NRNP6635 Final Exam ACTUAL EXAM
2026/2027: 100% Verified Questions &
Correct Answers
Question 1: A 23-year-old woman with borderline personality disorder (BPD) self-harms by
cutting after perceived abandonment. She has failed two SSRIs. Which evidence-based
psychotherapy is most appropriate to reduce self-harm?
A. Supportive psychotherapy
B. Dialectical behavior therapy (DBT)
C. Interpersonal psychotherapy (IPT)
D. Psychoanalytic psychotherapy
Correct Answer: B
Rationale: DBT is the gold-standard, manualized treatment for BPD that specifically targets
self-harm through skills training and behavioral chain analysis.
Question 2: A 34-year-old man with schizophrenia takes clozapine 350 mg nightly. His WBC is
2.8 × 10⁹/L with absolute neutrophil count (ANC) 1.2 × 10⁹/L. He is afebrile. What is the next
step per clozapine REMS?
A. Continue clozapine and recheck in 1 week
B. Hold clozapine immediately; obtain repeat CBC and differential within 24 h
C. Reduce dose to 200 mg and monitor
D. Add lithium to boost ANC
Correct Answer: B
Rationale: ANC <1.5 × 10⁹/L mandates immediate hold and repeat testing within 24 h per
2025 REMS guidelines to rule out clozapine-induced neutropenia.
Question 3: A 19-year-old college student presents with 6 weeks of depressed mood,
anhedonia, hypersomnia, and 8-lb weight gain after a breakup. Symptoms impair academics
but resolve within 4 weeks after supportive counseling. Diagnosis?
,A. Major depressive disorder, single episode
B. Adjustment disorder with depressed mood
C. Persistent depressive disorder (dysthymia)
D. Bipolar II disorder
Correct Answer: B
Rationale: Symptoms are clearly linked to an identifiable stressor, last <6 months, and do not
meet full MDD criteria—consistent with adjustment disorder.
Question 4: A 29-year-old woman with bipolar I disorder on lithium 900 mg nightly has plasma
level 0.4 mmol/L (goal 0.8–1.0) and reports 3 days of racing thoughts, decreased need for
sleep, and hypersexuality. Most appropriate action?
A. Increase lithium to 1200 mg nightly and recheck level in 5 days
B. Add quetiapine 50 mg nightly
C. Start cognitive-behavioral therapy focused on sleep hygiene only
D. Discontinue lithium and start valproate
Correct Answer: A
Rationale: Subtherapeutic lithium level explains breakthrough mania; guideline-based first
step is optimize lithium before adding agents.
Question 5: A 41-year-old veteran with PTSD has weekly nightmares and daytime
hypervigilance despite sertraline 150 mg daily for 12 weeks. Which medication has FDA
approval for PTSD nightmares?
A. Prazosin
B. Trazodone
C. Risperidone
D. Clonazepam
Correct Answer: A
Rationale: Although FDA has not formally approved any agent for PTSD nightmares, prazosin
has the strongest RCT evidence and is endorsed by 2024 APA guidelines.
,Question 6: A 14-year-old boy with ADHD on methylphenidate 20 mg BID develops new-onset
auditory hallucinations. No mood or psychotic history. What is the next step?
A. Add risperidone 0.5 mg
B. Discontinue methylphenidate immediately
C. Switch to atomoxetine 40 mg daily
D. Reassure and continue stimulant
Correct Answer: B
Rationale: Stimulant-induced psychosis is rare but absolute indication to stop offending
agent immediately; consider non-stimulant thereafter.
Question 7: A 26-year-old woman 8 weeks postpartum reports intrusive thoughts of harming
her baby, no desire to act, preserved bonding, and anxiety. She is tearful and feels “crazy.”
Diagnosis?
A. Postpartum psychosis
B. Obsessive-compulsive disorder with postpartum onset
C. Maternal filicidal ideation
D. Adjustment disorder
Correct Answer: B
Rationale: Ego-dystonic intrusive thoughts without intent or mood congruence are hallmark
of postpartum OCD, not psychosis.
Question 8: A 50-year-old man with alcohol use disorder (AUD) wants to reduce drinking days.
He has cirrhosis Child-Pugh B. Which medication is contraindicated?
A. Naltrexone
B. Acamprosate
C. Gabapentin
D. Topiramate
Correct Answer: A
, Rationale: Naltrexone is hepatotoxic and contraindicated in hepatic failure; acamprosate is
renally eliminated and preferred.
Question 9: A 37-year-old woman with generalized anxiety disorder (GAD) has failed sertraline
and venlafaxine. Genotype shows CYP2D6 ultrarapid metabolizer. Which augmentation
strategy is evidence-based?
A. Quetiapine 50 mg nightly
B. Hydroxyzine 25 mg TID
C. Buspirone 15 mg BID
D. Propranolol 40 mg BID
Correct Answer: A
Rationale: Second-generation antipsychotic augmentation (quetiapine) has Level 1 evidence
for treatment-resistant GAD.
Question 10: A 32-year-old man reports 1 year of depressed mood occurring only in winter
(October–February) with increased sleep and carbohydrate craving. He feels “back to normal”
by April. Which intervention is first-line?
A. Morning bright-light therapy 10,000 lux × 30 min
B. Start bupropion 150 mg daily year-round
C. Begin fluoxetine 20 mg daily
D. Cognitive-behavioral therapy for insomnia
Correct Answer: A
Rationale: Light therapy is first-line for seasonal pattern specifier with onset in fall/winter per
APA guidelines.
Question 11: A 45-year-old woman with schizoaffective disorder on risperidone 4 mg
develops galactorrhea and amenorrhea. Prolactin 98 ng/mL (normal <25). Switch to which
antipsychotic?
A. Haloperidol
B. Olanzapine
C. Aripiprazole
2026/2027: 100% Verified Questions &
Correct Answers
Question 1: A 23-year-old woman with borderline personality disorder (BPD) self-harms by
cutting after perceived abandonment. She has failed two SSRIs. Which evidence-based
psychotherapy is most appropriate to reduce self-harm?
A. Supportive psychotherapy
B. Dialectical behavior therapy (DBT)
C. Interpersonal psychotherapy (IPT)
D. Psychoanalytic psychotherapy
Correct Answer: B
Rationale: DBT is the gold-standard, manualized treatment for BPD that specifically targets
self-harm through skills training and behavioral chain analysis.
Question 2: A 34-year-old man with schizophrenia takes clozapine 350 mg nightly. His WBC is
2.8 × 10⁹/L with absolute neutrophil count (ANC) 1.2 × 10⁹/L. He is afebrile. What is the next
step per clozapine REMS?
A. Continue clozapine and recheck in 1 week
B. Hold clozapine immediately; obtain repeat CBC and differential within 24 h
C. Reduce dose to 200 mg and monitor
D. Add lithium to boost ANC
Correct Answer: B
Rationale: ANC <1.5 × 10⁹/L mandates immediate hold and repeat testing within 24 h per
2025 REMS guidelines to rule out clozapine-induced neutropenia.
Question 3: A 19-year-old college student presents with 6 weeks of depressed mood,
anhedonia, hypersomnia, and 8-lb weight gain after a breakup. Symptoms impair academics
but resolve within 4 weeks after supportive counseling. Diagnosis?
,A. Major depressive disorder, single episode
B. Adjustment disorder with depressed mood
C. Persistent depressive disorder (dysthymia)
D. Bipolar II disorder
Correct Answer: B
Rationale: Symptoms are clearly linked to an identifiable stressor, last <6 months, and do not
meet full MDD criteria—consistent with adjustment disorder.
Question 4: A 29-year-old woman with bipolar I disorder on lithium 900 mg nightly has plasma
level 0.4 mmol/L (goal 0.8–1.0) and reports 3 days of racing thoughts, decreased need for
sleep, and hypersexuality. Most appropriate action?
A. Increase lithium to 1200 mg nightly and recheck level in 5 days
B. Add quetiapine 50 mg nightly
C. Start cognitive-behavioral therapy focused on sleep hygiene only
D. Discontinue lithium and start valproate
Correct Answer: A
Rationale: Subtherapeutic lithium level explains breakthrough mania; guideline-based first
step is optimize lithium before adding agents.
Question 5: A 41-year-old veteran with PTSD has weekly nightmares and daytime
hypervigilance despite sertraline 150 mg daily for 12 weeks. Which medication has FDA
approval for PTSD nightmares?
A. Prazosin
B. Trazodone
C. Risperidone
D. Clonazepam
Correct Answer: A
Rationale: Although FDA has not formally approved any agent for PTSD nightmares, prazosin
has the strongest RCT evidence and is endorsed by 2024 APA guidelines.
,Question 6: A 14-year-old boy with ADHD on methylphenidate 20 mg BID develops new-onset
auditory hallucinations. No mood or psychotic history. What is the next step?
A. Add risperidone 0.5 mg
B. Discontinue methylphenidate immediately
C. Switch to atomoxetine 40 mg daily
D. Reassure and continue stimulant
Correct Answer: B
Rationale: Stimulant-induced psychosis is rare but absolute indication to stop offending
agent immediately; consider non-stimulant thereafter.
Question 7: A 26-year-old woman 8 weeks postpartum reports intrusive thoughts of harming
her baby, no desire to act, preserved bonding, and anxiety. She is tearful and feels “crazy.”
Diagnosis?
A. Postpartum psychosis
B. Obsessive-compulsive disorder with postpartum onset
C. Maternal filicidal ideation
D. Adjustment disorder
Correct Answer: B
Rationale: Ego-dystonic intrusive thoughts without intent or mood congruence are hallmark
of postpartum OCD, not psychosis.
Question 8: A 50-year-old man with alcohol use disorder (AUD) wants to reduce drinking days.
He has cirrhosis Child-Pugh B. Which medication is contraindicated?
A. Naltrexone
B. Acamprosate
C. Gabapentin
D. Topiramate
Correct Answer: A
, Rationale: Naltrexone is hepatotoxic and contraindicated in hepatic failure; acamprosate is
renally eliminated and preferred.
Question 9: A 37-year-old woman with generalized anxiety disorder (GAD) has failed sertraline
and venlafaxine. Genotype shows CYP2D6 ultrarapid metabolizer. Which augmentation
strategy is evidence-based?
A. Quetiapine 50 mg nightly
B. Hydroxyzine 25 mg TID
C. Buspirone 15 mg BID
D. Propranolol 40 mg BID
Correct Answer: A
Rationale: Second-generation antipsychotic augmentation (quetiapine) has Level 1 evidence
for treatment-resistant GAD.
Question 10: A 32-year-old man reports 1 year of depressed mood occurring only in winter
(October–February) with increased sleep and carbohydrate craving. He feels “back to normal”
by April. Which intervention is first-line?
A. Morning bright-light therapy 10,000 lux × 30 min
B. Start bupropion 150 mg daily year-round
C. Begin fluoxetine 20 mg daily
D. Cognitive-behavioral therapy for insomnia
Correct Answer: A
Rationale: Light therapy is first-line for seasonal pattern specifier with onset in fall/winter per
APA guidelines.
Question 11: A 45-year-old woman with schizoaffective disorder on risperidone 4 mg
develops galactorrhea and amenorrhea. Prolactin 98 ng/mL (normal <25). Switch to which
antipsychotic?
A. Haloperidol
B. Olanzapine
C. Aripiprazole
