NRNP 6665-01 PMHNP Final Exam | Week 11 Solutions
2026/2027 Complete Final Examination | Actual Questions &
Verified Solutions | Comprehensive Lifespan Psychiatry |
Advanced Clinical Scenarios | Pass Guarantee
1. A 7-year-old boy is brought by his teacher and mother for “constant motion,
blurting out answers, and climbing furniture.” Symptoms began at age 4, occur in
school and home, and cause him to be socially rejected. Vanderbilt
parent/teacher scales are positive for inattention (T-score 75) and hyperactivity
(T-score 70). Birth, medical, and family history are unremarkable; hearing/vision
normal. Which initial diagnosis is most accurate?
A. Disruptive mood dysregulation disorder (DMDD)
B. Attention-deficit/hyperactivity disorder, combined presentation
C. Autism spectrum disorder level 1
D. Adjustment disorder with mixed disturbance of emotions and conduct
Correct Answer: B
Rationale: Age-of-onset < 12, cross-setting, and clear evidence of both inattention and
hyperactivity-impulsivity meet DSM-5-TR criteria for ADHD-combined. DMDD requires
severe recurrent temper outbursts; ASD requires restrictive/repetitive behaviors;
adjustment disorder symptoms must be within 3 months of a stressor and do not
account for chronicity.
2. The same 7-year-old is diagnosed with ADHD-combined. Mother prefers
once-daily dosing and has good insurance. Which first-line pharmacotherapy and
dose best reflects current evidence?
A. Methylphenidate-ER (Concerta) 18 mg PO qAM
B. Atomoxetine 40 mg PO qHS
, C. Clonidine-ER (Kapvay) 0.1 mg PO bid
D. Guanfacine-IR 1 mg PO tid
Correct Answer: A
Rationale: Stimulants remain first-line; methylphenidate-ER is FDA-approved ≥6 y, dosed
qAM, and 18 mg is the recommended starting dose for a 25-kg child (≈0.3 mg/kg).
Atomoxetine is second-line and slower onset; alpha-agonists are adjunct or
monotherapy only when stimulants contraindicated/ineffective.
3. After 4 weeks on methylphenidate-ER 18 mg, teachers report 40 % improvement
but mother notes 2-h “rebound” at 2 pm and 3-lb weight loss. Height/weight track
50th percentile. Next best step?
A. Discontinue stimulant; start behavioral therapy alone
B. Increase to 27 mg qAM and add 3 pm 5-mg IR booster
C. Switch to mixed amphetamine salts-ER 10 mg
D. Add cyproheptadine 4 mg qHS for appetite
Correct Answer: B
Rationale: Partial response with wearing-off warrants longer coverage; increasing ER
plus low-dose IR booster is evidence-based and preserves appetite better than
switching to amphetamine. Behavioral therapy alone is less effective for
moderate-severe ADHD; cyproheptadine is reserved for significant failure-to-gain.
4. A 5-year-old girl speaks only 20 spontaneous words, flaps hands when excited,
lines up toy cars, and becomes aggressive if interrupted. She watches spinning
wheels for 30 min. M-CHAT-R total score 8. Which additional assessment is
essential before confirming diagnosis?
A. Lead level
B. Audiology evaluation
C. Fragile-X DNA PCR
D. EEG with sleep deprivation
Correct Answer: B
, Rationale: Language delay mandates hearing screening to rule out deafness as
contributor. Lead, Fragile-X, and EEG are indicated in select cases but not universal.
5. The girl is diagnosed with Autism Spectrum Disorder level 2. Parents request “the
medicine that helps communication.” Which statement best reflects evidence?
A. Risperidone is FDA-approved for irritability and may indirectly aid learning
B. Donepezil 5 mg daily improves core social communication
C. High-dose fluoxetine treats restrictive behaviors in preschoolers
D. Oxytocin nasal spray is first-line for social deficits
Correct Answer: A
Rationale: Only risperidone and aripiprazole have FDA indications in ASD (ages 5-16) for
irritability; reducing aggression allows participation in behavioral interventions.
Donepezil, fluoxetine, and oxytocin lack robust pediatric evidence.
6. A 14-year-old boy has weekly shoplifting, truancy, and forced a peer into oral sex
at knife-point. He shows no remorse and bullies a 9-year-old neighbor. Symptoms
started at age 10. Which diagnosis best accounts for the sexual coercion?
A. Oppositional defiant disorder
B. Conduct disorder, adolescent-onset, severe
C. Disruptive mood dysregulation disorder
D. Antisocial personality disorder
Correct Answer: B
Rationale: CD requires ≥3 criteria (aggression, destruction, deceitfulness, serious rule
violations) in past year; sexual assault fulfills “forced sex” criterion. Cannot diagnose
ASPD until age 18.
7. For the 14-year-old with CD, which multimodal intervention has strongest
evidence?
A. Residential placement plus lithium 900 mg bid
B. Multisystemic therapy (MST) targeting family/peer/school
2026/2027 Complete Final Examination | Actual Questions &
Verified Solutions | Comprehensive Lifespan Psychiatry |
Advanced Clinical Scenarios | Pass Guarantee
1. A 7-year-old boy is brought by his teacher and mother for “constant motion,
blurting out answers, and climbing furniture.” Symptoms began at age 4, occur in
school and home, and cause him to be socially rejected. Vanderbilt
parent/teacher scales are positive for inattention (T-score 75) and hyperactivity
(T-score 70). Birth, medical, and family history are unremarkable; hearing/vision
normal. Which initial diagnosis is most accurate?
A. Disruptive mood dysregulation disorder (DMDD)
B. Attention-deficit/hyperactivity disorder, combined presentation
C. Autism spectrum disorder level 1
D. Adjustment disorder with mixed disturbance of emotions and conduct
Correct Answer: B
Rationale: Age-of-onset < 12, cross-setting, and clear evidence of both inattention and
hyperactivity-impulsivity meet DSM-5-TR criteria for ADHD-combined. DMDD requires
severe recurrent temper outbursts; ASD requires restrictive/repetitive behaviors;
adjustment disorder symptoms must be within 3 months of a stressor and do not
account for chronicity.
2. The same 7-year-old is diagnosed with ADHD-combined. Mother prefers
once-daily dosing and has good insurance. Which first-line pharmacotherapy and
dose best reflects current evidence?
A. Methylphenidate-ER (Concerta) 18 mg PO qAM
B. Atomoxetine 40 mg PO qHS
, C. Clonidine-ER (Kapvay) 0.1 mg PO bid
D. Guanfacine-IR 1 mg PO tid
Correct Answer: A
Rationale: Stimulants remain first-line; methylphenidate-ER is FDA-approved ≥6 y, dosed
qAM, and 18 mg is the recommended starting dose for a 25-kg child (≈0.3 mg/kg).
Atomoxetine is second-line and slower onset; alpha-agonists are adjunct or
monotherapy only when stimulants contraindicated/ineffective.
3. After 4 weeks on methylphenidate-ER 18 mg, teachers report 40 % improvement
but mother notes 2-h “rebound” at 2 pm and 3-lb weight loss. Height/weight track
50th percentile. Next best step?
A. Discontinue stimulant; start behavioral therapy alone
B. Increase to 27 mg qAM and add 3 pm 5-mg IR booster
C. Switch to mixed amphetamine salts-ER 10 mg
D. Add cyproheptadine 4 mg qHS for appetite
Correct Answer: B
Rationale: Partial response with wearing-off warrants longer coverage; increasing ER
plus low-dose IR booster is evidence-based and preserves appetite better than
switching to amphetamine. Behavioral therapy alone is less effective for
moderate-severe ADHD; cyproheptadine is reserved for significant failure-to-gain.
4. A 5-year-old girl speaks only 20 spontaneous words, flaps hands when excited,
lines up toy cars, and becomes aggressive if interrupted. She watches spinning
wheels for 30 min. M-CHAT-R total score 8. Which additional assessment is
essential before confirming diagnosis?
A. Lead level
B. Audiology evaluation
C. Fragile-X DNA PCR
D. EEG with sleep deprivation
Correct Answer: B
, Rationale: Language delay mandates hearing screening to rule out deafness as
contributor. Lead, Fragile-X, and EEG are indicated in select cases but not universal.
5. The girl is diagnosed with Autism Spectrum Disorder level 2. Parents request “the
medicine that helps communication.” Which statement best reflects evidence?
A. Risperidone is FDA-approved for irritability and may indirectly aid learning
B. Donepezil 5 mg daily improves core social communication
C. High-dose fluoxetine treats restrictive behaviors in preschoolers
D. Oxytocin nasal spray is first-line for social deficits
Correct Answer: A
Rationale: Only risperidone and aripiprazole have FDA indications in ASD (ages 5-16) for
irritability; reducing aggression allows participation in behavioral interventions.
Donepezil, fluoxetine, and oxytocin lack robust pediatric evidence.
6. A 14-year-old boy has weekly shoplifting, truancy, and forced a peer into oral sex
at knife-point. He shows no remorse and bullies a 9-year-old neighbor. Symptoms
started at age 10. Which diagnosis best accounts for the sexual coercion?
A. Oppositional defiant disorder
B. Conduct disorder, adolescent-onset, severe
C. Disruptive mood dysregulation disorder
D. Antisocial personality disorder
Correct Answer: B
Rationale: CD requires ≥3 criteria (aggression, destruction, deceitfulness, serious rule
violations) in past year; sexual assault fulfills “forced sex” criterion. Cannot diagnose
ASPD until age 18.
7. For the 14-year-old with CD, which multimodal intervention has strongest
evidence?
A. Residential placement plus lithium 900 mg bid
B. Multisystemic therapy (MST) targeting family/peer/school
