[EXAM NRNP 6645 FINAL EXAM] QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | WALDEN UNIVERSITY | GRADED A+
Question 1
A psychiatric-mental health nurse practitioner is conducting an initial assessment of a 34-year-old client who
reports feeling sad, hopeless, and having difficulty sleeping for the past 6 months. Which therapeutic
communication technique is most appropriate for the PMHNP to use first?
A. "Tell me more about what has been happening in your life over the past 6 months."
B. "Have you had thoughts of harming yourself or others?"
C. "I understand you are feeling sad and having trouble sleeping."
D. "What do you think is causing these feelings?"
🟢 Correct Answer: C. "I understand you are feeling sad and having trouble sleeping."
🔴 RATIONALE: This response uses the therapeutic technique of reflection, which demonstrates empathy and
validates the client's feelings. It establishes rapport and encourages the client to elaborate. While assessing for
,safety is important, it should not be the first response. Open-ended questions are valuable but should follow
initial validation of the client's concerns.
Question 2
A 45-year-old client with a diagnosis of major depressive disorder has been prescribed fluoxetine 20 mg daily.
The client reports that they have been taking the medication for 4 weeks and feel no improvement. Which
response by the PMHNP is most appropriate?
A. "Let's discontinue the medication and try something else."
B. "It can take 4-6 weeks for the full therapeutic effect to be achieved."
C. "You may need to take a higher dose. I will increase your prescription."
D. "Let's add a second medication to enhance the effectiveness."
🟢 Correct Answer: B. "It can take 4-6 weeks for the full therapeutic effect to be achieved."
🔴 RATIONALE: SSRIs such as fluoxetine typically require 4-8 weeks to reach full therapeutic effect. The client
should be educated about the expected timeline and encouraged to continue the medication as prescribed.
Premature discontinuation or dose escalation without appropriate assessment is not indicated.
,Question 3
A PMHNP is evaluating a 28-year-old client who presents with symptoms of excessive worry, restlessness, and
difficulty concentrating. The client reports these symptoms have been present for most days over the past 7
months. The PMHNP suspects generalized anxiety disorder. Which additional symptom should the PMHNP
assess to support this diagnosis?
A. Recurrent panic attacks
B. Sleep disturbance
C. Flashbacks of a traumatic event
D. Obsessive thoughts
🟢 Correct Answer: B. Sleep disturbance
🔴 RATIONALE: Generalized anxiety disorder is characterized by excessive anxiety and worry occurring more
days than not for at least 6 months, along with symptoms such as restlessness, fatigue, difficulty concentrating,
irritability, muscle tension, and sleep disturbance. Panic attacks are associated with panic disorder, flashbacks
with PTSD, and obsessive thoughts with OCD.
Question 4
A 16-year-old client is brought to the clinic by their parent due to concerns about declining grades, social
withdrawal, and irritability. The PMHNP is considering a diagnosis of major depressive disorder. Which
, assessment finding would be most consistent with this diagnosis in an adolescent?
A. Excessive talkativeness and decreased need for sleep
B. Weight loss and increased appetite
C. Irritability and social withdrawal
D. Grandiose beliefs and risk-taking behavior
🟢 Correct Answer: C. Irritability and social withdrawal
🔴 RATIONALE: In adolescents, major depressive disorder often presents with irritability, social withdrawal, and
declining academic performance rather than the classic sad mood seen in adults. Excessive talkativeness and
decreased need for sleep are characteristic of mania. Weight changes can occur but are not the most distinctive
adolescent presentation.
Question 5
A PMHNP is prescribing aripiprazole for a 32-year-old client with schizophrenia. The client asks about potential
side effects. Which side effect should the PMHNP prioritize in client education?
A. Sedation
B. Weight gain
ALREADY GRADED A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | WALDEN UNIVERSITY | GRADED A+
Question 1
A psychiatric-mental health nurse practitioner is conducting an initial assessment of a 34-year-old client who
reports feeling sad, hopeless, and having difficulty sleeping for the past 6 months. Which therapeutic
communication technique is most appropriate for the PMHNP to use first?
A. "Tell me more about what has been happening in your life over the past 6 months."
B. "Have you had thoughts of harming yourself or others?"
C. "I understand you are feeling sad and having trouble sleeping."
D. "What do you think is causing these feelings?"
🟢 Correct Answer: C. "I understand you are feeling sad and having trouble sleeping."
🔴 RATIONALE: This response uses the therapeutic technique of reflection, which demonstrates empathy and
validates the client's feelings. It establishes rapport and encourages the client to elaborate. While assessing for
,safety is important, it should not be the first response. Open-ended questions are valuable but should follow
initial validation of the client's concerns.
Question 2
A 45-year-old client with a diagnosis of major depressive disorder has been prescribed fluoxetine 20 mg daily.
The client reports that they have been taking the medication for 4 weeks and feel no improvement. Which
response by the PMHNP is most appropriate?
A. "Let's discontinue the medication and try something else."
B. "It can take 4-6 weeks for the full therapeutic effect to be achieved."
C. "You may need to take a higher dose. I will increase your prescription."
D. "Let's add a second medication to enhance the effectiveness."
🟢 Correct Answer: B. "It can take 4-6 weeks for the full therapeutic effect to be achieved."
🔴 RATIONALE: SSRIs such as fluoxetine typically require 4-8 weeks to reach full therapeutic effect. The client
should be educated about the expected timeline and encouraged to continue the medication as prescribed.
Premature discontinuation or dose escalation without appropriate assessment is not indicated.
,Question 3
A PMHNP is evaluating a 28-year-old client who presents with symptoms of excessive worry, restlessness, and
difficulty concentrating. The client reports these symptoms have been present for most days over the past 7
months. The PMHNP suspects generalized anxiety disorder. Which additional symptom should the PMHNP
assess to support this diagnosis?
A. Recurrent panic attacks
B. Sleep disturbance
C. Flashbacks of a traumatic event
D. Obsessive thoughts
🟢 Correct Answer: B. Sleep disturbance
🔴 RATIONALE: Generalized anxiety disorder is characterized by excessive anxiety and worry occurring more
days than not for at least 6 months, along with symptoms such as restlessness, fatigue, difficulty concentrating,
irritability, muscle tension, and sleep disturbance. Panic attacks are associated with panic disorder, flashbacks
with PTSD, and obsessive thoughts with OCD.
Question 4
A 16-year-old client is brought to the clinic by their parent due to concerns about declining grades, social
withdrawal, and irritability. The PMHNP is considering a diagnosis of major depressive disorder. Which
, assessment finding would be most consistent with this diagnosis in an adolescent?
A. Excessive talkativeness and decreased need for sleep
B. Weight loss and increased appetite
C. Irritability and social withdrawal
D. Grandiose beliefs and risk-taking behavior
🟢 Correct Answer: C. Irritability and social withdrawal
🔴 RATIONALE: In adolescents, major depressive disorder often presents with irritability, social withdrawal, and
declining academic performance rather than the classic sad mood seen in adults. Excessive talkativeness and
decreased need for sleep are characteristic of mania. Weight changes can occur but are not the most distinctive
adolescent presentation.
Question 5
A PMHNP is prescribing aripiprazole for a 32-year-old client with schizophrenia. The client asks about potential
side effects. Which side effect should the PMHNP prioritize in client education?
A. Sedation
B. Weight gain
