NRNP 6665 Final Exam - Version 2 (2026/2027) Walden University | PMHNP Curriculum
NRNP 6665 Final Exam
Version 2 - Latest 2026/2027 | 100 Questions & Answers with A+ Graded Rationales
Walden University | PMHNP Care Across the Lifespan I | 3 Credits | Aligned with DSM-5-TR and PMHNP Certification
Competencies
Examination Instructions: This comprehensive final examination consists of 100 multiple-choice questions distributed
across eight content domains aligned with the NRNP 6665 curriculum and PMHNP certification competencies. Each
question has one best answer. Cognitive level distribution: 30% recall, 50% application, 20% analysis. Question style:
70% scenario-based, 25% direct recall, 5% clinical analysis. Rationales provide PMHNP-level clinical reasoning
including DSM-5-TR diagnostic criteria, psychopharmacology principles, developmental considerations, and ethical
standards. Target passing score: 90%.
Section 1: Psychotherapy Modalities and Therapeutic Interventions (Q1-15)
Q1: A 28-year-old client with major depressive disorder repeatedly tells the PMHNP, "If I fail this exam, my
whole life is over and I am a complete failure." Which CBT technique is MOST appropriate to help the client
identify and restructure this thought pattern?
A. Cognitive reframing guided by Socratic questioning to evaluate evidence for and against the automatic
thought [CORRECT]
B. Free association to uncover unconscious conflicts driving the catastrophic belief
C. Empty chair technique to externalize the inner critic and dialogue with it
D. Systematic desensitization to reduce anxiety associated with the examination
Correct Answer: A
Rationale: The client is demonstrating catastrophizing and all-or-nothing thinking, two core cognitive distortions in
Beck's CBT model. Socratic questioning and cognitive reframing help the client examine evidence for and against the
automatic thought, identify distortions, and generate balanced alternatives. Free association (B) is psychoanalytic, the
empty chair (C) is Gestalt therapy, and systematic desensitization (D) is a behavioral exposure technique for phobias,
not cognitive restructuring.
Q2: A PMHNP is leading a DBT skills group for clients with borderline personality disorder. Which of the
following modules teaches clients techniques such as TIPP (Temperature, Intense exercise, Paced breathing,
Paired muscle relaxation)?
A. Mindfulness module
B. Distress tolerance module [CORRECT]
C. Emotion regulation module
D. Interpersonal effectiveness module
Correct Answer: B
Rationale: The TIPP skill is part of the DBT distress tolerance module, designed to help clients survive crisis situations
without making them worse by rapidly altering physiological arousal. Mindfulness (A) focuses on present-moment
awareness and observing/describing. Emotion regulation (C) addresses understanding and modifying emotional
responses. Interpersonal effectiveness (D) teaches assertiveness and relationship maintenance skills.
Page 1 | NRNP 6665 Final Exam V2 | A+ Graded Rationales
,NRNP 6665 Final Exam - Version 2 (2026/2027) Walden University | PMHNP Curriculum
Q3: A 42-year-old woman seeks therapy six months after her husband's sudden death. She reports feeling
disconnected from friends, difficulty returning to work, and persistent sadness. The PMHNP selects
Interpersonal Therapy (IPT). Which of the four IPT problem areas is the PRIMARY focus?
A. Role dispute
B. Role transition
C. Grief [CORRECT]
D. Interpersonal deficits
Correct Answer: C
Rationale: IPT identifies four problem areas: grief, role disputes, role transitions, and interpersonal deficits. Because
the presenting problem follows the death of a significant other and includes symptoms of complicated bereavement,
grief is the targeted problem area. Role transition (B) would apply to life-stage changes (e.g., new parenthood,
retirement), role dispute (A) to conflicts with a significant other, and interpersonal deficits (D) to longstanding social skill
deficits.
Q4: A family presents for therapy because the identified patient, a 16-year-old with anorexia nervosa, is
restricting food. The structural family therapist observes that the mother and daughter are enmeshed while
the father is disengaged and peripheral. Which intervention is MOST consistent with structural family
therapy?
A. Exploring the multigenerational transmission of eating patterns
B. Externalizing the anorexia as a separate entity from the adolescent
C. Restructuring boundaries by coaching the father to take a more active parenting role [CORRECT]
D. Using paradoxical injunctions to disrupt the family's symptomatic behavior
Correct Answer: C
Rationale: Structural family therapy (Minuchin) focuses on restructuring family organization, boundaries, and
hierarchies. Enmeshment between mother and daughter and a disengaged father indicate diffuse and rigid boundaries
respectively; the therapist actively restructures these boundaries, such as coaching the father into a more central
parenting role. Multigenerational transmission (A) is Bowenian, externalizing (B) is narrative therapy, and paradoxical
injunctions (D) are strategic family therapy techniques.
Q5: According to Yalom's therapeutic factors of group therapy, which factor is MOST responsible for the
therapeutic effect when a member with social anxiety realizes that other group members also struggle with
similar fears of judgment?
A. Altruism
B. Universality [CORRECT]
C. Catharsis
D. Corrective recapitulation of the primary family group
Correct Answer: B
Rationale: Universality is Yalom's recognition that one is not alone in one's problems, feelings, or thoughts, which is
particularly powerful for clients who feel isolated or unique in their distress. Altruism (A) is the benefit derived from
helping others. Catharsis (C) is emotional release. Corrective recapitulation of the primary family group (D) is the
opportunity to re-experience and resolve early family conflicts within the group.
Page 2 | NRNP 6665 Final Exam V2 | A+ Graded Rationales
,NRNP 6665 Final Exam - Version 2 (2026/2027) Walden University | PMHNP Curriculum
Q6: A PMHNP is using Motivational Interviewing (MI) with a 35-year-old client who has alcohol use disorder
and states, "Maybe I should cut back, but I'm not ready to quit completely." Which response BEST
demonstrates the OARS technique of reflective listening?
A. "You need to quit completely because your liver enzymes are elevated."
B. "So you're considering reducing your drinking, though stopping altogether feels like too big a step right
now." [CORRECT]
C. "Have you considered attending Alcoholics Anonymous meetings in your area?"
D. "Tell me about a time when you successfully made a major life change."
Correct Answer: B
Rationale: Reflective listening, the R in OARS, involves restating or paraphrasing the client's statement to deepen
understanding and demonstrate active listening, often amplifying the meaning. Option B is an amplified reflection that
captures the client's ambivalence. Option A is confrontational and prescriptive. Option C is a closed question offering
advice. Option D is an open-ended question (the O in OARS) but is not a reflection of the client's stated ambivalence.
Q7: Which of the following BEST distinguishes supportive psychotherapy from insight-oriented
psychotherapy?
A. Supportive therapy aims to uncover unconscious conflicts, while insight therapy focuses on symptom
management
B. Supportive therapy strengthens existing defenses and coping mechanisms, while insight therapy seeks to
bring unconscious material into awareness [CORRECT]
C. Supportive therapy requires more frequent sessions than insight therapy
D. Supportive therapy is appropriate only for psychotic disorders, while insight therapy is for neurotic disorders
Correct Answer: B
Rationale: Supportive psychotherapy aims to strengthen existing defenses, enhance coping, restore adaptive
functioning, and reinforce self-esteem without exploring unconscious conflicts. Insight-oriented therapy (e.g.,
psychodynamic) seeks to bring unconscious material into awareness to produce understanding and personality change.
Option A reverses the goals. Frequency (C) varies for both. Supportive therapy is broadly applicable across many
diagnoses, not only psychosis (D).
Q8: A PMHNP is providing psychoeducation to the family of a patient newly diagnosed with schizophrenia.
Which of the following statements by a family member indicates a NEED for additional teaching about
expressed emotion (EE)?
A. "We should avoid criticizing him when he has symptoms."
B. "We need to maintain a calm, low-stress home environment."
C. "We should push him to be more independent even when he is symptomatic." [CORRECT]
D. "We will participate in a family psychoeducation program to learn communication skills."
Correct Answer: C
Rationale: High expressed emotion (criticism, hostility, emotional overinvolvement) is associated with increased
relapse rates in schizophrenia. Pushing the patient to be more independent while symptomatic reflects high EE and can
worsen outcomes. Options A, B, and D reflect low-EE strategies and evidence-based family psychoeducation principles
that reduce relapse rates by approximately 50%.
Page 3 | NRNP 6665 Final Exam V2 | A+ Graded Rationales
, NRNP 6665 Final Exam - Version 2 (2026/2027) Walden University | PMHNP Curriculum
Q9: A patient presents to the emergency department in an acute crisis following a sexual assault. The PMHNP
initiates crisis intervention. Which principle is MOST central to crisis intervention as distinct from ongoing
psychotherapy?
A. Exploring childhood origins of the current distress
B. Focusing on personality restructuring
C. Restoring the patient to pre-crisis level of functioning using timelimited, present-focused interventions
[CORRECT]
D. Establishing a long-term therapeutic alliance spanning multiple years
Correct Answer: C
Rationale: Crisis intervention is short-term (typically 1-6 sessions), present-focused, and aims to restore the individual
to their pre-crisis baseline level of functioning by addressing the immediate crisis, ensuring safety, and mobilizing coping
resources. Options A, B, and D describe goals of long-term psychodynamic or psychoanalytic therapy and are
inappropriate for acute crisis work.
Q10: In CBT for panic disorder, which technique involves having the patient intentionally reproduce the
physical sensations of a panic attack (e.g., spinning in a chair, hyperventilating) in a controlled setting?
A. Systematic desensitization
B. Interoceptive exposure [CORRECT]
C. Flooding
D. Response prevention
Correct Answer: B
Rationale: Interoceptive exposure involves deliberately inducing feared internal physical sensations to extinguish the
fear response through habituation, and it is a core CBT technique for panic disorder. Systematic desensitization (A)
uses graded exposure paired with relaxation for external phobias. Flooding (C) is prolonged exposure to the most
feared external stimulus. Response prevention (D) is the ERP component used with OCD to refrain from compulsions.
Q11: A 45-year-old client with chronic suicidal ideation and borderline personality disorder is enrolled in a
comprehensive DBT program. Which component is REQUIRED for the program to be considered
comprehensive (standard) DBT?
A. Group skills training only
B. Individual therapy only
C. Individual therapy, group skills training, phone coaching, and consultation team for therapists
[CORRECT]
D. Inpatient hospitalization followed by weekly group therapy
Correct Answer: C
Rationale: Comprehensive DBT, as developed by Marsha Linehan, consists of four required modes: individual therapy,
group skills training, in-the-moment phone coaching, and a therapist consultation team. Providing only skills groups (A)
or individual therapy (B) is considered DBT-informed rather than comprehensive DBT and has weaker evidence.
Inpatient hospitalization (D) is not a required component of standard outpatient DBT.
Page 4 | NRNP 6665 Final Exam V2 | A+ Graded Rationales
NRNP 6665 Final Exam
Version 2 - Latest 2026/2027 | 100 Questions & Answers with A+ Graded Rationales
Walden University | PMHNP Care Across the Lifespan I | 3 Credits | Aligned with DSM-5-TR and PMHNP Certification
Competencies
Examination Instructions: This comprehensive final examination consists of 100 multiple-choice questions distributed
across eight content domains aligned with the NRNP 6665 curriculum and PMHNP certification competencies. Each
question has one best answer. Cognitive level distribution: 30% recall, 50% application, 20% analysis. Question style:
70% scenario-based, 25% direct recall, 5% clinical analysis. Rationales provide PMHNP-level clinical reasoning
including DSM-5-TR diagnostic criteria, psychopharmacology principles, developmental considerations, and ethical
standards. Target passing score: 90%.
Section 1: Psychotherapy Modalities and Therapeutic Interventions (Q1-15)
Q1: A 28-year-old client with major depressive disorder repeatedly tells the PMHNP, "If I fail this exam, my
whole life is over and I am a complete failure." Which CBT technique is MOST appropriate to help the client
identify and restructure this thought pattern?
A. Cognitive reframing guided by Socratic questioning to evaluate evidence for and against the automatic
thought [CORRECT]
B. Free association to uncover unconscious conflicts driving the catastrophic belief
C. Empty chair technique to externalize the inner critic and dialogue with it
D. Systematic desensitization to reduce anxiety associated with the examination
Correct Answer: A
Rationale: The client is demonstrating catastrophizing and all-or-nothing thinking, two core cognitive distortions in
Beck's CBT model. Socratic questioning and cognitive reframing help the client examine evidence for and against the
automatic thought, identify distortions, and generate balanced alternatives. Free association (B) is psychoanalytic, the
empty chair (C) is Gestalt therapy, and systematic desensitization (D) is a behavioral exposure technique for phobias,
not cognitive restructuring.
Q2: A PMHNP is leading a DBT skills group for clients with borderline personality disorder. Which of the
following modules teaches clients techniques such as TIPP (Temperature, Intense exercise, Paced breathing,
Paired muscle relaxation)?
A. Mindfulness module
B. Distress tolerance module [CORRECT]
C. Emotion regulation module
D. Interpersonal effectiveness module
Correct Answer: B
Rationale: The TIPP skill is part of the DBT distress tolerance module, designed to help clients survive crisis situations
without making them worse by rapidly altering physiological arousal. Mindfulness (A) focuses on present-moment
awareness and observing/describing. Emotion regulation (C) addresses understanding and modifying emotional
responses. Interpersonal effectiveness (D) teaches assertiveness and relationship maintenance skills.
Page 1 | NRNP 6665 Final Exam V2 | A+ Graded Rationales
,NRNP 6665 Final Exam - Version 2 (2026/2027) Walden University | PMHNP Curriculum
Q3: A 42-year-old woman seeks therapy six months after her husband's sudden death. She reports feeling
disconnected from friends, difficulty returning to work, and persistent sadness. The PMHNP selects
Interpersonal Therapy (IPT). Which of the four IPT problem areas is the PRIMARY focus?
A. Role dispute
B. Role transition
C. Grief [CORRECT]
D. Interpersonal deficits
Correct Answer: C
Rationale: IPT identifies four problem areas: grief, role disputes, role transitions, and interpersonal deficits. Because
the presenting problem follows the death of a significant other and includes symptoms of complicated bereavement,
grief is the targeted problem area. Role transition (B) would apply to life-stage changes (e.g., new parenthood,
retirement), role dispute (A) to conflicts with a significant other, and interpersonal deficits (D) to longstanding social skill
deficits.
Q4: A family presents for therapy because the identified patient, a 16-year-old with anorexia nervosa, is
restricting food. The structural family therapist observes that the mother and daughter are enmeshed while
the father is disengaged and peripheral. Which intervention is MOST consistent with structural family
therapy?
A. Exploring the multigenerational transmission of eating patterns
B. Externalizing the anorexia as a separate entity from the adolescent
C. Restructuring boundaries by coaching the father to take a more active parenting role [CORRECT]
D. Using paradoxical injunctions to disrupt the family's symptomatic behavior
Correct Answer: C
Rationale: Structural family therapy (Minuchin) focuses on restructuring family organization, boundaries, and
hierarchies. Enmeshment between mother and daughter and a disengaged father indicate diffuse and rigid boundaries
respectively; the therapist actively restructures these boundaries, such as coaching the father into a more central
parenting role. Multigenerational transmission (A) is Bowenian, externalizing (B) is narrative therapy, and paradoxical
injunctions (D) are strategic family therapy techniques.
Q5: According to Yalom's therapeutic factors of group therapy, which factor is MOST responsible for the
therapeutic effect when a member with social anxiety realizes that other group members also struggle with
similar fears of judgment?
A. Altruism
B. Universality [CORRECT]
C. Catharsis
D. Corrective recapitulation of the primary family group
Correct Answer: B
Rationale: Universality is Yalom's recognition that one is not alone in one's problems, feelings, or thoughts, which is
particularly powerful for clients who feel isolated or unique in their distress. Altruism (A) is the benefit derived from
helping others. Catharsis (C) is emotional release. Corrective recapitulation of the primary family group (D) is the
opportunity to re-experience and resolve early family conflicts within the group.
Page 2 | NRNP 6665 Final Exam V2 | A+ Graded Rationales
,NRNP 6665 Final Exam - Version 2 (2026/2027) Walden University | PMHNP Curriculum
Q6: A PMHNP is using Motivational Interviewing (MI) with a 35-year-old client who has alcohol use disorder
and states, "Maybe I should cut back, but I'm not ready to quit completely." Which response BEST
demonstrates the OARS technique of reflective listening?
A. "You need to quit completely because your liver enzymes are elevated."
B. "So you're considering reducing your drinking, though stopping altogether feels like too big a step right
now." [CORRECT]
C. "Have you considered attending Alcoholics Anonymous meetings in your area?"
D. "Tell me about a time when you successfully made a major life change."
Correct Answer: B
Rationale: Reflective listening, the R in OARS, involves restating or paraphrasing the client's statement to deepen
understanding and demonstrate active listening, often amplifying the meaning. Option B is an amplified reflection that
captures the client's ambivalence. Option A is confrontational and prescriptive. Option C is a closed question offering
advice. Option D is an open-ended question (the O in OARS) but is not a reflection of the client's stated ambivalence.
Q7: Which of the following BEST distinguishes supportive psychotherapy from insight-oriented
psychotherapy?
A. Supportive therapy aims to uncover unconscious conflicts, while insight therapy focuses on symptom
management
B. Supportive therapy strengthens existing defenses and coping mechanisms, while insight therapy seeks to
bring unconscious material into awareness [CORRECT]
C. Supportive therapy requires more frequent sessions than insight therapy
D. Supportive therapy is appropriate only for psychotic disorders, while insight therapy is for neurotic disorders
Correct Answer: B
Rationale: Supportive psychotherapy aims to strengthen existing defenses, enhance coping, restore adaptive
functioning, and reinforce self-esteem without exploring unconscious conflicts. Insight-oriented therapy (e.g.,
psychodynamic) seeks to bring unconscious material into awareness to produce understanding and personality change.
Option A reverses the goals. Frequency (C) varies for both. Supportive therapy is broadly applicable across many
diagnoses, not only psychosis (D).
Q8: A PMHNP is providing psychoeducation to the family of a patient newly diagnosed with schizophrenia.
Which of the following statements by a family member indicates a NEED for additional teaching about
expressed emotion (EE)?
A. "We should avoid criticizing him when he has symptoms."
B. "We need to maintain a calm, low-stress home environment."
C. "We should push him to be more independent even when he is symptomatic." [CORRECT]
D. "We will participate in a family psychoeducation program to learn communication skills."
Correct Answer: C
Rationale: High expressed emotion (criticism, hostility, emotional overinvolvement) is associated with increased
relapse rates in schizophrenia. Pushing the patient to be more independent while symptomatic reflects high EE and can
worsen outcomes. Options A, B, and D reflect low-EE strategies and evidence-based family psychoeducation principles
that reduce relapse rates by approximately 50%.
Page 3 | NRNP 6665 Final Exam V2 | A+ Graded Rationales
, NRNP 6665 Final Exam - Version 2 (2026/2027) Walden University | PMHNP Curriculum
Q9: A patient presents to the emergency department in an acute crisis following a sexual assault. The PMHNP
initiates crisis intervention. Which principle is MOST central to crisis intervention as distinct from ongoing
psychotherapy?
A. Exploring childhood origins of the current distress
B. Focusing on personality restructuring
C. Restoring the patient to pre-crisis level of functioning using timelimited, present-focused interventions
[CORRECT]
D. Establishing a long-term therapeutic alliance spanning multiple years
Correct Answer: C
Rationale: Crisis intervention is short-term (typically 1-6 sessions), present-focused, and aims to restore the individual
to their pre-crisis baseline level of functioning by addressing the immediate crisis, ensuring safety, and mobilizing coping
resources. Options A, B, and D describe goals of long-term psychodynamic or psychoanalytic therapy and are
inappropriate for acute crisis work.
Q10: In CBT for panic disorder, which technique involves having the patient intentionally reproduce the
physical sensations of a panic attack (e.g., spinning in a chair, hyperventilating) in a controlled setting?
A. Systematic desensitization
B. Interoceptive exposure [CORRECT]
C. Flooding
D. Response prevention
Correct Answer: B
Rationale: Interoceptive exposure involves deliberately inducing feared internal physical sensations to extinguish the
fear response through habituation, and it is a core CBT technique for panic disorder. Systematic desensitization (A)
uses graded exposure paired with relaxation for external phobias. Flooding (C) is prolonged exposure to the most
feared external stimulus. Response prevention (D) is the ERP component used with OCD to refrain from compulsions.
Q11: A 45-year-old client with chronic suicidal ideation and borderline personality disorder is enrolled in a
comprehensive DBT program. Which component is REQUIRED for the program to be considered
comprehensive (standard) DBT?
A. Group skills training only
B. Individual therapy only
C. Individual therapy, group skills training, phone coaching, and consultation team for therapists
[CORRECT]
D. Inpatient hospitalization followed by weekly group therapy
Correct Answer: C
Rationale: Comprehensive DBT, as developed by Marsha Linehan, consists of four required modes: individual therapy,
group skills training, in-the-moment phone coaching, and a therapist consultation team. Providing only skills groups (A)
or individual therapy (B) is considered DBT-informed rather than comprehensive DBT and has weaker evidence.
Inpatient hospitalization (D) is not a required component of standard outpatient DBT.
Page 4 | NRNP 6665 Final Exam V2 | A+ Graded Rationales
