NRNP 6635 Week 6 Midterm Exam Questions and
Revised Correct Answers & Rationales ()
250 Original PMHNP Practice Questions — high-yield clinical-reasoning practice. These questions are newly written and
are not reproduced from proprietary/leaked exam banks. A practice bank cannot guarantee a passing grade.
1. A 9-year-old has persistent difficulty sustaining attention, frequently loses school
materials, and makes careless mistakes in multiple settings. Which diagnosis is most
consistent?
• Specific learning disorder
☑ Attention-deficit/hyperactivity disorder
• Autism spectrum disorder
•Rationale:
Oppositional defiant disorder
The pattern of persistent inattention across settings with functional impairment is characteristic of
ADHD.
2. Which finding most strongly supports autism spectrum disorder rather than ADHD?
☑ Restricted, repetitive behaviors and sensory differences
• Occasional forgetfulness
• Difficulty completing long assignments
•Rationale:
Fidgeting during class
Autism spectrum disorder requires social-communication differences plus restricted/repetitive patterns
of behavior or interests.
3. For a child with suspected ADHD, which assessment approach is most appropriate?
• Use one brief office observation only
☑ Obtain information from multiple settings and informants
• Diagnose solely from parent report
•Rationale:
Require neuroimaging before diagnosis
ADHD assessment should integrate developmental history and impairment across settings, often using
parent and teacher reports.
4. Which medication class is commonly considered first-line pharmacotherapy for
school-age ADHD when medication is indicated?
☑ Stimulants
• Antipsychotics
• Benzodiazepines
•Rationale:
Mood stabilizers
Stimulants such as methylphenidate or amphetamine formulations are commonly first-line
pharmacologic options for ADHD.
5. A child with ADHD develops reduced appetite after starting a stimulant. Which
intervention is most appropriate first?
☑ Assess growth and meal pattern and adjust timing/dose as clinically indicated
• Stop all nutrition immediately
• Add an antipsychotic
• Tell the family the effect is unrelated to medication
, Rationale: Appetite suppression is a known stimulant effect; growth, nutrition, timing, and dose should be
reviewed.
6. Which feature is required for a diagnosis of intellectual disability?
• Only low academic grades
☑ Deficits in intellectual and adaptive functioning with developmental onset
• Psychotic symptoms before age 18
•Rationale:
A specific abnormal MRI
Intellectual disability involves deficits in intellectual and adaptive functioning originating during the
developmental period.
7. Which adaptive domain includes communication, social judgment, and interpersonal
skills?
• Conceptual
☑ Social
• Practical
•Rationale:
Motor
Social adaptive functioning includes communication, social judgment, empathy, and relationship skills.
8. A child has normal early language but later develops loss of previously acquired social
and communication abilities with repetitive behaviors. Which condition should be
considered?
☑ Autism spectrum disorder
• Delirium
• Major depressive disorder
•Rationale:
Panic disorder
Regression in social communication with restricted/repetitive behaviors warrants evaluation for autism
spectrum disorder and other neurologic causes.
9. Which intervention is most appropriate for a child with autism and significant
communication impairment?
☑ Individualized behavioral/developmental and communication supports
• Routine benzodiazepines
• Electroconvulsive therapy
•Rationale:
Long-term physical restraint
Individualized behavioral, developmental, educational, and communication interventions are central to
autism care.
10. A patient with Tourette syndrome has both motor and vocal tics for more than one
year. Which treatment principle is appropriate?
☑ Use behavioral interventions and medication when impairment warrants it
• Require complete suppression of every tic
• Treat only with antidepressants
•Rationale:
Avoid assessment of comorbid ADHD
Behavioral therapy such as CBIT and selected medications may be used when tics cause clinically
significant impairment.
,11. An older adult has a gradual decline in recent memory and increasing difficulty
managing finances, with loss of independence. Which syndrome is most likely?
• Delirium
☑ Major neurocognitive disorder
• Adjustment disorder
•Rationale:
Specific phobia
Progressive cognitive decline that interferes with independent functioning is consistent with major
neurocognitive disorder.
12. Which feature best distinguishes delirium from a major neurocognitive disorder?
☑ Acute onset with fluctuating attention and awareness
• Slow progression over years
• Stable attention throughout the day
•Rationale:
No identifiable medical contributors
Delirium typically has an acute or subacute onset, fluctuating course, and prominent disturbance of
attention and awareness.
13. What is the first priority when a hospitalized older adult develops acute confusion?
☑ Look for medical causes and assess safety
• Assume dementia progression
• Start a stimulant immediately
•Rationale:
Perform personality testing
Acute confusion requires urgent assessment for medical, medication, metabolic, infectious, or
neurologic causes.
14. Which medication type is particularly important to review in an older adult with new
confusion?
☑ Anticholinergic medications
• Topical emollients
• Saline nasal spray
•Rationale:
Simple vitamin supplements
Anticholinergic burden can worsen cognition and precipitate delirium, especially in older adults.
15. Which finding is most characteristic of Alzheimer disease?
☑ Progressive impairment beginning prominently with episodic memory in many cases
, • Abrupt onset after one night
• Exclusive visual hallucinations with preserved cognition
•Rationale:
Only motor symptoms
Alzheimer disease commonly presents with insidious, progressive cognitive decline, often prominently
affecting episodic memory early.
16. Which pattern is classically associated with dementia with Lewy bodies?
☑ Cognitive fluctuations, visual hallucinations, and parkinsonism
• Early isolated language impairment only
• Early disinhibition with no other deficits
•Rationale:
Only episodic panic attacks
Fluctuating cognition, recurrent visual hallucinations, and spontaneous parkinsonism are characteristic
clinical features.
17. Which feature favors frontotemporal dementia over Alzheimer disease?
☑ Early prominent behavioral disinhibition or language change
• Early isolated hearing loss
• Acute fluctuating attention
•Rationale:
Symptoms limited to sleep
Frontotemporal disorders often present with early behavioral/personality changes or language
impairment.
18. Which cognitive domain is often prominently impaired in vascular neurocognitive
disorder?
☑ Executive functioning and processing speed
• Only taste
• Only visual acuity
•Rationale:
Only reflexes
Vascular cognitive impairment often affects executive function, processing speed, and attention,
depending on vascular burden and location.
19. What is an important reversible contributor to cognitive impairment that should be
assessed?
☑ Medication effects and metabolic abnormalities
• Eye color
• Hand dominance
•Rationale:
Hair texture
Medication effects, thyroid dysfunction, vitamin deficiencies, sleep disorders, substance use, and other
medical causes can contribute to cognitive symptoms.
20. A patient with suspected delirium is pulling at IV lines and attempting to leave. What
is the immediate nursing priority?
☑ Ensure safety while identifying and treating the underlying cause
• Provide an elaborate cognitive test first
• Place the patient alone without observation
•Rationale:
Ignore the behavior
Safety is immediate while the team evaluates and treats the underlying cause of delirium.
Revised Correct Answers & Rationales ()
250 Original PMHNP Practice Questions — high-yield clinical-reasoning practice. These questions are newly written and
are not reproduced from proprietary/leaked exam banks. A practice bank cannot guarantee a passing grade.
1. A 9-year-old has persistent difficulty sustaining attention, frequently loses school
materials, and makes careless mistakes in multiple settings. Which diagnosis is most
consistent?
• Specific learning disorder
☑ Attention-deficit/hyperactivity disorder
• Autism spectrum disorder
•Rationale:
Oppositional defiant disorder
The pattern of persistent inattention across settings with functional impairment is characteristic of
ADHD.
2. Which finding most strongly supports autism spectrum disorder rather than ADHD?
☑ Restricted, repetitive behaviors and sensory differences
• Occasional forgetfulness
• Difficulty completing long assignments
•Rationale:
Fidgeting during class
Autism spectrum disorder requires social-communication differences plus restricted/repetitive patterns
of behavior or interests.
3. For a child with suspected ADHD, which assessment approach is most appropriate?
• Use one brief office observation only
☑ Obtain information from multiple settings and informants
• Diagnose solely from parent report
•Rationale:
Require neuroimaging before diagnosis
ADHD assessment should integrate developmental history and impairment across settings, often using
parent and teacher reports.
4. Which medication class is commonly considered first-line pharmacotherapy for
school-age ADHD when medication is indicated?
☑ Stimulants
• Antipsychotics
• Benzodiazepines
•Rationale:
Mood stabilizers
Stimulants such as methylphenidate or amphetamine formulations are commonly first-line
pharmacologic options for ADHD.
5. A child with ADHD develops reduced appetite after starting a stimulant. Which
intervention is most appropriate first?
☑ Assess growth and meal pattern and adjust timing/dose as clinically indicated
• Stop all nutrition immediately
• Add an antipsychotic
• Tell the family the effect is unrelated to medication
, Rationale: Appetite suppression is a known stimulant effect; growth, nutrition, timing, and dose should be
reviewed.
6. Which feature is required for a diagnosis of intellectual disability?
• Only low academic grades
☑ Deficits in intellectual and adaptive functioning with developmental onset
• Psychotic symptoms before age 18
•Rationale:
A specific abnormal MRI
Intellectual disability involves deficits in intellectual and adaptive functioning originating during the
developmental period.
7. Which adaptive domain includes communication, social judgment, and interpersonal
skills?
• Conceptual
☑ Social
• Practical
•Rationale:
Motor
Social adaptive functioning includes communication, social judgment, empathy, and relationship skills.
8. A child has normal early language but later develops loss of previously acquired social
and communication abilities with repetitive behaviors. Which condition should be
considered?
☑ Autism spectrum disorder
• Delirium
• Major depressive disorder
•Rationale:
Panic disorder
Regression in social communication with restricted/repetitive behaviors warrants evaluation for autism
spectrum disorder and other neurologic causes.
9. Which intervention is most appropriate for a child with autism and significant
communication impairment?
☑ Individualized behavioral/developmental and communication supports
• Routine benzodiazepines
• Electroconvulsive therapy
•Rationale:
Long-term physical restraint
Individualized behavioral, developmental, educational, and communication interventions are central to
autism care.
10. A patient with Tourette syndrome has both motor and vocal tics for more than one
year. Which treatment principle is appropriate?
☑ Use behavioral interventions and medication when impairment warrants it
• Require complete suppression of every tic
• Treat only with antidepressants
•Rationale:
Avoid assessment of comorbid ADHD
Behavioral therapy such as CBIT and selected medications may be used when tics cause clinically
significant impairment.
,11. An older adult has a gradual decline in recent memory and increasing difficulty
managing finances, with loss of independence. Which syndrome is most likely?
• Delirium
☑ Major neurocognitive disorder
• Adjustment disorder
•Rationale:
Specific phobia
Progressive cognitive decline that interferes with independent functioning is consistent with major
neurocognitive disorder.
12. Which feature best distinguishes delirium from a major neurocognitive disorder?
☑ Acute onset with fluctuating attention and awareness
• Slow progression over years
• Stable attention throughout the day
•Rationale:
No identifiable medical contributors
Delirium typically has an acute or subacute onset, fluctuating course, and prominent disturbance of
attention and awareness.
13. What is the first priority when a hospitalized older adult develops acute confusion?
☑ Look for medical causes and assess safety
• Assume dementia progression
• Start a stimulant immediately
•Rationale:
Perform personality testing
Acute confusion requires urgent assessment for medical, medication, metabolic, infectious, or
neurologic causes.
14. Which medication type is particularly important to review in an older adult with new
confusion?
☑ Anticholinergic medications
• Topical emollients
• Saline nasal spray
•Rationale:
Simple vitamin supplements
Anticholinergic burden can worsen cognition and precipitate delirium, especially in older adults.
15. Which finding is most characteristic of Alzheimer disease?
☑ Progressive impairment beginning prominently with episodic memory in many cases
, • Abrupt onset after one night
• Exclusive visual hallucinations with preserved cognition
•Rationale:
Only motor symptoms
Alzheimer disease commonly presents with insidious, progressive cognitive decline, often prominently
affecting episodic memory early.
16. Which pattern is classically associated with dementia with Lewy bodies?
☑ Cognitive fluctuations, visual hallucinations, and parkinsonism
• Early isolated language impairment only
• Early disinhibition with no other deficits
•Rationale:
Only episodic panic attacks
Fluctuating cognition, recurrent visual hallucinations, and spontaneous parkinsonism are characteristic
clinical features.
17. Which feature favors frontotemporal dementia over Alzheimer disease?
☑ Early prominent behavioral disinhibition or language change
• Early isolated hearing loss
• Acute fluctuating attention
•Rationale:
Symptoms limited to sleep
Frontotemporal disorders often present with early behavioral/personality changes or language
impairment.
18. Which cognitive domain is often prominently impaired in vascular neurocognitive
disorder?
☑ Executive functioning and processing speed
• Only taste
• Only visual acuity
•Rationale:
Only reflexes
Vascular cognitive impairment often affects executive function, processing speed, and attention,
depending on vascular burden and location.
19. What is an important reversible contributor to cognitive impairment that should be
assessed?
☑ Medication effects and metabolic abnormalities
• Eye color
• Hand dominance
•Rationale:
Hair texture
Medication effects, thyroid dysfunction, vitamin deficiencies, sleep disorders, substance use, and other
medical causes can contribute to cognitive symptoms.
20. A patient with suspected delirium is pulling at IV lines and attempting to leave. What
is the immediate nursing priority?
☑ Ensure safety while identifying and treating the underlying cause
• Provide an elaborate cognitive test first
• Place the patient alone without observation
•Rationale:
Ignore the behavior
Safety is immediate while the team evaluates and treats the underlying cause of delirium.
