NRNP 6665 Midterm Exam Practice Questions plus rationales with
verified answers 2026/2027 version
1. A PMHNP is assessing a 45-year-old client who reports persistent depressive symptoms
for the past 2 years. The client describes periods of feeling "down" but also notes that some
days are better than others. Which of the following diagnoses best describes this
presentation?
• A. Major Depressive Disorder (MDD)
• B. Persistent Depressive Disorder (Dysthymia)
• C. Bipolar II Disorder
• D. Adjustment Disorder with Depressed Mood
Answer: B. Persistent Depressive Disorder (Dysthymia)
Rationale: Persistent Depressive Disorder (PDD) is characterized by a depressed mood for most
of the day, for more days than not, for at least 2 years in adults. Symptoms do not remit for more
than 2 months at a time. MDD requires discrete episodes.
2. A 28-year-old client presents with symptoms of anxiety, including excessive worry,
restlessness, and difficulty sleeping. Which screening tool is most appropriate for the
PMHNP to use to assess the severity of these symptoms?
• A. PHQ-9
• B. GAD-7
• C. MDQ
• D. CAGE-AID
Answer: B. GAD-7
,Rationale: The GAD-7 is a validated screening tool for generalized anxiety disorder. PHQ-9
screens for depression, MDQ screens for bipolar disorder, and CAGE-AID screens for substance
use disorders.
3. A PMHNP is prescribing an SSRI for a client with major depressive disorder. Which of
the following is an important consideration for the initiation of SSRI therapy?
• A. Therapeutic effects are typically seen immediately
• B. The dose should be started at the highest therapeutic dose
• C. The PMHNP should monitor for activation syndrome
• D. SSRIs are contraindicated in pregnancy
Answer: C. The PMHNP should monitor for activation syndrome
Rationale: Activation syndrome is an adverse effect of SSRIs, particularly in children,
adolescents, and young adults. It may present as agitation, anxiety, insomnia, or impulsivity.
SSRIs should be started at a low dose and titrated gradually. They are not contraindicated in
pregnancy but require risk-benefit analysis.
4. A 60-year-old client with a history of bipolar I disorder is being prescribed lithium.
Which of the following baseline assessments should the PMHNP obtain before initiating
lithium therapy?
• A. Complete blood count and liver function tests
• B. Thyroid function tests, renal function tests, and electrolytes
• C. Electrocardiogram and cardiac enzymes
• D. Fasting blood glucose and hemoglobin A1c
,Answer: B. Thyroid function tests, renal function tests, and electrolytes
Rationale: Lithium can affect thyroid (causing hypothyroidism) and renal function. Baseline and
periodic monitoring of thyroid (TSH), renal (BUN, creatinine), and electrolyte levels, as well as
serum lithium levels, is essential.
5. A 35-year-old client reports experiencing episodes of intense fear, palpitations, and
shortness of breath that peak within 10 minutes. These episodes occur unexpectedly and
are followed by a persistent concern about having another episode. Which of the following
diagnoses is most likely?
• A. Generalized Anxiety Disorder
• B. Social Anxiety Disorder
• C. Panic Disorder
• D. Specific Phobia
Answer: C. Panic Disorder
Rationale: Panic Disorder is characterized by recurrent, unexpected panic attacks followed by at
least 1 month of persistent concern about additional attacks, worry about consequences, or
significant maladaptive behavioral changes. The attacks peak within minutes.
6. A PMHNP is evaluating a client who reports auditory hallucinations telling them that
they are "worthless" and should "hurt themselves." The client describes the voices as
coming from outside their head. Which of the following best describes these hallucinations?
• A. Command hallucinations
• B. Visual hallucinations
, • C. Somatic hallucinations
• D. Olfactory hallucinations
Answer: A. Command hallucinations
Rationale: Command hallucinations are auditory hallucinations that direct the individual to
perform specific actions, often self-harm or harm to others. These require immediate assessment
for safety and potential hospitalization.
7. A 22-year-old client is brought to the emergency department by police for erratic
behavior. The client is talking rapidly, jumping from topic to topic, and reports needing
very little sleep over the past 3 days. Which of the following diagnoses should the PMHNP
consider?
• A. Major Depressive Disorder with Psychotic Features
• B. Manic Episode
• C. Schizophrenia
• D. Substance-Induced Psychotic Disorder
Answer: B. Manic Episode
Rationale: Manic episodes are characterized by elevated, expansive, or irritable mood, increased
goal-directed activity, decreased need for sleep, grandiosity, and pressured speech. The
symptoms must last at least 1 week and cause significant functional impairment.
8. A PMHNP is prescribing quetiapine for a client with bipolar disorder. Which of the
following adverse effects should the PMHNP include in the teaching?
verified answers 2026/2027 version
1. A PMHNP is assessing a 45-year-old client who reports persistent depressive symptoms
for the past 2 years. The client describes periods of feeling "down" but also notes that some
days are better than others. Which of the following diagnoses best describes this
presentation?
• A. Major Depressive Disorder (MDD)
• B. Persistent Depressive Disorder (Dysthymia)
• C. Bipolar II Disorder
• D. Adjustment Disorder with Depressed Mood
Answer: B. Persistent Depressive Disorder (Dysthymia)
Rationale: Persistent Depressive Disorder (PDD) is characterized by a depressed mood for most
of the day, for more days than not, for at least 2 years in adults. Symptoms do not remit for more
than 2 months at a time. MDD requires discrete episodes.
2. A 28-year-old client presents with symptoms of anxiety, including excessive worry,
restlessness, and difficulty sleeping. Which screening tool is most appropriate for the
PMHNP to use to assess the severity of these symptoms?
• A. PHQ-9
• B. GAD-7
• C. MDQ
• D. CAGE-AID
Answer: B. GAD-7
,Rationale: The GAD-7 is a validated screening tool for generalized anxiety disorder. PHQ-9
screens for depression, MDQ screens for bipolar disorder, and CAGE-AID screens for substance
use disorders.
3. A PMHNP is prescribing an SSRI for a client with major depressive disorder. Which of
the following is an important consideration for the initiation of SSRI therapy?
• A. Therapeutic effects are typically seen immediately
• B. The dose should be started at the highest therapeutic dose
• C. The PMHNP should monitor for activation syndrome
• D. SSRIs are contraindicated in pregnancy
Answer: C. The PMHNP should monitor for activation syndrome
Rationale: Activation syndrome is an adverse effect of SSRIs, particularly in children,
adolescents, and young adults. It may present as agitation, anxiety, insomnia, or impulsivity.
SSRIs should be started at a low dose and titrated gradually. They are not contraindicated in
pregnancy but require risk-benefit analysis.
4. A 60-year-old client with a history of bipolar I disorder is being prescribed lithium.
Which of the following baseline assessments should the PMHNP obtain before initiating
lithium therapy?
• A. Complete blood count and liver function tests
• B. Thyroid function tests, renal function tests, and electrolytes
• C. Electrocardiogram and cardiac enzymes
• D. Fasting blood glucose and hemoglobin A1c
,Answer: B. Thyroid function tests, renal function tests, and electrolytes
Rationale: Lithium can affect thyroid (causing hypothyroidism) and renal function. Baseline and
periodic monitoring of thyroid (TSH), renal (BUN, creatinine), and electrolyte levels, as well as
serum lithium levels, is essential.
5. A 35-year-old client reports experiencing episodes of intense fear, palpitations, and
shortness of breath that peak within 10 minutes. These episodes occur unexpectedly and
are followed by a persistent concern about having another episode. Which of the following
diagnoses is most likely?
• A. Generalized Anxiety Disorder
• B. Social Anxiety Disorder
• C. Panic Disorder
• D. Specific Phobia
Answer: C. Panic Disorder
Rationale: Panic Disorder is characterized by recurrent, unexpected panic attacks followed by at
least 1 month of persistent concern about additional attacks, worry about consequences, or
significant maladaptive behavioral changes. The attacks peak within minutes.
6. A PMHNP is evaluating a client who reports auditory hallucinations telling them that
they are "worthless" and should "hurt themselves." The client describes the voices as
coming from outside their head. Which of the following best describes these hallucinations?
• A. Command hallucinations
• B. Visual hallucinations
, • C. Somatic hallucinations
• D. Olfactory hallucinations
Answer: A. Command hallucinations
Rationale: Command hallucinations are auditory hallucinations that direct the individual to
perform specific actions, often self-harm or harm to others. These require immediate assessment
for safety and potential hospitalization.
7. A 22-year-old client is brought to the emergency department by police for erratic
behavior. The client is talking rapidly, jumping from topic to topic, and reports needing
very little sleep over the past 3 days. Which of the following diagnoses should the PMHNP
consider?
• A. Major Depressive Disorder with Psychotic Features
• B. Manic Episode
• C. Schizophrenia
• D. Substance-Induced Psychotic Disorder
Answer: B. Manic Episode
Rationale: Manic episodes are characterized by elevated, expansive, or irritable mood, increased
goal-directed activity, decreased need for sleep, grandiosity, and pressured speech. The
symptoms must last at least 1 week and cause significant functional impairment.
8. A PMHNP is prescribing quetiapine for a client with bipolar disorder. Which of the
following adverse effects should the PMHNP include in the teaching?
