NRNP 6645 MIDTERM EXAM REVIEW |
COMPLETE QUESTIONS AND ANSWERS
| 2026/27 UPDATED | 100% CORRECT.
145 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
NRNP 6645 MIDTERM EXAM REVIEW | COMPLETE QUESTIONS AND ANSWERS | 2026/27 UPDATED |
100% CORRECT.. It contains 145 carefully selected questions that reflect the most current exam content and
testing strategies. Each question is accompanied by a correct answer and a detailed rationale that explains the
underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 145 Questions
Foundations - Application - NRNP 6645 Review Complete AND 2026/27 Updated 100 Correct
Psychiatric-mental Health Advanced Nursing Psychotherapy Modalities Psychopharmacology AND
Assessment Graduate Msn/pmhnp
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Advanced Psychiatric Mental 1-25 Disorder, Schizophrenia, Therapeutic, Finding, Reports
Health Nursing Foundations
Neurobiology AND 26-50 Disorder, Reports, Depressive, Appropriate, Lithium
Psychopharmacology
Psychiatric Assessment AND 51-75 Disorder, Lithium, Finding, Syndrome, Laboratory
Diagnostic Reasoning
MOOD Disorders AND 76-100 Disorder, Depressive, Lithium, Explains, Mechanism
Anxiety Disorders
Psychotic Disorders AND 101-125 Disorder, Appropriate, Laboratory, Reports, Schizophrenia
Schizophrenia
Personality Disorders AND 126-145 Disorder, Therapy, Finding, Laboratory, Monitoring
Trauma-related Disorders
TOTAL 145 All questions include answers and detailed rationales
,Section A - Advanced Psychiatric Mental Health Nursing
Foundations
Q1.
A patient with borderline personality disorder engages in splitting behavior toward the
treatment team. Which therapeutic approach is most consistent with evidence-based
management of this dynamic?
A. Interpret the splitting as resistance and B. Maintain a consistent, non-reactive
confront it directly in the next session. stance with clear boundaries and team
communication.
C. Alternate therapists to prevent the patient D. Reduce session frequency to minimize
from becoming attached to one clinician. opportunities for splitting.
Correct: B - Maintain a consistent, non-reactive stance with clear boundaries and team
communication.
Rationale:Splitting is managed through consistent team communication, clear boundaries,
and a non-reactive therapeutic stance, which prevents reinforcement of polarized perceptions.
Confrontation, therapist rotation, and reduced frequency tend to escalate splitting and
undermine the therapeutic alliance.
Why the other answers are wrong:
A. Direct confrontation of splitting often intensifies shame and rupture rather than resolving the
dynamic.
C. Rotating therapists disrupts attachment and worsens splitting rather than containing it.
D. Decreasing session frequency reduces containment and typically increases acting-out
behavior.
Reference: Gabbard, G.O. (2024). Psychodynamic Psychiatry in Clinical Practice, 6th Ed., Ch. 23
Q2.
Which finding best supports a diagnosis of serotonin syndrome rather than neuroleptic
malignant syndrome in a patient taking multiple serotonergic agents?
A. Lead-pipe rigidity with markedly elevated B. Hyperreflexia and clonus with rapid onset
creatine kinase after dose escalation
C. Bradyreflexia with profound diaphoresis D. Gradual onset over 5-7 days with
and hypothermia asymmetric rigidity
Correct: B - Hyperreflexia and clonus with rapid onset after dose escalation
Page 3
, Section A - Advanced Psychiatric Mental Health Nursing Foundations
Rationale: Serotonin syndrome is characterized by rapid onset, neuromuscular
hyperexcitability (hyperreflexia, clonus), and autonomic instability, often after adding or
increasing serotonergic drugs. NMS typically presents with lead-pipe rigidity, elevated CK,
and a slower onset, distinguishing it from serotonin toxicity.
Why the other answers are wrong:
A. Lead-pipe rigidity and elevated CK are classic features of NMS, not serotonin syndrome.
C. Bradyreflexia and hypothermia are inconsistent with serotonin syndrome's hyperexcitable
profile.
D. Gradual onset with asymmetric rigidity does not fit the acute hyperreflexic picture of
serotonin syndrome.
Reference: Stahl, S.M. (2024). Stahl's Essential Psychopharmacology, 5th Ed., Ch. 12
Q3.
A patient on lithium reports new-onset coarse tremor, ataxia, and vomiting. Which action
is most appropriate?
A. Continue lithium and add propranolol for B. Hold lithium, obtain serum level, and
tremor control. evaluate renal function.
C. Reduce lithium dose by 25% and recheck D. Switch to valproate immediately without
level in one week. further labs.
Correct: B - Hold lithium, obtain serum level, and evaluate renal function.
Rationale:Coarse tremor, ataxia, and vomiting suggest lithium toxicity; the priority is to hold
the drug, measure serum level, and assess renal function and hydration. Adding propranolol,
partial dose reduction, or blind switching risks continued toxicity and fails to address the acute
problem.
Why the other answers are wrong:
A. Propranolol treats benign tremor but does not address acute lithium toxicity.
C. A 25% reduction is insufficient in suspected toxicity and delays needed evaluation.
D. Abrupt switching without labs ignores the acute medical risk and lacks diagnostic data.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 31
Q4.
Which statement best reflects the core mechanism of cognitive behavioral therapy (CBT)
in treating major depressive disorder?
A. It primarily resolves unconscious conflicts B. It modifies maladaptive automatic
through dream interpretation. thoughts and behavioral patterns to reduce
depressive symptoms.
C. It relies on free association to uncover D. It uses unconditional positive regard as
repressed memories. the sole agent of change.
Page 4
COMPLETE QUESTIONS AND ANSWERS
| 2026/27 UPDATED | 100% CORRECT.
145 Questions with Answers and Detailed Rationales
100 PERCENT GUARANTEED PASS
INSTANT DOWNLOAD ANSWERS INCLUDED
IMPORTANCE OF THIS DOCUMENT
This comprehensive examination preparation guide has been meticulously developed to help you succeed in the
NRNP 6645 MIDTERM EXAM REVIEW | COMPLETE QUESTIONS AND ANSWERS | 2026/27 UPDATED |
100% CORRECT.. It contains 145 carefully selected questions that reflect the most current exam content and
testing strategies. Each question is accompanied by a correct answer and a detailed rationale that explains the
underlying pathophysiology, pharmacology, or clinical reasoning.
Self-Assessment – Test your knowledge and Exam Preparation – Familiarize yourself with the
identify areas requiring further question format and content
study areas
Concept Reinforcement – Deepen your Confidence Building – Develop test-taking
understanding through strategies and reduce
evidence-based exam anxiety
rationales
Time Management – Practice answering
questions under simulated
exam conditions
Review Summary 145 Questions
Foundations - Application - NRNP 6645 Review Complete AND 2026/27 Updated 100 Correct
Psychiatric-mental Health Advanced Nursing Psychotherapy Modalities Psychopharmacology AND
Assessment Graduate Msn/pmhnp
All answers with rationales
,Table of Contents
Content Area Questions Key Topics
Advanced Psychiatric Mental 1-25 Disorder, Schizophrenia, Therapeutic, Finding, Reports
Health Nursing Foundations
Neurobiology AND 26-50 Disorder, Reports, Depressive, Appropriate, Lithium
Psychopharmacology
Psychiatric Assessment AND 51-75 Disorder, Lithium, Finding, Syndrome, Laboratory
Diagnostic Reasoning
MOOD Disorders AND 76-100 Disorder, Depressive, Lithium, Explains, Mechanism
Anxiety Disorders
Psychotic Disorders AND 101-125 Disorder, Appropriate, Laboratory, Reports, Schizophrenia
Schizophrenia
Personality Disorders AND 126-145 Disorder, Therapy, Finding, Laboratory, Monitoring
Trauma-related Disorders
TOTAL 145 All questions include answers and detailed rationales
,Section A - Advanced Psychiatric Mental Health Nursing
Foundations
Q1.
A patient with borderline personality disorder engages in splitting behavior toward the
treatment team. Which therapeutic approach is most consistent with evidence-based
management of this dynamic?
A. Interpret the splitting as resistance and B. Maintain a consistent, non-reactive
confront it directly in the next session. stance with clear boundaries and team
communication.
C. Alternate therapists to prevent the patient D. Reduce session frequency to minimize
from becoming attached to one clinician. opportunities for splitting.
Correct: B - Maintain a consistent, non-reactive stance with clear boundaries and team
communication.
Rationale:Splitting is managed through consistent team communication, clear boundaries,
and a non-reactive therapeutic stance, which prevents reinforcement of polarized perceptions.
Confrontation, therapist rotation, and reduced frequency tend to escalate splitting and
undermine the therapeutic alliance.
Why the other answers are wrong:
A. Direct confrontation of splitting often intensifies shame and rupture rather than resolving the
dynamic.
C. Rotating therapists disrupts attachment and worsens splitting rather than containing it.
D. Decreasing session frequency reduces containment and typically increases acting-out
behavior.
Reference: Gabbard, G.O. (2024). Psychodynamic Psychiatry in Clinical Practice, 6th Ed., Ch. 23
Q2.
Which finding best supports a diagnosis of serotonin syndrome rather than neuroleptic
malignant syndrome in a patient taking multiple serotonergic agents?
A. Lead-pipe rigidity with markedly elevated B. Hyperreflexia and clonus with rapid onset
creatine kinase after dose escalation
C. Bradyreflexia with profound diaphoresis D. Gradual onset over 5-7 days with
and hypothermia asymmetric rigidity
Correct: B - Hyperreflexia and clonus with rapid onset after dose escalation
Page 3
, Section A - Advanced Psychiatric Mental Health Nursing Foundations
Rationale: Serotonin syndrome is characterized by rapid onset, neuromuscular
hyperexcitability (hyperreflexia, clonus), and autonomic instability, often after adding or
increasing serotonergic drugs. NMS typically presents with lead-pipe rigidity, elevated CK,
and a slower onset, distinguishing it from serotonin toxicity.
Why the other answers are wrong:
A. Lead-pipe rigidity and elevated CK are classic features of NMS, not serotonin syndrome.
C. Bradyreflexia and hypothermia are inconsistent with serotonin syndrome's hyperexcitable
profile.
D. Gradual onset with asymmetric rigidity does not fit the acute hyperreflexic picture of
serotonin syndrome.
Reference: Stahl, S.M. (2024). Stahl's Essential Psychopharmacology, 5th Ed., Ch. 12
Q3.
A patient on lithium reports new-onset coarse tremor, ataxia, and vomiting. Which action
is most appropriate?
A. Continue lithium and add propranolol for B. Hold lithium, obtain serum level, and
tremor control. evaluate renal function.
C. Reduce lithium dose by 25% and recheck D. Switch to valproate immediately without
level in one week. further labs.
Correct: B - Hold lithium, obtain serum level, and evaluate renal function.
Rationale:Coarse tremor, ataxia, and vomiting suggest lithium toxicity; the priority is to hold
the drug, measure serum level, and assess renal function and hydration. Adding propranolol,
partial dose reduction, or blind switching risks continued toxicity and fails to address the acute
problem.
Why the other answers are wrong:
A. Propranolol treats benign tremor but does not address acute lithium toxicity.
C. A 25% reduction is insufficient in suspected toxicity and delays needed evaluation.
D. Abrupt switching without labs ignores the acute medical risk and lacks diagnostic data.
Reference: Lehne, R.A. (2026). Pharmacology for Nursing Care, 12th Ed., Ch. 31
Q4.
Which statement best reflects the core mechanism of cognitive behavioral therapy (CBT)
in treating major depressive disorder?
A. It primarily resolves unconscious conflicts B. It modifies maladaptive automatic
through dream interpretation. thoughts and behavioral patterns to reduce
depressive symptoms.
C. It relies on free association to uncover D. It uses unconditional positive regard as
repressed memories. the sole agent of change.
Page 4
