NRNP 6665-01 Week 11 Final Exam Solutions 2026/2027
Complete Final Exam Guide | Actual Questions & Verified
Solutions | PMHNP Lifespan Psychiatry | Pass Guarantee
1. Clinical Vignette:
A 19-year-old college freshman is brought to the ER by roommates who found
him awake at 03:00 “talking to the TV,” claiming the newscaster was sending him
“coded messages.” He has not slept in three nights, has no prior psych history,
and admits to daily high-potency cannabis for two years. Urine tox: THC positive;
serum EtOH, other drugs negative. CBC, CMP, TSH, B-12, folate, CT head
normal. He is oriented but insists “the world is about to reboot.” PHQ-9 6, GAD-7
8, DSM-5-TR bipolar screen positive for mania.
Which is the MOST accurate working diagnosis?
A. Substance-induced psychotic disorder
B. Brief psychotic disorder
C. Bipolar I disorder, manic episode with psychotic features
D. Delusional disorder
Correct Answer: C
Rationale: >3 manic symptoms plus psychosis, no medical cause, and chronic
cannabis does not preclude independent BD; cannabis can precipitate but not
fully explain episode. B requires <1 mo without prominent mood symptoms; D
lacks functional impairment and non-bizarre delusion only.
2. Vignette:
A 7-year-old girl is referred for “explosive outbursts” that occur only at school
when transitioning from preferred activities. Episodes last 20-30 min, involve
kicking desks, and are followed by sincere apologies. Parents report no similar
behaviors at home or with peers; she sleeps well, reads above grade level, and
has age-appropriate friendships. Conners-3 teacher scale: T-scores <55 for
inattention/hyperactivity; ECBI intensity T 58.
What is the PRIMARY differential to explore first?
A. ADHD combined presentation
B. Autism spectrum disorder level 1
C. Disruptive mood dysregulation disorder
D. Situational anxiety with poor executive functioning
Correct Answer: D
, Rationale: Context-specific, remorseful, high-functioning home vs. structured
school transitions suggests anxiety/executive skill deficit rather than pervasive
neurodevelopmental or mood disorder; ADHD/ASD screens negative.
3. Vignette:
A 32-year-old woman with bipolar I (last manic episode 3 y ago) takes lithium 900
mg HS; level 0.8 mmol/L, Cr 0.9 mg/dL, TSH 1.8. She plans pregnancy in 6 mo.
She had one depressive relapse on lithium monotherapy.
Which evidence-based plan BEST prevents perinatal mood episodes?
A. Continue lithium, add lamotrigine now
B. Taper lithium pre-conception, start quetiapine
C. Continue lithium through pregnancy with level checks q4 wk
D. Switch to valproate before conception
Correct Answer: C
Rationale: 2023 APA guidelines: lithium is perinatal-safe with obstetric
collaboration; relapse risk > teratogenic risk (cardiac defect 0.6 %); valproate
higher teratogenicity; adding lamotrigine during pregnancy is slower and less
effective for mania.
4. Vignette:
A 14-year-old transgender male (on testosterone 6 mo) presents with 4-week
depressed mood, anhedonia, insomnia, 5-lb weight loss, passive SI. PHQ-9 19,
CAD-7 12. Parents ask about starting fluoxetine.
FIRST discussion point:
A. Obtain baseline ECG before any SSRI
B. Review FDA black-box warning on suicidal thoughts
C. Discontinue testosterone prior to antidepressant
D. Hospitalize for inpatient initiation
Correct Answer: B
Rationale: FDA BBW for ↑ suicidal thinking in 18-24 y extends to adolescents;
informed consent/psychoeducation precedes pharmacology; no evidence
testosterone interferes; ECG not routine unless cardiac risk; severity does not
mandate inpatient.
5. Vignette:
A 78-year-old man with vascular dementia (MMSE 20/30) is brought by daughter
for “hallucinations—talking to dead wife.” He has fluctuating attention,
parkinsonian gait, nocturnal wandering, and normal MoCA except poor
visuospatial. MRI: periventricular white-matter disease.
Most accurate diagnosis:
A. Major NCD due to Alzheimer’s with psychosis
B. Dementia with Lewy bodies
C. Parkinson’s disease psychosis
Complete Final Exam Guide | Actual Questions & Verified
Solutions | PMHNP Lifespan Psychiatry | Pass Guarantee
1. Clinical Vignette:
A 19-year-old college freshman is brought to the ER by roommates who found
him awake at 03:00 “talking to the TV,” claiming the newscaster was sending him
“coded messages.” He has not slept in three nights, has no prior psych history,
and admits to daily high-potency cannabis for two years. Urine tox: THC positive;
serum EtOH, other drugs negative. CBC, CMP, TSH, B-12, folate, CT head
normal. He is oriented but insists “the world is about to reboot.” PHQ-9 6, GAD-7
8, DSM-5-TR bipolar screen positive for mania.
Which is the MOST accurate working diagnosis?
A. Substance-induced psychotic disorder
B. Brief psychotic disorder
C. Bipolar I disorder, manic episode with psychotic features
D. Delusional disorder
Correct Answer: C
Rationale: >3 manic symptoms plus psychosis, no medical cause, and chronic
cannabis does not preclude independent BD; cannabis can precipitate but not
fully explain episode. B requires <1 mo without prominent mood symptoms; D
lacks functional impairment and non-bizarre delusion only.
2. Vignette:
A 7-year-old girl is referred for “explosive outbursts” that occur only at school
when transitioning from preferred activities. Episodes last 20-30 min, involve
kicking desks, and are followed by sincere apologies. Parents report no similar
behaviors at home or with peers; she sleeps well, reads above grade level, and
has age-appropriate friendships. Conners-3 teacher scale: T-scores <55 for
inattention/hyperactivity; ECBI intensity T 58.
What is the PRIMARY differential to explore first?
A. ADHD combined presentation
B. Autism spectrum disorder level 1
C. Disruptive mood dysregulation disorder
D. Situational anxiety with poor executive functioning
Correct Answer: D
, Rationale: Context-specific, remorseful, high-functioning home vs. structured
school transitions suggests anxiety/executive skill deficit rather than pervasive
neurodevelopmental or mood disorder; ADHD/ASD screens negative.
3. Vignette:
A 32-year-old woman with bipolar I (last manic episode 3 y ago) takes lithium 900
mg HS; level 0.8 mmol/L, Cr 0.9 mg/dL, TSH 1.8. She plans pregnancy in 6 mo.
She had one depressive relapse on lithium monotherapy.
Which evidence-based plan BEST prevents perinatal mood episodes?
A. Continue lithium, add lamotrigine now
B. Taper lithium pre-conception, start quetiapine
C. Continue lithium through pregnancy with level checks q4 wk
D. Switch to valproate before conception
Correct Answer: C
Rationale: 2023 APA guidelines: lithium is perinatal-safe with obstetric
collaboration; relapse risk > teratogenic risk (cardiac defect 0.6 %); valproate
higher teratogenicity; adding lamotrigine during pregnancy is slower and less
effective for mania.
4. Vignette:
A 14-year-old transgender male (on testosterone 6 mo) presents with 4-week
depressed mood, anhedonia, insomnia, 5-lb weight loss, passive SI. PHQ-9 19,
CAD-7 12. Parents ask about starting fluoxetine.
FIRST discussion point:
A. Obtain baseline ECG before any SSRI
B. Review FDA black-box warning on suicidal thoughts
C. Discontinue testosterone prior to antidepressant
D. Hospitalize for inpatient initiation
Correct Answer: B
Rationale: FDA BBW for ↑ suicidal thinking in 18-24 y extends to adolescents;
informed consent/psychoeducation precedes pharmacology; no evidence
testosterone interferes; ECG not routine unless cardiac risk; severity does not
mandate inpatient.
5. Vignette:
A 78-year-old man with vascular dementia (MMSE 20/30) is brought by daughter
for “hallucinations—talking to dead wife.” He has fluctuating attention,
parkinsonian gait, nocturnal wandering, and normal MoCA except poor
visuospatial. MRI: periventricular white-matter disease.
Most accurate diagnosis:
A. Major NCD due to Alzheimer’s with psychosis
B. Dementia with Lewy bodies
C. Parkinson’s disease psychosis
