NRNP 6675 Final Exam | 200 Questions &
Answers | Walden University
NRNP 6675 Final Exam | 200 Questions & Answers | Walden University
Examination Overview
This comprehensive 200-question final examination is designed for students enrolled in NRNP 6675:
Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan II at Walden University. The
examination assesses mastery of advanced psychiatric-mental health nursing practice, including
diagnostic reasoning using the DSM-5-TR, psychopharmacological management, psychotherapeutic
modalities, neurobiological foundations, ethical-legal principles, and culturally competent care
across the lifespan. Questions are structured according to professional certification examination
standards and reflect the course learning objectives emphasizing clinical competence, differential
diagnosis, treatment planning, and interprofessional collaboration.
Table of Contents
1. Scientific Foundations & Neurobiology (Q1–Q25)
2. Psychopharmacology & Somatic Treatments (Q26–Q55)
3. Psychotherapy & Therapeutic Modalities (Q56–Q75)
4. Mood Disorders (Q76–Q95)
5. Anxiety, OCD, Trauma & Stressor-Related Disorders (Q96–Q115)
6. Schizophrenia Spectrum & Psychotic Disorders (Q116–Q135)
7. Neurodevelopmental & Neurocognitive Disorders (Q136–Q150)
8. Personality Disorders (Q151–Q160)
9. Substance Use & Addictive Disorders (Q161–Q170)
10. Legal, Ethical & Professional Practice Issues (Q171–Q185)
11. Crisis & Emergency Psychiatry (Q186–Q200)
Section 1: Scientific Foundations & Neurobiology
Q1. A PMHNP is reviewing the neurobiological basis of schizophrenia. Which dopaminergic pathway
is primarily implicated in the positive symptoms of schizophrenia?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Correct Answer: C. Mesolimbic pathway
pg. 1
,Rationale: The dopamine hypothesis posits that positive symptoms of schizophrenia (hallucinations,
delusions) result from excessive dopaminergic activity in the mesolimbic pathway, which projects
from the ventral tegmental area to limbic structures. The mesocortical pathway is associated with
negative symptoms, the nigrostriatal pathway with extrapyramidal symptoms, and the
tuberoinfundibular pathway with prolactin regulation.
Q2. A PMHNP is assessing a patient with suspected neuroleptic malignant syndrome (NMS). Which
set of findings is most consistent with this diagnosis?
A. Hypothermia, bradycardia, hypotension, and decreased muscle tone
B. Hyperthermia, muscle rigidity, autonomic instability, and altered mental status
C. Hyporeflexia, sedation, weight gain, and hyperglycemia
D. Tardive dyskinesia, akathisia, and parkinsonism
Correct Answer: B. Hyperthermia, muscle rigidity, autonomic instability, and altered mental status
Rationale: NMS is a life-threatening condition characterized by the tetrad of hyperthermia, severe
muscle rigidity ("lead-pipe"), autonomic instability (fever, tachycardia, labile blood pressure), and
altered mental status. It is associated with antipsychotic use, particularly high-potency typical
antipsychotics or rapid dose escalation. Tardive dyskinesia and akathisia are separate extrapyramidal
side effects.
Q3. Which brain structure is most closely associated with the pathophysiology of obsessive-
compulsive disorder (OCD)?
A. Amygdala
B. Hippocampus
C. Orbitofrontal cortex and caudate nucleus
D. Substantia nigra
Correct Answer: C. Orbitofrontal cortex and caudate nucleus
Rationale: OCD is associated with dysfunction in the cortico-striato-thalamo-cortical circuitry,
particularly involving the orbitofrontal cortex, anterior cingulate cortex, and caudate nucleus. This
circuit dysregulation produces the intrusive thoughts (obsessions) and repetitive behaviors
(compulsions) characteristic of OCD.
Q4. A PMHNP is evaluating a patient for possible serotonin syndrome. Which combination of
medications most commonly precipitates this condition?
A. Lithium and haloperidol
B. Fluoxetine and tramadol
C. Clozapine and valproate
D. Bupropion and naltrexone
Correct Answer: B. Fluoxetine and tramadol
pg. 2
,Rationale: Serotonin syndrome results from excessive serotonergic activity, typically when two or
more serotonergic agents are combined. Fluoxetine (an SSRI) and tramadol (which has serotonergic
properties) together increase serotonin levels, potentially causing the triad of mental status changes,
autonomic hyperactivity, and neuromuscular abnormalities.
Q5. A 28-year-old patient presents with depressed mood, anhedonia, insomnia, and feelings of
worthlessness for the past 6 weeks. The PMHNP should first:
A. Initiate sertraline 50 mg daily
B. Obtain a comprehensive psychiatric evaluation including suicide risk assessment
C. Refer for electroconvulsive therapy
D. Start cognitive behavioral therapy alone
Correct Answer: B. Obtain a comprehensive psychiatric evaluation including suicide risk
assessment
Rationale: The priority is to conduct a comprehensive psychiatric evaluation, including assessment
of suicide risk, before initiating treatment. This guides diagnosis, safety planning, and treatment
selection. Medication and psychotherapy follow assessment.
Q6. Which of the following are risk factors for neuroleptic malignant syndrome (NMS)?
A. Rapid dose escalation of antipsychotics
B. Parenteral route of antipsychotic administration
C. Use of higher potency typical antipsychotics
D. All of the above
Correct Answer: D. All of the above
Rationale: Risk factors for NMS include rapid dose escalation, parenteral administration, use of high-
potency typical antipsychotics, dehydration, agitation, and male gender. All listed options are
recognized risk factors.
Q7. A discrepancy between anatomical sex and gender is known as:
A. Gender dysphoria
B. Gender discordance
C. Sexual dysfunction
D. Paraphilic disorder
Correct Answer: B. Gender discordance
Rationale: Gender discordance refers to the discrepancy between an individual's assigned sex at
birth and their experienced gender identity. Gender dysphoria is the distress that may accompany
this discrepancy and is a DSM-5-TR diagnosis.
pg. 3
, Q8. Antipsychotic medication provides D2 blockage in the mesocortical pathway causing which of
the following effects?
A. Increases positive symptoms
B. Increases extrapyramidal symptoms
C. Reduces negative symptoms
D. Reduces positive symptoms
Correct Answer: C. Reduces negative symptoms
Rationale: D2 blockade in the mesocortical pathway is thought to help reduce negative symptoms of
schizophrenia (flat affect, avolition, alogia). However, excessive blockade in this pathway may also
contribute to cognitive and negative symptom worsening in some patients.
Q9. According to the dopamine hypothesis of schizophrenia, which statement best describes the
underlying neurobiological mechanism?
A. Schizophrenia results from deficient dopaminergic activity in all brain regions
B. Schizophrenia results from excessive dopaminergic activity, particularly in the mesolimbic
pathway
C. Schizophrenia is caused by a single genetic mutation affecting dopamine receptor density
D. Schizophrenia results from excessive serotonergic activity
Correct Answer: B. Schizophrenia results from excessive dopaminergic activity, particularly in the
mesolimbic pathway
Rationale: The dopamine hypothesis posits that positive symptoms of schizophrenia result from
excessive dopaminergic activity in the mesolimbic pathway, while negative symptoms may relate to
hypodopaminergic activity in the mesocortical pathway.
Q10. Which of the following is true regarding the blood-brain barrier and psychotropic medications?
A. All psychotropic medications cross the blood-brain barrier freely
B. Only lipophilic medications can cross the blood-brain barrier
C. The blood-brain barrier has no effect on psychotropic medication efficacy
D. Psychotropic medications are actively transported out of the brain
Correct Answer: B. Only lipophilic medications can cross the blood-brain barrier
Rationale: The blood-brain barrier restricts passage of hydrophilic substances. Psychotropic
medications must be sufficiently lipophilic to cross into the central nervous system and exert their
therapeutic effects. This property influences drug selection and dosing.
Q11. A PMHNP is assessing a patient who has been taking clozapine for 3 months. Which laboratory
monitoring parameter is most critical for this patient?
A. Absolute neutrophil count
B. Serum lithium level
pg. 4
Answers | Walden University
NRNP 6675 Final Exam | 200 Questions & Answers | Walden University
Examination Overview
This comprehensive 200-question final examination is designed for students enrolled in NRNP 6675:
Psychiatric Mental Health Nurse Practitioner Care Across the Lifespan II at Walden University. The
examination assesses mastery of advanced psychiatric-mental health nursing practice, including
diagnostic reasoning using the DSM-5-TR, psychopharmacological management, psychotherapeutic
modalities, neurobiological foundations, ethical-legal principles, and culturally competent care
across the lifespan. Questions are structured according to professional certification examination
standards and reflect the course learning objectives emphasizing clinical competence, differential
diagnosis, treatment planning, and interprofessional collaboration.
Table of Contents
1. Scientific Foundations & Neurobiology (Q1–Q25)
2. Psychopharmacology & Somatic Treatments (Q26–Q55)
3. Psychotherapy & Therapeutic Modalities (Q56–Q75)
4. Mood Disorders (Q76–Q95)
5. Anxiety, OCD, Trauma & Stressor-Related Disorders (Q96–Q115)
6. Schizophrenia Spectrum & Psychotic Disorders (Q116–Q135)
7. Neurodevelopmental & Neurocognitive Disorders (Q136–Q150)
8. Personality Disorders (Q151–Q160)
9. Substance Use & Addictive Disorders (Q161–Q170)
10. Legal, Ethical & Professional Practice Issues (Q171–Q185)
11. Crisis & Emergency Psychiatry (Q186–Q200)
Section 1: Scientific Foundations & Neurobiology
Q1. A PMHNP is reviewing the neurobiological basis of schizophrenia. Which dopaminergic pathway
is primarily implicated in the positive symptoms of schizophrenia?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Correct Answer: C. Mesolimbic pathway
pg. 1
,Rationale: The dopamine hypothesis posits that positive symptoms of schizophrenia (hallucinations,
delusions) result from excessive dopaminergic activity in the mesolimbic pathway, which projects
from the ventral tegmental area to limbic structures. The mesocortical pathway is associated with
negative symptoms, the nigrostriatal pathway with extrapyramidal symptoms, and the
tuberoinfundibular pathway with prolactin regulation.
Q2. A PMHNP is assessing a patient with suspected neuroleptic malignant syndrome (NMS). Which
set of findings is most consistent with this diagnosis?
A. Hypothermia, bradycardia, hypotension, and decreased muscle tone
B. Hyperthermia, muscle rigidity, autonomic instability, and altered mental status
C. Hyporeflexia, sedation, weight gain, and hyperglycemia
D. Tardive dyskinesia, akathisia, and parkinsonism
Correct Answer: B. Hyperthermia, muscle rigidity, autonomic instability, and altered mental status
Rationale: NMS is a life-threatening condition characterized by the tetrad of hyperthermia, severe
muscle rigidity ("lead-pipe"), autonomic instability (fever, tachycardia, labile blood pressure), and
altered mental status. It is associated with antipsychotic use, particularly high-potency typical
antipsychotics or rapid dose escalation. Tardive dyskinesia and akathisia are separate extrapyramidal
side effects.
Q3. Which brain structure is most closely associated with the pathophysiology of obsessive-
compulsive disorder (OCD)?
A. Amygdala
B. Hippocampus
C. Orbitofrontal cortex and caudate nucleus
D. Substantia nigra
Correct Answer: C. Orbitofrontal cortex and caudate nucleus
Rationale: OCD is associated with dysfunction in the cortico-striato-thalamo-cortical circuitry,
particularly involving the orbitofrontal cortex, anterior cingulate cortex, and caudate nucleus. This
circuit dysregulation produces the intrusive thoughts (obsessions) and repetitive behaviors
(compulsions) characteristic of OCD.
Q4. A PMHNP is evaluating a patient for possible serotonin syndrome. Which combination of
medications most commonly precipitates this condition?
A. Lithium and haloperidol
B. Fluoxetine and tramadol
C. Clozapine and valproate
D. Bupropion and naltrexone
Correct Answer: B. Fluoxetine and tramadol
pg. 2
,Rationale: Serotonin syndrome results from excessive serotonergic activity, typically when two or
more serotonergic agents are combined. Fluoxetine (an SSRI) and tramadol (which has serotonergic
properties) together increase serotonin levels, potentially causing the triad of mental status changes,
autonomic hyperactivity, and neuromuscular abnormalities.
Q5. A 28-year-old patient presents with depressed mood, anhedonia, insomnia, and feelings of
worthlessness for the past 6 weeks. The PMHNP should first:
A. Initiate sertraline 50 mg daily
B. Obtain a comprehensive psychiatric evaluation including suicide risk assessment
C. Refer for electroconvulsive therapy
D. Start cognitive behavioral therapy alone
Correct Answer: B. Obtain a comprehensive psychiatric evaluation including suicide risk
assessment
Rationale: The priority is to conduct a comprehensive psychiatric evaluation, including assessment
of suicide risk, before initiating treatment. This guides diagnosis, safety planning, and treatment
selection. Medication and psychotherapy follow assessment.
Q6. Which of the following are risk factors for neuroleptic malignant syndrome (NMS)?
A. Rapid dose escalation of antipsychotics
B. Parenteral route of antipsychotic administration
C. Use of higher potency typical antipsychotics
D. All of the above
Correct Answer: D. All of the above
Rationale: Risk factors for NMS include rapid dose escalation, parenteral administration, use of high-
potency typical antipsychotics, dehydration, agitation, and male gender. All listed options are
recognized risk factors.
Q7. A discrepancy between anatomical sex and gender is known as:
A. Gender dysphoria
B. Gender discordance
C. Sexual dysfunction
D. Paraphilic disorder
Correct Answer: B. Gender discordance
Rationale: Gender discordance refers to the discrepancy between an individual's assigned sex at
birth and their experienced gender identity. Gender dysphoria is the distress that may accompany
this discrepancy and is a DSM-5-TR diagnosis.
pg. 3
, Q8. Antipsychotic medication provides D2 blockage in the mesocortical pathway causing which of
the following effects?
A. Increases positive symptoms
B. Increases extrapyramidal symptoms
C. Reduces negative symptoms
D. Reduces positive symptoms
Correct Answer: C. Reduces negative symptoms
Rationale: D2 blockade in the mesocortical pathway is thought to help reduce negative symptoms of
schizophrenia (flat affect, avolition, alogia). However, excessive blockade in this pathway may also
contribute to cognitive and negative symptom worsening in some patients.
Q9. According to the dopamine hypothesis of schizophrenia, which statement best describes the
underlying neurobiological mechanism?
A. Schizophrenia results from deficient dopaminergic activity in all brain regions
B. Schizophrenia results from excessive dopaminergic activity, particularly in the mesolimbic
pathway
C. Schizophrenia is caused by a single genetic mutation affecting dopamine receptor density
D. Schizophrenia results from excessive serotonergic activity
Correct Answer: B. Schizophrenia results from excessive dopaminergic activity, particularly in the
mesolimbic pathway
Rationale: The dopamine hypothesis posits that positive symptoms of schizophrenia result from
excessive dopaminergic activity in the mesolimbic pathway, while negative symptoms may relate to
hypodopaminergic activity in the mesocortical pathway.
Q10. Which of the following is true regarding the blood-brain barrier and psychotropic medications?
A. All psychotropic medications cross the blood-brain barrier freely
B. Only lipophilic medications can cross the blood-brain barrier
C. The blood-brain barrier has no effect on psychotropic medication efficacy
D. Psychotropic medications are actively transported out of the brain
Correct Answer: B. Only lipophilic medications can cross the blood-brain barrier
Rationale: The blood-brain barrier restricts passage of hydrophilic substances. Psychotropic
medications must be sufficiently lipophilic to cross into the central nervous system and exert their
therapeutic effects. This property influences drug selection and dosing.
Q11. A PMHNP is assessing a patient who has been taking clozapine for 3 months. Which laboratory
monitoring parameter is most critical for this patient?
A. Absolute neutrophil count
B. Serum lithium level
pg. 4
