum standards, MI is an evidence-based approach particularly effective for substance use disorders and other conditions where
ambivalence about change is a primary treatment barrier.
6. A patient in psychoanalysis begins to direct feelings about their deceased parent toward the PMHNP, treating the PMHNP with
the same anger and resentment they felt toward the parent. This phenomenon is best described as:
A. Countertransference
B. Transference
C. Resistance
D. Projection
Correct Answer: B
Rationale: Transference is the unconscious redirection of feelings, desires, and expectations from significant figures in the patient's past onto the
therapist. This patient is transferring feelings about their deceased parent onto the PMHNP. Countertransference (A) is the therapist's emotional
reactions to the patient based on the therapist's own past experiences. Resistance (C) is unconscious opposition to the therapeutic process.
Projection (D) is attributing one's own feelings to others. Per psychodynamic theory, recognizing and managing transference is a core competency
for PMHNP practice.
NRNP 6665 Final Exam 2026/2027 | Page 2
,7. A PMHNP is using systematic desensitization to treat a patient with a specific phobia of spiders. This behavioral technique is
based on which learning principle?
A. Operant conditioning through negative reinforcement
B. Classical conditioning through reciprocal inhibition
C. Social learning through observational modeling
D. Cognitive restructuring through thought challenging
Correct Answer: B
Rationale: Systematic desensitization, developed by Joseph Wolpe, is based on classical conditioning through reciprocal inhibition. The patient is
gradually exposed to the feared stimulus while practicing relaxation techniques, and the relaxation response inhibits the anxiety response. Operant
conditioning (A) involves consequences modifying behavior. Social learning (C) involves learning through observation. Cognitive restructuring
(D) is a cognitive therapy technique. Per behavioral theory, systematic desensitization is an evidence-based treatment for specific phobias and
anxiety disorders.
8. Interpersonal Therapy (IPT) focuses on which of the following four primary problem areas?
A. Grief, Role disputes, Role transitions, and Interpersonal deficits
B. Childhood trauma, Attachment disruptions, Emotional dysregulation, and Identity confusion
C. Cognitive distortions, Behavioral patterns, Emotional avoidance, and Somatic complaints
D. Family conflict, Financial stress, Occupational problems, and Spiritual crisis
Correct Answer: A
Rationale: IPT, developed by Gerald Klerman and Myrna Weissman, focuses on four primary interpersonal problem areas: grief (complicated
bereavement), role disputes (conflicts with significant others), role transitions (difficulty adjusting to life changes), and interpersonal deficits
(social isolation and inadequate social support). Options B, C, and D describe areas addressed by other therapeutic modalities. Per PMHNP
certification standards, IPT is an evidence-based time-limited psychotherapy particularly effective for major depressive disorder.
9. A patient who was repeatedly criticized by their father now excessively pursues artistic achievements to compensate for feelings
of inadequacy. According to psychodynamic theory, which defense mechanism is this patient primarily using?
A. Sublimation
B. Compensation
C. Repression
D. Regression
Correct Answer: B
Rationale: Compensation is a defense mechanism in which a person overachieves in one area to offset real or perceived deficiencies in another
area. This patient is using artistic achievement to compensate for feelings of inadequacy stemming from paternal criticism. Sublimation (A)
involves channeling unacceptable impulses into socially acceptable activities (e.g., aggression into sports). Repression (C) is unconsciously
blocking unacceptable thoughts. Regression (D) is reverting to an earlier developmental stage under stress. Per psychodynamic theory, identifying
defense mechanisms helps PMHNPs understand the patient's unconscious psychological processes.
10. Which of the following best describes Ellis's Rational Emotive Behavior Therapy (REBT) approach to emotional disturbance?
A. Emotional disturbance is caused by unconscious conflicts from early childhood
B. Emotional disturbance is primarily caused by irrational beliefs about activating events
C. Emotional disturbance results from maladaptive reinforcement patterns
D. Emotional disturbance stems from distorted sensory processing of environmental stimuli
Correct Answer: B
Rationale: Albert Ellis's REBT posits that emotional disturbance is primarily caused by irrational beliefs (B) that a person holds about activating
events, not the events themselves. The A-B-C model: Activating event, Belief system (irrational beliefs), and Consequences (emotional and
behavioral). Unconscious conflicts (A) is the psychoanalytic view. Reinforcement patterns (C) is the behavioral view. Sensory processing (D) is
not a framework for emotional disturbance in any major psychotherapy model. Per PMHNP curriculum standards, understanding REBT
principles is important as it is a foundational cognitive therapy approach that influenced modern CBT.
NRNP 6665 Final Exam 2026/2027 | Page 3
, 11. A PMHNP is treating a patient with social anxiety disorder using exposure-based interventions. The PMHNP gradually
exposes the patient to increasingly anxiety-provoking social situations while the patient practices relaxation techniques. Which
behavioral principle underlies this approach?
A. Spontaneous recovery through extinction of conditioned responses
B. Habituation through sustained and graduated exposure to feared stimuli
C. Insight development through interpretation of unconscious conflicts
D. Reinforcement scheduling through variable-ratio reward patterns
Correct Answer: B
Rationale: Gradual exposure to feared stimuli leads to habituation, a process by which the anxiety response diminishes through repeated and
sustained contact with the anxiety-provoking stimulus. This is the core principle underlying exposure therapy. Spontaneous recovery (A) refers to
the reappearance of an extinguished response. Insight development (C) is a psychoanalytic concept. Reinforcement scheduling (D) is an operant
conditioning principle. Per behavioral theory and PMHNP certification standards, exposure therapy is among the most effective treatments for
anxiety disorders, with robust evidence supporting its efficacy.
12. According to B.F. Skinner's operant conditioning theory, which type of reinforcement schedule produces the highest rate of
response and the greatest resistance to extinction?
A. Fixed ratio schedule
B. Fixed interval schedule
C. Variable ratio schedule
D. Continuous reinforcement schedule
Correct Answer: C
Rationale: A variable ratio (VR) schedule, where reinforcement is delivered after an unpredictable number of responses, produces the highest and
most steady response rate and the greatest resistance to extinction. This principle explains why gambling behaviors are so persistent. Fixed ratio
(A) produces high but pausing-prone response rates. Fixed interval (B) produces a scalloped pattern of responding. Continuous reinforcement (D)
produces rapid acquisition but rapid extinction. Per behavioral theory foundational to PMHNP practice, understanding reinforcement schedules
informs the development of behavioral modification interventions in psychiatric care.
Section 2: DSM-5-TR Diagnostic Criteria and Differential Diagnosis
Questions 13-30
13. A 28-year-old patient presents with auditory hallucinations, persecutory delusions, and disorganized speech for the past 8
weeks. Symptoms began 6 months ago with a 2-month prodromal period of social withdrawal and eccentric behavior. What is the
most accurate diagnosis?
A. Brief Psychotic Disorder
B. Schizophrenia
C. Schizoaffective Disorder
D. Delusional Disorder
Correct Answer: B
Rationale: This patient meets DSM-5-TR criteria for schizophrenia: active-phase symptoms (hallucinations, delusions, disorganized speech)
lasting at least 1 month (8 weeks), with a total duration of at least 6 months including prodromal/residual symptoms. Brief Psychotic Disorder (A)
lasts less than 1 month. Schizoaffective Disorder (C) requires a concurrent major mood episode. Delusional Disorder (D) requires only delusions
without other prominent psychotic symptoms. Per DSM-5-TR, the 6-month total duration criterion distinguishes schizophrenia from brief
psychotic and schizoaffective disorders.
NRNP 6665 Final Exam 2026/2027 | Page 4
