LANIF • 5766 PNRN
★ ★
Walden University
W College of Nursing
A HIGHER DEGREE OF GOOD
EST. 1970
NRNP 6675 — Final Examination
PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER: PSYCHOPHARMACOLOGY, PERSONALITY DISORDERS, ETHICS & LIFESPAN
INSTITUTION Walden University COURSE CODE NRNP 6675
PROGRAM PMHNP — Psychiatric-Mental Health Nurse Practitioner ACADEMIC YEAR
EXAM TITLE Final Examination — Comprehensive TOTAL QUESTIONS 150+ Questions
COURSE TITLE PMHNP Advanced Practice Psychiatric Nursing FORMAT Multiple Choice — Select All That Apply Included
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless "Select all that apply" is specified.
▸ Psychopharmacology — antipsychotics, lithium, antidepressants, and their side effects (EPS, NMS, TD, akathisia) are core competencies.
▸ DSM-5 diagnostic criteria — schizophrenia, bipolar disorder, personality disorders (Clusters A/B/C), PTSD, OCD, and substance use disorders are emphasized.
▸ Ethical principles (beneficence, non-maleficence, justice, autonomy, fidelity), HIPAA, malpractice, and scope of practice are testable content.
▸ Lifespan considerations — child/adolescent disorders, geriatric psychopharmacology, Freud/Erikson developmental stages, and pregnancy/lactation.
▸ Correct answers and clinical rationales appear below each question for PMHNP board certification review purposes.
▸ All content reflects current DSM-5-TR criteria, APA practice guidelines, and ANCC PMHNP certification exam blueprint.
SECTION I — PSYCHOPHARMACOLOGY, NEUROBIOLOGY & SCHIZOPHRENIA SPECTRUM Questions 1 – 20
1. Which of the following are risk factors for neuroleptic malignant syndrome (NMS)? (Select all that apply)
A. Rapid dose escalation
B. Parental route of administration
C. Higher potency typical antipsychotics
D. Use of atypical antipsychotics only
E. Slow titration of medication
CORRECT ANSWER A, B, C — Rapid dose escalation, parenteral route of administration, and higher potency typical antipsychotics (e.g., haloperidol, fluphenazine) increase NMS risk
RATIONALE Neuroleptic Malignant Syndrome (NMS) is a life-threatening idiosyncratic reaction to antipsychotic medications characterized by hyperthermia, severe muscle rigidity, autonomic instability, altered
consciousness, and elevated creatine phosphokinase (CPK). Key risk factors: (A) Rapid dose escalation — the most significant modifiable risk factor; always titrate antipsychotics gradually. (B) Parenteral
(IM/IV) route — long-acting injectable (LAI) or IM formulations increase risk. (C) High-potency typical antipsychotics — haloperidol (Haldol) and fluphenazine (Prolixin) have the highest risk due to potent D2
blockade. Additional risks: dehydration, agitation, exhaustion, malnutrition, organic brain syndromes, lithium use, and past history of ECT. NMS onset is typically rapid (24-72 hours). Treatment:
discontinue offending agent, supportive care (cooling, hydration), dantrolene (muscle relaxant), and bromocriptine (dopamine agonist). Atypical antipsychotics (D) carry lower but still present risk.
2. Discrepancy between anatomical sex and gender is known as?
A. Gender Dysphoria
B. Gender Discordance
C. Transvestic Disorder
D. Sexual Orientation Disturbance
CORRECT ANSWER B — Gender Discordance; the discrepancy between one's anatomical/assigned sex at birth and their experienced gender identity
RATIONALE Gender discordance refers to the mismatch between a person's anatomical sex (assigned at birth) and their internal sense of gender identity. This is distinct from Gender Dysphoria (A), which is the DSM-5
diagnosis requiring clinically significant distress or impairment related to this incongruence. Not all individuals with gender discordance experience dysphoria. Transvestic Disorder (C) involves sexual
arousal from cross-dressing. Key terminology: AFAB (assigned female at birth), AMAB (assigned male at birth), cis (matching — gender identity matches assigned sex), trans (moving across the range —
gender identity differs from assigned sex). The PMHNP provides affirming, non-judgmental care using the patient's preferred name and pronouns.
3. Antipsychotic medication provides D2 blockade in the mesocortical pathway causing which of the following effects?
A. Reduces negative symptoms of schizophrenia
B. Increases EPS (extrapyramidal symptoms)
C. Causes prolactinemia
D. Reduces positive symptoms
CORRECT ANSWER B — Increases EPS; D2 blockade in the mesocortical pathway (already hypo-dopaminergic in schizophrenia) worsens negative symptoms and cognitive deficits
RATIONALE The four dopamine pathways and antipsychotic effects: (1) Mesolimbic pathway — HYPERactive in schizophrenia → positive symptoms; D2 blockade here REDUCES positive symptoms. (2) Mesocortical
pathway — HYPOactive in schizophrenia → negative symptoms (flat affect, avolition, social withdrawal) and cognitive deficits; D2 blockade here WORSENS these symptoms and increases EPS-like features.
(3) Nigrostriatal pathway — D2 blockade causes EPS (parkinsonism, dystonia, akathisia, TD). (4) Tuberoinfundibular pathway — D2 blockade causes hyperprolactinemia (galactorrhea, amenorrhea, sexual
dysfunction). The mesocortical pathway is responsible for cognitive function, reward, and motivation. Antipsychotics cannot selectively block only the mesolimbic pathway, which is why side effects occur.
4. Phencyclidine (PCP) and ketamine exert their unique behavioral effects by blocking which of the following receptors?
A. GABA receptors
B. Serotonin receptors
C. Dopamine receptors
D. NMDA type receptors
CORRECT ANSWER D — NMDA type receptors; PCP and ketamine are non-competitive NMDA glutamate receptor antagonists
RATIONALE Phencyclidine (PCP) and ketamine are dissociative anesthetics that produce their unique effects — dissociation, hallucinations, depersonalization, and analgesia — by blocking NMDA (N-methyl-D-
aspartate) type glutamate receptors. This blockade prevents the excitatory neurotransmitter glutamate from activating the receptor. The NMDA receptor hypofunction hypothesis of schizophrenia is based
partly on the observation that PCP and ketamine induce both positive and negative schizophrenia-like symptoms. GABA receptors (A) are affected by benzodiazepines and alcohol. Serotonin receptors (B)
are affected by SSRIs and psychedelics (LSD, psilocybin). Dopamine receptors (C) are affected by antipsychotics and stimulants. Ketamine has emerging evidence for treatment-resistant depression at sub-
anesthetic doses.
5. Abnormal involuntary movements in a rhythmic pattern affecting the face, mouth, tongue, and jaw is known as which of the following?
A. Akathisia
B. Dystonia
C. Tardive dyskinesia
D. Extrapyramidal symptoms (EPS)
CORRECT ANSWER C — Tardive dyskinesia; late-appearing, potentially irreversible abnormal involuntary movements, primarily orofacial (tongue protrusion, lip smacking, chewing, grimacing)
RATIONALE Tardive Dyskinesia (TD) is a late-appearing, potentially IRREVERSIBLE movement disorder caused by long-term dopamine receptor blockade from antipsychotics. Classic presentation: rhythmic,
involuntary movements of the face, mouth (tongue protrusion/"fly-catching," lip smacking, puckering), jaw (chewing, grimacing), and sometimes trunk and limbs (choreoathetoid movements).
Pathophysiology: chronic D2 blockade → postsynaptic dopamine receptor upregulation and hypersensitivity. TD is distinct from: Akathisia (A — subjective feeling of restlessness with motor agitation,
pacing), Dystonia (B — acute sustained muscle contractions, torticollis, oculogyric crisis), and general EPS (D — parkinsonism, tremor, rigidity, bradykinesia). Best assessment tool: AIMS (Abnormal
Involuntary Movement Scale). Treatment: VMAT2 inhibitors — Valbenazine (Ingrezza) and Deutetrabenazine (Austedo) are FDA-approved. Prevention: use atypical antipsychotics, lowest effective dose,
monitor AIMS regularly.
★ ★
Walden University
W College of Nursing
A HIGHER DEGREE OF GOOD
EST. 1970
NRNP 6675 — Final Examination
PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER: PSYCHOPHARMACOLOGY, PERSONALITY DISORDERS, ETHICS & LIFESPAN
INSTITUTION Walden University COURSE CODE NRNP 6675
PROGRAM PMHNP — Psychiatric-Mental Health Nurse Practitioner ACADEMIC YEAR
EXAM TITLE Final Examination — Comprehensive TOTAL QUESTIONS 150+ Questions
COURSE TITLE PMHNP Advanced Practice Psychiatric Nursing FORMAT Multiple Choice — Select All That Apply Included
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless "Select all that apply" is specified.
▸ Psychopharmacology — antipsychotics, lithium, antidepressants, and their side effects (EPS, NMS, TD, akathisia) are core competencies.
▸ DSM-5 diagnostic criteria — schizophrenia, bipolar disorder, personality disorders (Clusters A/B/C), PTSD, OCD, and substance use disorders are emphasized.
▸ Ethical principles (beneficence, non-maleficence, justice, autonomy, fidelity), HIPAA, malpractice, and scope of practice are testable content.
▸ Lifespan considerations — child/adolescent disorders, geriatric psychopharmacology, Freud/Erikson developmental stages, and pregnancy/lactation.
▸ Correct answers and clinical rationales appear below each question for PMHNP board certification review purposes.
▸ All content reflects current DSM-5-TR criteria, APA practice guidelines, and ANCC PMHNP certification exam blueprint.
SECTION I — PSYCHOPHARMACOLOGY, NEUROBIOLOGY & SCHIZOPHRENIA SPECTRUM Questions 1 – 20
1. Which of the following are risk factors for neuroleptic malignant syndrome (NMS)? (Select all that apply)
A. Rapid dose escalation
B. Parental route of administration
C. Higher potency typical antipsychotics
D. Use of atypical antipsychotics only
E. Slow titration of medication
CORRECT ANSWER A, B, C — Rapid dose escalation, parenteral route of administration, and higher potency typical antipsychotics (e.g., haloperidol, fluphenazine) increase NMS risk
RATIONALE Neuroleptic Malignant Syndrome (NMS) is a life-threatening idiosyncratic reaction to antipsychotic medications characterized by hyperthermia, severe muscle rigidity, autonomic instability, altered
consciousness, and elevated creatine phosphokinase (CPK). Key risk factors: (A) Rapid dose escalation — the most significant modifiable risk factor; always titrate antipsychotics gradually. (B) Parenteral
(IM/IV) route — long-acting injectable (LAI) or IM formulations increase risk. (C) High-potency typical antipsychotics — haloperidol (Haldol) and fluphenazine (Prolixin) have the highest risk due to potent D2
blockade. Additional risks: dehydration, agitation, exhaustion, malnutrition, organic brain syndromes, lithium use, and past history of ECT. NMS onset is typically rapid (24-72 hours). Treatment:
discontinue offending agent, supportive care (cooling, hydration), dantrolene (muscle relaxant), and bromocriptine (dopamine agonist). Atypical antipsychotics (D) carry lower but still present risk.
2. Discrepancy between anatomical sex and gender is known as?
A. Gender Dysphoria
B. Gender Discordance
C. Transvestic Disorder
D. Sexual Orientation Disturbance
CORRECT ANSWER B — Gender Discordance; the discrepancy between one's anatomical/assigned sex at birth and their experienced gender identity
RATIONALE Gender discordance refers to the mismatch between a person's anatomical sex (assigned at birth) and their internal sense of gender identity. This is distinct from Gender Dysphoria (A), which is the DSM-5
diagnosis requiring clinically significant distress or impairment related to this incongruence. Not all individuals with gender discordance experience dysphoria. Transvestic Disorder (C) involves sexual
arousal from cross-dressing. Key terminology: AFAB (assigned female at birth), AMAB (assigned male at birth), cis (matching — gender identity matches assigned sex), trans (moving across the range —
gender identity differs from assigned sex). The PMHNP provides affirming, non-judgmental care using the patient's preferred name and pronouns.
3. Antipsychotic medication provides D2 blockade in the mesocortical pathway causing which of the following effects?
A. Reduces negative symptoms of schizophrenia
B. Increases EPS (extrapyramidal symptoms)
C. Causes prolactinemia
D. Reduces positive symptoms
CORRECT ANSWER B — Increases EPS; D2 blockade in the mesocortical pathway (already hypo-dopaminergic in schizophrenia) worsens negative symptoms and cognitive deficits
RATIONALE The four dopamine pathways and antipsychotic effects: (1) Mesolimbic pathway — HYPERactive in schizophrenia → positive symptoms; D2 blockade here REDUCES positive symptoms. (2) Mesocortical
pathway — HYPOactive in schizophrenia → negative symptoms (flat affect, avolition, social withdrawal) and cognitive deficits; D2 blockade here WORSENS these symptoms and increases EPS-like features.
(3) Nigrostriatal pathway — D2 blockade causes EPS (parkinsonism, dystonia, akathisia, TD). (4) Tuberoinfundibular pathway — D2 blockade causes hyperprolactinemia (galactorrhea, amenorrhea, sexual
dysfunction). The mesocortical pathway is responsible for cognitive function, reward, and motivation. Antipsychotics cannot selectively block only the mesolimbic pathway, which is why side effects occur.
4. Phencyclidine (PCP) and ketamine exert their unique behavioral effects by blocking which of the following receptors?
A. GABA receptors
B. Serotonin receptors
C. Dopamine receptors
D. NMDA type receptors
CORRECT ANSWER D — NMDA type receptors; PCP and ketamine are non-competitive NMDA glutamate receptor antagonists
RATIONALE Phencyclidine (PCP) and ketamine are dissociative anesthetics that produce their unique effects — dissociation, hallucinations, depersonalization, and analgesia — by blocking NMDA (N-methyl-D-
aspartate) type glutamate receptors. This blockade prevents the excitatory neurotransmitter glutamate from activating the receptor. The NMDA receptor hypofunction hypothesis of schizophrenia is based
partly on the observation that PCP and ketamine induce both positive and negative schizophrenia-like symptoms. GABA receptors (A) are affected by benzodiazepines and alcohol. Serotonin receptors (B)
are affected by SSRIs and psychedelics (LSD, psilocybin). Dopamine receptors (C) are affected by antipsychotics and stimulants. Ketamine has emerging evidence for treatment-resistant depression at sub-
anesthetic doses.
5. Abnormal involuntary movements in a rhythmic pattern affecting the face, mouth, tongue, and jaw is known as which of the following?
A. Akathisia
B. Dystonia
C. Tardive dyskinesia
D. Extrapyramidal symptoms (EPS)
CORRECT ANSWER C — Tardive dyskinesia; late-appearing, potentially irreversible abnormal involuntary movements, primarily orofacial (tongue protrusion, lip smacking, chewing, grimacing)
RATIONALE Tardive Dyskinesia (TD) is a late-appearing, potentially IRREVERSIBLE movement disorder caused by long-term dopamine receptor blockade from antipsychotics. Classic presentation: rhythmic,
involuntary movements of the face, mouth (tongue protrusion/"fly-catching," lip smacking, puckering), jaw (chewing, grimacing), and sometimes trunk and limbs (choreoathetoid movements).
Pathophysiology: chronic D2 blockade → postsynaptic dopamine receptor upregulation and hypersensitivity. TD is distinct from: Akathisia (A — subjective feeling of restlessness with motor agitation,
pacing), Dystonia (B — acute sustained muscle contractions, torticollis, oculogyric crisis), and general EPS (D — parkinsonism, tremor, rigidity, bradykinesia). Best assessment tool: AIMS (Abnormal
Involuntary Movement Scale). Treatment: VMAT2 inhibitors — Valbenazine (Ingrezza) and Deutetrabenazine (Austedo) are FDA-approved. Prevention: use atypical antipsychotics, lowest effective dose,
monitor AIMS regularly.
