NRNP 6635 FINAL EXAM – WALDEN UNIVERSITY
2025/2026 COMPLETE QUESTIONS AND
DETAILED ANSWERS WITH RATIONALES || 100%
GUARANTEED PASS <LATEST VERSION>
1. The primary purpose of a mental status examination (MSE) is to:
A. Diagnose a specific psychiatric disorder.
B. Provide a snapshot of a patient's cognitive, emotional, and behavioral functioning at a given
time.
C. Determine the patient's long-term prognosis.
D. Replace the need for a comprehensive medical history.
Rationale: The MSE is a cross-sectional, objective assessment of a patient's current mental
state. It describes behavior, mood, thought process, cognition, and perceptions. While it informs
diagnosis, it alone is not sufficient for a definitive diagnosis, which requires a longitudinal
history.
2. A 25-year-old patient reports a persistent, irrational fear of public speaking that causes
significant distress and avoidance, impacting their work. This is most consistent with:
A. Panic Disorder
B. Generalized Anxiety Disorder
C. Social Anxiety Disorder (Social Phobia)
D. Agoraphobia
Rationale: Social Anxiety Disorder is characterized by a marked fear or anxiety about one or
more social situations where the individual is exposed to possible scrutiny by others (e.g., social
interactions, being observed, performing). The fear is out of proportion and leads to avoidance
or endurance with intense anxiety.
3. When assessing for Major Depressive Disorder (MDD), which of the following symptoms
must be present for a diagnosis?
A. Psychomotor agitation or retardation
B. Significant weight change or appetite disturbance
C. Depressed mood and/or anhedonia
D. Fatigue or loss of energy
,Rationale: According to DSM-5-TR criteria, for a diagnosis of MDD, either depressed mood or
markedly diminished interest or pleasure (anhedonia) must be one of the five (or more)
symptoms present during the same 2-week period.
4. A patient presents with fluctuating levels of consciousness, disorganized thinking, and
visual hallucinations that developed over 48 hours following surgery. The most likely
diagnosis is:
A. Schizophrenia
B. Delirium
C. Dementia
D. Brief Psychotic Disorder
Rationale: Delirium is characterized by an acute disturbance in attention and awareness that
develops over a short period (hours to days) and tends to fluctuate in severity. It is often caused
by a medical condition, substance intoxication, or medication side effect, which is common post-
operatively.
5. The concept of "negative symptoms" in schizophrenia refers to:
A. The presence of hallucinations and delusions.
B. A poor prognosis.
C. The absence or diminution of normal behaviors and emotions.
D. Symptoms that are not responsive to medication.
Rationale: Negative symptoms reflect a loss or decrease in normal functions and include
affective flattening, alogia (poverty of speech), avolition (lack of motivation), anhedonia, and
asociality. This is distinct from "positive symptoms" like hallucinations and delusions.
Psychopharmacology & Somatic Therapies
6. A common, potentially life-threatening side effect of antipsychotic medications that
requires immediate medical attention is:
A. Orthostatic hypotension
B. Akathisia
C. Neuroleptic Malignant Syndrome (NMS)
D. Weight gain
Rationale: NMS is a rare but serious idiosyncratic reaction characterized by fever, muscle
rigidity, altered mental status, autonomic instability (e.g., tachycardia, labile BP), and elevated
CPK. It is a medical emergency.
, 7. Which class of antidepressants is considered first-line for many anxiety disorders due to its
favorable side effect profile and efficacy?
A. Tricyclic Antidepressants (TCAs)
B. Monoamine Oxidase Inhibitors (MAOIs)
C. Selective Serotonin Reuptake Inhibitors (SSRIs)
D. Benzodiazepines
Rationale: SSRIs are generally first-line for anxiety disorders (e.g., GAD, Panic, Social Anxiety)
because they are effective, non-habit forming, and have a better safety profile in overdose
compared to TCAs and MAOIs.
8. A patient on Lithium for Bipolar I Disorder presents with fine hand tremor, polyuria, and
mild nausea. Their Lithium level is 1.2 mEq/L. The PMHNP should:
A. Admit the patient immediately for impending toxicity.
B. Discontinue Lithium and switch to Valproate.
C. Recognize these as common, manageable side effects and counsel on monitoring.
D. Increase the dose to achieve a more therapeutic level.
Rationale: A level of 1.2 mEq/L is within the therapeutic range (0.8-1.2 mEq/L for acute mania).
Fine tremor, polyuria, and mild nausea are common side effects. Management includes
supportive care (e.g., taking with food, ensuring adequate fluid intake) and monitoring. The
PMHNP would not discontinue a therapeutic medication for manageable side effects.
9. Tardive Dyskinesia (TD) is associated with long-term use of which class of medications?
A. SSRIs
B. Mood Stabilizers
C. Antipsychotics
D. Benzodiazepines
Rationale: TD is a potentially irreversible movement disorder characterized by involuntary,
choreoathetoid movements of the tongue, face, and limbs. It is a late-onset adverse effect of
antipsychotic medications, particularly first-generation (typical) antipsychotics.
10. The mechanism of action for Benzodiazepines is:
A. Blockade of dopamine D2 receptors.
B. Inhibition of serotonin reuptake.
C. Potentiation of GABA neurotransmission.
D. Blockade of NMDA glutamate receptors.
2025/2026 COMPLETE QUESTIONS AND
DETAILED ANSWERS WITH RATIONALES || 100%
GUARANTEED PASS <LATEST VERSION>
1. The primary purpose of a mental status examination (MSE) is to:
A. Diagnose a specific psychiatric disorder.
B. Provide a snapshot of a patient's cognitive, emotional, and behavioral functioning at a given
time.
C. Determine the patient's long-term prognosis.
D. Replace the need for a comprehensive medical history.
Rationale: The MSE is a cross-sectional, objective assessment of a patient's current mental
state. It describes behavior, mood, thought process, cognition, and perceptions. While it informs
diagnosis, it alone is not sufficient for a definitive diagnosis, which requires a longitudinal
history.
2. A 25-year-old patient reports a persistent, irrational fear of public speaking that causes
significant distress and avoidance, impacting their work. This is most consistent with:
A. Panic Disorder
B. Generalized Anxiety Disorder
C. Social Anxiety Disorder (Social Phobia)
D. Agoraphobia
Rationale: Social Anxiety Disorder is characterized by a marked fear or anxiety about one or
more social situations where the individual is exposed to possible scrutiny by others (e.g., social
interactions, being observed, performing). The fear is out of proportion and leads to avoidance
or endurance with intense anxiety.
3. When assessing for Major Depressive Disorder (MDD), which of the following symptoms
must be present for a diagnosis?
A. Psychomotor agitation or retardation
B. Significant weight change or appetite disturbance
C. Depressed mood and/or anhedonia
D. Fatigue or loss of energy
,Rationale: According to DSM-5-TR criteria, for a diagnosis of MDD, either depressed mood or
markedly diminished interest or pleasure (anhedonia) must be one of the five (or more)
symptoms present during the same 2-week period.
4. A patient presents with fluctuating levels of consciousness, disorganized thinking, and
visual hallucinations that developed over 48 hours following surgery. The most likely
diagnosis is:
A. Schizophrenia
B. Delirium
C. Dementia
D. Brief Psychotic Disorder
Rationale: Delirium is characterized by an acute disturbance in attention and awareness that
develops over a short period (hours to days) and tends to fluctuate in severity. It is often caused
by a medical condition, substance intoxication, or medication side effect, which is common post-
operatively.
5. The concept of "negative symptoms" in schizophrenia refers to:
A. The presence of hallucinations and delusions.
B. A poor prognosis.
C. The absence or diminution of normal behaviors and emotions.
D. Symptoms that are not responsive to medication.
Rationale: Negative symptoms reflect a loss or decrease in normal functions and include
affective flattening, alogia (poverty of speech), avolition (lack of motivation), anhedonia, and
asociality. This is distinct from "positive symptoms" like hallucinations and delusions.
Psychopharmacology & Somatic Therapies
6. A common, potentially life-threatening side effect of antipsychotic medications that
requires immediate medical attention is:
A. Orthostatic hypotension
B. Akathisia
C. Neuroleptic Malignant Syndrome (NMS)
D. Weight gain
Rationale: NMS is a rare but serious idiosyncratic reaction characterized by fever, muscle
rigidity, altered mental status, autonomic instability (e.g., tachycardia, labile BP), and elevated
CPK. It is a medical emergency.
, 7. Which class of antidepressants is considered first-line for many anxiety disorders due to its
favorable side effect profile and efficacy?
A. Tricyclic Antidepressants (TCAs)
B. Monoamine Oxidase Inhibitors (MAOIs)
C. Selective Serotonin Reuptake Inhibitors (SSRIs)
D. Benzodiazepines
Rationale: SSRIs are generally first-line for anxiety disorders (e.g., GAD, Panic, Social Anxiety)
because they are effective, non-habit forming, and have a better safety profile in overdose
compared to TCAs and MAOIs.
8. A patient on Lithium for Bipolar I Disorder presents with fine hand tremor, polyuria, and
mild nausea. Their Lithium level is 1.2 mEq/L. The PMHNP should:
A. Admit the patient immediately for impending toxicity.
B. Discontinue Lithium and switch to Valproate.
C. Recognize these as common, manageable side effects and counsel on monitoring.
D. Increase the dose to achieve a more therapeutic level.
Rationale: A level of 1.2 mEq/L is within the therapeutic range (0.8-1.2 mEq/L for acute mania).
Fine tremor, polyuria, and mild nausea are common side effects. Management includes
supportive care (e.g., taking with food, ensuring adequate fluid intake) and monitoring. The
PMHNP would not discontinue a therapeutic medication for manageable side effects.
9. Tardive Dyskinesia (TD) is associated with long-term use of which class of medications?
A. SSRIs
B. Mood Stabilizers
C. Antipsychotics
D. Benzodiazepines
Rationale: TD is a potentially irreversible movement disorder characterized by involuntary,
choreoathetoid movements of the tongue, face, and limbs. It is a late-onset adverse effect of
antipsychotic medications, particularly first-generation (typical) antipsychotics.
10. The mechanism of action for Benzodiazepines is:
A. Blockade of dopamine D2 receptors.
B. Inhibition of serotonin reuptake.
C. Potentiation of GABA neurotransmission.
D. Blockade of NMDA glutamate receptors.
