NRNP 6665 – MIDTERM EXAM: PSYCHIATRIC-MENTAL
HEALTH NURSE PRACTITIONER ACROSS THE LIFESPAN I |
WALDEN UNIVERSITY (2026/2027) | ACTUAL QUESTIONS
AND EXPERT-VERIFIED ANSWERS
NRNP 6665 Midterm Examination Practice Guide
Course: NRNP 6665 – Psychiatric-Mental Health Nurse Practitioner (PMHNP) Care Across the
Lifespan I
Format: Comprehensive Practice Exam (75 Items) with Answer Key & Clinical Rationales
Table of Contents
1. Section 1: Ethical, Legal, and Scope of Practice Foundations (Questions 1–15)
2. Section 2: Neurodevelopmental & Child/Adolescent Disorders (Questions 16–30)
3. Section 3: Somatic Symptom, Conversion, & Dissociative Disorders (Questions 31–45)
4. Section 4: Mood, Anxiety, & Psychotic Disorders Across the Lifespan (Questions 46–60)
5. Section 5: Neurocognitive Disorders, Delirium, & Psychopharmacology (Questions 61–
75)
Section 1: Ethical, Legal, and Scope of Practice Foundations
Question 1
A PMHNP is evaluating a 14-year-old adolescent who discloses engaging in self-injurious
behavior (cutting) without suicidal intent. The minor requests that the PMHNP not tell their
parents. Which ethical and legal principle primarily guides the PMHNP's duty regarding
confidentiality and disclosure?
• A. Absolute confidentiality must be maintained because the minor did not express active
suicidal ideation.
• B. Confidentiality is limited; safety concerns and minor consent laws dictate that
parent/guardian involvement must be navigated based on state law and risk assessment.
• C. The PMHNP must immediately terminate care if the patient refuses to allow parental
notification.
• D. The Tarasoff doctrine mandates immediate involuntary commitment of the adolescent.
Correct Answer: B
,Rationale: Confidentiality with minor patients involves balancing minor autonomy/assent with
parental legal rights and safety concerns. Non-suicidal self-injury (NSSI) requires a thorough
risk evaluation; state laws govern minor rights to confidential mental health treatment, but safety
risks may necessitate engaging guardians while attempting to preserve therapeutic rapport.
Question 2
Under the Tarasoff v. Regents of the University of California decision, what is the primary legal
obligation of a PMHNP when a patient expresses an explicit, credible threat to harm a specific
individual?
• A. Duty to protect/warn the identified victim and notify law enforcement.
• B. Duty to strictly preserve HIPAA confidentiality regardless of the threat.
• C. Obligation only to inform the facility's legal counsel.
• D. Requirement to immediately order physical restraints.
Correct Answer: A
Rationale: The Tarasoff ruling established that when a mental health professional determines
that a patient presents a serious threat of violence to a foreseeable victim, the provider has a legal
"duty to protect/warn" the potential victim and notify law enforcement agency personnel.
Question 3
A PMHNP is obtaining consent for psychotropic medication initiation in an 8-year-old child with
severe ADHD. Which of the following statements regarding consent and assent is accurate?
• A. The 8-year-old child must sign a legally binding informed consent form.
• B. The parent/legal guardian provides legal informed consent, while the child provides
informed assent appropriate to developmental level.
• C. Minors are never included in discussions regarding medication treatment.
• D. Assent replaces the need for parental consent in pediatric psychiatry.
Correct Answer: B
Rationale: Minors under the age of legal adulthood generally lack the legal capacity to give
formal informed consent. Therefore, the parent or court-appointed legal guardian provides formal
informed consent, while the minor child provides informed assent (agreement) adapted to their
cognitive capacity.
Question 4
, Which ethical principle is demonstrated when a PMHNP respects a competent adult patient’s
decision to refuse a recommended psychotropic medication?
• A. Beneficence
• B. Non-maleficence
• C. Autonomy
• D. Justice
Correct Answer: C
Rationale: Autonomy refers to the ethical right of individuals to make independent decisions
regarding their own health care, including the right to refuse treatments when competent.
Question 5
During a routine psychiatric evaluation, an 80-year-old patient reveals physical bruising and
indicates that their adult caregiver child frequently withhold food and funds. What is the
immediate legal requirement for the PMHNP?
• A. Conduct an independent investigation before taking action.
• B. Report suspected elder abuse and financial exploitation to Adult Protective Services
(APS) or the designated state mandatory reporting body immediately.
• C. Request a psychiatric consult for delusional disorder.
• D. Advise the patient to leave the home without notifying authorities.
Correct Answer: B
Rationale: Healthcare professionals, including PMHNPs, are legally mandated reporters for
suspected child, elder, and vulnerable adult abuse, neglect, or exploitation. Reporting must occur
upon reasonable suspicion rather than requiring concrete proof.
Question 6
Which term describes a civil wrong or injury committed by a healthcare professional that results
in harm to a patient through failure to act according to established standards of care?
• A. Tort law / Negligence / Malpractice
• B. Criminal code breach
• C. Non-maleficence violation
• D. Administrative hearing
Correct Answer: A
HEALTH NURSE PRACTITIONER ACROSS THE LIFESPAN I |
WALDEN UNIVERSITY (2026/2027) | ACTUAL QUESTIONS
AND EXPERT-VERIFIED ANSWERS
NRNP 6665 Midterm Examination Practice Guide
Course: NRNP 6665 – Psychiatric-Mental Health Nurse Practitioner (PMHNP) Care Across the
Lifespan I
Format: Comprehensive Practice Exam (75 Items) with Answer Key & Clinical Rationales
Table of Contents
1. Section 1: Ethical, Legal, and Scope of Practice Foundations (Questions 1–15)
2. Section 2: Neurodevelopmental & Child/Adolescent Disorders (Questions 16–30)
3. Section 3: Somatic Symptom, Conversion, & Dissociative Disorders (Questions 31–45)
4. Section 4: Mood, Anxiety, & Psychotic Disorders Across the Lifespan (Questions 46–60)
5. Section 5: Neurocognitive Disorders, Delirium, & Psychopharmacology (Questions 61–
75)
Section 1: Ethical, Legal, and Scope of Practice Foundations
Question 1
A PMHNP is evaluating a 14-year-old adolescent who discloses engaging in self-injurious
behavior (cutting) without suicidal intent. The minor requests that the PMHNP not tell their
parents. Which ethical and legal principle primarily guides the PMHNP's duty regarding
confidentiality and disclosure?
• A. Absolute confidentiality must be maintained because the minor did not express active
suicidal ideation.
• B. Confidentiality is limited; safety concerns and minor consent laws dictate that
parent/guardian involvement must be navigated based on state law and risk assessment.
• C. The PMHNP must immediately terminate care if the patient refuses to allow parental
notification.
• D. The Tarasoff doctrine mandates immediate involuntary commitment of the adolescent.
Correct Answer: B
,Rationale: Confidentiality with minor patients involves balancing minor autonomy/assent with
parental legal rights and safety concerns. Non-suicidal self-injury (NSSI) requires a thorough
risk evaluation; state laws govern minor rights to confidential mental health treatment, but safety
risks may necessitate engaging guardians while attempting to preserve therapeutic rapport.
Question 2
Under the Tarasoff v. Regents of the University of California decision, what is the primary legal
obligation of a PMHNP when a patient expresses an explicit, credible threat to harm a specific
individual?
• A. Duty to protect/warn the identified victim and notify law enforcement.
• B. Duty to strictly preserve HIPAA confidentiality regardless of the threat.
• C. Obligation only to inform the facility's legal counsel.
• D. Requirement to immediately order physical restraints.
Correct Answer: A
Rationale: The Tarasoff ruling established that when a mental health professional determines
that a patient presents a serious threat of violence to a foreseeable victim, the provider has a legal
"duty to protect/warn" the potential victim and notify law enforcement agency personnel.
Question 3
A PMHNP is obtaining consent for psychotropic medication initiation in an 8-year-old child with
severe ADHD. Which of the following statements regarding consent and assent is accurate?
• A. The 8-year-old child must sign a legally binding informed consent form.
• B. The parent/legal guardian provides legal informed consent, while the child provides
informed assent appropriate to developmental level.
• C. Minors are never included in discussions regarding medication treatment.
• D. Assent replaces the need for parental consent in pediatric psychiatry.
Correct Answer: B
Rationale: Minors under the age of legal adulthood generally lack the legal capacity to give
formal informed consent. Therefore, the parent or court-appointed legal guardian provides formal
informed consent, while the minor child provides informed assent (agreement) adapted to their
cognitive capacity.
Question 4
, Which ethical principle is demonstrated when a PMHNP respects a competent adult patient’s
decision to refuse a recommended psychotropic medication?
• A. Beneficence
• B. Non-maleficence
• C. Autonomy
• D. Justice
Correct Answer: C
Rationale: Autonomy refers to the ethical right of individuals to make independent decisions
regarding their own health care, including the right to refuse treatments when competent.
Question 5
During a routine psychiatric evaluation, an 80-year-old patient reveals physical bruising and
indicates that their adult caregiver child frequently withhold food and funds. What is the
immediate legal requirement for the PMHNP?
• A. Conduct an independent investigation before taking action.
• B. Report suspected elder abuse and financial exploitation to Adult Protective Services
(APS) or the designated state mandatory reporting body immediately.
• C. Request a psychiatric consult for delusional disorder.
• D. Advise the patient to leave the home without notifying authorities.
Correct Answer: B
Rationale: Healthcare professionals, including PMHNPs, are legally mandated reporters for
suspected child, elder, and vulnerable adult abuse, neglect, or exploitation. Reporting must occur
upon reasonable suspicion rather than requiring concrete proof.
Question 6
Which term describes a civil wrong or injury committed by a healthcare professional that results
in harm to a patient through failure to act according to established standards of care?
• A. Tort law / Negligence / Malpractice
• B. Criminal code breach
• C. Non-maleficence violation
• D. Administrative hearing
Correct Answer: A
