NRNP 6675 Exam Prep 2026-27
1. A 72-year-old patient develops new-onset depression, cognitive changes, and
visual hallucinations. Which diagnosis should the PMHNP consider especially
strongly?
A. Major depressive disorder
B. Lewy body dementia
C. Generalized anxiety disorder
D. Adjustment disorder
Answer: B. Lewy body dementia
Rationale: Visual hallucinations, cognitive fluctuations, and other parkinsonian features are
characteristic clues for Lewy body dementia. In an older adult with new psychiatric
symptoms, an underlying neurocognitive disorder should be considered.
2. Which neurotransmitter system is most directly associated with the
therapeutic effects of SSRIs?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. Acetylcholine
Answer: C. Serotonin
Rationale: SSRIs inhibit serotonin reuptake, increasing serotonergic signaling in the
synaptic cleft. Their therapeutic effects are primarily associated with modulation of the
serotonin system.
3. A patient taking an antipsychotic develops fever, severe muscle rigidity, altered
mental status, and autonomic instability. What is the most likely diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Acute dystonia
Answer: B. Neuroleptic malignant syndrome
Rationale: The combination of hyperthermia, severe rigidity, altered consciousness, and
autonomic instability is classic for neuroleptic malignant syndrome (NMS), a potentially
life-threatening reaction to dopamine-blocking medications.
, 4. Which finding most strongly distinguishes serotonin syndrome from
neuroleptic malignant syndrome?
A. Hyperthermia
B. Altered mental status
C. Hyperreflexia and clonus
D. Autonomic instability
Answer: C. Hyperreflexia and clonus
Rationale: Both syndromes can cause fever, altered mental status, and autonomic
abnormalities. Serotonin syndrome is particularly associated with hyperreflexia, clonus, and
neuromuscular hyperactivity.
5. A patient taking an antipsychotic develops involuntary repetitive movements of
the tongue and face after long-term treatment. Which adverse effect is most
likely?
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Parkinsonism
Answer: C. Tardive dyskinesia
Rationale: Tardive dyskinesia is associated with prolonged exposure to
dopamine-receptor-blocking medications and commonly involves repetitive involuntary
orofacial movements.
6. Which ethical principle refers to the obligation to avoid causing harm?
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice
Answer: C. Nonmaleficence
Rationale: Nonmaleficence means avoiding or minimizing harm to the patient. Beneficence
focuses on promoting the patient's welfare.
, 7. A competent adult patient refuses a recommended psychiatric medication after
receiving adequate information about its risks and benefits. Which ethical
principle primarily supports respecting this decision?
A. Justice
B. Autonomy
C. Fidelity
D. Nonmaleficence
Answer: B. Autonomy
Rationale: Autonomy recognizes a competent patient's right to make informed decisions
regarding their own healthcare, including refusing treatment.
8. Which personality disorder is characterized by a pervasive pattern of instability
in relationships, self-image, affect, and marked impulsivity?
A. Avoidant personality disorder
B. Borderline personality disorder
C. Obsessive-compulsive personality disorder
D. Schizoid personality disorder
Answer: B. Borderline personality disorder
Rationale: Borderline personality disorder commonly involves emotional instability, unstable
interpersonal relationships, identity disturbance, impulsivity, and recurrent suicidal behavior
or self-injury.
9. A patient has a persistent pattern of grandiosity, need for admiration, and lack
of empathy. Which personality disorder is most consistent with these findings?
A. Narcissistic personality disorder
B. Dependent personality disorder
C. Schizotypal personality disorder
D. Avoidant personality disorder
Answer: A. Narcissistic personality disorder
Rationale: Grandiosity, excessive need for admiration, entitlement, and reduced empathy
are central features of narcissistic personality disorder.
10.Which psychotherapy is particularly associated with treatment of borderline
personality disorder?
, A. Dialectical behavior therapy
B. Psychoanalysis only
C. Exposure therapy
D. Light therapy
Answer: A. Dialectical behavior therapy
Rationale: Dialectical behavior therapy (DBT) was developed specifically to address severe
emotional dysregulation and self-destructive behaviors associated with borderline
personality disorder.
11.A patient experiences recurrent unexpected panic attacks and subsequently
develops persistent concern about having additional attacks. Which diagnosis
is most appropriate?
A. Social anxiety disorder
B. Panic disorder
C. Specific phobia
D. Generalized anxiety disorder
Answer: B. Panic disorder
Rationale: Panic disorder involves recurrent unexpected panic attacks followed by
persistent concern about additional attacks and/or maladaptive behavioral changes.
12.Which medication class is generally considered first-line pharmacotherapy for
generalized anxiety disorder?
A. SSRIs or SNRIs
B. Stimulants
C. Typical antipsychotics
D. Mood stabilizers only
Answer: A. SSRIs or SNRIs
Rationale: SSRIs and SNRIs are commonly used as first-line pharmacologic treatments for
generalized anxiety disorder because of their efficacy and suitability for longer-term
treatment.
13.A patient taking lithium develops worsening tremor, vomiting, diarrhea,
confusion, and impaired coordination. What should the PMHNP suspect?
A. Lithium toxicity
B. Serotonin syndrome
1. A 72-year-old patient develops new-onset depression, cognitive changes, and
visual hallucinations. Which diagnosis should the PMHNP consider especially
strongly?
A. Major depressive disorder
B. Lewy body dementia
C. Generalized anxiety disorder
D. Adjustment disorder
Answer: B. Lewy body dementia
Rationale: Visual hallucinations, cognitive fluctuations, and other parkinsonian features are
characteristic clues for Lewy body dementia. In an older adult with new psychiatric
symptoms, an underlying neurocognitive disorder should be considered.
2. Which neurotransmitter system is most directly associated with the
therapeutic effects of SSRIs?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. Acetylcholine
Answer: C. Serotonin
Rationale: SSRIs inhibit serotonin reuptake, increasing serotonergic signaling in the
synaptic cleft. Their therapeutic effects are primarily associated with modulation of the
serotonin system.
3. A patient taking an antipsychotic develops fever, severe muscle rigidity, altered
mental status, and autonomic instability. What is the most likely diagnosis?
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Panic disorder
D. Acute dystonia
Answer: B. Neuroleptic malignant syndrome
Rationale: The combination of hyperthermia, severe rigidity, altered consciousness, and
autonomic instability is classic for neuroleptic malignant syndrome (NMS), a potentially
life-threatening reaction to dopamine-blocking medications.
, 4. Which finding most strongly distinguishes serotonin syndrome from
neuroleptic malignant syndrome?
A. Hyperthermia
B. Altered mental status
C. Hyperreflexia and clonus
D. Autonomic instability
Answer: C. Hyperreflexia and clonus
Rationale: Both syndromes can cause fever, altered mental status, and autonomic
abnormalities. Serotonin syndrome is particularly associated with hyperreflexia, clonus, and
neuromuscular hyperactivity.
5. A patient taking an antipsychotic develops involuntary repetitive movements of
the tongue and face after long-term treatment. Which adverse effect is most
likely?
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Parkinsonism
Answer: C. Tardive dyskinesia
Rationale: Tardive dyskinesia is associated with prolonged exposure to
dopamine-receptor-blocking medications and commonly involves repetitive involuntary
orofacial movements.
6. Which ethical principle refers to the obligation to avoid causing harm?
A. Autonomy
B. Beneficence
C. Nonmaleficence
D. Justice
Answer: C. Nonmaleficence
Rationale: Nonmaleficence means avoiding or minimizing harm to the patient. Beneficence
focuses on promoting the patient's welfare.
, 7. A competent adult patient refuses a recommended psychiatric medication after
receiving adequate information about its risks and benefits. Which ethical
principle primarily supports respecting this decision?
A. Justice
B. Autonomy
C. Fidelity
D. Nonmaleficence
Answer: B. Autonomy
Rationale: Autonomy recognizes a competent patient's right to make informed decisions
regarding their own healthcare, including refusing treatment.
8. Which personality disorder is characterized by a pervasive pattern of instability
in relationships, self-image, affect, and marked impulsivity?
A. Avoidant personality disorder
B. Borderline personality disorder
C. Obsessive-compulsive personality disorder
D. Schizoid personality disorder
Answer: B. Borderline personality disorder
Rationale: Borderline personality disorder commonly involves emotional instability, unstable
interpersonal relationships, identity disturbance, impulsivity, and recurrent suicidal behavior
or self-injury.
9. A patient has a persistent pattern of grandiosity, need for admiration, and lack
of empathy. Which personality disorder is most consistent with these findings?
A. Narcissistic personality disorder
B. Dependent personality disorder
C. Schizotypal personality disorder
D. Avoidant personality disorder
Answer: A. Narcissistic personality disorder
Rationale: Grandiosity, excessive need for admiration, entitlement, and reduced empathy
are central features of narcissistic personality disorder.
10.Which psychotherapy is particularly associated with treatment of borderline
personality disorder?
, A. Dialectical behavior therapy
B. Psychoanalysis only
C. Exposure therapy
D. Light therapy
Answer: A. Dialectical behavior therapy
Rationale: Dialectical behavior therapy (DBT) was developed specifically to address severe
emotional dysregulation and self-destructive behaviors associated with borderline
personality disorder.
11.A patient experiences recurrent unexpected panic attacks and subsequently
develops persistent concern about having additional attacks. Which diagnosis
is most appropriate?
A. Social anxiety disorder
B. Panic disorder
C. Specific phobia
D. Generalized anxiety disorder
Answer: B. Panic disorder
Rationale: Panic disorder involves recurrent unexpected panic attacks followed by
persistent concern about additional attacks and/or maladaptive behavioral changes.
12.Which medication class is generally considered first-line pharmacotherapy for
generalized anxiety disorder?
A. SSRIs or SNRIs
B. Stimulants
C. Typical antipsychotics
D. Mood stabilizers only
Answer: A. SSRIs or SNRIs
Rationale: SSRIs and SNRIs are commonly used as first-line pharmacologic treatments for
generalized anxiety disorder because of their efficacy and suitability for longer-term
treatment.
13.A patient taking lithium develops worsening tremor, vomiting, diarrhea,
confusion, and impaired coordination. What should the PMHNP suspect?
A. Lithium toxicity
B. Serotonin syndrome
