NURS 6675 Mid Term Exam 2026
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,NURS 6675 Mid Term Exam 2026
2026/2027 Examination
Total Questions: 200
Instructions:
• Answer all questions.
• Select the single best answer.
• Each question has four answer choices: A, B, C, and D.
• Select only ONE answer for each question.
SECTION 1: Foundations of Psychiatric Mental Health Nursing Practice
Questions 1–25
Q1. A PMHNP is conducting an initial assessment with a patient who reports feeling "empty" and
"unable to experience pleasure." The nurse practitioner recognizes that the ability to experience
pleasure is most closely linked to which neurobiological process?
A. Serotonergic dysregulation in the raphe nuclei
B. Dopaminergic transmission in the mesolimbic pathway
C. GABAergic inhibition in the thalamus
D. Noradrenergic excess in the locus coeruleus
Correct Answer: B. Dopaminergic transmission in the mesolimbic pathway
Rationale: The mesolimbic dopamine pathway is central to the brain's reward and pleasure
system. Anhedonia, or the inability to experience pleasure, is associated with reduced dopaminergic
activity in this pathway. Serotonergic dysregulation is more closely linked to mood and anxiety,
GABAergic inhibition relates to sedation and anxiety reduction, and noradrenergic excess is
associated with hyperarousal and anxiety.
Q2. During a psychiatric evaluation, a patient describes hearing voices that others do not hear
and expresses a belief that government agents are monitoring her through her television. The
PMHNP should document these findings as which of the following?
A. Mood-congruent psychotic features
B. Negative symptoms of schizophrenia
C. Positive symptoms of schizophrenia
D. Cognitive symptoms of schizophrenia
Correct Answer: C. Positive symptoms of schizophrenia
Rationale: Positive symptoms of schizophrenia include hallucinations and delusions, which
represent an excess or distortion of normal functioning. Negative symptoms include avolition, alogia,
and affective flattening. Cognitive symptoms involve difficulties with attention, memory, and
executive function. Mood-congruent psychotic features refer to hallucinations or delusions whose
content is consistent with a mood episode.
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, Q3. A PMHNP is educating a patient about the mechanism of action of selective serotonin
reuptake inhibitors (SSRIs). Which statement by the patient indicates correct understanding?
A. "SSRIs increase serotonin by blocking its reuptake, making more available in the synapse."
B. "SSRIs work by directly stimulating serotonin receptors in the brain."
C. "SSRIs decrease serotonin levels to prevent overstimulation."
D. "SSRIs block dopamine receptors to reduce psychotic symptoms."
Correct Answer: A. "SSRIs increase serotonin by blocking its reuptake, making more available in
the synapse."
Rationale: SSRIs work by inhibiting the serotonin transporter, preventing the reuptake of
serotonin into the presynaptic neuron. This increases serotonin availability in the synaptic cleft. They
do not directly stimulate receptors, decrease serotonin, or block dopamine receptors.
Q4. A patient presents with symptoms of generalized anxiety disorder. The PMHNP explains that
the "fight-or-flight" response is primarily mediated by which neurotransmitter system?
A. Dopaminergic
B. Serotonergic
C. Noradrenergic
D. Cholinergic
Correct Answer: C. Noradrenergic
Rationale: The noradrenergic system, particularly involving the locus coeruleus, plays a central
role in mediating the fight-or-flight response and arousal. Anxiety disorders are associated with
noradrenergic dysregulation. While serotonin and GABA also modulate anxiety, the acute stress
response is primarily noradrenergic.
Q5. A PMHNP is assessing a patient who reports persistent low mood, anhedonia, and feelings of
worthlessness for the past three months. Which diagnostic criterion is essential to establish a
diagnosis of major depressive disorder?
A. The presence of psychotic features
B. Symptoms lasting at least two weeks
C. A history of manic episodes
D. Suicidal ideation
Correct Answer: B. Symptoms lasting at least two weeks
Rationale: According to DSM-5-TR criteria, a major depressive episode requires symptoms to be
present for at least two weeks. Psychotic features and suicidal ideation may be present but are not
required for diagnosis. A history of manic episodes would suggest bipolar disorder rather than major
depressive disorder.
Q6. A patient tells the PMHNP, "I feel like I'm outside my body watching myself." This experience
is best described as which of the following?
A. Derealization
B. Depersonalization
C. Hallucination
D. Illusion
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, Correct Answer: B. Depersonalization
Rationale: Depersonalization is characterized by a sense of detachment from oneself, as if one is
an outside observer of one's mental processes or body. Derealization involves a sense of unreality or
detachment from the external environment. Hallucinations are sensory perceptions without external
stimuli, and illusions are misinterpretations of real external stimuli.
Q7. A PMHNP is considering the role of GABA in psychiatric disorders. Reduced GABAergic
activity has been most strongly implicated in which condition?
A. Schizophrenia
B. Anxiety disorders
C. Bipolar disorder
D. Neurocognitive disorder
Correct Answer: B. Anxiety disorders
Rationale: GABA is the primary inhibitory neurotransmitter in the central nervous system.
Reduced GABAergic activity leads to decreased inhibition and increased neuronal excitability, which
is associated with anxiety disorders. Benzodiazepines, which enhance GABA activity, are effective
anxiolytics. While GABA may play a role in other conditions, its primary association is with anxiety.
Q8. A patient asks the PMHNP about the difference between a psychiatrist and a psychiatric
mental health nurse practitioner. Which response best describes the PMHNP scope of practice?
A. "PMHNPs can prescribe medications but cannot provide psychotherapy."
B. "PMHNPs focus only on medication management."
C. "PMHNPs provide both psychotherapy and medication management within their scope."
D. "PMHNPs work only in inpatient settings."
Correct Answer: C. "PMHNPs provide both psychotherapy and medication management within
their scope."
Rationale: PMHNPs are prepared to provide both psychotherapeutic interventions and
medication management, integrating both approaches in holistic care. They are not limited to
medication-only practice or inpatient settings. The PMHNP role emphasizes a comprehensive
biopsychosocial approach.
Q9. During a mental status examination, a patient's speech is rapid, pressured, and difficult to
interrupt. This finding is most consistent with which condition?
A. Major depressive disorder
B. Manic episode
C. Schizophrenia
D. Generalized anxiety disorder
Correct Answer: B. Manic episode
Rationale: Pressured speech is a hallmark of manic episodes. It is characterized by rapid, urgent
speech that is difficult to interrupt. Depressive episodes typically feature slowed speech.
Schizophrenia may present with disorganized speech, but the pressured quality is more specific to
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,NURS 6675 Mid Term Exam 2026
2026/2027 Examination
Total Questions: 200
Instructions:
• Answer all questions.
• Select the single best answer.
• Each question has four answer choices: A, B, C, and D.
• Select only ONE answer for each question.
SECTION 1: Foundations of Psychiatric Mental Health Nursing Practice
Questions 1–25
Q1. A PMHNP is conducting an initial assessment with a patient who reports feeling "empty" and
"unable to experience pleasure." The nurse practitioner recognizes that the ability to experience
pleasure is most closely linked to which neurobiological process?
A. Serotonergic dysregulation in the raphe nuclei
B. Dopaminergic transmission in the mesolimbic pathway
C. GABAergic inhibition in the thalamus
D. Noradrenergic excess in the locus coeruleus
Correct Answer: B. Dopaminergic transmission in the mesolimbic pathway
Rationale: The mesolimbic dopamine pathway is central to the brain's reward and pleasure
system. Anhedonia, or the inability to experience pleasure, is associated with reduced dopaminergic
activity in this pathway. Serotonergic dysregulation is more closely linked to mood and anxiety,
GABAergic inhibition relates to sedation and anxiety reduction, and noradrenergic excess is
associated with hyperarousal and anxiety.
Q2. During a psychiatric evaluation, a patient describes hearing voices that others do not hear
and expresses a belief that government agents are monitoring her through her television. The
PMHNP should document these findings as which of the following?
A. Mood-congruent psychotic features
B. Negative symptoms of schizophrenia
C. Positive symptoms of schizophrenia
D. Cognitive symptoms of schizophrenia
Correct Answer: C. Positive symptoms of schizophrenia
Rationale: Positive symptoms of schizophrenia include hallucinations and delusions, which
represent an excess or distortion of normal functioning. Negative symptoms include avolition, alogia,
and affective flattening. Cognitive symptoms involve difficulties with attention, memory, and
executive function. Mood-congruent psychotic features refer to hallucinations or delusions whose
content is consistent with a mood episode.
2|Page
, Q3. A PMHNP is educating a patient about the mechanism of action of selective serotonin
reuptake inhibitors (SSRIs). Which statement by the patient indicates correct understanding?
A. "SSRIs increase serotonin by blocking its reuptake, making more available in the synapse."
B. "SSRIs work by directly stimulating serotonin receptors in the brain."
C. "SSRIs decrease serotonin levels to prevent overstimulation."
D. "SSRIs block dopamine receptors to reduce psychotic symptoms."
Correct Answer: A. "SSRIs increase serotonin by blocking its reuptake, making more available in
the synapse."
Rationale: SSRIs work by inhibiting the serotonin transporter, preventing the reuptake of
serotonin into the presynaptic neuron. This increases serotonin availability in the synaptic cleft. They
do not directly stimulate receptors, decrease serotonin, or block dopamine receptors.
Q4. A patient presents with symptoms of generalized anxiety disorder. The PMHNP explains that
the "fight-or-flight" response is primarily mediated by which neurotransmitter system?
A. Dopaminergic
B. Serotonergic
C. Noradrenergic
D. Cholinergic
Correct Answer: C. Noradrenergic
Rationale: The noradrenergic system, particularly involving the locus coeruleus, plays a central
role in mediating the fight-or-flight response and arousal. Anxiety disorders are associated with
noradrenergic dysregulation. While serotonin and GABA also modulate anxiety, the acute stress
response is primarily noradrenergic.
Q5. A PMHNP is assessing a patient who reports persistent low mood, anhedonia, and feelings of
worthlessness for the past three months. Which diagnostic criterion is essential to establish a
diagnosis of major depressive disorder?
A. The presence of psychotic features
B. Symptoms lasting at least two weeks
C. A history of manic episodes
D. Suicidal ideation
Correct Answer: B. Symptoms lasting at least two weeks
Rationale: According to DSM-5-TR criteria, a major depressive episode requires symptoms to be
present for at least two weeks. Psychotic features and suicidal ideation may be present but are not
required for diagnosis. A history of manic episodes would suggest bipolar disorder rather than major
depressive disorder.
Q6. A patient tells the PMHNP, "I feel like I'm outside my body watching myself." This experience
is best described as which of the following?
A. Derealization
B. Depersonalization
C. Hallucination
D. Illusion
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, Correct Answer: B. Depersonalization
Rationale: Depersonalization is characterized by a sense of detachment from oneself, as if one is
an outside observer of one's mental processes or body. Derealization involves a sense of unreality or
detachment from the external environment. Hallucinations are sensory perceptions without external
stimuli, and illusions are misinterpretations of real external stimuli.
Q7. A PMHNP is considering the role of GABA in psychiatric disorders. Reduced GABAergic
activity has been most strongly implicated in which condition?
A. Schizophrenia
B. Anxiety disorders
C. Bipolar disorder
D. Neurocognitive disorder
Correct Answer: B. Anxiety disorders
Rationale: GABA is the primary inhibitory neurotransmitter in the central nervous system.
Reduced GABAergic activity leads to decreased inhibition and increased neuronal excitability, which
is associated with anxiety disorders. Benzodiazepines, which enhance GABA activity, are effective
anxiolytics. While GABA may play a role in other conditions, its primary association is with anxiety.
Q8. A patient asks the PMHNP about the difference between a psychiatrist and a psychiatric
mental health nurse practitioner. Which response best describes the PMHNP scope of practice?
A. "PMHNPs can prescribe medications but cannot provide psychotherapy."
B. "PMHNPs focus only on medication management."
C. "PMHNPs provide both psychotherapy and medication management within their scope."
D. "PMHNPs work only in inpatient settings."
Correct Answer: C. "PMHNPs provide both psychotherapy and medication management within
their scope."
Rationale: PMHNPs are prepared to provide both psychotherapeutic interventions and
medication management, integrating both approaches in holistic care. They are not limited to
medication-only practice or inpatient settings. The PMHNP role emphasizes a comprehensive
biopsychosocial approach.
Q9. During a mental status examination, a patient's speech is rapid, pressured, and difficult to
interrupt. This finding is most consistent with which condition?
A. Major depressive disorder
B. Manic episode
C. Schizophrenia
D. Generalized anxiety disorder
Correct Answer: B. Manic episode
Rationale: Pressured speech is a hallmark of manic episodes. It is characterized by rapid, urgent
speech that is difficult to interrupt. Depressive episodes typically feature slowed speech.
Schizophrenia may present with disorganized speech, but the pressured quality is more specific to
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