NRNP 6665 Final Exam Question and Answers 2026/2027 - WALDEN
UNIVERSITY PMHNP Care Across the Lifespan | Comprehensive
Clinical Competency Assessment | Actual Questions & Verified
Answers | | Pass Guarantee
1. A 17-year-old cis-girl is brought to the ER after writing "I want to disappear" on
social media. For 3 weeks she has slept 3 h nightly, talks rapidly, and believes she
can "control traffic lights." She began escitalopram 10 mg 4 weeks ago for
"anxiety" and reports mood swings since age 14. PHQ-A 4, DSM-5-TR manic
checklist positive, family history bipolar I in father. Urine drug screen negative.
Which is the MOST accurate diagnosis?
A. Antidepressant-induced mania
B. Bipolar I disorder, most recent episode manic
C. Substance-induced bipolar disorder
D. Borderline personality disorder with psychotic features
Correct Answer: B
Rationale: Clear manic syndrome (>3 symptoms, impairment, ≥1 week) that
predates SSRI (mood swings since 14) meets bipolar I; SSRI may have uncovered
but did not create episode. Substance screen negative. BPD lacks discrete manic
duration/energy.
2. A 6-year-old boy, adopted from orphanage at age 3, is referred for "hyperactivity
and hugs strangers." Teacher notes he "never checks back with adults" and falls
frequently. Growth parameters <5th %. No repetitive behaviors. Conners-3
T-scores 55; no mood symptoms. Which primary diagnosis should be ruled in
FIRST?
A. Autism spectrum disorder
B. Disinhibited social engagement disorder
C. ADHD combined presentation
D. Intellectual developmental disorder
Correct Answer: B
Rationale: History of neglect, indiscriminate approach to strangers, poor
supervision checking, and growth delay fit DSED; ADHD scores sub-threshold, no
restrictive interests for ASD, developmental quotient not yet assessed.
, 3. A 29-year-old transgender man (on testosterone 9 months) presents with 5-week
low mood, anhedonia, fatigue, and 8-lb weight gain while "dieting." PHQ-9 17,
GAD-7 10, menstrual bleeding resumed 2 cycles ago. TSH 3.0 mIU/L, free T4 1.2
ng/dL, total testosterone 650 ng/dL (male range). He worries "hormones are
failing me." Next diagnostic step?
A. Order serum estradiol and prolactin
B. Increase testosterone dose
C. Start sertraline 50 mg
D. Refer urgently to endocrinology
Correct Answer: A
Rationale: Resumption of menses plus depressive symptoms suggests
insufficient hormonal suppression; check estradiol/prolactin before attributing to
primary MDD; testosterone level adequate.
4. A 72-year-old retired teacher is brought by daughter for "forgetting bills." He
scored 24/30 MoCA (lost points in recall/visuospatial), clock-draw 7. He denies
sadness but sleeps 10 h, appetite poor, and has lost 12 lb. PHQ-9 6. Labs: B12
220 pg/mL, TSH 5.5, free T4 0.6. Which is the most accurate diagnosis?
A. Major neurocognitive disorder due to Alzheimer’s disease
B. Mild neurocognitive disorder due to multiple etiologies
C. Major depressive episode with cognitive impairment
D. Hypothyroid dementia
Correct Answer: B
Rationale: Cognitive scores show mild impairment; multiple reversible
contributors (low-normal B12, subclinical hypothyroid) per DSM-5-TR; depression
screen negative; does not meet major NCD yet.
5. A 35-year-old Iraq veteran reports 2-month insomnia, irritability, and "jumpiness"
after his neighbor set off fireworks. He drinks 8 beers nightly "to sleep." CAPS-5
38, AUDIT 18. Which is the evidence-based FIRST medication for PTSD?
A. Paroxetine 20 mg AM
B. Prazosin 2 mg HS
C. Lorazepam 1 mg HS PRN
D. Gabapentin 300 mg TID
Correct Answer: A
Rationale: APA PTSD guideline: SSRIs (paroxetine, sertraline, fluoxetine,
venlafaxine) have Level-A evidence; prazosin helps nightmares but not global
PTSD; must treat alcohol use concurrently; avoid benzos.
6. A 15-year-old girl with insulin-dependent diabetes is cutting forearms weekly
after peer conflicts. She denies suicidal intent, shows cuts proudly, and states "It
calms me." No other Axis-I pathology. Most evidence-based initial
UNIVERSITY PMHNP Care Across the Lifespan | Comprehensive
Clinical Competency Assessment | Actual Questions & Verified
Answers | | Pass Guarantee
1. A 17-year-old cis-girl is brought to the ER after writing "I want to disappear" on
social media. For 3 weeks she has slept 3 h nightly, talks rapidly, and believes she
can "control traffic lights." She began escitalopram 10 mg 4 weeks ago for
"anxiety" and reports mood swings since age 14. PHQ-A 4, DSM-5-TR manic
checklist positive, family history bipolar I in father. Urine drug screen negative.
Which is the MOST accurate diagnosis?
A. Antidepressant-induced mania
B. Bipolar I disorder, most recent episode manic
C. Substance-induced bipolar disorder
D. Borderline personality disorder with psychotic features
Correct Answer: B
Rationale: Clear manic syndrome (>3 symptoms, impairment, ≥1 week) that
predates SSRI (mood swings since 14) meets bipolar I; SSRI may have uncovered
but did not create episode. Substance screen negative. BPD lacks discrete manic
duration/energy.
2. A 6-year-old boy, adopted from orphanage at age 3, is referred for "hyperactivity
and hugs strangers." Teacher notes he "never checks back with adults" and falls
frequently. Growth parameters <5th %. No repetitive behaviors. Conners-3
T-scores 55; no mood symptoms. Which primary diagnosis should be ruled in
FIRST?
A. Autism spectrum disorder
B. Disinhibited social engagement disorder
C. ADHD combined presentation
D. Intellectual developmental disorder
Correct Answer: B
Rationale: History of neglect, indiscriminate approach to strangers, poor
supervision checking, and growth delay fit DSED; ADHD scores sub-threshold, no
restrictive interests for ASD, developmental quotient not yet assessed.
, 3. A 29-year-old transgender man (on testosterone 9 months) presents with 5-week
low mood, anhedonia, fatigue, and 8-lb weight gain while "dieting." PHQ-9 17,
GAD-7 10, menstrual bleeding resumed 2 cycles ago. TSH 3.0 mIU/L, free T4 1.2
ng/dL, total testosterone 650 ng/dL (male range). He worries "hormones are
failing me." Next diagnostic step?
A. Order serum estradiol and prolactin
B. Increase testosterone dose
C. Start sertraline 50 mg
D. Refer urgently to endocrinology
Correct Answer: A
Rationale: Resumption of menses plus depressive symptoms suggests
insufficient hormonal suppression; check estradiol/prolactin before attributing to
primary MDD; testosterone level adequate.
4. A 72-year-old retired teacher is brought by daughter for "forgetting bills." He
scored 24/30 MoCA (lost points in recall/visuospatial), clock-draw 7. He denies
sadness but sleeps 10 h, appetite poor, and has lost 12 lb. PHQ-9 6. Labs: B12
220 pg/mL, TSH 5.5, free T4 0.6. Which is the most accurate diagnosis?
A. Major neurocognitive disorder due to Alzheimer’s disease
B. Mild neurocognitive disorder due to multiple etiologies
C. Major depressive episode with cognitive impairment
D. Hypothyroid dementia
Correct Answer: B
Rationale: Cognitive scores show mild impairment; multiple reversible
contributors (low-normal B12, subclinical hypothyroid) per DSM-5-TR; depression
screen negative; does not meet major NCD yet.
5. A 35-year-old Iraq veteran reports 2-month insomnia, irritability, and "jumpiness"
after his neighbor set off fireworks. He drinks 8 beers nightly "to sleep." CAPS-5
38, AUDIT 18. Which is the evidence-based FIRST medication for PTSD?
A. Paroxetine 20 mg AM
B. Prazosin 2 mg HS
C. Lorazepam 1 mg HS PRN
D. Gabapentin 300 mg TID
Correct Answer: A
Rationale: APA PTSD guideline: SSRIs (paroxetine, sertraline, fluoxetine,
venlafaxine) have Level-A evidence; prazosin helps nightmares but not global
PTSD; must treat alcohol use concurrently; avoid benzos.
6. A 15-year-old girl with insulin-dependent diabetes is cutting forearms weekly
after peer conflicts. She denies suicidal intent, shows cuts proudly, and states "It
calms me." No other Axis-I pathology. Most evidence-based initial
