NRNP 6675 FINAL EXAM - WALDENUNIVERSITY
PRACTICE | ADVANCED STUDY GUIDE |
COMPREHENSIVE TESTBANK WITH PRACTICE
QUESTIONS & ANSWERS | EXAM PREPARATION
| LATEST UPDATE 2026/2027
Walden university
NRNP 6675 advanced practice psychiatric-mental health nursing
higher education level student
100+ Q&As with rationales
12 domains
academic year 2026/2027
TABLE OF CONTENTS
1. Advanced Psychiatric Assessment and Diagnostic Reasoning
2. Psychopharmacology and Medication Management
3. Depressive and Bipolar Disorders
4. Anxiety, Trauma, and Stressor-Related Disorders
5. Psychotic Disorders and Schizophrenia Spectrum
6. Substance Use and Addictive Disorders
7. Personality Disorders and Complex Clinical Presentations
8. Neurocognitive and Neurodevelopmental Disorders
9. Suicide, Safety, and Crisis Management
10. Psychotherapy and Advanced Therapeutic Interventions
11. Special Populations and Lifespan Considerations
12. Ethics, Legal Issues, and Professional Practice
,1 NRNP 6675 advanced practice psychiatric-mental health nursing
DESCRIPTION
NRNP 6675 Final Exam focuses on advanced psychiatric-mental health nursing practice,
emphasizing clinical reasoning, differential diagnosis, evidence-based psychopharmacology,
psychotherapy, risk assessment, and management of complex psychiatric presentations. This
study-oriented question bank is designed around major graduate-level PMHNP concepts
commonly addressed in advanced psychiatric nursing coursework, including mood disorders,
anxiety and trauma-related conditions, psychotic disorders, substance use disorders,
personality disorders, neurocognitive conditions, safety assessment, and medication
management. Questions emphasize application rather than simple memorization and require
interpretation of clinical findings, medication risks, diagnostic criteria, treatment response,
comorbidities, and ethical considerations. The following items are independently written
study questions and are not actual NRNP 6675 examination questions or a reproduction of
any university examination.
QUESTION 1.
A 34-year-old patient with recurrent major depressive episodes presents with decreased need
for sleep, increased goal-directed activity, pressured speech, grandiosity, and impulsive
spending lasting 8 days. The patient reports that the elevated mood began after starting an
antidepressant 3 weeks earlier. Which diagnostic formulation is most appropriate?
A. Major depressive disorder with mixed features
B. Bipolar I disorder, current or most recent episode manic
C. Cyclothymic disorder
D. Substance/medication-induced depressive disorder
Correct Answer: B. Bipolar I disorder, current or most recent episode manic
Explanation: The presence of a distinct manic episode characterized by elevated or irritable
mood, decreased need for sleep, increased activity, pressured speech, grandiosity, and
significant behavioral disturbance supports bipolar I disorder. A full manic episode
establishes bipolar I disorder regardless of whether it was precipitated or unmasked by an
antidepressant. Cyclothymia does not involve full manic episodes, and the presentation is
inconsistent with a depressive disorder.
QUESTION 2.
A patient taking lithium for bipolar I disorder develops coarse tremor, vomiting, diarrhea,
ataxia, and increasing confusion. The patient recently began a medication for hypertension.
Which intervention is the priority?
A. Administer the next scheduled lithium dose with food
B. Increase lithium because the symptoms indicate worsening mania
C. Hold lithium and urgently evaluate the patient for toxicity
D. Add a benzodiazepine to control the tremor
Correct Answer: C. Hold lithium and urgently evaluate the patient for toxicity
,2 NRNP 6675 advanced practice psychiatric-mental health nursing
Explanation: Coarse tremor, gastrointestinal symptoms, ataxia, and altered mental status are
concerning for lithium toxicity, which can become neurologically and medically dangerous.
Several medications, including some antihypertensive agents such as thiazide diuretics and
ACE inhibitors, can increase lithium concentrations. The immediate priority is to withhold
lithium and obtain urgent clinical assessment, including a serum lithium concentration and
evaluation of renal function and electrolytes.
QUESTION 3.
A 42-year-old patient with schizophrenia has been taking an antipsychotic for 6 weeks.
Auditory hallucinations have improved, but the patient develops repetitive chewing
movements and involuntary tongue protrusion. Which complication should the PMHNP
suspect?
A. Tardive dyskinesia
B. Acute dystonia
C. Neuroleptic malignant syndrome
D. Akathisia
Correct Answer: A. Tardive dyskinesia
Explanation: Repetitive involuntary oral-buccal-lingual movements after prolonged exposure
to dopamine-receptor-blocking medications are characteristic of tardive dyskinesia. Acute
dystonia typically presents with sustained muscle contractions early after treatment, while
akathisia manifests as subjective and objective restlessness. Neuroleptic malignant syndrome
is an acute medical emergency characterized by rigidity, hyperthermia, autonomic instability,
and altered mental status.
QUESTION 4.
A patient with severe depression reports, “I have decided exactly how I will kill myself, and I
already obtained the medication.” The patient denies psychotic symptoms and states that the
decision is final. What is the most appropriate initial management?
A. Schedule outpatient psychotherapy within 48 hours
B. Develop a safety plan and allow the patient to return home alone
C. Increase the antidepressant dose and reassess in one week
D. Initiate immediate safety intervention with a high level of psychiatric containment
Correct Answer: D. Initiate immediate safety intervention with a high level of
psychiatric containment
Explanation: A specific suicide plan, access to lethal means, and stated intent indicate an
acute and potentially imminent suicide risk. The clinician must prioritize protection from self-
harm through immediate containment, removal or restriction of access to lethal means, and
appropriate emergency psychiatric evaluation. Routine outpatient follow-up alone is
insufficient for this level of risk.
QUESTION 5.
, 3 NRNP 6675 advanced practice psychiatric-mental health nursing
A 29-year-old patient reports recurrent episodes of palpitations, chest tightness, trembling,
shortness of breath, and fear of dying that peak within several minutes. Cardiac evaluation is
normal. The patient subsequently develops persistent concern about experiencing another
episode and begins avoiding public transportation. Which diagnosis best accounts for the
overall presentation?
A. Generalized anxiety disorder
B. Panic disorder with avoidance behavior
C. Social anxiety disorder
D. Somatic symptom disorder
Correct Answer: B. Panic disorder with avoidance behavior
Explanation: Recurrent unexpected panic attacks followed by persistent concern about
additional attacks or maladaptive behavioral changes are characteristic of panic disorder.
Avoidance of public transportation can develop because the patient fears being unable to
escape or obtain help during another attack. Generalized anxiety disorder involves excessive
worry across multiple domains rather than recurrent unexpected panic episodes as the
central feature.
QUESTION 6.
A patient with bipolar disorder taking valproate becomes pregnant and asks whether
treatment should simply continue because the medication has controlled mood episodes
effectively. Which response demonstrates the most appropriate advanced clinical reasoning?
A. Continue valproate without modification because relapse prevention always outweighs
fetal risk
B. Stop all psychotropic medications immediately
C. Reassess the risk-benefit balance and consider safer evidence-based alternatives with
appropriate psychiatric and obstetric collaboration
D. Increase valproate because pregnancy reduces its effectiveness
Correct Answer: C. Reassess the risk-benefit balance and consider safer evidence-based
alternatives with appropriate psychiatric and obstetric collaboration
Explanation: Valproate presents significant reproductive and fetal safety concerns, so
pregnancy requires a careful reassessment of treatment rather than automatic continuation
or abrupt discontinuation. Abruptly stopping an effective mood stabilizer can also create
substantial relapse risk. Management should incorporate illness severity, reproductive risks,
alternative treatments, and coordinated psychiatric and obstetric care.
QUESTION 7.
A patient with schizophrenia has been taking clozapine and develops fever, sore throat, and
profound fatigue. What is the most important clinical concern?
A. Agranulocytosis or severe neutropenia
B. Anticholinergic withdrawal
PRACTICE | ADVANCED STUDY GUIDE |
COMPREHENSIVE TESTBANK WITH PRACTICE
QUESTIONS & ANSWERS | EXAM PREPARATION
| LATEST UPDATE 2026/2027
Walden university
NRNP 6675 advanced practice psychiatric-mental health nursing
higher education level student
100+ Q&As with rationales
12 domains
academic year 2026/2027
TABLE OF CONTENTS
1. Advanced Psychiatric Assessment and Diagnostic Reasoning
2. Psychopharmacology and Medication Management
3. Depressive and Bipolar Disorders
4. Anxiety, Trauma, and Stressor-Related Disorders
5. Psychotic Disorders and Schizophrenia Spectrum
6. Substance Use and Addictive Disorders
7. Personality Disorders and Complex Clinical Presentations
8. Neurocognitive and Neurodevelopmental Disorders
9. Suicide, Safety, and Crisis Management
10. Psychotherapy and Advanced Therapeutic Interventions
11. Special Populations and Lifespan Considerations
12. Ethics, Legal Issues, and Professional Practice
,1 NRNP 6675 advanced practice psychiatric-mental health nursing
DESCRIPTION
NRNP 6675 Final Exam focuses on advanced psychiatric-mental health nursing practice,
emphasizing clinical reasoning, differential diagnosis, evidence-based psychopharmacology,
psychotherapy, risk assessment, and management of complex psychiatric presentations. This
study-oriented question bank is designed around major graduate-level PMHNP concepts
commonly addressed in advanced psychiatric nursing coursework, including mood disorders,
anxiety and trauma-related conditions, psychotic disorders, substance use disorders,
personality disorders, neurocognitive conditions, safety assessment, and medication
management. Questions emphasize application rather than simple memorization and require
interpretation of clinical findings, medication risks, diagnostic criteria, treatment response,
comorbidities, and ethical considerations. The following items are independently written
study questions and are not actual NRNP 6675 examination questions or a reproduction of
any university examination.
QUESTION 1.
A 34-year-old patient with recurrent major depressive episodes presents with decreased need
for sleep, increased goal-directed activity, pressured speech, grandiosity, and impulsive
spending lasting 8 days. The patient reports that the elevated mood began after starting an
antidepressant 3 weeks earlier. Which diagnostic formulation is most appropriate?
A. Major depressive disorder with mixed features
B. Bipolar I disorder, current or most recent episode manic
C. Cyclothymic disorder
D. Substance/medication-induced depressive disorder
Correct Answer: B. Bipolar I disorder, current or most recent episode manic
Explanation: The presence of a distinct manic episode characterized by elevated or irritable
mood, decreased need for sleep, increased activity, pressured speech, grandiosity, and
significant behavioral disturbance supports bipolar I disorder. A full manic episode
establishes bipolar I disorder regardless of whether it was precipitated or unmasked by an
antidepressant. Cyclothymia does not involve full manic episodes, and the presentation is
inconsistent with a depressive disorder.
QUESTION 2.
A patient taking lithium for bipolar I disorder develops coarse tremor, vomiting, diarrhea,
ataxia, and increasing confusion. The patient recently began a medication for hypertension.
Which intervention is the priority?
A. Administer the next scheduled lithium dose with food
B. Increase lithium because the symptoms indicate worsening mania
C. Hold lithium and urgently evaluate the patient for toxicity
D. Add a benzodiazepine to control the tremor
Correct Answer: C. Hold lithium and urgently evaluate the patient for toxicity
,2 NRNP 6675 advanced practice psychiatric-mental health nursing
Explanation: Coarse tremor, gastrointestinal symptoms, ataxia, and altered mental status are
concerning for lithium toxicity, which can become neurologically and medically dangerous.
Several medications, including some antihypertensive agents such as thiazide diuretics and
ACE inhibitors, can increase lithium concentrations. The immediate priority is to withhold
lithium and obtain urgent clinical assessment, including a serum lithium concentration and
evaluation of renal function and electrolytes.
QUESTION 3.
A 42-year-old patient with schizophrenia has been taking an antipsychotic for 6 weeks.
Auditory hallucinations have improved, but the patient develops repetitive chewing
movements and involuntary tongue protrusion. Which complication should the PMHNP
suspect?
A. Tardive dyskinesia
B. Acute dystonia
C. Neuroleptic malignant syndrome
D. Akathisia
Correct Answer: A. Tardive dyskinesia
Explanation: Repetitive involuntary oral-buccal-lingual movements after prolonged exposure
to dopamine-receptor-blocking medications are characteristic of tardive dyskinesia. Acute
dystonia typically presents with sustained muscle contractions early after treatment, while
akathisia manifests as subjective and objective restlessness. Neuroleptic malignant syndrome
is an acute medical emergency characterized by rigidity, hyperthermia, autonomic instability,
and altered mental status.
QUESTION 4.
A patient with severe depression reports, “I have decided exactly how I will kill myself, and I
already obtained the medication.” The patient denies psychotic symptoms and states that the
decision is final. What is the most appropriate initial management?
A. Schedule outpatient psychotherapy within 48 hours
B. Develop a safety plan and allow the patient to return home alone
C. Increase the antidepressant dose and reassess in one week
D. Initiate immediate safety intervention with a high level of psychiatric containment
Correct Answer: D. Initiate immediate safety intervention with a high level of
psychiatric containment
Explanation: A specific suicide plan, access to lethal means, and stated intent indicate an
acute and potentially imminent suicide risk. The clinician must prioritize protection from self-
harm through immediate containment, removal or restriction of access to lethal means, and
appropriate emergency psychiatric evaluation. Routine outpatient follow-up alone is
insufficient for this level of risk.
QUESTION 5.
, 3 NRNP 6675 advanced practice psychiatric-mental health nursing
A 29-year-old patient reports recurrent episodes of palpitations, chest tightness, trembling,
shortness of breath, and fear of dying that peak within several minutes. Cardiac evaluation is
normal. The patient subsequently develops persistent concern about experiencing another
episode and begins avoiding public transportation. Which diagnosis best accounts for the
overall presentation?
A. Generalized anxiety disorder
B. Panic disorder with avoidance behavior
C. Social anxiety disorder
D. Somatic symptom disorder
Correct Answer: B. Panic disorder with avoidance behavior
Explanation: Recurrent unexpected panic attacks followed by persistent concern about
additional attacks or maladaptive behavioral changes are characteristic of panic disorder.
Avoidance of public transportation can develop because the patient fears being unable to
escape or obtain help during another attack. Generalized anxiety disorder involves excessive
worry across multiple domains rather than recurrent unexpected panic episodes as the
central feature.
QUESTION 6.
A patient with bipolar disorder taking valproate becomes pregnant and asks whether
treatment should simply continue because the medication has controlled mood episodes
effectively. Which response demonstrates the most appropriate advanced clinical reasoning?
A. Continue valproate without modification because relapse prevention always outweighs
fetal risk
B. Stop all psychotropic medications immediately
C. Reassess the risk-benefit balance and consider safer evidence-based alternatives with
appropriate psychiatric and obstetric collaboration
D. Increase valproate because pregnancy reduces its effectiveness
Correct Answer: C. Reassess the risk-benefit balance and consider safer evidence-based
alternatives with appropriate psychiatric and obstetric collaboration
Explanation: Valproate presents significant reproductive and fetal safety concerns, so
pregnancy requires a careful reassessment of treatment rather than automatic continuation
or abrupt discontinuation. Abruptly stopping an effective mood stabilizer can also create
substantial relapse risk. Management should incorporate illness severity, reproductive risks,
alternative treatments, and coordinated psychiatric and obstetric care.
QUESTION 7.
A patient with schizophrenia has been taking clozapine and develops fever, sore throat, and
profound fatigue. What is the most important clinical concern?
A. Agranulocytosis or severe neutropenia
B. Anticholinergic withdrawal
