NRNP 6675 MIDTERM EXAM QUESTIONS AND CORRECT
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
Core Domains
Psychiatric Assessment & Diagnostic Reasoning
Psychopharmacology & Neurobiology
Mood Disorders & Treatment Resistance
Psychotic Disorders & Antipsychotic Management
Anxiety, OCD & Trauma-Related Disorders
Ethics, Law & Professional Standards
Special Populations & Lifespan Considerations
Substance Use Disorders & Comorbidity
Introduction
The NRNP 6675 midterm examination assesses the psychiatric
mental health nurse practitioner's readiness for advanced clinical
practice. It evaluates knowledge in diagnostic formulation using
DSM-5-TR criteria, psychopharmacological decision-making,
therapeutic modalities, and ethical-legal parameters of PMHNP
practice. The exam employs multiple-choice and scenario-based
questions that mirror real-world clinical encounters. Emphasis is
placed on applying foundational theory to complex patient
presentations, prioritizing safety, evidence-based interventions, and
professional accountability. This assessment ensures candidates
demonstrate the critical thinking and clinical judgment required for
independent psychiatric practice across the lifespan.
,SECTION ONE: QUESTIONS 1–100
Question 1
A PMHNP is evaluating a 28-year-old patient with major
depressive disorder who has been taking sertraline 100 mg daily
for four weeks. The patient reports minimal improvement. Which
neurobiological mechanism best explains the typical delayed
therapeutic response to SSRIs?
A. Immediate downregulation of presynaptic 5-HT1A
autoreceptors within hours of first dose
B. Progressive desensitization of somatodendritic 5-HT1A
autoreceptors leading to increased serotonergic firing over weeks
C. Direct inhibition of the serotonin transporter on astrocytes
causing glutamate surge
D. Rapid upregulation of postsynaptic 5-HT2A receptors
enhancing cortical excitability
🟢 B. Progressive desensitization of somatodendritic 5-HT1A
autoreceptors leading to increased serotonergic firing over weeks
🔴 RATIONALE: Therapeutic lag is attributed to gradual
desensitization of somatodendritic 5-HT1A autoreceptors, which
disinhibits raphe firing and elevates synaptic serotonin over 2–4
weeks . Option A is incorrect because downregulation is not
immediate. Options C and D misstate receptor dynamics and glial
mechanisms.
Question 2
A patient with bipolar I disorder on lithium presents with coarse
tremor, ataxia, and confusion. Serum lithium is 2.1 mEq/L and
,creatinine has risen. Which is the most appropriate immediate
action?
A. Continue lithium at a reduced dose and monitor levels every 6
hours
B. Administer oral sodium polystyrene sulfonate to enhance
lithium excretion
C. Hold lithium, initiate hemodialysis, and provide supportive care
D. Start furosemide to promote renal lithium clearance
🟢 C. Hold lithium, initiate hemodialysis, and provide supportive
care
🔴 RATIONALE: Lithium toxicity with levels >2.0 mEq/L and
neurologic/renal impairment requires discontinuation and
hemodialysis for rapid removal . Loop diuretics like furosemide
increase lithium reabsorption and worsen toxicity. Polystyrene
sulfonate is for potassium, not lithium.
Question 3
Which finding most strongly supports a diagnosis of catatonia
rather than neuroleptic malignant syndrome (NMS) in a patient
with psychomotor abnormalities?
A. Lead-pipe rigidity and hyperthermia
B. Elevated creatine kinase and leukocytosis
C. Waxy flexibility and negativism with symptom relief from
lorazepam
D. Autonomic instability with tachycardia and diaphoresis
🟢 C. Waxy flexibility and negativism with symptom relief from
lorazepam
, 🔴 RATIONALE: Catatonia classically presents with waxy flexibility,
negativism, and a dramatic response to benzodiazepines
(lorazepam challenge) . NMS shares rigidity, hyperthermia,
autonomic instability, and elevated CK, making A, B, and D more
consistent with NMS.
Question 4
A patient with schizophrenia has failed adequate trials of
risperidone and olanzapine due to inefficacy. Which is the most
evidence-based next step according to current APA guidelines?
A. Switch to aripiprazole, a partial D2 agonist
B. Initiate clozapine with weekly ANC monitoring
C. Add valproate for mood stabilization
D. Augment with an SSRI for negative symptoms
🟢 B. Initiate clozapine with weekly ANC monitoring
🔴 RATIONALE: Clozapine is the only antipsychotic with proven
superior efficacy in treatment-resistant schizophrenia and is
indicated after failure of two adequate antipsychotic trials .
Aripiprazole is not first-line after two failures. Valproate
augmentation and SSRI augmentation lack robust evidence for
this indication.
Question 5
A 34-year-old presents for initial psychiatric evaluation with
persistent sadness, loss of interest, and insomnia for three weeks.
ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A |
INSTANT DOWNLOAD PDF.
Core Domains
Psychiatric Assessment & Diagnostic Reasoning
Psychopharmacology & Neurobiology
Mood Disorders & Treatment Resistance
Psychotic Disorders & Antipsychotic Management
Anxiety, OCD & Trauma-Related Disorders
Ethics, Law & Professional Standards
Special Populations & Lifespan Considerations
Substance Use Disorders & Comorbidity
Introduction
The NRNP 6675 midterm examination assesses the psychiatric
mental health nurse practitioner's readiness for advanced clinical
practice. It evaluates knowledge in diagnostic formulation using
DSM-5-TR criteria, psychopharmacological decision-making,
therapeutic modalities, and ethical-legal parameters of PMHNP
practice. The exam employs multiple-choice and scenario-based
questions that mirror real-world clinical encounters. Emphasis is
placed on applying foundational theory to complex patient
presentations, prioritizing safety, evidence-based interventions, and
professional accountability. This assessment ensures candidates
demonstrate the critical thinking and clinical judgment required for
independent psychiatric practice across the lifespan.
,SECTION ONE: QUESTIONS 1–100
Question 1
A PMHNP is evaluating a 28-year-old patient with major
depressive disorder who has been taking sertraline 100 mg daily
for four weeks. The patient reports minimal improvement. Which
neurobiological mechanism best explains the typical delayed
therapeutic response to SSRIs?
A. Immediate downregulation of presynaptic 5-HT1A
autoreceptors within hours of first dose
B. Progressive desensitization of somatodendritic 5-HT1A
autoreceptors leading to increased serotonergic firing over weeks
C. Direct inhibition of the serotonin transporter on astrocytes
causing glutamate surge
D. Rapid upregulation of postsynaptic 5-HT2A receptors
enhancing cortical excitability
🟢 B. Progressive desensitization of somatodendritic 5-HT1A
autoreceptors leading to increased serotonergic firing over weeks
🔴 RATIONALE: Therapeutic lag is attributed to gradual
desensitization of somatodendritic 5-HT1A autoreceptors, which
disinhibits raphe firing and elevates synaptic serotonin over 2–4
weeks . Option A is incorrect because downregulation is not
immediate. Options C and D misstate receptor dynamics and glial
mechanisms.
Question 2
A patient with bipolar I disorder on lithium presents with coarse
tremor, ataxia, and confusion. Serum lithium is 2.1 mEq/L and
,creatinine has risen. Which is the most appropriate immediate
action?
A. Continue lithium at a reduced dose and monitor levels every 6
hours
B. Administer oral sodium polystyrene sulfonate to enhance
lithium excretion
C. Hold lithium, initiate hemodialysis, and provide supportive care
D. Start furosemide to promote renal lithium clearance
🟢 C. Hold lithium, initiate hemodialysis, and provide supportive
care
🔴 RATIONALE: Lithium toxicity with levels >2.0 mEq/L and
neurologic/renal impairment requires discontinuation and
hemodialysis for rapid removal . Loop diuretics like furosemide
increase lithium reabsorption and worsen toxicity. Polystyrene
sulfonate is for potassium, not lithium.
Question 3
Which finding most strongly supports a diagnosis of catatonia
rather than neuroleptic malignant syndrome (NMS) in a patient
with psychomotor abnormalities?
A. Lead-pipe rigidity and hyperthermia
B. Elevated creatine kinase and leukocytosis
C. Waxy flexibility and negativism with symptom relief from
lorazepam
D. Autonomic instability with tachycardia and diaphoresis
🟢 C. Waxy flexibility and negativism with symptom relief from
lorazepam
, 🔴 RATIONALE: Catatonia classically presents with waxy flexibility,
negativism, and a dramatic response to benzodiazepines
(lorazepam challenge) . NMS shares rigidity, hyperthermia,
autonomic instability, and elevated CK, making A, B, and D more
consistent with NMS.
Question 4
A patient with schizophrenia has failed adequate trials of
risperidone and olanzapine due to inefficacy. Which is the most
evidence-based next step according to current APA guidelines?
A. Switch to aripiprazole, a partial D2 agonist
B. Initiate clozapine with weekly ANC monitoring
C. Add valproate for mood stabilization
D. Augment with an SSRI for negative symptoms
🟢 B. Initiate clozapine with weekly ANC monitoring
🔴 RATIONALE: Clozapine is the only antipsychotic with proven
superior efficacy in treatment-resistant schizophrenia and is
indicated after failure of two adequate antipsychotic trials .
Aripiprazole is not first-line after two failures. Valproate
augmentation and SSRI augmentation lack robust evidence for
this indication.
Question 5
A 34-year-old presents for initial psychiatric evaluation with
persistent sadness, loss of interest, and insomnia for three weeks.
