NRNP 6665-01 Week 11 Final Exam Solutions 2026/2027
Complete Final Exam Guide | Actual Questions & Verified
Solutions | PMHNP Lifespan Psychiatry | Pass Guarantee
1. A 19-year-old college freshman is referred by student health after two months of
declining grades, social withdrawal, and “hearing classmates whisper my name” when
alone in his dorm. He reports intermittent 3-hour periods of elevated mood and racing
thoughts but says, “I’m mostly scared.” His mother has bipolar I disorder. Urine tox and
CBC are unremarkable. PHQ-9 = 14, GAD-7 = 12, Young Mania Rating Scale (YMRS) = 9.
Which diagnosis best captures his presentation?
A. Bipolar I disorder, current episode manic
B. Major depressive disorder with psychotic features
C. Brief psychotic disorder
D. Bipolar II disorder with psychotic features
Correct Answer: D
Rationale: Sub-threshold manic symptoms (YMRS 9) lasting <4 days plus clear
psychosis (auditory hallucinations) and functional decline meet DSM-5-TR criteria for
bipolar II with psychotic features. Full mania requires ≥7 days or hospitalization.
Psychosis can accompany hypomania depressive or mixed features.
2. A 7-year-old girl has 6-month history of multiple daily motor tics (eye blinking,
shoulder shrugging) and recent coprolalia. ADHD combined type was diagnosed at age
,5; methylphenidate OROS 27 mg qAM improved focus but tics emerged 4 weeks after
dose increase. Parents ask if stimulant caused tics. Most evidence-based response:
A. Discontinue stimulant immediately; stimulants are contraindicated with tics
B. Reduce dose by 50 % and switch to guanfacine XR monotherapy
C. Continue current dose; stimulants rarely worsen tic severity long-term
D. Add haloperidol 0.5 mg BID to suppress tics
Correct Answer: C
Rationale: AACAP 2022 guidelines: large RCTs (e.g., MTA) show tics may transiently
increase when starting stimulants but severity returns to baseline; effective ADHD
treatment should not be withheld. Alpha-2-agonists are first-line for tics if needed, not
antipsychotics initially.
3. A 34-year-old woman 28 weeks pregnant reports 4-week episode of depressed mood,
guilt, insomnia, and 5-lb weight loss. She discontinued sertraline 100 mg when she
conceived. PHQ-9 = 18. Obstetric history: one prior preterm birth at 34 weeks while on
sertraline. She prefers “no medications.” Which option best balances maternal-fetal
risk?
A. Re-start sertraline 50 mg with plan to titrate
B. Start IPT (interpersonal psychotherapy) weekly
C. Start bupropion XL 150 mg (category B)
D. Admit for ECT three times weekly
Correct Answer: A
,Rationale: Moderate-severe perinatal depression: relapse risk > drug risk. Sertraline has
largest safety database (no major malformations, slight ↑ risk PPHN 3 vs 2/1000). IPT
alone insufficient for moderate-severe episode. Bupropion less data; ECT reserved for
psychotic/severe suicidality.
4. A 72-year-old widower with vascular depression (PHQ-9 = 17, executive dysfunction,
mild MRI white-matter changes) on sertraline 100 mg ×8 weeks reports partial response
(PHQ-9 12). He has HTN, diabetes, and falls x1. Next best pharmacologic step:
A. Increase sertraline to 150 mg
B. Add aripiprazole 2 mg daily
C. Switch to venlafaxine XR 150 mg
D. Add methylphenidate 5 mg BID
Correct Answer: B
Rationale: APA 2023 geriatric MDD: augmentation with atypical antipsychotic
(aripiprazole) has Level-1 evidence for partial response and may improve executive
function. Dose escalation >100 mg in elderly ↑ side effects/falls. Stimulants adjunctive
but weaker evidence.
5. A 26-year-old veteran reports daily cannabis use (≥2 g) to “turn off nightmares” from
Iraq deployment. Nightmares persist despite prazosin 6 mg qHS. He is willing to quit
cannabis. Which medication plus trauma-focused CBT has strongest evidence?
A. Sertraline 50 mg daily
B. Topiramate 50 mg BID titrated to 200 mg
, C. Nabilone 0.5 mg qHS
D. Gabapentin 300 mg TID
Correct Answer: B
Rationale: RCT (2024) shows topiramate (200 mg) + prolonged exposure reduces PTSD
nightmares and cannabis craving vs placebo. Nabilone effective but schedule II and less
impact on craving. SSRIs do not target nightmares. Gabapentin insufficient data.
6. A 15-year-old transgender male (on testosterone 6 months) presents with 3-week
manic episode (YMRS 26). Parents request stopping testosterone “because it caused
bipolar.” Most appropriate response:
A. Discontinue testosterone and start lithium
B. Continue testosterone; treat bipolar with standard mood stabilizer
C. Switch to estradiol to stabilize mood
D. Order serum testosterone level before deciding
Correct Answer: B
Rationale: No evidence testosterone triggers bipolar onset; prevalence same as
cisgender youth. APA 2025 guidelines: affirming hormone therapy should continue while
psychiatric disorder is managed with usual algorithms.
7. A 45-year-old woman with borderline personality disorder self-inflicts superficial cuts
after perceived abandonment. She is in DBT skills group but continues self-harm
weekly. Current meds: sertraline 150 mg, quetiapine 100 mg HS. Most evidence-based
medication addition:
Complete Final Exam Guide | Actual Questions & Verified
Solutions | PMHNP Lifespan Psychiatry | Pass Guarantee
1. A 19-year-old college freshman is referred by student health after two months of
declining grades, social withdrawal, and “hearing classmates whisper my name” when
alone in his dorm. He reports intermittent 3-hour periods of elevated mood and racing
thoughts but says, “I’m mostly scared.” His mother has bipolar I disorder. Urine tox and
CBC are unremarkable. PHQ-9 = 14, GAD-7 = 12, Young Mania Rating Scale (YMRS) = 9.
Which diagnosis best captures his presentation?
A. Bipolar I disorder, current episode manic
B. Major depressive disorder with psychotic features
C. Brief psychotic disorder
D. Bipolar II disorder with psychotic features
Correct Answer: D
Rationale: Sub-threshold manic symptoms (YMRS 9) lasting <4 days plus clear
psychosis (auditory hallucinations) and functional decline meet DSM-5-TR criteria for
bipolar II with psychotic features. Full mania requires ≥7 days or hospitalization.
Psychosis can accompany hypomania depressive or mixed features.
2. A 7-year-old girl has 6-month history of multiple daily motor tics (eye blinking,
shoulder shrugging) and recent coprolalia. ADHD combined type was diagnosed at age
,5; methylphenidate OROS 27 mg qAM improved focus but tics emerged 4 weeks after
dose increase. Parents ask if stimulant caused tics. Most evidence-based response:
A. Discontinue stimulant immediately; stimulants are contraindicated with tics
B. Reduce dose by 50 % and switch to guanfacine XR monotherapy
C. Continue current dose; stimulants rarely worsen tic severity long-term
D. Add haloperidol 0.5 mg BID to suppress tics
Correct Answer: C
Rationale: AACAP 2022 guidelines: large RCTs (e.g., MTA) show tics may transiently
increase when starting stimulants but severity returns to baseline; effective ADHD
treatment should not be withheld. Alpha-2-agonists are first-line for tics if needed, not
antipsychotics initially.
3. A 34-year-old woman 28 weeks pregnant reports 4-week episode of depressed mood,
guilt, insomnia, and 5-lb weight loss. She discontinued sertraline 100 mg when she
conceived. PHQ-9 = 18. Obstetric history: one prior preterm birth at 34 weeks while on
sertraline. She prefers “no medications.” Which option best balances maternal-fetal
risk?
A. Re-start sertraline 50 mg with plan to titrate
B. Start IPT (interpersonal psychotherapy) weekly
C. Start bupropion XL 150 mg (category B)
D. Admit for ECT three times weekly
Correct Answer: A
,Rationale: Moderate-severe perinatal depression: relapse risk > drug risk. Sertraline has
largest safety database (no major malformations, slight ↑ risk PPHN 3 vs 2/1000). IPT
alone insufficient for moderate-severe episode. Bupropion less data; ECT reserved for
psychotic/severe suicidality.
4. A 72-year-old widower with vascular depression (PHQ-9 = 17, executive dysfunction,
mild MRI white-matter changes) on sertraline 100 mg ×8 weeks reports partial response
(PHQ-9 12). He has HTN, diabetes, and falls x1. Next best pharmacologic step:
A. Increase sertraline to 150 mg
B. Add aripiprazole 2 mg daily
C. Switch to venlafaxine XR 150 mg
D. Add methylphenidate 5 mg BID
Correct Answer: B
Rationale: APA 2023 geriatric MDD: augmentation with atypical antipsychotic
(aripiprazole) has Level-1 evidence for partial response and may improve executive
function. Dose escalation >100 mg in elderly ↑ side effects/falls. Stimulants adjunctive
but weaker evidence.
5. A 26-year-old veteran reports daily cannabis use (≥2 g) to “turn off nightmares” from
Iraq deployment. Nightmares persist despite prazosin 6 mg qHS. He is willing to quit
cannabis. Which medication plus trauma-focused CBT has strongest evidence?
A. Sertraline 50 mg daily
B. Topiramate 50 mg BID titrated to 200 mg
, C. Nabilone 0.5 mg qHS
D. Gabapentin 300 mg TID
Correct Answer: B
Rationale: RCT (2024) shows topiramate (200 mg) + prolonged exposure reduces PTSD
nightmares and cannabis craving vs placebo. Nabilone effective but schedule II and less
impact on craving. SSRIs do not target nightmares. Gabapentin insufficient data.
6. A 15-year-old transgender male (on testosterone 6 months) presents with 3-week
manic episode (YMRS 26). Parents request stopping testosterone “because it caused
bipolar.” Most appropriate response:
A. Discontinue testosterone and start lithium
B. Continue testosterone; treat bipolar with standard mood stabilizer
C. Switch to estradiol to stabilize mood
D. Order serum testosterone level before deciding
Correct Answer: B
Rationale: No evidence testosterone triggers bipolar onset; prevalence same as
cisgender youth. APA 2025 guidelines: affirming hormone therapy should continue while
psychiatric disorder is managed with usual algorithms.
7. A 45-year-old woman with borderline personality disorder self-inflicts superficial cuts
after perceived abandonment. She is in DBT skills group but continues self-harm
weekly. Current meds: sertraline 150 mg, quetiapine 100 mg HS. Most evidence-based
medication addition:
