NRNP 6675 Midterm Exam Study
GuidePsychiatric-Mental Health Nurse
Practitioner (PMHNP)Practice questions,
correct answers, and detailed rationales
1. A client reports two weeks of depressed mood, anhedonia, fatigue, insomnia, and feelings of
worthlessness. Which diagnosis is most likely?
A. Bipolar I disorder B. Major depressive disorder C. Schizophrenia D. Generalized anxiety disorder
Correct answer: B. Major depressive disorder
Rationale: Major depressive disorder involves at least five depressive symptoms occurring during
the same two-week period, including depressed mood or loss of interest or pleasure, with clinically
significant distress or impairment. The clinician must also assess for mania or hypomania,
substance effects, medical causes, and suicide risk.
2. Which question is most important when assessing suicide risk?
A. "What is your favorite activity?" B. "Have you thought about killing yourself, and do you have a
plan?" C. "Do you exercise regularly?" D. "How many siblings do you have?"
Correct answer: B
Rationale: Direct questions about suicidal thoughts, intent, planning, access to lethal means, and
previous attempts are essential. Asking directly does not cause suicidal behavior. An imminent risk
requires immediate safety measures and urgent evaluation.
3. A client has periods of elevated mood, decreased need for sleep, grandiosity, and significant
impairment requiring hospitalization. Which diagnosis is most consistent?
A. Bipolar I disorder B. Cyclothymic disorder C. Persistent depressive disorder D. Adjustment
disorder
Correct answer: A. Bipolar I disorder
,Rationale: Bipolar I disorder requires at least one manic episode. Mania generally lasts at least one
week, or any duration if hospitalization is necessary, and causes marked impairment,
hospitalization, or psychotic features.
4. Which finding is a negative symptom of schizophrenia?
A. Auditory hallucinations B. Delusions of persecution C. Avolition D. Disorganized speech
Correct answer: C. Avolition
Rationale: Negative symptoms involve reductions in normal functioning, such as diminished
motivation, reduced emotional expression, poverty of speech, and social withdrawal.
Hallucinations and delusions are positive symptoms.
5. A client taking an antipsychotic develops fever, severe muscle rigidity, confusion, and
autonomic instability. Which condition is most concerning?
A. Serotonin syndrome B. Neuroleptic malignant syndrome C. Acute dystonia D. Tardive dyskinesia
Correct answer: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a potentially fatal reaction associated with
dopamine-blocking medications. Findings include hyperthermia, severe rigidity, altered mental
status, and autonomic instability. The medication should be stopped and emergency medical
treatment initiated.
6. Which finding is most characteristic of serotonin syndrome?
A. Hyperreflexia and clonus B. Isolated constipation C. Decreased body temperature with
bradycardia D. Gradual hair loss
Correct answer: A. Hyperreflexia and clonus
Rationale: Serotonin syndrome can occur after exposure to serotonergic medications, especially
combinations or dose increases. Neuromuscular excitation, clonus, hyperreflexia, agitation,
sweating, and hyperthermia are characteristic findings. Severe symptoms require emergency
treatment.
7. Which medication class is commonly considered first-line pharmacotherapy for generalized
anxiety disorder?
A. SSRIs B. Opioids C. Stimulants D. First-generation antipsychotics
Correct answer: A. SSRIs
,Rationale: SSRIs and SNRIs are common first-line medication options for generalized anxiety
disorder. Selection depends on the client's symptoms, comorbidities, previous response, adverse-
effect profile, and preferences. Psychotherapy, particularly cognitive behavioral therapy, is also an
evidence-based treatment.
8. A client taking lithium develops vomiting, coarse tremor, unsteady gait, and confusion. What
is the priority?
A. Reassure the client that this is expected B. Recommend taking an extra dose C. Suspect lithium
toxicity and arrange urgent evaluation D. Advise restricting all fluids
Correct answer: C
Rationale: Gastrointestinal symptoms, worsening tremor, ataxia, and confusion can indicate
lithium toxicity. The client needs urgent assessment, serum lithium and renal-function testing,
electrolyte evaluation, and medication review. Dehydration and certain medications can increase
lithium concentrations.
9. Which symptom is most characteristic of post-traumatic stress disorder (PTSD)?
A. Re-experiencing a traumatic event through intrusive memories B. Elevated mood lasting one day
C. Memory loss limited to childhood in every case D. Persistent hallucinations in the absence of
trauma symptoms
Correct answer: A
Rationale: PTSD may include intrusive memories or nightmares, avoidance, negative changes in
cognition and mood, and hyperarousal following qualifying trauma. Symptoms persist for more
than one month and cause clinically significant distress or impairment.
10. Which therapeutic communication response is most appropriate when a client says,
"Nobody understands what I am going through"?
A. "You should not feel that way." B. "Other people have worse problems." C. "It sounds like you feel
alone. Can you tell me more?" D. "You need to think positively."
Correct answer: C
Rationale: Reflecting the client's feelings and inviting elaboration demonstrates empathy and
encourages exploration. Judgment, minimizing, and giving premature advice can interfere with the
therapeutic relationship.
11. Which feature distinguishes delirium from many primary psychiatric disorders?
, A. Acute onset with fluctuating attention and awareness B. Stable symptoms over many years
without change C. Normal attention in all cases D. Symptoms occurring only during adolescence
Correct answer: A
Rationale: Delirium often develops over hours to days and involves fluctuating attention and
awareness. It can result from infection, medications, metabolic abnormalities, intoxication, or
withdrawal and requires prompt evaluation for an underlying cause.
12. A client has recurrent unexpected panic attacks and persistent concern about additional
attacks for several weeks. Which diagnosis is most likely?
A. Panic disorder B. Schizophrenia C. Somatic symptom disorder in every case D. Bipolar I disorder
Correct answer: A. Panic disorder
Rationale: Panic disorder involves recurrent unexpected panic attacks followed by at least one
month of persistent concern about further attacks or maladaptive behavioral changes. The
clinician should evaluate medical and substance-related causes of panic-like symptoms.
13. Which assessment is essential before initiating an antidepressant?
A. Suicide risk and history of mania or hypomania B. Favorite television program C. Hair color D.
Hand dominance only
Correct answer: A
Rationale: Suicide risk assessment helps determine safety needs, while screening for previous
mania or hypomania can identify possible bipolar disorder. Antidepressant monotherapy may
precipitate mood switching in some clients with bipolar illness.
14. Which medication is commonly used for opioid use disorder?
A. Buprenorphine B. Amoxicillin C. Levothyroxine D. Furosemide
Correct answer: A. Buprenorphine
Rationale: Buprenorphine is an evidence-based medication for opioid use disorder. Methadone
and extended-release naltrexone are additional options for appropriate patients. Medication
treatment reduces overdose risk and supports recovery.
15. A client reports hearing a voice telling them to harm another person. What should the
PMHNP assess first?
A. The client's favorite hobbies B. The content of the command, intent, access to means, and ability
to resist C. The client's educational history only D. Whether the client prefers individual therapy
GuidePsychiatric-Mental Health Nurse
Practitioner (PMHNP)Practice questions,
correct answers, and detailed rationales
1. A client reports two weeks of depressed mood, anhedonia, fatigue, insomnia, and feelings of
worthlessness. Which diagnosis is most likely?
A. Bipolar I disorder B. Major depressive disorder C. Schizophrenia D. Generalized anxiety disorder
Correct answer: B. Major depressive disorder
Rationale: Major depressive disorder involves at least five depressive symptoms occurring during
the same two-week period, including depressed mood or loss of interest or pleasure, with clinically
significant distress or impairment. The clinician must also assess for mania or hypomania,
substance effects, medical causes, and suicide risk.
2. Which question is most important when assessing suicide risk?
A. "What is your favorite activity?" B. "Have you thought about killing yourself, and do you have a
plan?" C. "Do you exercise regularly?" D. "How many siblings do you have?"
Correct answer: B
Rationale: Direct questions about suicidal thoughts, intent, planning, access to lethal means, and
previous attempts are essential. Asking directly does not cause suicidal behavior. An imminent risk
requires immediate safety measures and urgent evaluation.
3. A client has periods of elevated mood, decreased need for sleep, grandiosity, and significant
impairment requiring hospitalization. Which diagnosis is most consistent?
A. Bipolar I disorder B. Cyclothymic disorder C. Persistent depressive disorder D. Adjustment
disorder
Correct answer: A. Bipolar I disorder
,Rationale: Bipolar I disorder requires at least one manic episode. Mania generally lasts at least one
week, or any duration if hospitalization is necessary, and causes marked impairment,
hospitalization, or psychotic features.
4. Which finding is a negative symptom of schizophrenia?
A. Auditory hallucinations B. Delusions of persecution C. Avolition D. Disorganized speech
Correct answer: C. Avolition
Rationale: Negative symptoms involve reductions in normal functioning, such as diminished
motivation, reduced emotional expression, poverty of speech, and social withdrawal.
Hallucinations and delusions are positive symptoms.
5. A client taking an antipsychotic develops fever, severe muscle rigidity, confusion, and
autonomic instability. Which condition is most concerning?
A. Serotonin syndrome B. Neuroleptic malignant syndrome C. Acute dystonia D. Tardive dyskinesia
Correct answer: B. Neuroleptic malignant syndrome
Rationale: Neuroleptic malignant syndrome is a potentially fatal reaction associated with
dopamine-blocking medications. Findings include hyperthermia, severe rigidity, altered mental
status, and autonomic instability. The medication should be stopped and emergency medical
treatment initiated.
6. Which finding is most characteristic of serotonin syndrome?
A. Hyperreflexia and clonus B. Isolated constipation C. Decreased body temperature with
bradycardia D. Gradual hair loss
Correct answer: A. Hyperreflexia and clonus
Rationale: Serotonin syndrome can occur after exposure to serotonergic medications, especially
combinations or dose increases. Neuromuscular excitation, clonus, hyperreflexia, agitation,
sweating, and hyperthermia are characteristic findings. Severe symptoms require emergency
treatment.
7. Which medication class is commonly considered first-line pharmacotherapy for generalized
anxiety disorder?
A. SSRIs B. Opioids C. Stimulants D. First-generation antipsychotics
Correct answer: A. SSRIs
,Rationale: SSRIs and SNRIs are common first-line medication options for generalized anxiety
disorder. Selection depends on the client's symptoms, comorbidities, previous response, adverse-
effect profile, and preferences. Psychotherapy, particularly cognitive behavioral therapy, is also an
evidence-based treatment.
8. A client taking lithium develops vomiting, coarse tremor, unsteady gait, and confusion. What
is the priority?
A. Reassure the client that this is expected B. Recommend taking an extra dose C. Suspect lithium
toxicity and arrange urgent evaluation D. Advise restricting all fluids
Correct answer: C
Rationale: Gastrointestinal symptoms, worsening tremor, ataxia, and confusion can indicate
lithium toxicity. The client needs urgent assessment, serum lithium and renal-function testing,
electrolyte evaluation, and medication review. Dehydration and certain medications can increase
lithium concentrations.
9. Which symptom is most characteristic of post-traumatic stress disorder (PTSD)?
A. Re-experiencing a traumatic event through intrusive memories B. Elevated mood lasting one day
C. Memory loss limited to childhood in every case D. Persistent hallucinations in the absence of
trauma symptoms
Correct answer: A
Rationale: PTSD may include intrusive memories or nightmares, avoidance, negative changes in
cognition and mood, and hyperarousal following qualifying trauma. Symptoms persist for more
than one month and cause clinically significant distress or impairment.
10. Which therapeutic communication response is most appropriate when a client says,
"Nobody understands what I am going through"?
A. "You should not feel that way." B. "Other people have worse problems." C. "It sounds like you feel
alone. Can you tell me more?" D. "You need to think positively."
Correct answer: C
Rationale: Reflecting the client's feelings and inviting elaboration demonstrates empathy and
encourages exploration. Judgment, minimizing, and giving premature advice can interfere with the
therapeutic relationship.
11. Which feature distinguishes delirium from many primary psychiatric disorders?
, A. Acute onset with fluctuating attention and awareness B. Stable symptoms over many years
without change C. Normal attention in all cases D. Symptoms occurring only during adolescence
Correct answer: A
Rationale: Delirium often develops over hours to days and involves fluctuating attention and
awareness. It can result from infection, medications, metabolic abnormalities, intoxication, or
withdrawal and requires prompt evaluation for an underlying cause.
12. A client has recurrent unexpected panic attacks and persistent concern about additional
attacks for several weeks. Which diagnosis is most likely?
A. Panic disorder B. Schizophrenia C. Somatic symptom disorder in every case D. Bipolar I disorder
Correct answer: A. Panic disorder
Rationale: Panic disorder involves recurrent unexpected panic attacks followed by at least one
month of persistent concern about further attacks or maladaptive behavioral changes. The
clinician should evaluate medical and substance-related causes of panic-like symptoms.
13. Which assessment is essential before initiating an antidepressant?
A. Suicide risk and history of mania or hypomania B. Favorite television program C. Hair color D.
Hand dominance only
Correct answer: A
Rationale: Suicide risk assessment helps determine safety needs, while screening for previous
mania or hypomania can identify possible bipolar disorder. Antidepressant monotherapy may
precipitate mood switching in some clients with bipolar illness.
14. Which medication is commonly used for opioid use disorder?
A. Buprenorphine B. Amoxicillin C. Levothyroxine D. Furosemide
Correct answer: A. Buprenorphine
Rationale: Buprenorphine is an evidence-based medication for opioid use disorder. Methadone
and extended-release naltrexone are additional options for appropriate patients. Medication
treatment reduces overdose risk and supports recovery.
15. A client reports hearing a voice telling them to harm another person. What should the
PMHNP assess first?
A. The client's favorite hobbies B. The content of the command, intent, access to means, and ability
to resist C. The client's educational history only D. Whether the client prefers individual therapy
