NRNP 6665 – Psychiatric Mental Health Nurse
Practitioner Across the Lifespan II (Walden
University) | Midterm Exam 2025/2026 – Verified
Questions, 100% Correct Answers & Expert
Rationales, Graded A+
Question 1: A 14-year-old adolescent presents with persistent sadness, anhedonia, and suicidal
ideation for 3 weeks after a breakup. According to DSM-5-TR, what is the most appropriate
initial diagnosis?
A. Adjustment disorder with depressed mood
B. Major depressive disorder
C. Persistent depressive disorder (dysthymia)
D. Bipolar II disorder
Correct Answer: B. Major depressive disorder
Rationale: DSM-5-TR requires ≥5 symptoms (including depressed mood or anhedonia) for ≥2
weeks causing impairment; adolescent onset common with irritability/suicidality. A if <2 weeks
stressor-related; C chronic >1 year; D needs hypomanic episode. Initiate SSRI like fluoxetine
(FDA-approved adolescents) with psychotherapy (CBT); monitor black box warning for
suicidality.
Question 2: In prescribing bupropion for a 45-year-old with MDD and nicotine dependence,
what is the primary mechanism of action and key contraindication?
A. SNRI; seizure disorder
B. NDRI; bulimia
C. SSRI; hypertension
D. MAOI; epilepsy
Correct Answer: B. NDRI; bulimia
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor effective for depression
and smoking cessation (Zyban); lowers seizure threshold, contraindicated in eating disorders like
bulimia due to electrolyte imbalance risk. A venlafaxine; C SSRIs; D phenelzine. Monitor BP,
avoid in seizure history.
Question 3: A 7-year-old child with ADHD inattentive type is started on methylphenidate. What
is the expected therapeutic effect on neuroimaging?
A. Increased frontal lobe dopamine
B. Decreased amygdala activity
,C. Enhanced serotonin in hippocampus
D. GABA modulation in basal ganglia
Correct Answer: A. Increased frontal lobe dopamine
Rationale: Stimulants block DAT/NET, increasing dopamine/norepinephrine in prefrontal
cortex improving executive function (Barkley model). Monitor growth, appetite; titrate 5-
60mg/day. B anxiety meds; C SSRIs; D benzodiazepines.
Question 4: According to HIPAA, when can a PMHNP disclose PHI without consent in a
psychiatric emergency?
A. Only to family
B. To prevent imminent harm
C. For billing
D. Never
Correct Answer: B. To prevent imminent harm
Rationale: HIPAA permits disclosure for safety (Tarasoff duty to warn); document threat
assessment. A needs ROI; C routine; D absolute privacy violates ethics.
Question 5: A 65-year-old with schizophrenia on risperidone develops EPS. What is the first-
line management?
A. Switch to clozapine
B. Add benztropine
C. Increase dose
D. Discontinue
Correct Answer: B. Add benztropine
Rationale: Anticholinergics like benztropine treat dystonia/parkinsonism from D2 blockade;
monitor anticholinergic SE. A refractory cases; C worsens; D nonadherence risk.
Question 6: In Erikson's stages, a 9-year-old struggling with peer rejection is at risk for what
psychosocial crisis outcome?
A. Inferiority
B. Guilt
C. Mistrust
D. Isolation
Correct Answer: A. Inferiority
Rationale: Industry vs. Inferiority (6-12 years); competence building. Failure leads to low self-
esteem; intervene with skill-building therapy.
, Question 7: A pregnant woman at 28 weeks with bipolar I needs mood stabilization. What is the
safest pharmacologic option?
A. Lamotrigine
B. Valproate
C. Lithium
D. Olanzapine
Correct Answer: A. Lamotrigine
Rationale: Lamotrigine category C, lower teratogenicity than valproate (neural tube defects) or
lithium (Ebstein's); monitor rash (SJS). APA guidelines recommend psychotherapy first; folate
supplement.
Question 8: The neurobiological basis of PTSD involves hyperactivity in which brain structure?
A. Amygdala
B. Prefrontal cortex
C. Hippocampus
D. Basal ganglia
Correct Answer: A. Amygdala
Rationale: Fear conditioning; hyperarousal. Reduced hippocampal volume affects memory;
hypoactive PFC poor extinction. Treat with SSRI (sertraline) and EMDR.
Question 9: A 22-year-old with anorexia nervosa refuses treatment. Under what ethical principle
can involuntary hospitalization occur?
A. Beneficence for life-threatening malnutrition
B. Autonomy always
C. Justice
D. Nonmaleficence alone
Correct Answer: A. Beneficence for life-threatening malnutrition
Rationale: ANA ethics: duty to promote good when imminent harm (BMI<14, bradycardia);
court order if needed. Respect autonomy post-stabilization with MOT.
Question 10: In CBT for OCD, what is the primary technique to reduce compulsions?
A. Exposure and response prevention (ERP)
B. Thought challenging
C. Mindfulness
D. Free association
Correct Answer: A. Exposure and response prevention (ERP)
Rationale: Gradual exposure to obsessions without ritual; 60-70% efficacy (APA). Y-BOCS
monitor; add SSRI if severe.
Practitioner Across the Lifespan II (Walden
University) | Midterm Exam 2025/2026 – Verified
Questions, 100% Correct Answers & Expert
Rationales, Graded A+
Question 1: A 14-year-old adolescent presents with persistent sadness, anhedonia, and suicidal
ideation for 3 weeks after a breakup. According to DSM-5-TR, what is the most appropriate
initial diagnosis?
A. Adjustment disorder with depressed mood
B. Major depressive disorder
C. Persistent depressive disorder (dysthymia)
D. Bipolar II disorder
Correct Answer: B. Major depressive disorder
Rationale: DSM-5-TR requires ≥5 symptoms (including depressed mood or anhedonia) for ≥2
weeks causing impairment; adolescent onset common with irritability/suicidality. A if <2 weeks
stressor-related; C chronic >1 year; D needs hypomanic episode. Initiate SSRI like fluoxetine
(FDA-approved adolescents) with psychotherapy (CBT); monitor black box warning for
suicidality.
Question 2: In prescribing bupropion for a 45-year-old with MDD and nicotine dependence,
what is the primary mechanism of action and key contraindication?
A. SNRI; seizure disorder
B. NDRI; bulimia
C. SSRI; hypertension
D. MAOI; epilepsy
Correct Answer: B. NDRI; bulimia
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor effective for depression
and smoking cessation (Zyban); lowers seizure threshold, contraindicated in eating disorders like
bulimia due to electrolyte imbalance risk. A venlafaxine; C SSRIs; D phenelzine. Monitor BP,
avoid in seizure history.
Question 3: A 7-year-old child with ADHD inattentive type is started on methylphenidate. What
is the expected therapeutic effect on neuroimaging?
A. Increased frontal lobe dopamine
B. Decreased amygdala activity
,C. Enhanced serotonin in hippocampus
D. GABA modulation in basal ganglia
Correct Answer: A. Increased frontal lobe dopamine
Rationale: Stimulants block DAT/NET, increasing dopamine/norepinephrine in prefrontal
cortex improving executive function (Barkley model). Monitor growth, appetite; titrate 5-
60mg/day. B anxiety meds; C SSRIs; D benzodiazepines.
Question 4: According to HIPAA, when can a PMHNP disclose PHI without consent in a
psychiatric emergency?
A. Only to family
B. To prevent imminent harm
C. For billing
D. Never
Correct Answer: B. To prevent imminent harm
Rationale: HIPAA permits disclosure for safety (Tarasoff duty to warn); document threat
assessment. A needs ROI; C routine; D absolute privacy violates ethics.
Question 5: A 65-year-old with schizophrenia on risperidone develops EPS. What is the first-
line management?
A. Switch to clozapine
B. Add benztropine
C. Increase dose
D. Discontinue
Correct Answer: B. Add benztropine
Rationale: Anticholinergics like benztropine treat dystonia/parkinsonism from D2 blockade;
monitor anticholinergic SE. A refractory cases; C worsens; D nonadherence risk.
Question 6: In Erikson's stages, a 9-year-old struggling with peer rejection is at risk for what
psychosocial crisis outcome?
A. Inferiority
B. Guilt
C. Mistrust
D. Isolation
Correct Answer: A. Inferiority
Rationale: Industry vs. Inferiority (6-12 years); competence building. Failure leads to low self-
esteem; intervene with skill-building therapy.
, Question 7: A pregnant woman at 28 weeks with bipolar I needs mood stabilization. What is the
safest pharmacologic option?
A. Lamotrigine
B. Valproate
C. Lithium
D. Olanzapine
Correct Answer: A. Lamotrigine
Rationale: Lamotrigine category C, lower teratogenicity than valproate (neural tube defects) or
lithium (Ebstein's); monitor rash (SJS). APA guidelines recommend psychotherapy first; folate
supplement.
Question 8: The neurobiological basis of PTSD involves hyperactivity in which brain structure?
A. Amygdala
B. Prefrontal cortex
C. Hippocampus
D. Basal ganglia
Correct Answer: A. Amygdala
Rationale: Fear conditioning; hyperarousal. Reduced hippocampal volume affects memory;
hypoactive PFC poor extinction. Treat with SSRI (sertraline) and EMDR.
Question 9: A 22-year-old with anorexia nervosa refuses treatment. Under what ethical principle
can involuntary hospitalization occur?
A. Beneficence for life-threatening malnutrition
B. Autonomy always
C. Justice
D. Nonmaleficence alone
Correct Answer: A. Beneficence for life-threatening malnutrition
Rationale: ANA ethics: duty to promote good when imminent harm (BMI<14, bradycardia);
court order if needed. Respect autonomy post-stabilization with MOT.
Question 10: In CBT for OCD, what is the primary technique to reduce compulsions?
A. Exposure and response prevention (ERP)
B. Thought challenging
C. Mindfulness
D. Free association
Correct Answer: A. Exposure and response prevention (ERP)
Rationale: Gradual exposure to obsessions without ritual; 60-70% efficacy (APA). Y-BOCS
monitor; add SSRI if severe.
