NRNP 6675 Final Exam Qs and Ans with Explanation (Latest
): Most Comprehensive to Pass the Exam — 250
Exam-Style Practice Questions
Original exam-style practice bank aligned to major NRNP 6675 PMHNP Across the Lifespan II domains. These are not official Walden University exam items or
leaked/secured questions. Correct choices are marked with a large green tick in an empty box.
1. A patient taking an SSRI develops agitation, diaphoresis, tremor, hyperreflexia, and diarrhea after
starting linezolid. What is the priority concern?
■ Serotonin syndrome
• Neuroleptic malignant syndrome
• Anticholinergic toxicity
• Lithium toxicity
Explanation: The combination of serotonergic drugs can produce serotonin syndrome, characterized by autonomic instability,
gastrointestinal symptoms, neuromuscular hyperactivity, and mental-status changes.
2. Which adverse effect is most characteristic of atypical antipsychotics and warrants metabolic
monitoring?
■ Weight gain and dyslipidemia
• Severe neutropenia with every agent
• Permanent hearing loss
• Hypoglycemia in most patients
Explanation: Second-generation antipsychotics vary, but several increase weight, glucose, and lipids; baseline and follow-up
metabolic monitoring is therefore important.
3. A patient receiving clozapine reports fever and sore throat. What is the most appropriate next step?
■ Obtain an urgent CBC/ANC evaluation
• Double the clozapine dose
• Give a stimulant
• Reassure the patient that this is expected
Explanation: Fever and sore throat may signal neutropenia or agranulocytosis. Prompt blood-count assessment is required.
4. Which antipsychotic adverse effect is most closely associated with dopamine D2 blockade in the
nigrostriatal pathway?
■ Extrapyramidal symptoms
• Hyperglycemia
• Nephrogenic diabetes insipidus
• Sexual disinhibition
Explanation: D2 blockade in the nigrostriatal pathway can produce dystonia, akathisia, parkinsonism, and tardive dyskinesia.
NRNP 6675 • 250-question exam-style practice bank • 2026/2027 Page 1
, 5. A patient taking lithium develops coarse tremor, vomiting, diarrhea, ataxia, and confusion. What should
the PMHNP suspect?
■ Lithium toxicity
• SSRI discontinuation
• Benzodiazepine withdrawal
• Akathisia
Explanation: GI symptoms, worsening tremor, ataxia, and confusion are concerning for lithium toxicity and require prompt
evaluation.
6. Which medication class is generally first-line for acute mania when rapid symptom control is needed?
■ Antipsychotics
• Stimulants
• Cholinesterase inhibitors
• Buspirone alone
Explanation: Antipsychotics are commonly used for acute mania because they can reduce agitation, psychosis, and manic
symptoms relatively rapidly.
7. A patient taking valproate develops severe abdominal pain and persistent vomiting. Which serious
adverse effect should be considered?
■ Pancreatitis
• Aplastic anemia from every dose
• Serotonin syndrome
• Torsades from QT shortening
Explanation: Valproate can rarely cause pancreatitis; severe abdominal pain and vomiting warrant urgent evaluation.
8. Which antidepressant is most associated with dose-dependent QT prolongation and therefore requires
caution in patients with other QT-prolonging risks?
■ Citalopram
• Bupropion
• Mirtazapine
• Vortioxetine
Explanation: Citalopram has dose-related QT prolongation risk; the clinician should consider cardiac and medication risk factors.
9. A patient abruptly stops long-term paroxetine and develops dizziness, irritability, and electric-shock
sensations. What is the best explanation?
■ Antidepressant discontinuation syndrome
• Mania
• Neuroleptic malignant syndrome
• Delirium tremens
Explanation: Paroxetine has a short half-life and is particularly associated with discontinuation symptoms after abrupt cessation.
NRNP 6675 • 250-question exam-style practice bank • 2026/2027 Page 2
, 10. Which antidepressant is generally avoided in a patient with a seizure disorder because it can lower
the seizure threshold?
■ Bupropion
• Sertraline
• Escitalopram
• Mirtazapine
Explanation: Bupropion can lower seizure threshold, especially at higher doses or in patients with predisposing conditions.
11. A patient taking an antipsychotic develops sustained painful neck contraction shortly after initiation.
Which treatment is most appropriate?
■ An anticholinergic such as benztropine
• A stimulant
• A cholinesterase inhibitor
• A beta-lactam antibiotic
Explanation: Acute dystonia is an early extrapyramidal reaction that responds to anticholinergic agents such as benztropine or
diphenhydramine.
12. Which medication is a classic treatment option for akathisia caused by an antipsychotic?
■ Propranolol
• Donepezil
• Lithium
• Disulfiram
Explanation: Propranolol is commonly used for antipsychotic-induced akathisia after assessing contraindications.
13. Which finding most strongly suggests neuroleptic malignant syndrome?
■ Lead-pipe rigidity with hyperthermia and autonomic instability
• Fine tremor with diarrhea only
• Isolated insomnia
• Increased appetite without fever
Explanation: NMS is characterized by hyperthermia, severe rigidity, altered mental status, and autonomic instability, often with
elevated CK.
14. Which antipsychotic is particularly associated with hyperprolactinemia?
■ Risperidone
• Aripiprazole
• Quetiapine
• Clozapine
Explanation: Risperidone can substantially increase prolactin because of dopamine blockade in the tuberoinfundibular pathway.
NRNP 6675 • 250-question exam-style practice bank • 2026/2027 Page 3
, 15. Which antipsychotic has partial dopamine D2 agonist activity and is often considered relatively
prolactin-sparing?
■ Aripiprazole
• Haloperidol
• Risperidone
• Chlorpromazine
Explanation: Aripiprazole is a D2 partial agonist and often lowers or minimizes prolactin elevation compared with strong D2
antagonists.
16. A patient on carbamazepine develops confusion, headache, and hyponatremia. Which adverse effect
is most likely?
■ SIADH-related hyponatremia
• Hypercalcemia
• Serotonin syndrome
• Malignant hyperthermia
Explanation: Carbamazepine can cause SIADH and clinically important hyponatremia, particularly in susceptible patients.
17. Which laboratory monitoring is most directly associated with valproate therapy?
■ Liver function tests and platelet count
• Troponin every week
• Thyroid ultrasound
• Urinalysis for ketones only
Explanation: Valproate can cause hepatotoxicity and thrombocytopenia, so liver function and platelet monitoring are clinically
relevant.
18. A patient taking an MAOI asks about aged cheese and cured meats. What is the major concern?
■ Hypertensive crisis from tyramine
• Severe hypoglycemia
• Nephrolithiasis
• QT shortening
Explanation: Tyramine-rich foods can precipitate dangerous hypertension in patients taking MAOIs.
19. Which medication is an evidence-based option for alcohol use disorder that reduces rewarding
effects and craving?
■ Naltrexone
• Levodopa
• Benztropine
• Lamotrigine
Explanation: Naltrexone, when medically appropriate, can reduce alcohol craving and the reinforcing effects of alcohol.
NRNP 6675 • 250-question exam-style practice bank • 2026/2027 Page 4
): Most Comprehensive to Pass the Exam — 250
Exam-Style Practice Questions
Original exam-style practice bank aligned to major NRNP 6675 PMHNP Across the Lifespan II domains. These are not official Walden University exam items or
leaked/secured questions. Correct choices are marked with a large green tick in an empty box.
1. A patient taking an SSRI develops agitation, diaphoresis, tremor, hyperreflexia, and diarrhea after
starting linezolid. What is the priority concern?
■ Serotonin syndrome
• Neuroleptic malignant syndrome
• Anticholinergic toxicity
• Lithium toxicity
Explanation: The combination of serotonergic drugs can produce serotonin syndrome, characterized by autonomic instability,
gastrointestinal symptoms, neuromuscular hyperactivity, and mental-status changes.
2. Which adverse effect is most characteristic of atypical antipsychotics and warrants metabolic
monitoring?
■ Weight gain and dyslipidemia
• Severe neutropenia with every agent
• Permanent hearing loss
• Hypoglycemia in most patients
Explanation: Second-generation antipsychotics vary, but several increase weight, glucose, and lipids; baseline and follow-up
metabolic monitoring is therefore important.
3. A patient receiving clozapine reports fever and sore throat. What is the most appropriate next step?
■ Obtain an urgent CBC/ANC evaluation
• Double the clozapine dose
• Give a stimulant
• Reassure the patient that this is expected
Explanation: Fever and sore throat may signal neutropenia or agranulocytosis. Prompt blood-count assessment is required.
4. Which antipsychotic adverse effect is most closely associated with dopamine D2 blockade in the
nigrostriatal pathway?
■ Extrapyramidal symptoms
• Hyperglycemia
• Nephrogenic diabetes insipidus
• Sexual disinhibition
Explanation: D2 blockade in the nigrostriatal pathway can produce dystonia, akathisia, parkinsonism, and tardive dyskinesia.
NRNP 6675 • 250-question exam-style practice bank • 2026/2027 Page 1
, 5. A patient taking lithium develops coarse tremor, vomiting, diarrhea, ataxia, and confusion. What should
the PMHNP suspect?
■ Lithium toxicity
• SSRI discontinuation
• Benzodiazepine withdrawal
• Akathisia
Explanation: GI symptoms, worsening tremor, ataxia, and confusion are concerning for lithium toxicity and require prompt
evaluation.
6. Which medication class is generally first-line for acute mania when rapid symptom control is needed?
■ Antipsychotics
• Stimulants
• Cholinesterase inhibitors
• Buspirone alone
Explanation: Antipsychotics are commonly used for acute mania because they can reduce agitation, psychosis, and manic
symptoms relatively rapidly.
7. A patient taking valproate develops severe abdominal pain and persistent vomiting. Which serious
adverse effect should be considered?
■ Pancreatitis
• Aplastic anemia from every dose
• Serotonin syndrome
• Torsades from QT shortening
Explanation: Valproate can rarely cause pancreatitis; severe abdominal pain and vomiting warrant urgent evaluation.
8. Which antidepressant is most associated with dose-dependent QT prolongation and therefore requires
caution in patients with other QT-prolonging risks?
■ Citalopram
• Bupropion
• Mirtazapine
• Vortioxetine
Explanation: Citalopram has dose-related QT prolongation risk; the clinician should consider cardiac and medication risk factors.
9. A patient abruptly stops long-term paroxetine and develops dizziness, irritability, and electric-shock
sensations. What is the best explanation?
■ Antidepressant discontinuation syndrome
• Mania
• Neuroleptic malignant syndrome
• Delirium tremens
Explanation: Paroxetine has a short half-life and is particularly associated with discontinuation symptoms after abrupt cessation.
NRNP 6675 • 250-question exam-style practice bank • 2026/2027 Page 2
, 10. Which antidepressant is generally avoided in a patient with a seizure disorder because it can lower
the seizure threshold?
■ Bupropion
• Sertraline
• Escitalopram
• Mirtazapine
Explanation: Bupropion can lower seizure threshold, especially at higher doses or in patients with predisposing conditions.
11. A patient taking an antipsychotic develops sustained painful neck contraction shortly after initiation.
Which treatment is most appropriate?
■ An anticholinergic such as benztropine
• A stimulant
• A cholinesterase inhibitor
• A beta-lactam antibiotic
Explanation: Acute dystonia is an early extrapyramidal reaction that responds to anticholinergic agents such as benztropine or
diphenhydramine.
12. Which medication is a classic treatment option for akathisia caused by an antipsychotic?
■ Propranolol
• Donepezil
• Lithium
• Disulfiram
Explanation: Propranolol is commonly used for antipsychotic-induced akathisia after assessing contraindications.
13. Which finding most strongly suggests neuroleptic malignant syndrome?
■ Lead-pipe rigidity with hyperthermia and autonomic instability
• Fine tremor with diarrhea only
• Isolated insomnia
• Increased appetite without fever
Explanation: NMS is characterized by hyperthermia, severe rigidity, altered mental status, and autonomic instability, often with
elevated CK.
14. Which antipsychotic is particularly associated with hyperprolactinemia?
■ Risperidone
• Aripiprazole
• Quetiapine
• Clozapine
Explanation: Risperidone can substantially increase prolactin because of dopamine blockade in the tuberoinfundibular pathway.
NRNP 6675 • 250-question exam-style practice bank • 2026/2027 Page 3
, 15. Which antipsychotic has partial dopamine D2 agonist activity and is often considered relatively
prolactin-sparing?
■ Aripiprazole
• Haloperidol
• Risperidone
• Chlorpromazine
Explanation: Aripiprazole is a D2 partial agonist and often lowers or minimizes prolactin elevation compared with strong D2
antagonists.
16. A patient on carbamazepine develops confusion, headache, and hyponatremia. Which adverse effect
is most likely?
■ SIADH-related hyponatremia
• Hypercalcemia
• Serotonin syndrome
• Malignant hyperthermia
Explanation: Carbamazepine can cause SIADH and clinically important hyponatremia, particularly in susceptible patients.
17. Which laboratory monitoring is most directly associated with valproate therapy?
■ Liver function tests and platelet count
• Troponin every week
• Thyroid ultrasound
• Urinalysis for ketones only
Explanation: Valproate can cause hepatotoxicity and thrombocytopenia, so liver function and platelet monitoring are clinically
relevant.
18. A patient taking an MAOI asks about aged cheese and cured meats. What is the major concern?
■ Hypertensive crisis from tyramine
• Severe hypoglycemia
• Nephrolithiasis
• QT shortening
Explanation: Tyramine-rich foods can precipitate dangerous hypertension in patients taking MAOIs.
19. Which medication is an evidence-based option for alcohol use disorder that reduces rewarding
effects and craving?
■ Naltrexone
• Levodopa
• Benztropine
• Lamotrigine
Explanation: Naltrexone, when medically appropriate, can reduce alcohol craving and the reinforcing effects of alcohol.
NRNP 6675 • 250-question exam-style practice bank • 2026/2027 Page 4
