NRNP 6665-01 PMHNP Final Exam | Week 11 Solutions
2026/2027 Complete Final Examination | Actual Questions &
Verified Solutions | Comprehensive Lifespan Psychiatry |
Advanced Clinical Scenarios | Pass Guarantee
1. A 7-year-old boy is brought by his teacher and mother for “constant motion,
blurting answers, and climbing on furniture since preschool.” Vanderbilt
parent/teacher scales show 9/9 inattention, 8/9 hyperactivity-impulsivity. Birth
weight 1.8 kg; mother smoked during pregnancy. He currently reads at 1st-grade
level (2nd month). BMI 17 kg/m², HR 92, BP 94/58. Which initial pharmacologic
plan is best?
A. Methylphenidate 5 mg PO qAM, increase by 5 mg weekly to 20 mg qAM.
B. Atomoxetine 0.5 mg/kg/day × 1 week, then 1.2 mg/kg/day.
C. Clonidine 0.05 mg PO qHS, titrate to 0.1 mg BID.
D. Guanfacine ER 1 mg qHS, increase by 1 mg weekly to 3 mg.
Correct Answer: A
Rationale: Stimulants remain first-line for ADHD ≥6 y. Immediate-release
methylphenidate allows flexible titration and early school observation.
Atomoxetine is second-line and slower; α-agonists are adjunctive or when
stimulants fail/contraindicated. Low birth weight and maternal smoking heighten
stimulant benefit.
2. A 14-year-old girl with 6-week history of depressed mood, anhedonia, insomnia,
5-lb weight loss, and PHQ-A 15. Parents report 1 prior week of “giddiness, texting
friends all night, buying $400 shoes.” She denies current euphoria. Which
diagnosis is most accurate?
A. Major depressive disorder, single episode, moderate.
B. Bipolar I disorder, most recent episode depressed.
C. ADHD, combined presentation, with comorbid MDD.
D. Disruptive mood dysregulation disorder.
Correct Answer: B
Rationale: Prior clear hypomanic/manic behaviour (texting, spending) lasting ≥4
days meets criteria even if current presentation is depression. Thus lifetime
diagnosis is bipolar spectrum; antidepressant monotherapy risks switch.
,3. A 5-year-old boy speaks only 2-word phrases, lines up cars, ignores peers, and
becomes aggressive when routines change. M-CHAT-R score 11; ADOS-2
confirms autism spectrum disorder, level-2. Which evidence-based intervention
should be initiated first?
A. Risperidone 0.25 mg qHS for irritability.
B. Applied behavior analysis (ABA) 25 h/week.
C. Sertraline 12.5 mg qAM for anxiety.
D. Acetyl-l-carnitine 50 mg/kg/day.
Correct Answer: B
Rationale: ABA is the most robust early intervention for core ASD symptoms and
maladaptive behaviours. Risperidone is FDA-approved for irritability but only after
behavioural intervention failure or severe aggression.
4. A 16-year-old male with cannabis use 4×/week reports 3 months of “feeling
unreal,” derealization, and intrusive thoughts that he might stab his mother. He is
horrified, hides knives, and denies hallucinations. Y-BOCS score 22. Which SSRI
and dose is first-line?
A. Fluoxetine 10 mg daily.
B. Sertraline 25 mg daily.
C. Escitalopram 5 mg daily.
D. Paroxetine 10 mg daily.
Correct Answer: A
Rationale: FDA-approved for pediatric OCD ages 8–17; longest half-life simplifies
adherence. Start 10 mg, titrate to 20–40 mg. Sertraline also FDA-approved but
fluoxetine has stronger youth OCD evidence (POTS trial).
5. A 9-year-old girl with ADHD on methylphenidate ER 20 mg develops weight loss
(BMI dropped 10th→5th percentile), height velocity 4 cm/y (<3rd). Plan?
A. Discontinue stimulant immediately.
B. Switch to lisdexamfetamine 30 mg.
C. Add cyproheptadine 2 mg qHS and continue stimulant.
D. Change to atomoxetine 40 mg.
Correct Answer: D
Rationale: Non-stimulant atomoxetine does not suppress appetite/growth.
Cyproheptadine may help but does not address mechanism; continuing or
switching stimulants risks further deceleration.
, 6. A 12-year-old boy with oppositional defiant disorder punches walls, blames
teachers, and argues daily. Parents attend 4 sessions of individual therapy with
little change. Next best step?
A. Start lithium 300 mg BID.
B. Refer for parent-management training (PMT).
C. Admit to inpatient psychiatry.
D. Begin quetiapine 25 mg BID.
Correct Answer: B
Rationale: PMT (e.g., Defiant Children program) has strongest evidence for ODD.
Medications are adjunctive for severe aggression unresponsive to behavioural
interventions.
7. A 6-year-old adopted boy witnesses domestic violence and presents with
nightmares, bed-wetting, hypervigilance. Which trauma-focused therapy is
first-line?
A. Child-parent psychotherapy (CPP).
B. Cognitive processing therapy (CPT).
C. Eye-movement desensitization (EMDR).
D. Dialectical behaviour therapy (DBT).
Correct Answer: A
Rationale: CPP is manualized for ages 0–5 but extended to 6 y; focuses on
attachment and dyadic work. CPT/EMDR are ≥12 y; DBT is for emotion
dysregulation/adolescents.
8. An 8-year-old girl on risperidone 1 mg qHS for severe irritability/autism develops
galactorrhea and prolactin 84 ng/mL (4–23). Aripiprazole is considered. Which
dose equivalently controls behaviour?
A. 2 mg qHS.
B. 5 mg qHS.
C. 10 mg qHS.
D. 15 mg qHS.
Correct Answer: B
Rationale: 1 mg risperidone ≈ 5 mg aripiprazole in dopamine-occupancy models;
aripiprazole is partial agonist hence lower D2 blockade and less
hyperprolactinemia.
2026/2027 Complete Final Examination | Actual Questions &
Verified Solutions | Comprehensive Lifespan Psychiatry |
Advanced Clinical Scenarios | Pass Guarantee
1. A 7-year-old boy is brought by his teacher and mother for “constant motion,
blurting answers, and climbing on furniture since preschool.” Vanderbilt
parent/teacher scales show 9/9 inattention, 8/9 hyperactivity-impulsivity. Birth
weight 1.8 kg; mother smoked during pregnancy. He currently reads at 1st-grade
level (2nd month). BMI 17 kg/m², HR 92, BP 94/58. Which initial pharmacologic
plan is best?
A. Methylphenidate 5 mg PO qAM, increase by 5 mg weekly to 20 mg qAM.
B. Atomoxetine 0.5 mg/kg/day × 1 week, then 1.2 mg/kg/day.
C. Clonidine 0.05 mg PO qHS, titrate to 0.1 mg BID.
D. Guanfacine ER 1 mg qHS, increase by 1 mg weekly to 3 mg.
Correct Answer: A
Rationale: Stimulants remain first-line for ADHD ≥6 y. Immediate-release
methylphenidate allows flexible titration and early school observation.
Atomoxetine is second-line and slower; α-agonists are adjunctive or when
stimulants fail/contraindicated. Low birth weight and maternal smoking heighten
stimulant benefit.
2. A 14-year-old girl with 6-week history of depressed mood, anhedonia, insomnia,
5-lb weight loss, and PHQ-A 15. Parents report 1 prior week of “giddiness, texting
friends all night, buying $400 shoes.” She denies current euphoria. Which
diagnosis is most accurate?
A. Major depressive disorder, single episode, moderate.
B. Bipolar I disorder, most recent episode depressed.
C. ADHD, combined presentation, with comorbid MDD.
D. Disruptive mood dysregulation disorder.
Correct Answer: B
Rationale: Prior clear hypomanic/manic behaviour (texting, spending) lasting ≥4
days meets criteria even if current presentation is depression. Thus lifetime
diagnosis is bipolar spectrum; antidepressant monotherapy risks switch.
,3. A 5-year-old boy speaks only 2-word phrases, lines up cars, ignores peers, and
becomes aggressive when routines change. M-CHAT-R score 11; ADOS-2
confirms autism spectrum disorder, level-2. Which evidence-based intervention
should be initiated first?
A. Risperidone 0.25 mg qHS for irritability.
B. Applied behavior analysis (ABA) 25 h/week.
C. Sertraline 12.5 mg qAM for anxiety.
D. Acetyl-l-carnitine 50 mg/kg/day.
Correct Answer: B
Rationale: ABA is the most robust early intervention for core ASD symptoms and
maladaptive behaviours. Risperidone is FDA-approved for irritability but only after
behavioural intervention failure or severe aggression.
4. A 16-year-old male with cannabis use 4×/week reports 3 months of “feeling
unreal,” derealization, and intrusive thoughts that he might stab his mother. He is
horrified, hides knives, and denies hallucinations. Y-BOCS score 22. Which SSRI
and dose is first-line?
A. Fluoxetine 10 mg daily.
B. Sertraline 25 mg daily.
C. Escitalopram 5 mg daily.
D. Paroxetine 10 mg daily.
Correct Answer: A
Rationale: FDA-approved for pediatric OCD ages 8–17; longest half-life simplifies
adherence. Start 10 mg, titrate to 20–40 mg. Sertraline also FDA-approved but
fluoxetine has stronger youth OCD evidence (POTS trial).
5. A 9-year-old girl with ADHD on methylphenidate ER 20 mg develops weight loss
(BMI dropped 10th→5th percentile), height velocity 4 cm/y (<3rd). Plan?
A. Discontinue stimulant immediately.
B. Switch to lisdexamfetamine 30 mg.
C. Add cyproheptadine 2 mg qHS and continue stimulant.
D. Change to atomoxetine 40 mg.
Correct Answer: D
Rationale: Non-stimulant atomoxetine does not suppress appetite/growth.
Cyproheptadine may help but does not address mechanism; continuing or
switching stimulants risks further deceleration.
, 6. A 12-year-old boy with oppositional defiant disorder punches walls, blames
teachers, and argues daily. Parents attend 4 sessions of individual therapy with
little change. Next best step?
A. Start lithium 300 mg BID.
B. Refer for parent-management training (PMT).
C. Admit to inpatient psychiatry.
D. Begin quetiapine 25 mg BID.
Correct Answer: B
Rationale: PMT (e.g., Defiant Children program) has strongest evidence for ODD.
Medications are adjunctive for severe aggression unresponsive to behavioural
interventions.
7. A 6-year-old adopted boy witnesses domestic violence and presents with
nightmares, bed-wetting, hypervigilance. Which trauma-focused therapy is
first-line?
A. Child-parent psychotherapy (CPP).
B. Cognitive processing therapy (CPT).
C. Eye-movement desensitization (EMDR).
D. Dialectical behaviour therapy (DBT).
Correct Answer: A
Rationale: CPP is manualized for ages 0–5 but extended to 6 y; focuses on
attachment and dyadic work. CPT/EMDR are ≥12 y; DBT is for emotion
dysregulation/adolescents.
8. An 8-year-old girl on risperidone 1 mg qHS for severe irritability/autism develops
galactorrhea and prolactin 84 ng/mL (4–23). Aripiprazole is considered. Which
dose equivalently controls behaviour?
A. 2 mg qHS.
B. 5 mg qHS.
C. 10 mg qHS.
D. 15 mg qHS.
Correct Answer: B
Rationale: 1 mg risperidone ≈ 5 mg aripiprazole in dopamine-occupancy models;
aripiprazole is partial agonist hence lower D2 blockade and less
hyperprolactinemia.
