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 fidgeting,
calling out, and incomplete worksheets.” Vanderbilt parent/teacher scales show
9/9 inattention items and 8/9 hyperactive/impulsive items. Birth weight 1.8 kg;
mother smoked ½ ppd during pregnancy. Which initial diagnosis is most
accurate?
A. Autism spectrum disorder
B. ADHD, combined presentation
C. Fetal alcohol spectrum disorder
D. Intellectual developmental disorder
Correct Answer: B
Rationale: DSM-5-TR requires ≥6 symptoms in two settings before age 12; scales
corroborate cross-situational impairment. Low birth weight & prenatal nicotine
are ADHD risk factors. No social-communication deficits or global cognitive
delay described to justify A, C, or D.
2. The same child weighs 23 kg. Which first-line pharmacotherapy and dose best
reflects APA/AAFP 2024 guidelines?
A. Methylphenidate XR 18 mg qAM
B. Atomoxetine 40 mg qHS
C. Clonidine 0.1 mg BID
D. Sertraline 25 mg qAM
Correct Answer: A
Rationale: Stimulants remain first-line; methylphenidate XR 0.3–0.8 mg/kg → 18
mg (≈0.8 mg/kg) is guideline-based starting dose. Atomoxetine is second-line;
clonidine adjunctive; sertraline not indicated.
3. After 4 weeks on methylphenidate XR 18 mg, teacher Vanderbilt shows 50 %
symptom reduction, but mother reports “he stares into space for 10 s at a time.”
Which next step?
, A. Increase to 27 mg
B. Add lamotrigine
C. Obtain EEG; consider absence seizure vs. ADHD rebound
D. Discontinue stimulant; start guanfacine alone
Correct Answer: C
Rationale: New staring spells raise possibility of stimulant-unmasked absence
epilepsy; EEG is indicated before further dose escalation. Simple rebound would
occur after medication wears off, not midday.
4. A 14-year-old girl (Tanner IV) reports 3-week history of daily tearfulness,
hypersomnia 12 h, PHQ-A 17, and 5-lb weight gain. She started lamotrigine 100
mg BID 6 weeks ago for bipolar depression. Which is the most likely cause of her
current symptoms?
A. Lamotrigine-induced switch to mania
B. Breakthrough bipolar depression
C. Medication-induced hyponatremia
D. Normal adolescent hormonal fluctuation
Correct Answer: B
Rationale: Lamotrigine is more effective for maintenance than acute bipolar
depression; dose <200 mg may be subtherapeutic. No manic symptoms,
hyponatremia SIADH risk minimal with lamotrigine.
5. Best evidence-based next pharmacotherapy for the above teen?
A. Increase lamotrigine to 200 mg daily (target 200 mg)
B. Add aripiprazole 2 mg daily
C. Switch to lithium 300 mg TID
D. Start fluoxetine 20 mg monotherapy
Correct Answer: A
Rationale: APA 2024 bipolar depression: optimize lamotrigine to 200 mg before
adding second agent; lowest switch risk in adolescents. Lithium requires levels;
SSRI monotherapy risks switch.
6. A 5-year-old boy presents with no spontaneous language, hand-flapping, and
insists on lining up cars. M-CHAT-R score 11; ADOS-2 meets autism cutoff. Which
intervention is FIRST-LINE?
A. Risperidone 0.25 mg BID
B. Begin applied behavior analysis (ABA) 25 h/week
C. Start methylphenidate 2.5 mg BID
D. Order chromosome microarray only
Correct Answer: B
Rationale: ABA is evidence-based core intervention for preschool autism; APA
, 2023. Pharmacotherapy targets irritability or ADHD comorbidity only after
behavioral plans.
7. An 8-year-old girl with autism exhibits severe self-injury when routines change.
Which FDA-approved medication for irritability in autism?
A. Risperidone
B. Sertraline
C. Clonidine patch
D. Lithium carbonate
Correct Answer: A
Rationale: Risperidone (age ≥5) and aripiprazole are FDA-approved for irritability
in autism; others lack indication.
8. A 16-year-old male with ODD is suspended for fighting. Parents report chronic
defiance but no remorse. Which therapy has strongest evidence?
A. Parent management training (PMT)
B. Psychoanalytic psychotherapy 3×/week
C. Diazepam 5 mg BID PRN
D. Residential placement immediately
Correct Answer: A
Rationale: APA 2024: PMT (e.g., Defiant Teens) is first-line for ODD; medication
only for comorbid ADHD/anger.
9. A 10-year-old girl witnessed domestic violence and now has nightmares,
bed-wetting, and refuses to sleep alone. Which is the most accurate initial
diagnosis?
A. Adjustment disorder
B. PTSD in preschool subtype
C. PTSD in children ≥6 years
D. Acute stress disorder
Correct Answer: C
Rationale: Symptoms >1 month, witnessed violence, functional impairment;
bed-wetting = trauma-related re-experiencing in children.
10. First-line medication for this child’s PTSD nightmares?
A. Prazosin 1 mg qHS
B. Clonazepam 0.5 mg qHS
C. Risperidone 0.5 mg BID
D. Sertraline 100 mg qAM
Correct Answer: A
Rationale: RCTs (APA 2023) support prazosin for trauma nightmares ≥6 y; start 1
mg, titrate to weight-based 2–5 mg. SSRIs first-line for global PTSD but not
targeted for nightmares.
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 fidgeting,
calling out, and incomplete worksheets.” Vanderbilt parent/teacher scales show
9/9 inattention items and 8/9 hyperactive/impulsive items. Birth weight 1.8 kg;
mother smoked ½ ppd during pregnancy. Which initial diagnosis is most
accurate?
A. Autism spectrum disorder
B. ADHD, combined presentation
C. Fetal alcohol spectrum disorder
D. Intellectual developmental disorder
Correct Answer: B
Rationale: DSM-5-TR requires ≥6 symptoms in two settings before age 12; scales
corroborate cross-situational impairment. Low birth weight & prenatal nicotine
are ADHD risk factors. No social-communication deficits or global cognitive
delay described to justify A, C, or D.
2. The same child weighs 23 kg. Which first-line pharmacotherapy and dose best
reflects APA/AAFP 2024 guidelines?
A. Methylphenidate XR 18 mg qAM
B. Atomoxetine 40 mg qHS
C. Clonidine 0.1 mg BID
D. Sertraline 25 mg qAM
Correct Answer: A
Rationale: Stimulants remain first-line; methylphenidate XR 0.3–0.8 mg/kg → 18
mg (≈0.8 mg/kg) is guideline-based starting dose. Atomoxetine is second-line;
clonidine adjunctive; sertraline not indicated.
3. After 4 weeks on methylphenidate XR 18 mg, teacher Vanderbilt shows 50 %
symptom reduction, but mother reports “he stares into space for 10 s at a time.”
Which next step?
, A. Increase to 27 mg
B. Add lamotrigine
C. Obtain EEG; consider absence seizure vs. ADHD rebound
D. Discontinue stimulant; start guanfacine alone
Correct Answer: C
Rationale: New staring spells raise possibility of stimulant-unmasked absence
epilepsy; EEG is indicated before further dose escalation. Simple rebound would
occur after medication wears off, not midday.
4. A 14-year-old girl (Tanner IV) reports 3-week history of daily tearfulness,
hypersomnia 12 h, PHQ-A 17, and 5-lb weight gain. She started lamotrigine 100
mg BID 6 weeks ago for bipolar depression. Which is the most likely cause of her
current symptoms?
A. Lamotrigine-induced switch to mania
B. Breakthrough bipolar depression
C. Medication-induced hyponatremia
D. Normal adolescent hormonal fluctuation
Correct Answer: B
Rationale: Lamotrigine is more effective for maintenance than acute bipolar
depression; dose <200 mg may be subtherapeutic. No manic symptoms,
hyponatremia SIADH risk minimal with lamotrigine.
5. Best evidence-based next pharmacotherapy for the above teen?
A. Increase lamotrigine to 200 mg daily (target 200 mg)
B. Add aripiprazole 2 mg daily
C. Switch to lithium 300 mg TID
D. Start fluoxetine 20 mg monotherapy
Correct Answer: A
Rationale: APA 2024 bipolar depression: optimize lamotrigine to 200 mg before
adding second agent; lowest switch risk in adolescents. Lithium requires levels;
SSRI monotherapy risks switch.
6. A 5-year-old boy presents with no spontaneous language, hand-flapping, and
insists on lining up cars. M-CHAT-R score 11; ADOS-2 meets autism cutoff. Which
intervention is FIRST-LINE?
A. Risperidone 0.25 mg BID
B. Begin applied behavior analysis (ABA) 25 h/week
C. Start methylphenidate 2.5 mg BID
D. Order chromosome microarray only
Correct Answer: B
Rationale: ABA is evidence-based core intervention for preschool autism; APA
, 2023. Pharmacotherapy targets irritability or ADHD comorbidity only after
behavioral plans.
7. An 8-year-old girl with autism exhibits severe self-injury when routines change.
Which FDA-approved medication for irritability in autism?
A. Risperidone
B. Sertraline
C. Clonidine patch
D. Lithium carbonate
Correct Answer: A
Rationale: Risperidone (age ≥5) and aripiprazole are FDA-approved for irritability
in autism; others lack indication.
8. A 16-year-old male with ODD is suspended for fighting. Parents report chronic
defiance but no remorse. Which therapy has strongest evidence?
A. Parent management training (PMT)
B. Psychoanalytic psychotherapy 3×/week
C. Diazepam 5 mg BID PRN
D. Residential placement immediately
Correct Answer: A
Rationale: APA 2024: PMT (e.g., Defiant Teens) is first-line for ODD; medication
only for comorbid ADHD/anger.
9. A 10-year-old girl witnessed domestic violence and now has nightmares,
bed-wetting, and refuses to sleep alone. Which is the most accurate initial
diagnosis?
A. Adjustment disorder
B. PTSD in preschool subtype
C. PTSD in children ≥6 years
D. Acute stress disorder
Correct Answer: C
Rationale: Symptoms >1 month, witnessed violence, functional impairment;
bed-wetting = trauma-related re-experiencing in children.
10. First-line medication for this child’s PTSD nightmares?
A. Prazosin 1 mg qHS
B. Clonazepam 0.5 mg qHS
C. Risperidone 0.5 mg BID
D. Sertraline 100 mg qAM
Correct Answer: A
Rationale: RCTs (APA 2023) support prazosin for trauma nightmares ≥6 y; start 1
mg, titrate to weight-based 2–5 mg. SSRIs first-line for global PTSD but not
targeted for nightmares.
