Walden University NURS 6660 Final Exam (pdf) | 2026/2027 | PMHNP
Q&A | Psychiatry
**1. A 15-year-old male in foster care for 6 years presents with low-level
behavior problems, such as skipping school and ignoring curfew. During the
mental status exam, the PMHNP notes his expressions are inconsistent with
the topic of conversation and he struggles to transition between emotions.
This represents an abnormality in:**
A) Mood
B) Affect
C) Thought process and content
D) Judgment and insight
**Correct Answer: B**
**Rationale:** Inconsistent facial expressions and difficulty transitioning
between emotions indicate an abnormality in affect, which is the outward
expression of emotion. Mood refers to the patient's sustained emotional
state, thought process refers to the flow of ideas, and judgment/insight refer
to decision-making and self-awareness.
---
**2. Which tool is considered an interviewer-based instrument to assist the
PMHNP with comprehensive data collection?**
A) Mini-Mental State Examination (MMSE)
B) Structured Clinical Interview for DSM-5 (SCID-5)
C) Beck Depression Inventory (BDI)
D) Child Behavior Checklist (CBCL)
,**Correct Answer: B**
**Rationale:** The SCID-5 is an interviewer-based tool designed to guide
clinicians in collecting diagnostic information systematically, aligning with
DSM-5 criteria. The MMSE is a cognitive screening tool, the BDI is a self-
report depression scale, and the CBCL is a parent-report questionnaire.
---
**3. In which demographic is depression twice as prevalent in girls compared
to boys?**
A) Preschoolers
B) School-aged
C) Adolescents
D) All children
**Correct Answer: C**
**Rationale:** Depression is twice as prevalent in adolescent girls compared
to boys, often linked to hormonal changes and social pressures during
puberty. This gender disparity emerges around puberty and persists into
adulthood.
---
**4. Andrew is a 14-year-old male who is being managed for bipolar I
disorder. He was started on lithium 6 weeks ago and has achieved a serum
level of 1.1 mEq/L. He reports no change in how he feels, but both parents
,and teachers report improvement in his mood, stability, and school
performance. The PMHNP plans to maintain Andrew on lithium. Which
ongoing laboratory assessments will be needed?**
A) Complete blood count, thyroid function tests, and serum calcium
B) Liver function tests, complete blood count, and 12-lead electrocardiogram
C) White blood cell differential, fasting glucose, and fasting lipid profile
D) Comprehensive metabolic panel, complete blood count, and thyroid
function tests
**Correct Answer: D**
**Rationale:** Lithium therapy requires monitoring of renal function
(comprehensive metabolic panel, including creatinine and BUN), thyroid
function tests (lithium can cause hypothyroidism), and complete blood count
(to monitor for leukocytosis).
---
**5. Confidentiality is a complex topic in child and adolescent psychiatry.
Which of the following is NOT a true statement with respect to confidentiality
of the child or adolescent client?**
A) The PMHNP should not be concerned with consent for disclosure when
child abuse or maltreatment has occurred.
B) In 1979, the American Psychiatric Association (APA) stated that children
12 years of age or older can give consent for disclosure.
C) The American Academy of Child and Adolescent Psychiatry (AACAP) Code
of Ethics states that consent is not required for disclosure.
D) All of the above
, **Correct Answer: B**
**Rationale:** The APA did not issue a blanket statement that children 12
years or older can give consent for disclosure. Consent and confidentiality in
child and adolescent psychiatry are complex, involving parental consent, the
child's assent, and legal mandates such as mandatory reporting of abuse.
The statement that the PMHNP should not be concerned with consent when
child abuse has occurred is also false, as mandatory reporting is required
regardless of consent.
---
**6. Conventional antipsychotics are not first-line interventions in early-onset
schizophrenia due to the risk of dystonic reactions. When children are not
responsive to first-line therapy with atypical antipsychotics, which
conventional antipsychotic is most appropriate?**
A) Haloperidol
B) Fluphenazine
C) Thioridazine
D) Chlorpromazine
**Correct Answer: D**
**Rationale:** Chlorpromazine is a conventional antipsychotic that may be
used as a second-line agent when children do not respond to atypical
antipsychotics. It has a lower risk of dystonic reactions compared to high-
potency antipsychotics like haloperidol.
---
Q&A | Psychiatry
**1. A 15-year-old male in foster care for 6 years presents with low-level
behavior problems, such as skipping school and ignoring curfew. During the
mental status exam, the PMHNP notes his expressions are inconsistent with
the topic of conversation and he struggles to transition between emotions.
This represents an abnormality in:**
A) Mood
B) Affect
C) Thought process and content
D) Judgment and insight
**Correct Answer: B**
**Rationale:** Inconsistent facial expressions and difficulty transitioning
between emotions indicate an abnormality in affect, which is the outward
expression of emotion. Mood refers to the patient's sustained emotional
state, thought process refers to the flow of ideas, and judgment/insight refer
to decision-making and self-awareness.
---
**2. Which tool is considered an interviewer-based instrument to assist the
PMHNP with comprehensive data collection?**
A) Mini-Mental State Examination (MMSE)
B) Structured Clinical Interview for DSM-5 (SCID-5)
C) Beck Depression Inventory (BDI)
D) Child Behavior Checklist (CBCL)
,**Correct Answer: B**
**Rationale:** The SCID-5 is an interviewer-based tool designed to guide
clinicians in collecting diagnostic information systematically, aligning with
DSM-5 criteria. The MMSE is a cognitive screening tool, the BDI is a self-
report depression scale, and the CBCL is a parent-report questionnaire.
---
**3. In which demographic is depression twice as prevalent in girls compared
to boys?**
A) Preschoolers
B) School-aged
C) Adolescents
D) All children
**Correct Answer: C**
**Rationale:** Depression is twice as prevalent in adolescent girls compared
to boys, often linked to hormonal changes and social pressures during
puberty. This gender disparity emerges around puberty and persists into
adulthood.
---
**4. Andrew is a 14-year-old male who is being managed for bipolar I
disorder. He was started on lithium 6 weeks ago and has achieved a serum
level of 1.1 mEq/L. He reports no change in how he feels, but both parents
,and teachers report improvement in his mood, stability, and school
performance. The PMHNP plans to maintain Andrew on lithium. Which
ongoing laboratory assessments will be needed?**
A) Complete blood count, thyroid function tests, and serum calcium
B) Liver function tests, complete blood count, and 12-lead electrocardiogram
C) White blood cell differential, fasting glucose, and fasting lipid profile
D) Comprehensive metabolic panel, complete blood count, and thyroid
function tests
**Correct Answer: D**
**Rationale:** Lithium therapy requires monitoring of renal function
(comprehensive metabolic panel, including creatinine and BUN), thyroid
function tests (lithium can cause hypothyroidism), and complete blood count
(to monitor for leukocytosis).
---
**5. Confidentiality is a complex topic in child and adolescent psychiatry.
Which of the following is NOT a true statement with respect to confidentiality
of the child or adolescent client?**
A) The PMHNP should not be concerned with consent for disclosure when
child abuse or maltreatment has occurred.
B) In 1979, the American Psychiatric Association (APA) stated that children
12 years of age or older can give consent for disclosure.
C) The American Academy of Child and Adolescent Psychiatry (AACAP) Code
of Ethics states that consent is not required for disclosure.
D) All of the above
, **Correct Answer: B**
**Rationale:** The APA did not issue a blanket statement that children 12
years or older can give consent for disclosure. Consent and confidentiality in
child and adolescent psychiatry are complex, involving parental consent, the
child's assent, and legal mandates such as mandatory reporting of abuse.
The statement that the PMHNP should not be concerned with consent when
child abuse has occurred is also false, as mandatory reporting is required
regardless of consent.
---
**6. Conventional antipsychotics are not first-line interventions in early-onset
schizophrenia due to the risk of dystonic reactions. When children are not
responsive to first-line therapy with atypical antipsychotics, which
conventional antipsychotic is most appropriate?**
A) Haloperidol
B) Fluphenazine
C) Thioridazine
D) Chlorpromazine
**Correct Answer: D**
**Rationale:** Chlorpromazine is a conventional antipsychotic that may be
used as a second-line agent when children do not respond to atypical
antipsychotics. It has a lower risk of dystonic reactions compared to high-
potency antipsychotics like haloperidol.
---
