NRNP 6675 PMHNP CARE ACROSS THE LIFESPAN
II MIDTERM EXAM – WALDEN
UNIVERSITYPRACTICE | 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
10 domains
academic year 2026/2027
TABLE OF CONTENTS
1. Advanced Psychiatric Assessment and Diagnostic Reasoning
2. Substance-Related and Addictive Disorders
3. Mood Disorders Across the Lifespan
4. Psychotic Disorders and Differential Diagnosis
5. Personality Disorders and Paraphilic Disorders
6. Geriatric Psychiatry and Neurocognitive Disorders
7. Psychopharmacology and Medication Safety
8. Psychotherapy and Integrated Treatment Planning
9. Psychiatric Emergencies, Risk Assessment, and Safety
10. Legal, Ethical, Documentation, and Professional Practice
NRNP 6675 MIDTERM EXAM PRACTICE, PMHNP CARE ACROSS THE LIFESPAN II,
STUDY GUIDE, TESTBANK, PRACTICE QUESTIONS & ANSWERS, EXAM
PREPARATION, ADVANCED REVIEW, 2026/2027 QUESTIONS, GRADUATE-LEVEL
PSYCHIATRIC-MENTAL HEALTH NURSING, CORRECT ANSWERS
,1 NRNP 6675 advanced practice psychiatric-mental health nursing
DESCRIPTION
This comprehensive NRNP 6675 Midterm Exam Practice Study Guide is an original
educational resource designed to support advanced preparation for PMHNP Care Across the
Lifespan II. It focuses on graduate-level clinical reasoning involving psychiatric assessment,
differential diagnosis, psychopharmacology, substance-related disorders, mood and
psychotic disorders, personality pathology, neurocognitive disorders, psychiatric
emergencies, and evidence-informed treatment planning across developmental stages. The
questions emphasize application rather than memorization, requiring interpretation of
clinical presentations, medication risks, safety concerns, ethical considerations, and
appropriate treatment decisions. Scenarios are structured to challenge advanced-practice
nursing judgment and integrate concepts commonly emphasized in PMHNP coursework and
professional preparation materials. This resource is not an actual university examination and
does not reproduce or claim to reproduce confidential examination questions.
QUESTION 1.
A 68-year-old patient with recurrent major depressive disorder reports that an antidepressant
previously produced adequate remission but now causes dizziness, constipation, and
confusion after a modest dose increase. The patient has also recently started several
medications prescribed by different clinicians. Which clinical principle should most strongly
guide the PMHNP's next step?
A. Increase the antidepressant because reduced hepatic metabolism generally requires higher
maintenance doses in older adults.
B. Review the complete medication regimen for pharmacokinetic and pharmacodynamic
interactions before further titration.
C. Discontinue all psychiatric medications immediately because polypharmacy is inherently
inappropriate in older adults.
D. Assume the symptoms represent treatment-resistant depression and switch immediately to
an antipsychotic.
Correct Answer: B. Review the complete medication regimen for pharmacokinetic and
pharmacodynamic interactions before further titration.
Explanation: Older adults are more vulnerable to adverse effects because physiologic
changes can alter drug distribution, metabolism, and elimination, while polypharmacy
increases interaction risk. A comprehensive medication reconciliation should occur before
escalating or switching therapy. Increasing medication without evaluating the medication
burden could worsen toxicity, while abrupt discontinuation or premature antipsychotic
treatment is not justified.
QUESTION 2.
A 32-year-old patient presents after abruptly stopping daily high-dose alprazolam use. The
patient is anxious, tremulous, diaphoretic, tachycardic, and reports perceptual disturbances.
Which concern requires the highest priority?
A. Development of a primary panic disorder.
B. Emergence of obsessive-compulsive symptoms.
C. Benzodiazepine withdrawal progressing to seizures or delirium.
D. Conversion of generalized anxiety disorder into bipolar disorder.
,2 NRNP 6675 advanced practice psychiatric-mental health nursing
Correct Answer: C. Benzodiazepine withdrawal progressing to seizures or delirium.
Explanation: Abrupt discontinuation after prolonged high-dose benzodiazepine exposure can
produce potentially life-threatening withdrawal, including seizures and delirium. Autonomic
hyperactivity, tremor, severe anxiety, and perceptual disturbances increase concern for
significant withdrawal. Panic disorder or another chronic anxiety diagnosis does not
adequately explain the acute temporal relationship to medication cessation.
QUESTION 3.
A 45-year-old patient reports four days of markedly decreased need for sleep, pressured
speech, grandiosity, impulsive spending, and increasingly disorganized goal-directed
behavior. The patient denies hallucinations and states that the symptoms are caused by
"finally discovering my true potential." Which diagnostic feature most strongly supports a
manic episode rather than hypomania?
A. The presence of decreased need for sleep.
B. The presence of grandiose thinking.
C. The absence of hallucinations.
D. The degree of functional impairment and behavioral disorganization.
Correct Answer: D. The degree of functional impairment and behavioral
disorganization.
Explanation: Mania is distinguished from hypomania primarily by greater severity, marked
functional impairment, hospitalization, or psychotic features. Decreased need for sleep and
grandiosity may occur in both states. Psychosis is not required for mania, so its absence does
not exclude the diagnosis.
QUESTION 4.
A 74-year-old patient develops fluctuating attention, visual hallucinations, marked sensitivity
to antipsychotic medications, and recurrent episodes of cognitive impairment over several
months. Parkinsonian features are also observed. Which diagnosis should receive the
strongest consideration?
A. Dementia with Lewy bodies.
B. Major depressive disorder with psychotic features.
C. Schizophrenia.
D. Vascular neurocognitive disorder.
Correct Answer: A. Dementia with Lewy bodies.
Explanation: Fluctuating cognition, recurrent well-formed visual hallucinations,
parkinsonism, and neuroleptic sensitivity are characteristic features of dementia with Lewy
bodies. Depression can cause cognitive complaints but does not adequately account for this
constellation. Schizophrenia and vascular neurocognitive disorder are less consistent with
the characteristic combination of symptoms and fluctuations.
QUESTION 5.
A patient with alcohol use disorder presents with agitation, tremor, diaphoresis, hypertension,
, 3 NRNP 6675 advanced practice psychiatric-mental health nursing
and visual hallucinations approximately 48 hours after the last drink. Which intervention is
most clinically appropriate?
A. Initiate an SSRI as the primary treatment for the acute symptoms.
B. Treat the presentation as uncomplicated generalized anxiety disorder.
C. Recognize possible severe alcohol withdrawal and prioritize medically supervised
withdrawal management.
D. Administer a stimulant to counteract the patient's psychomotor slowing.
Correct Answer: C. Recognize possible severe alcohol withdrawal and prioritize
medically supervised withdrawal management.
Explanation: Severe autonomic activation and hallucinations occurring after cessation of
heavy alcohol use raise concern for complicated withdrawal and possible progression to
delirium tremens. Immediate safety and medically supervised withdrawal management take
priority. An antidepressant or stimulant does not treat the underlying withdrawal syndrome
and could delay appropriate intervention.
QUESTION 6.
A 27-year-old patient with bipolar I disorder has been euthymic for several months on
lithium. The patient begins a strict low-sodium diet and develops vomiting and diarrhea from
an acute gastrointestinal illness. Which finding should prompt the greatest concern?
A. Increased appetite.
B. Mild daytime fatigue.
C. Decreased need for sleep.
D. New coarse tremor, ataxia, and gastrointestinal symptoms.
Correct Answer: D. New coarse tremor, ataxia, and gastrointestinal symptoms.
Explanation: Lithium toxicity can manifest with gastrointestinal symptoms, coarse tremor,
ataxia, confusion, and potentially severe neurologic complications. Sodium depletion and
dehydration can increase lithium concentrations. The combination of acute illness, dietary
sodium reduction, and neurologic symptoms warrants urgent evaluation rather than routine
continuation without assessment.
QUESTION 7.
A 19-year-old college student reports six months of social withdrawal, declining academic
performance, diminished emotional expression, and increasingly odd beliefs. The patient has
no sustained period of mania or major depression and has not used substances. Which
assessment finding would most strongly support a schizophrenia-spectrum disorder?
A. Persistent hallucinations or delusions accompanied by functional decline.
B. Episodic anxiety occurring before examinations.
C. A history of childhood separation anxiety.
D. Increased appetite during periods of stress.
Correct Answer: A. Persistent hallucinations or delusions accompanied by functional
decline.
II MIDTERM EXAM – WALDEN
UNIVERSITYPRACTICE | 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
10 domains
academic year 2026/2027
TABLE OF CONTENTS
1. Advanced Psychiatric Assessment and Diagnostic Reasoning
2. Substance-Related and Addictive Disorders
3. Mood Disorders Across the Lifespan
4. Psychotic Disorders and Differential Diagnosis
5. Personality Disorders and Paraphilic Disorders
6. Geriatric Psychiatry and Neurocognitive Disorders
7. Psychopharmacology and Medication Safety
8. Psychotherapy and Integrated Treatment Planning
9. Psychiatric Emergencies, Risk Assessment, and Safety
10. Legal, Ethical, Documentation, and Professional Practice
NRNP 6675 MIDTERM EXAM PRACTICE, PMHNP CARE ACROSS THE LIFESPAN II,
STUDY GUIDE, TESTBANK, PRACTICE QUESTIONS & ANSWERS, EXAM
PREPARATION, ADVANCED REVIEW, 2026/2027 QUESTIONS, GRADUATE-LEVEL
PSYCHIATRIC-MENTAL HEALTH NURSING, CORRECT ANSWERS
,1 NRNP 6675 advanced practice psychiatric-mental health nursing
DESCRIPTION
This comprehensive NRNP 6675 Midterm Exam Practice Study Guide is an original
educational resource designed to support advanced preparation for PMHNP Care Across the
Lifespan II. It focuses on graduate-level clinical reasoning involving psychiatric assessment,
differential diagnosis, psychopharmacology, substance-related disorders, mood and
psychotic disorders, personality pathology, neurocognitive disorders, psychiatric
emergencies, and evidence-informed treatment planning across developmental stages. The
questions emphasize application rather than memorization, requiring interpretation of
clinical presentations, medication risks, safety concerns, ethical considerations, and
appropriate treatment decisions. Scenarios are structured to challenge advanced-practice
nursing judgment and integrate concepts commonly emphasized in PMHNP coursework and
professional preparation materials. This resource is not an actual university examination and
does not reproduce or claim to reproduce confidential examination questions.
QUESTION 1.
A 68-year-old patient with recurrent major depressive disorder reports that an antidepressant
previously produced adequate remission but now causes dizziness, constipation, and
confusion after a modest dose increase. The patient has also recently started several
medications prescribed by different clinicians. Which clinical principle should most strongly
guide the PMHNP's next step?
A. Increase the antidepressant because reduced hepatic metabolism generally requires higher
maintenance doses in older adults.
B. Review the complete medication regimen for pharmacokinetic and pharmacodynamic
interactions before further titration.
C. Discontinue all psychiatric medications immediately because polypharmacy is inherently
inappropriate in older adults.
D. Assume the symptoms represent treatment-resistant depression and switch immediately to
an antipsychotic.
Correct Answer: B. Review the complete medication regimen for pharmacokinetic and
pharmacodynamic interactions before further titration.
Explanation: Older adults are more vulnerable to adverse effects because physiologic
changes can alter drug distribution, metabolism, and elimination, while polypharmacy
increases interaction risk. A comprehensive medication reconciliation should occur before
escalating or switching therapy. Increasing medication without evaluating the medication
burden could worsen toxicity, while abrupt discontinuation or premature antipsychotic
treatment is not justified.
QUESTION 2.
A 32-year-old patient presents after abruptly stopping daily high-dose alprazolam use. The
patient is anxious, tremulous, diaphoretic, tachycardic, and reports perceptual disturbances.
Which concern requires the highest priority?
A. Development of a primary panic disorder.
B. Emergence of obsessive-compulsive symptoms.
C. Benzodiazepine withdrawal progressing to seizures or delirium.
D. Conversion of generalized anxiety disorder into bipolar disorder.
,2 NRNP 6675 advanced practice psychiatric-mental health nursing
Correct Answer: C. Benzodiazepine withdrawal progressing to seizures or delirium.
Explanation: Abrupt discontinuation after prolonged high-dose benzodiazepine exposure can
produce potentially life-threatening withdrawal, including seizures and delirium. Autonomic
hyperactivity, tremor, severe anxiety, and perceptual disturbances increase concern for
significant withdrawal. Panic disorder or another chronic anxiety diagnosis does not
adequately explain the acute temporal relationship to medication cessation.
QUESTION 3.
A 45-year-old patient reports four days of markedly decreased need for sleep, pressured
speech, grandiosity, impulsive spending, and increasingly disorganized goal-directed
behavior. The patient denies hallucinations and states that the symptoms are caused by
"finally discovering my true potential." Which diagnostic feature most strongly supports a
manic episode rather than hypomania?
A. The presence of decreased need for sleep.
B. The presence of grandiose thinking.
C. The absence of hallucinations.
D. The degree of functional impairment and behavioral disorganization.
Correct Answer: D. The degree of functional impairment and behavioral
disorganization.
Explanation: Mania is distinguished from hypomania primarily by greater severity, marked
functional impairment, hospitalization, or psychotic features. Decreased need for sleep and
grandiosity may occur in both states. Psychosis is not required for mania, so its absence does
not exclude the diagnosis.
QUESTION 4.
A 74-year-old patient develops fluctuating attention, visual hallucinations, marked sensitivity
to antipsychotic medications, and recurrent episodes of cognitive impairment over several
months. Parkinsonian features are also observed. Which diagnosis should receive the
strongest consideration?
A. Dementia with Lewy bodies.
B. Major depressive disorder with psychotic features.
C. Schizophrenia.
D. Vascular neurocognitive disorder.
Correct Answer: A. Dementia with Lewy bodies.
Explanation: Fluctuating cognition, recurrent well-formed visual hallucinations,
parkinsonism, and neuroleptic sensitivity are characteristic features of dementia with Lewy
bodies. Depression can cause cognitive complaints but does not adequately account for this
constellation. Schizophrenia and vascular neurocognitive disorder are less consistent with
the characteristic combination of symptoms and fluctuations.
QUESTION 5.
A patient with alcohol use disorder presents with agitation, tremor, diaphoresis, hypertension,
, 3 NRNP 6675 advanced practice psychiatric-mental health nursing
and visual hallucinations approximately 48 hours after the last drink. Which intervention is
most clinically appropriate?
A. Initiate an SSRI as the primary treatment for the acute symptoms.
B. Treat the presentation as uncomplicated generalized anxiety disorder.
C. Recognize possible severe alcohol withdrawal and prioritize medically supervised
withdrawal management.
D. Administer a stimulant to counteract the patient's psychomotor slowing.
Correct Answer: C. Recognize possible severe alcohol withdrawal and prioritize
medically supervised withdrawal management.
Explanation: Severe autonomic activation and hallucinations occurring after cessation of
heavy alcohol use raise concern for complicated withdrawal and possible progression to
delirium tremens. Immediate safety and medically supervised withdrawal management take
priority. An antidepressant or stimulant does not treat the underlying withdrawal syndrome
and could delay appropriate intervention.
QUESTION 6.
A 27-year-old patient with bipolar I disorder has been euthymic for several months on
lithium. The patient begins a strict low-sodium diet and develops vomiting and diarrhea from
an acute gastrointestinal illness. Which finding should prompt the greatest concern?
A. Increased appetite.
B. Mild daytime fatigue.
C. Decreased need for sleep.
D. New coarse tremor, ataxia, and gastrointestinal symptoms.
Correct Answer: D. New coarse tremor, ataxia, and gastrointestinal symptoms.
Explanation: Lithium toxicity can manifest with gastrointestinal symptoms, coarse tremor,
ataxia, confusion, and potentially severe neurologic complications. Sodium depletion and
dehydration can increase lithium concentrations. The combination of acute illness, dietary
sodium reduction, and neurologic symptoms warrants urgent evaluation rather than routine
continuation without assessment.
QUESTION 7.
A 19-year-old college student reports six months of social withdrawal, declining academic
performance, diminished emotional expression, and increasingly odd beliefs. The patient has
no sustained period of mania or major depression and has not used substances. Which
assessment finding would most strongly support a schizophrenia-spectrum disorder?
A. Persistent hallucinations or delusions accompanied by functional decline.
B. Episodic anxiety occurring before examinations.
C. A history of childhood separation anxiety.
D. Increased appetite during periods of stress.
Correct Answer: A. Persistent hallucinations or delusions accompanied by functional
decline.
