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NRNP 6568 Week 11 Final Exam Practice
Questions & Answers | Walden University | 300
Q&A with Rationales | Latest 2026 Update
1. A 45-year-old patient with a history of major depressive disorder presents for a
follow-up telehealth visit. The patient reports feeling "a little better" but mentions
increased anxiety and difficulty sleeping since starting a new antidepressant two
weeks ago. Which of the following is the most appropriate initial action by the NP?
A) Discontinue the antidepressant immediately due to adverse effects
B) Increase the dose of the antidepressant to achieve faster therapeutic effect
C) Reassure the patient that these symptoms may be transient and schedule a sooner
follow-up
D) Prescribe a benzodiazepine for long-term management of anxiety
Answer: C) Reassure the patient that these symptoms may be transient and
schedule a sooner follow-up
Rationale: Initial activation syndrome (anxiety, insomnia, agitation) can occur with
many antidepressants, especially SSRIs and SNRIs, during the first 1–2 weeks. These
symptoms are often transient and resolve as the patient adjusts to the medication.
Discontinuation is not indicated unless symptoms are severe or intolerable. Dose
increases should not be made before the therapeutic window is reached (typically 4–6
weeks). Benzodiazepines may be used short-term but are not first-line for long-term
management.
2. A 9-year-old girl who has been in and out of foster care for the past four years is
brought in for a well-child visit. She is withdrawn, avoids eye contact, and shows little
emotional response when her foster mother speaks to her. Which of the following is
the most likely diagnosis?
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A) Attention-Deficit/Hyperactivity Disorder (ADHD)
B) Oppositional Defiant Disorder (ODD)
C) Reactive Attachment Disorder (RAD)
D) Generalized Anxiety Disorder (GAD)
Answer: C) Reactive Attachment Disorder (RAD)
Rationale: RAD is a trauma- and stressor-related disorder that occurs in children who
have experienced severe early neglect, frequent changes in caregivers, or institutional
care. Key features include socially withdrawn behavior, minimal social and emotional
responsiveness, and lack of comfort-seeking. ADHD, ODD, and GAD do not typically
present with this pattern of emotional withdrawal in the context of severe attachment
disruptions.
3. An NP is performing a telehealth visit with a 32-year-old patient who complains of
unilateral eye redness, mucopurulent discharge, and crusting on the eyelashes upon
waking. The patient denies photophobia and reports that vision is unchanged. Which
of the following is the most likely diagnosis?
A) Viral conjunctivitis
B) Bacterial conjunctivitis
C) Allergic conjunctivitis
D) Acute angle-closure glaucoma
Answer: B) Bacterial conjunctivitis
Rationale: Bacterial conjunctivitis typically presents with unilateral or bilateral
mucopurulent discharge, crusting, and redness without photophobia or vision changes.
Viral conjunctivitis more commonly presents with watery discharge and may be
associated with preauricular lymphadenopathy. Allergic conjunctivitis is usually
bilateral with itching and tearing. Acute angle-closure glaucoma presents with severe
pain, photophobia, halos, and blurred vision, and is an ophthalmologic emergency.
4. A 68-year-old male with a history of hypertension and diabetes presents for a routine
eye exam. Tonometry reveals an intraocular pressure (IOP) of 24 mmHg in both eyes.
What is the normal range for intraocular pressure?
A) 5–10 mmHg
B) 10–21 mmHg
, 3|Page
C) 22–30 mmHg
D) 31–40 mmHg
Answer: B) 10–21 mmHg
Rationale: Normal intraocular pressure (IOP) ranges from 10 to 21 mmHg. Pressures
above 21 mmHg are considered elevated and are a risk factor for glaucoma. An IOP of
24 mmHg warrants further evaluation, including optic nerve assessment and visual
field testing, especially in a patient with diabetes and hypertension who are at higher
risk for glaucoma.
5. A 72-year-old patient with a history of benign prostatic hyperplasia (BPH) and
hypertension presents with new-onset urinary retention, confusion, and a dry mouth.
His wife reports he started a new medication prescribed by his psychiatrist one week
ago for neuropathic pain. Which of the following medications is most likely
responsible for his symptoms?
A) Duloxetine
B) Amitriptyline
C) Gabapentin
D) Pregabalin
Answer: B) Amitriptyline
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) with potent anticholinergic
properties. In elderly patients, TCAs frequently cause urinary retention (due to bladder
sphincter relaxation), confusion/delirium, and xerostomia (dry mouth). Duloxetine,
gabapentin, and pregabalin have lower anticholinergic burdens and are less likely to
cause this classic triad of symptoms.
6. A 10-year-old male is brought to the clinic by his mother for a well-child visit. She
reports that he has always been "forgetful" and "constantly loses his school supplies."
His teacher notes that he frequently blurts out answers in class and has difficulty
waiting his turn. The NP diagnoses ADHD, predominantly hyperactive-impulsive type.
Which of the following non-stimulant medications is FDA-approved for ADHD and
works by selectively inhibiting the presynaptic norepinephrine transporter?
A) Methylphenidate
B) Dextroamphetamine
, 4|Page
C) Atomoxetine
D) Guanfacine
Answer: C) Atomoxetine
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that is
FDA-approved for ADHD in children and adults. It is a non-stimulant option, making it
useful in patients with a history of substance abuse, tics, or anxiety. Methylphenidate
and dextroamphetamine are stimulants that increase dopamine and norepinephrine
but are not selective norepinephrine transporter inhibitors. Guanfacine is an alpha-2
adrenergic agonist, not a norepinephrine reuptake inhibitor.
7. An NP is dismissing a non-compliant patient from the practice. The patient has
repeatedly failed to keep appointments and has not followed up on critical lab work
for diabetes management. Which of the following actions is legally required for
proper patient dismissal to avoid a claim of patient abandonment?
A) Verbally informing the patient during the final visit that they are being dismissed
B) Sending a certified letter with return receipt requested that provides 30 days of
emergency coverage and instructions for transferring records
C) Placing a note in the chart and waiting for the patient to call back
D) Immediately terminating the relationship and ceasing all communication to avoid
liability
Answer: B) Sending a certified letter with return receipt requested that provides
30 days of emergency coverage and instructions for transferring records
Rationale: To avoid patient abandonment, the NP must formally notify the patient in
writing (preferably via certified mail). The letter must clearly state the reason for
dismissal, provide a reasonable time frame (typically 30 days) for the patient to find a
new provider, and offer emergency coverage during that transition period. Verbal
notification or simple chart documentation is legally insufficient and constitutes
abandonment.
8. During a telehealth encounter, a 55-year-old patient reports acute-onset, severe,
unilateral eye pain, associated with halos around lights, nausea, and blurred vision.
The patient's webcam shows a fixed, mid-dilated pupil in the affected eye. What is
the most appropriate action for the NP to take during this telehealth visit?
NRNP 6568 Week 11 Final Exam Practice
Questions & Answers | Walden University | 300
Q&A with Rationales | Latest 2026 Update
1. A 45-year-old patient with a history of major depressive disorder presents for a
follow-up telehealth visit. The patient reports feeling "a little better" but mentions
increased anxiety and difficulty sleeping since starting a new antidepressant two
weeks ago. Which of the following is the most appropriate initial action by the NP?
A) Discontinue the antidepressant immediately due to adverse effects
B) Increase the dose of the antidepressant to achieve faster therapeutic effect
C) Reassure the patient that these symptoms may be transient and schedule a sooner
follow-up
D) Prescribe a benzodiazepine for long-term management of anxiety
Answer: C) Reassure the patient that these symptoms may be transient and
schedule a sooner follow-up
Rationale: Initial activation syndrome (anxiety, insomnia, agitation) can occur with
many antidepressants, especially SSRIs and SNRIs, during the first 1–2 weeks. These
symptoms are often transient and resolve as the patient adjusts to the medication.
Discontinuation is not indicated unless symptoms are severe or intolerable. Dose
increases should not be made before the therapeutic window is reached (typically 4–6
weeks). Benzodiazepines may be used short-term but are not first-line for long-term
management.
2. A 9-year-old girl who has been in and out of foster care for the past four years is
brought in for a well-child visit. She is withdrawn, avoids eye contact, and shows little
emotional response when her foster mother speaks to her. Which of the following is
the most likely diagnosis?
, 2|Page
A) Attention-Deficit/Hyperactivity Disorder (ADHD)
B) Oppositional Defiant Disorder (ODD)
C) Reactive Attachment Disorder (RAD)
D) Generalized Anxiety Disorder (GAD)
Answer: C) Reactive Attachment Disorder (RAD)
Rationale: RAD is a trauma- and stressor-related disorder that occurs in children who
have experienced severe early neglect, frequent changes in caregivers, or institutional
care. Key features include socially withdrawn behavior, minimal social and emotional
responsiveness, and lack of comfort-seeking. ADHD, ODD, and GAD do not typically
present with this pattern of emotional withdrawal in the context of severe attachment
disruptions.
3. An NP is performing a telehealth visit with a 32-year-old patient who complains of
unilateral eye redness, mucopurulent discharge, and crusting on the eyelashes upon
waking. The patient denies photophobia and reports that vision is unchanged. Which
of the following is the most likely diagnosis?
A) Viral conjunctivitis
B) Bacterial conjunctivitis
C) Allergic conjunctivitis
D) Acute angle-closure glaucoma
Answer: B) Bacterial conjunctivitis
Rationale: Bacterial conjunctivitis typically presents with unilateral or bilateral
mucopurulent discharge, crusting, and redness without photophobia or vision changes.
Viral conjunctivitis more commonly presents with watery discharge and may be
associated with preauricular lymphadenopathy. Allergic conjunctivitis is usually
bilateral with itching and tearing. Acute angle-closure glaucoma presents with severe
pain, photophobia, halos, and blurred vision, and is an ophthalmologic emergency.
4. A 68-year-old male with a history of hypertension and diabetes presents for a routine
eye exam. Tonometry reveals an intraocular pressure (IOP) of 24 mmHg in both eyes.
What is the normal range for intraocular pressure?
A) 5–10 mmHg
B) 10–21 mmHg
, 3|Page
C) 22–30 mmHg
D) 31–40 mmHg
Answer: B) 10–21 mmHg
Rationale: Normal intraocular pressure (IOP) ranges from 10 to 21 mmHg. Pressures
above 21 mmHg are considered elevated and are a risk factor for glaucoma. An IOP of
24 mmHg warrants further evaluation, including optic nerve assessment and visual
field testing, especially in a patient with diabetes and hypertension who are at higher
risk for glaucoma.
5. A 72-year-old patient with a history of benign prostatic hyperplasia (BPH) and
hypertension presents with new-onset urinary retention, confusion, and a dry mouth.
His wife reports he started a new medication prescribed by his psychiatrist one week
ago for neuropathic pain. Which of the following medications is most likely
responsible for his symptoms?
A) Duloxetine
B) Amitriptyline
C) Gabapentin
D) Pregabalin
Answer: B) Amitriptyline
Rationale: Amitriptyline is a tricyclic antidepressant (TCA) with potent anticholinergic
properties. In elderly patients, TCAs frequently cause urinary retention (due to bladder
sphincter relaxation), confusion/delirium, and xerostomia (dry mouth). Duloxetine,
gabapentin, and pregabalin have lower anticholinergic burdens and are less likely to
cause this classic triad of symptoms.
6. A 10-year-old male is brought to the clinic by his mother for a well-child visit. She
reports that he has always been "forgetful" and "constantly loses his school supplies."
His teacher notes that he frequently blurts out answers in class and has difficulty
waiting his turn. The NP diagnoses ADHD, predominantly hyperactive-impulsive type.
Which of the following non-stimulant medications is FDA-approved for ADHD and
works by selectively inhibiting the presynaptic norepinephrine transporter?
A) Methylphenidate
B) Dextroamphetamine
, 4|Page
C) Atomoxetine
D) Guanfacine
Answer: C) Atomoxetine
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) that is
FDA-approved for ADHD in children and adults. It is a non-stimulant option, making it
useful in patients with a history of substance abuse, tics, or anxiety. Methylphenidate
and dextroamphetamine are stimulants that increase dopamine and norepinephrine
but are not selective norepinephrine transporter inhibitors. Guanfacine is an alpha-2
adrenergic agonist, not a norepinephrine reuptake inhibitor.
7. An NP is dismissing a non-compliant patient from the practice. The patient has
repeatedly failed to keep appointments and has not followed up on critical lab work
for diabetes management. Which of the following actions is legally required for
proper patient dismissal to avoid a claim of patient abandonment?
A) Verbally informing the patient during the final visit that they are being dismissed
B) Sending a certified letter with return receipt requested that provides 30 days of
emergency coverage and instructions for transferring records
C) Placing a note in the chart and waiting for the patient to call back
D) Immediately terminating the relationship and ceasing all communication to avoid
liability
Answer: B) Sending a certified letter with return receipt requested that provides
30 days of emergency coverage and instructions for transferring records
Rationale: To avoid patient abandonment, the NP must formally notify the patient in
writing (preferably via certified mail). The letter must clearly state the reason for
dismissal, provide a reasonable time frame (typically 30 days) for the patient to find a
new provider, and offer emergency coverage during that transition period. Verbal
notification or simple chart documentation is legally insufficient and constitutes
abandonment.
8. During a telehealth encounter, a 55-year-old patient reports acute-onset, severe,
unilateral eye pain, associated with halos around lights, nausea, and blurred vision.
The patient's webcam shows a fixed, mid-dilated pupil in the affected eye. What is
the most appropriate action for the NP to take during this telehealth visit?
