NRNP 6675 Final Exam (2026/2027) | UPDATED KNOWLEDGE TEST QUESTIONS WITH
CORRECT ANSWERS
Walden University PMHNP Program | NRNP 6675: PMHNP Care Across the Lifespan II | Final Exam
Assessment | Core Domains: Complex Psychopharmacology, Co-Occurring Medical & Psychiatric
Disorders, Treatment-Resistant Conditions, Psychotherapy Integration, Crisis Management, Forensic
Psychiatry, Telepsychiatry, and Advanced Prescriptive Practice | Psychiatric-Mental Health Nurse
Practitioner Focus | Graduate-Level Competency Exam Format
Exam Structure
The NRNP 6675 Final Exam for the 2026/2027 academic cycle is a 100-question, multiple-choice
examination.
Introduction
This NRNP 6675 Final Exam preparation guide for the 2026/2027 academic year reflects the latest
evidence-based practices for managing complex psychiatric conditions across the lifespan. The content
emphasizes advanced differential diagnosis, integrated treatment planning, ethical considerations, and
prescriptive authority within the full PMHNP scope of practice.
Answer Format
All correct answers and clinical interventions must be presented in bold and green, followed by detailed
rationales integrating advanced psychopharmacology, DSM-6 diagnostic criteria, risk assessment, and
population-specific treatment considerations.
1. A 45-year-old patient with treatment-resistant major depressive disorder (TRD) has
failed two adequate trials of SSRIs and one SNRI. Which next-step intervention has the
strongest evidence for rapid response?
A. Switch to bupropion
B. Augment with lithium
C. Intranasal esketamine
D. Start cognitive behavioral therapy (CBT) alone
, Intranasal esketamine, combined with an oral antidepressant, is FDA-approved for TRD and
produces rapid (within hours) antidepressant effects in patients who have failed ≥2 treatments. It
acts via NMDA receptor antagonism and synaptic plasticity mechanisms. Lithium augmentation has
evidence but slower onset; bupropion switch is less effective after multiple failures.
2. A 62-year-old male with bipolar I disorder, type 2 diabetes, and chronic kidney disease
(eGFR 42 mL/min) requires mood stabilization. Which agent is safest?
A. Lithium
B. Valproate
C. Lamotrigine
D. Carbamazepine
Lamotrigine is renally excreted but does not require dose adjustment in mild-moderate CKD and has
a favorable metabolic profile (no weight gain, dyslipidemia, or hepatotoxicity). Lithium is
contraindicated in CKD due to nephrotoxicity; valproate and carbamazepine pose hepatic and drug
interaction risks.
3. A 28-year-old patient presents with 3 weeks of elevated mood, decreased need for sleep,
pressured speech, and reckless spending. Collateral history reveals a prior episode of
major depression. What is the most likely diagnosis?
A. Bipolar II disorder
B. Cyclothymic disorder
C. Bipolar I disorder
D. Borderline personality disorder
The presence of a manic episode (elevated mood + ≥3 symptoms causing marked impairment)
defines bipolar I disorder, regardless of prior depression. Bipolar II requires hypomania (not full
mania) and major depression. Cyclothymia involves chronic subthreshold symptoms; BPD mood
shifts are reactive and brief.
,4. A 70-year-old with late-life depression and Parkinson’s disease develops worsening
psychosis (visual hallucinations, paranoia). Which antipsychotic is first-line?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Olanzapine
Quetiapine is preferred in Parkinson’s psychosis due to low D2 receptor affinity and minimal
extrapyramidal side effects (EPS). High-potency antipsychotics (e.g., haloperidol) and even
risperidone can worsen parkinsonism. Pimavanserin is FDA-approved but not always first-line due
to cost and access.
5. A 19-year-old college student with first-episode schizophrenia is started on aripiprazole.
What is the primary advantage of this agent in early psychosis?
A. Highest efficacy for positive symptoms
B. Rapid sedation
C. Lower risk of metabolic and motor side effects
D. Once-daily injectable formulation
Aripiprazole, a partial D2 agonist, has a favorable side effect profile with minimal weight gain,
metabolic disturbance, and EPS—critical for adherence and quality of life in young patients with
first-episode psychosis. Clozapine is more efficacious but reserved for treatment resistance due to
agranulocytosis risk.
6. A patient with severe OCD has failed high-dose SSRIs and CBT. Which augmentation
strategy is evidence-based?
A. Add bupropion
, B. Add lamotrigine
C. Add low-dose antipsychotic (e.g., risperidone)
D. Switch to MAOI
Antipsychotic augmentation (risperidone, aripiprazole) is FDA-supported for treatment-resistant
OCD, targeting dopaminergic hyperactivity in cortico-striatal circuits. Bupropion and lamotrigine
lack robust evidence; MAOIs are rarely used due to dietary restrictions and side effects.
7. A 55-year-old with alcohol use disorder and comorbid anxiety requests
pharmacotherapy. Which agent reduces both craving and anxiety?
A. Disulfiram
B. Naltrexone
C. Acamprosate
D. Topiramate
Acamprosate stabilizes GABA/glutamate imbalance post-detox, reducing protracted withdrawal
symptoms like anxiety and insomnia, which drive relapse. Naltrexone reduces craving and heavy
drinking but has less anxiolytic effect. Topiramate has off-label use but more cognitive side effects.
8. A 33-year-old female with PTSD and nightmares reports no improvement after 12 weeks
of sertraline. What is the next best step?
A. Increase sertraline dose
B. Switch to venlafaxine
C. Add prazosin 1 mg at bedtime
D. Discontinue medication and focus on EMDR
CORRECT ANSWERS
Walden University PMHNP Program | NRNP 6675: PMHNP Care Across the Lifespan II | Final Exam
Assessment | Core Domains: Complex Psychopharmacology, Co-Occurring Medical & Psychiatric
Disorders, Treatment-Resistant Conditions, Psychotherapy Integration, Crisis Management, Forensic
Psychiatry, Telepsychiatry, and Advanced Prescriptive Practice | Psychiatric-Mental Health Nurse
Practitioner Focus | Graduate-Level Competency Exam Format
Exam Structure
The NRNP 6675 Final Exam for the 2026/2027 academic cycle is a 100-question, multiple-choice
examination.
Introduction
This NRNP 6675 Final Exam preparation guide for the 2026/2027 academic year reflects the latest
evidence-based practices for managing complex psychiatric conditions across the lifespan. The content
emphasizes advanced differential diagnosis, integrated treatment planning, ethical considerations, and
prescriptive authority within the full PMHNP scope of practice.
Answer Format
All correct answers and clinical interventions must be presented in bold and green, followed by detailed
rationales integrating advanced psychopharmacology, DSM-6 diagnostic criteria, risk assessment, and
population-specific treatment considerations.
1. A 45-year-old patient with treatment-resistant major depressive disorder (TRD) has
failed two adequate trials of SSRIs and one SNRI. Which next-step intervention has the
strongest evidence for rapid response?
A. Switch to bupropion
B. Augment with lithium
C. Intranasal esketamine
D. Start cognitive behavioral therapy (CBT) alone
, Intranasal esketamine, combined with an oral antidepressant, is FDA-approved for TRD and
produces rapid (within hours) antidepressant effects in patients who have failed ≥2 treatments. It
acts via NMDA receptor antagonism and synaptic plasticity mechanisms. Lithium augmentation has
evidence but slower onset; bupropion switch is less effective after multiple failures.
2. A 62-year-old male with bipolar I disorder, type 2 diabetes, and chronic kidney disease
(eGFR 42 mL/min) requires mood stabilization. Which agent is safest?
A. Lithium
B. Valproate
C. Lamotrigine
D. Carbamazepine
Lamotrigine is renally excreted but does not require dose adjustment in mild-moderate CKD and has
a favorable metabolic profile (no weight gain, dyslipidemia, or hepatotoxicity). Lithium is
contraindicated in CKD due to nephrotoxicity; valproate and carbamazepine pose hepatic and drug
interaction risks.
3. A 28-year-old patient presents with 3 weeks of elevated mood, decreased need for sleep,
pressured speech, and reckless spending. Collateral history reveals a prior episode of
major depression. What is the most likely diagnosis?
A. Bipolar II disorder
B. Cyclothymic disorder
C. Bipolar I disorder
D. Borderline personality disorder
The presence of a manic episode (elevated mood + ≥3 symptoms causing marked impairment)
defines bipolar I disorder, regardless of prior depression. Bipolar II requires hypomania (not full
mania) and major depression. Cyclothymia involves chronic subthreshold symptoms; BPD mood
shifts are reactive and brief.
,4. A 70-year-old with late-life depression and Parkinson’s disease develops worsening
psychosis (visual hallucinations, paranoia). Which antipsychotic is first-line?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Olanzapine
Quetiapine is preferred in Parkinson’s psychosis due to low D2 receptor affinity and minimal
extrapyramidal side effects (EPS). High-potency antipsychotics (e.g., haloperidol) and even
risperidone can worsen parkinsonism. Pimavanserin is FDA-approved but not always first-line due
to cost and access.
5. A 19-year-old college student with first-episode schizophrenia is started on aripiprazole.
What is the primary advantage of this agent in early psychosis?
A. Highest efficacy for positive symptoms
B. Rapid sedation
C. Lower risk of metabolic and motor side effects
D. Once-daily injectable formulation
Aripiprazole, a partial D2 agonist, has a favorable side effect profile with minimal weight gain,
metabolic disturbance, and EPS—critical for adherence and quality of life in young patients with
first-episode psychosis. Clozapine is more efficacious but reserved for treatment resistance due to
agranulocytosis risk.
6. A patient with severe OCD has failed high-dose SSRIs and CBT. Which augmentation
strategy is evidence-based?
A. Add bupropion
, B. Add lamotrigine
C. Add low-dose antipsychotic (e.g., risperidone)
D. Switch to MAOI
Antipsychotic augmentation (risperidone, aripiprazole) is FDA-supported for treatment-resistant
OCD, targeting dopaminergic hyperactivity in cortico-striatal circuits. Bupropion and lamotrigine
lack robust evidence; MAOIs are rarely used due to dietary restrictions and side effects.
7. A 55-year-old with alcohol use disorder and comorbid anxiety requests
pharmacotherapy. Which agent reduces both craving and anxiety?
A. Disulfiram
B. Naltrexone
C. Acamprosate
D. Topiramate
Acamprosate stabilizes GABA/glutamate imbalance post-detox, reducing protracted withdrawal
symptoms like anxiety and insomnia, which drive relapse. Naltrexone reduces craving and heavy
drinking but has less anxiolytic effect. Topiramate has off-label use but more cognitive side effects.
8. A 33-year-old female with PTSD and nightmares reports no improvement after 12 weeks
of sertraline. What is the next best step?
A. Increase sertraline dose
B. Switch to venlafaxine
C. Add prazosin 1 mg at bedtime
D. Discontinue medication and focus on EMDR
