NRNP 6675 ADVANCED PRACTICE
PSYCHIATRIC-MENTAL HEALTH NURSING
EXAM PRACTICE | 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. Psychopharmacology and Medication Management
3. Mood Disorders and Suicide Risk
4. Psychotic Disorders and Schizophrenia Spectrum Disorders
5. Anxiety, Trauma, and Stressor-Related Disorders
6. Personality Disorders and Behavioral Dysregulation
7. Substance Use and Co-Occurring Disorders
8. Special Populations and Complex Psychiatric Presentations
9. Psychotherapy and Evidence-Based Interventions
10. Ethics, Safety, Legal Issues, and Professional Practice
,1 NRNP 6675 advanced practice psychiatric-mental health nursing
DESCRIPTION
This NRNP 6675 Advanced Practice Psychiatric-Mental Health Nursing study resource is
designed as a high-level practice and review bank for graduate nursing students preparing
for advanced psychiatric-mental health nursing assessments. The questions emphasize
clinical reasoning rather than simple memorization, incorporating complex psychiatric
presentations, differential diagnosis, psychopharmacology, psychotherapy, suicide and
violence risk assessment, substance use, trauma-related conditions, psychotic disorders,
mood disorders, personality disorders, and professional decision-making. Scenarios require
the learner to interpret clinical findings, prioritize interventions, evaluate medication-related
concerns, recognize diagnostic distinctions, and apply advanced-practice nursing principles.
The material is intentionally educational and independently constructed for study purposes;
it does not reproduce or claim to reproduce actual Walden University examination questions.
It is intended to complement course materials, instructor guidance, textbooks, lecture notes,
and other authorized study resources.
QUESTION 1.
A 34-year-old patient presents with a 3-week history of markedly decreased need for sleep,
pressured speech, grandiosity, impulsive financial decisions, and increased goal-directed
activity. The patient reports feeling "better than ever" and denies that anything is wrong.
During the interview, the clinician observes distractibility and rapidly shifting topics. Which
additional finding would most strongly support a diagnosis of bipolar I disorder, current
manic episode, rather than hypomania?
A. The patient has increased sociability and productivity at work.
B. The patient reports sleeping approximately 5 hours nightly without daytime fatigue.
C. The patient's symptoms have resulted in severe occupational impairment and require
psychiatric hospitalization.
D. The patient describes increased confidence and several new business ideas.
Correct Answer: C. The patient's symptoms have resulted in severe occupational
impairment and require psychiatric hospitalization.
Explanation: The defining distinction between mania and hypomania is the severity and
functional consequences of the episode. Mania causes marked impairment, may require
hospitalization, or may involve psychotic features, whereas hypomania does not cause
marked functional impairment or require hospitalization. Reduced sleep, increased
productivity, confidence, and business ideas can occur in either state and therefore do not
independently establish mania.
QUESTION 2.
A patient with schizophrenia has been stable for 8 months on an antipsychotic medication but
develops involuntary, repetitive movements of the tongue, jaw, and fingers. The movements
persist when the patient attempts to suppress them. Which clinical action is most appropriate?
A. Evaluate the patient for tardive dyskinesia and reassess the antipsychotic regimen.
B. Increase the antipsychotic dose because the movements indicate emerging psychosis.
C. Add a benzodiazepine as the primary treatment without further assessment.
D. Reassure the patient that the movements represent an expected transient adverse effect.
Walden university| NRNP 6675
,2 NRNP 6675 advanced practice psychiatric-mental health nursing
Correct Answer: A. Evaluate the patient for tardive dyskinesia and reassess the
antipsychotic regimen.
Explanation: Persistent involuntary orofacial and limb movements in a patient receiving
long-term antipsychotic therapy are concerning for tardive dyskinesia. The clinician should
perform a structured movement assessment and evaluate whether modification of
antipsychotic therapy and/or treatment specifically targeting tardive dyskinesia is indicated.
Increasing the antipsychotic dose may worsen the condition, while assuming the symptoms
are transient could delay appropriate management.
QUESTION 3.
A 42-year-old patient with major depressive disorder reports that depressive symptoms have
improved substantially after initiating an antidepressant. However, the patient now sleeps
only 3 hours nightly, has unusually high energy, speaks rapidly, and has begun making
unrealistic business plans. Which interpretation should guide the psychiatric mental health
nurse practitioner's next assessment?
A. The antidepressant is demonstrating an unusually strong therapeutic response.
B. The patient is experiencing normal recovery from depression.
C. The symptoms most likely represent medication-induced anxiety alone.
D. The clinician should assess for emerging mania or an underlying bipolar-spectrum
disorder.
Correct Answer: D. The clinician should assess for emerging mania or an underlying
bipolar-spectrum disorder.
Explanation: A transition from depression into decreased need for sleep, elevated or
expansive mood, increased energy, pressured speech, and grandiosity requires evaluation for
mania or hypomania. Antidepressant exposure can sometimes precipitate manic symptoms in
susceptible individuals, but the clinician must determine whether the episode represents a
broader bipolar disorder. Labeling the presentation as routine improvement or anxiety
without further assessment could miss a clinically significant diagnostic change.
QUESTION 4.
A patient presents to an outpatient psychiatric clinic stating, "My family would be better off
without me." The patient has developed a specific suicide plan, has access to the intended
means, and reports increasing intent over the past week. Which intervention should receive
the highest priority?
A. Schedule weekly psychotherapy and reassess suicidal ideation at the next visit.
B. Establish immediate safety through a higher level of psychiatric evaluation and restrict
access to lethal means.
C. Provide a written list of community resources and allow the patient to return home alone.
D. Initiate antidepressant therapy and defer safety planning until medication response can be
evaluated.
Correct Answer: B. Establish immediate safety through a higher level of psychiatric
evaluation and restrict access to lethal means.
Walden university| NRNP 6675
, 3 NRNP 6675 advanced practice psychiatric-mental health nursing
Explanation: A specific plan, access to lethal means, and escalating intent represent high-
acuity suicide risk requiring immediate safety intervention. Depending on the clinical
circumstances, this may involve emergency psychiatric evaluation, hospitalization, constant
observation, involvement of appropriate support persons, and lethal-means restriction.
Routine outpatient follow-up alone is inadequate when imminent risk is suspected.
QUESTION 5.
A patient taking lithium for bipolar disorder develops coarse tremor, persistent vomiting,
severe diarrhea, ataxia, and increasing confusion after several days of poor oral intake. Which
action is most appropriate?
A. Administer the next lithium dose with food to reduce gastrointestinal effects.
B. Increase lithium because the symptoms indicate inadequate mood stabilization.
C. Hold lithium and obtain urgent evaluation for possible lithium toxicity.
D. Encourage increased caffeine intake to counteract the neurologic symptoms.
Correct Answer: C. Hold lithium and obtain urgent evaluation for possible lithium
toxicity.
Explanation: Gastrointestinal symptoms accompanied by coarse tremor, ataxia, and altered
mental status are concerning for significant lithium toxicity. Dehydration and reduced
sodium or fluid intake can increase lithium concentrations and worsen toxicity. The
medication should not simply be adjusted upward or continued without urgent assessment,
including measurement of serum lithium and evaluation of renal function and electrolytes.
QUESTION 6.
A 29-year-old patient reports recurrent unexpected episodes of intense fear accompanied by
palpitations, dyspnea, trembling, chest discomfort, and fear of dying. The episodes peak
within minutes, and the patient has subsequently become persistently concerned about having
another attack. Which diagnostic feature most strongly supports panic disorder?
A. The attacks occur exclusively when the patient encounters a specific feared object.
B. The patient experiences recurrent unexpected panic attacks followed by persistent concern
or maladaptive behavioral change.
C. The patient experiences anxiety only in social situations involving potential evaluation.
D. The patient has intrusive thoughts that are relieved by repetitive compulsive behaviors.
Correct Answer: B. The patient experiences recurrent unexpected panic attacks
followed by persistent concern or maladaptive behavioral change.
Explanation: Panic disorder is characterized by recurrent unexpected panic attacks followed
by persistent concern about additional attacks or their consequences and/or significant
maladaptive behavioral changes. Specific phobia involves a particular feared stimulus, social
anxiety centers on scrutiny or evaluation, and obsessive-compulsive disorder involves
obsessions and compulsions.
QUESTION 7.
A patient with posttraumatic stress disorder reports nightmares, intrusive memories,
avoidance, hypervigilance, and exaggerated startle responses. The patient asks why the
Walden university| NRNP 6675
PSYCHIATRIC-MENTAL HEALTH NURSING
EXAM PRACTICE | 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. Psychopharmacology and Medication Management
3. Mood Disorders and Suicide Risk
4. Psychotic Disorders and Schizophrenia Spectrum Disorders
5. Anxiety, Trauma, and Stressor-Related Disorders
6. Personality Disorders and Behavioral Dysregulation
7. Substance Use and Co-Occurring Disorders
8. Special Populations and Complex Psychiatric Presentations
9. Psychotherapy and Evidence-Based Interventions
10. Ethics, Safety, Legal Issues, and Professional Practice
,1 NRNP 6675 advanced practice psychiatric-mental health nursing
DESCRIPTION
This NRNP 6675 Advanced Practice Psychiatric-Mental Health Nursing study resource is
designed as a high-level practice and review bank for graduate nursing students preparing
for advanced psychiatric-mental health nursing assessments. The questions emphasize
clinical reasoning rather than simple memorization, incorporating complex psychiatric
presentations, differential diagnosis, psychopharmacology, psychotherapy, suicide and
violence risk assessment, substance use, trauma-related conditions, psychotic disorders,
mood disorders, personality disorders, and professional decision-making. Scenarios require
the learner to interpret clinical findings, prioritize interventions, evaluate medication-related
concerns, recognize diagnostic distinctions, and apply advanced-practice nursing principles.
The material is intentionally educational and independently constructed for study purposes;
it does not reproduce or claim to reproduce actual Walden University examination questions.
It is intended to complement course materials, instructor guidance, textbooks, lecture notes,
and other authorized study resources.
QUESTION 1.
A 34-year-old patient presents with a 3-week history of markedly decreased need for sleep,
pressured speech, grandiosity, impulsive financial decisions, and increased goal-directed
activity. The patient reports feeling "better than ever" and denies that anything is wrong.
During the interview, the clinician observes distractibility and rapidly shifting topics. Which
additional finding would most strongly support a diagnosis of bipolar I disorder, current
manic episode, rather than hypomania?
A. The patient has increased sociability and productivity at work.
B. The patient reports sleeping approximately 5 hours nightly without daytime fatigue.
C. The patient's symptoms have resulted in severe occupational impairment and require
psychiatric hospitalization.
D. The patient describes increased confidence and several new business ideas.
Correct Answer: C. The patient's symptoms have resulted in severe occupational
impairment and require psychiatric hospitalization.
Explanation: The defining distinction between mania and hypomania is the severity and
functional consequences of the episode. Mania causes marked impairment, may require
hospitalization, or may involve psychotic features, whereas hypomania does not cause
marked functional impairment or require hospitalization. Reduced sleep, increased
productivity, confidence, and business ideas can occur in either state and therefore do not
independently establish mania.
QUESTION 2.
A patient with schizophrenia has been stable for 8 months on an antipsychotic medication but
develops involuntary, repetitive movements of the tongue, jaw, and fingers. The movements
persist when the patient attempts to suppress them. Which clinical action is most appropriate?
A. Evaluate the patient for tardive dyskinesia and reassess the antipsychotic regimen.
B. Increase the antipsychotic dose because the movements indicate emerging psychosis.
C. Add a benzodiazepine as the primary treatment without further assessment.
D. Reassure the patient that the movements represent an expected transient adverse effect.
Walden university| NRNP 6675
,2 NRNP 6675 advanced practice psychiatric-mental health nursing
Correct Answer: A. Evaluate the patient for tardive dyskinesia and reassess the
antipsychotic regimen.
Explanation: Persistent involuntary orofacial and limb movements in a patient receiving
long-term antipsychotic therapy are concerning for tardive dyskinesia. The clinician should
perform a structured movement assessment and evaluate whether modification of
antipsychotic therapy and/or treatment specifically targeting tardive dyskinesia is indicated.
Increasing the antipsychotic dose may worsen the condition, while assuming the symptoms
are transient could delay appropriate management.
QUESTION 3.
A 42-year-old patient with major depressive disorder reports that depressive symptoms have
improved substantially after initiating an antidepressant. However, the patient now sleeps
only 3 hours nightly, has unusually high energy, speaks rapidly, and has begun making
unrealistic business plans. Which interpretation should guide the psychiatric mental health
nurse practitioner's next assessment?
A. The antidepressant is demonstrating an unusually strong therapeutic response.
B. The patient is experiencing normal recovery from depression.
C. The symptoms most likely represent medication-induced anxiety alone.
D. The clinician should assess for emerging mania or an underlying bipolar-spectrum
disorder.
Correct Answer: D. The clinician should assess for emerging mania or an underlying
bipolar-spectrum disorder.
Explanation: A transition from depression into decreased need for sleep, elevated or
expansive mood, increased energy, pressured speech, and grandiosity requires evaluation for
mania or hypomania. Antidepressant exposure can sometimes precipitate manic symptoms in
susceptible individuals, but the clinician must determine whether the episode represents a
broader bipolar disorder. Labeling the presentation as routine improvement or anxiety
without further assessment could miss a clinically significant diagnostic change.
QUESTION 4.
A patient presents to an outpatient psychiatric clinic stating, "My family would be better off
without me." The patient has developed a specific suicide plan, has access to the intended
means, and reports increasing intent over the past week. Which intervention should receive
the highest priority?
A. Schedule weekly psychotherapy and reassess suicidal ideation at the next visit.
B. Establish immediate safety through a higher level of psychiatric evaluation and restrict
access to lethal means.
C. Provide a written list of community resources and allow the patient to return home alone.
D. Initiate antidepressant therapy and defer safety planning until medication response can be
evaluated.
Correct Answer: B. Establish immediate safety through a higher level of psychiatric
evaluation and restrict access to lethal means.
Walden university| NRNP 6675
, 3 NRNP 6675 advanced practice psychiatric-mental health nursing
Explanation: A specific plan, access to lethal means, and escalating intent represent high-
acuity suicide risk requiring immediate safety intervention. Depending on the clinical
circumstances, this may involve emergency psychiatric evaluation, hospitalization, constant
observation, involvement of appropriate support persons, and lethal-means restriction.
Routine outpatient follow-up alone is inadequate when imminent risk is suspected.
QUESTION 5.
A patient taking lithium for bipolar disorder develops coarse tremor, persistent vomiting,
severe diarrhea, ataxia, and increasing confusion after several days of poor oral intake. Which
action is most appropriate?
A. Administer the next lithium dose with food to reduce gastrointestinal effects.
B. Increase lithium because the symptoms indicate inadequate mood stabilization.
C. Hold lithium and obtain urgent evaluation for possible lithium toxicity.
D. Encourage increased caffeine intake to counteract the neurologic symptoms.
Correct Answer: C. Hold lithium and obtain urgent evaluation for possible lithium
toxicity.
Explanation: Gastrointestinal symptoms accompanied by coarse tremor, ataxia, and altered
mental status are concerning for significant lithium toxicity. Dehydration and reduced
sodium or fluid intake can increase lithium concentrations and worsen toxicity. The
medication should not simply be adjusted upward or continued without urgent assessment,
including measurement of serum lithium and evaluation of renal function and electrolytes.
QUESTION 6.
A 29-year-old patient reports recurrent unexpected episodes of intense fear accompanied by
palpitations, dyspnea, trembling, chest discomfort, and fear of dying. The episodes peak
within minutes, and the patient has subsequently become persistently concerned about having
another attack. Which diagnostic feature most strongly supports panic disorder?
A. The attacks occur exclusively when the patient encounters a specific feared object.
B. The patient experiences recurrent unexpected panic attacks followed by persistent concern
or maladaptive behavioral change.
C. The patient experiences anxiety only in social situations involving potential evaluation.
D. The patient has intrusive thoughts that are relieved by repetitive compulsive behaviors.
Correct Answer: B. The patient experiences recurrent unexpected panic attacks
followed by persistent concern or maladaptive behavioral change.
Explanation: Panic disorder is characterized by recurrent unexpected panic attacks followed
by persistent concern about additional attacks or their consequences and/or significant
maladaptive behavioral changes. Specific phobia involves a particular feared stimulus, social
anxiety centers on scrutiny or evaluation, and obsessive-compulsive disorder involves
obsessions and compulsions.
QUESTION 7.
A patient with posttraumatic stress disorder reports nightmares, intrusive memories,
avoidance, hypervigilance, and exaggerated startle responses. The patient asks why the
Walden university| NRNP 6675
