MRETDIM 5766 PNRN
W Walden University
College of Nursing · PMHNP Program
PMHNP
E D U C AT I O N F O R G O O D · P O S I T I V E S O C I A L C H A N G E
EST. 1970
NRNP 6675 — Midterm Examination
P SYC H I AT R I C M E N TA L H E A LT H N U R S E P R A C T I T I O N E R · P SYC H O PAT H O LO G Y, D I A G N O S I S &
P SYC H O P H A R M A CO LO G Y
INSTITUTION Walden University COURSE CODE NRNP 6675
PROGRAM MSN · Psychiatric Mental Health Nurse ACADEMIC YEAR
Practitioner (PMHNP)
EXAM TITLE NRNP 6675 — Midterm Comprehensive TOTAL QUESTIONS 60 Questions
Examination
COURSE TITLE PMHNP Care Across the Lifespan I: FORMAT Multiple Choice / Select All That Apply —
Psychopathology & Psychopharmacology Select the Single Best Answer Unless
Otherwise Noted
EXAMINATION INSTRUCTIONS
▸ Questions cover psychopathology, DSM-5 diagnostic criteria, psychopharmacology, personality disorders, neurobiology, and
PMHNP professional practice standards.
▸ Select the single best answer for each question unless "Select all that apply" is explicitly stated.
▸ Distinguish carefully between similar presentations: schizophrenia spectrum disorders, personality disorder clusters, medication
side effects, and psychiatric emergencies.
▸ Correct answers and detailed rationales appear below each question for comprehensive exam preparation.
▸ Content derived from NRNP 6675 curriculum, Walden University PMHNP program, and board certification standards.
SECTION I — PSYCHOPATHOLOGY, PERSONALITY DISORDERS, Questions
PSYCHOPHARMACOLOGY & PMHNP PROFESSIONAL PRACTICE 1 – 60
1. 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
RATIONALE Gender discordance describes the discrepancy between an individual's anatomical/assigned sex and their
experienced gender identity. Gender dysphoria (Option A) is the clinical diagnosis when this discrepancy causes
significant distress or functional impairment. Transvestic disorder involves cross-dressing for sexual arousal, not
gender identity mismatch.
,2. Which of the following are risk factors for neuroleptic malignant syndrome (NMS)? Select all that apply.
A. Rapid dose escalation
B. Parenteral route of administration
C. Higher potency typical antipsychotics
D. Concurrent antidepressant use
CORRECT ANSWER A, B, and C — Rapid dose escalation; Parenteral route of administration; Higher potency typical
antipsychotics
RATIONALE NMS is a life-threatening idiosyncratic reaction. Key risk factors include rapid dose escalation (sudden dopamine
blockade increase), parenteral administration (higher bioavailability), and high-potency typical antipsychotics like
haloperidol. Concurrent antidepressant use is not a primary NMS risk factor—though polypharmacy generally
increases complexity.
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 of schizophrenia
CORRECT ANSWER B. Increases EPS (extrapyramidal symptoms)
RATIONALE D2 blockade in the mesocortical pathway worsens negative symptoms by further reducing dopamine in an already
hypo-dopaminergic pathway. This manifests as increased EPS. Reducing negative symptoms would require
dopamine agonism in this pathway. Prolactinemia results from tuberoinfundibular pathway blockade. Positive
symptom reduction occurs via mesolimbic D2 blockade.
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 glutamate receptors
CORRECT ANSWER D. NMDA type glutamate receptors
RATIONALE PCP and ketamine are non-competitive NMDA receptor antagonists. By blocking NMDA glutamate receptors, they
produce dissociative effects including depersonalization, derealization, and psychotic symptoms that can mimic
schizophrenia. They do not primarily act on GABA, serotonin, or dopamine receptors, distinguishing them from
most other substances of abuse.
, 5. A patient presents with delusions, disorganized thoughts and speech, and poor self-care, all of which have persisted for
the past 7 months. The PMHNP knows this presentation indicates which diagnosis?
A. Schizophreniform disorder
B. Brief psychotic disorder
C. Schizophrenia
D. Schizoaffective disorder
CORRECT ANSWER C. Schizophrenia
RATIONALE Schizophrenia requires continuous signs of the disturbance for at least 6 months, including at least 1 month of
active-phase symptoms (delusions, hallucinations, disorganized speech). At 7 months with ongoing active
symptoms, the duration exceeds schizophreniform disorder (1–6 months) and brief psychotic disorder (1 day–1
month). No mood episode criteria are described to suggest schizoaffective disorder.
6. Which of the following are keys to distinguishing OCD from psychosis?
A. OCD patients cannot recognize the irrationality of their symptoms
B. Patients with OCD can almost always acknowledge the unreasonable nature of their symptoms
C. Psychotic patients retain full insight into their delusions
D. OCD and psychosis are indistinguishable without neuroimaging
CORRECT ANSWER B. Patients with OCD can almost always acknowledge the unreasonable nature of their symptoms
RATIONALE A key differentiator is insight: most OCD patients recognize their obsessions and compulsions are excessive or
unreasonable (though some may have poor insight). In psychotic disorders, patients typically lack insight and
firmly believe in their delusions despite contrary evidence. This distinction is critical for accurate diagnosis and
treatment planning.
7. Abnormal involuntary movements in a rhythmic pattern affecting the face, mouth, tongue, and jaw is known as:
A. Akathisia
B. Dystonia
C. Tardive dyskinesia
D. EPS (extrapyramidal symptoms — general)
CORRECT ANSWER C. Tardive dyskinesia
RATIONALE Tardive dyskinesia (TD) is characterized by rhythmic, involuntary movements predominantly of the face, mouth
(tongue protrusion, lip smacking), and jaw. It is a late-onset, potentially irreversible side effect of long-term
antipsychotic use. Akathisia is motor restlessness. Dystonia involves sustained muscle contractions. EPS is a
broader category encompassing all drug-induced movement disorders.
W Walden University
College of Nursing · PMHNP Program
PMHNP
E D U C AT I O N F O R G O O D · P O S I T I V E S O C I A L C H A N G E
EST. 1970
NRNP 6675 — Midterm Examination
P SYC H I AT R I C M E N TA L H E A LT H N U R S E P R A C T I T I O N E R · P SYC H O PAT H O LO G Y, D I A G N O S I S &
P SYC H O P H A R M A CO LO G Y
INSTITUTION Walden University COURSE CODE NRNP 6675
PROGRAM MSN · Psychiatric Mental Health Nurse ACADEMIC YEAR
Practitioner (PMHNP)
EXAM TITLE NRNP 6675 — Midterm Comprehensive TOTAL QUESTIONS 60 Questions
Examination
COURSE TITLE PMHNP Care Across the Lifespan I: FORMAT Multiple Choice / Select All That Apply —
Psychopathology & Psychopharmacology Select the Single Best Answer Unless
Otherwise Noted
EXAMINATION INSTRUCTIONS
▸ Questions cover psychopathology, DSM-5 diagnostic criteria, psychopharmacology, personality disorders, neurobiology, and
PMHNP professional practice standards.
▸ Select the single best answer for each question unless "Select all that apply" is explicitly stated.
▸ Distinguish carefully between similar presentations: schizophrenia spectrum disorders, personality disorder clusters, medication
side effects, and psychiatric emergencies.
▸ Correct answers and detailed rationales appear below each question for comprehensive exam preparation.
▸ Content derived from NRNP 6675 curriculum, Walden University PMHNP program, and board certification standards.
SECTION I — PSYCHOPATHOLOGY, PERSONALITY DISORDERS, Questions
PSYCHOPHARMACOLOGY & PMHNP PROFESSIONAL PRACTICE 1 – 60
1. 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
RATIONALE Gender discordance describes the discrepancy between an individual's anatomical/assigned sex and their
experienced gender identity. Gender dysphoria (Option A) is the clinical diagnosis when this discrepancy causes
significant distress or functional impairment. Transvestic disorder involves cross-dressing for sexual arousal, not
gender identity mismatch.
,2. Which of the following are risk factors for neuroleptic malignant syndrome (NMS)? Select all that apply.
A. Rapid dose escalation
B. Parenteral route of administration
C. Higher potency typical antipsychotics
D. Concurrent antidepressant use
CORRECT ANSWER A, B, and C — Rapid dose escalation; Parenteral route of administration; Higher potency typical
antipsychotics
RATIONALE NMS is a life-threatening idiosyncratic reaction. Key risk factors include rapid dose escalation (sudden dopamine
blockade increase), parenteral administration (higher bioavailability), and high-potency typical antipsychotics like
haloperidol. Concurrent antidepressant use is not a primary NMS risk factor—though polypharmacy generally
increases complexity.
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 of schizophrenia
CORRECT ANSWER B. Increases EPS (extrapyramidal symptoms)
RATIONALE D2 blockade in the mesocortical pathway worsens negative symptoms by further reducing dopamine in an already
hypo-dopaminergic pathway. This manifests as increased EPS. Reducing negative symptoms would require
dopamine agonism in this pathway. Prolactinemia results from tuberoinfundibular pathway blockade. Positive
symptom reduction occurs via mesolimbic D2 blockade.
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 glutamate receptors
CORRECT ANSWER D. NMDA type glutamate receptors
RATIONALE PCP and ketamine are non-competitive NMDA receptor antagonists. By blocking NMDA glutamate receptors, they
produce dissociative effects including depersonalization, derealization, and psychotic symptoms that can mimic
schizophrenia. They do not primarily act on GABA, serotonin, or dopamine receptors, distinguishing them from
most other substances of abuse.
, 5. A patient presents with delusions, disorganized thoughts and speech, and poor self-care, all of which have persisted for
the past 7 months. The PMHNP knows this presentation indicates which diagnosis?
A. Schizophreniform disorder
B. Brief psychotic disorder
C. Schizophrenia
D. Schizoaffective disorder
CORRECT ANSWER C. Schizophrenia
RATIONALE Schizophrenia requires continuous signs of the disturbance for at least 6 months, including at least 1 month of
active-phase symptoms (delusions, hallucinations, disorganized speech). At 7 months with ongoing active
symptoms, the duration exceeds schizophreniform disorder (1–6 months) and brief psychotic disorder (1 day–1
month). No mood episode criteria are described to suggest schizoaffective disorder.
6. Which of the following are keys to distinguishing OCD from psychosis?
A. OCD patients cannot recognize the irrationality of their symptoms
B. Patients with OCD can almost always acknowledge the unreasonable nature of their symptoms
C. Psychotic patients retain full insight into their delusions
D. OCD and psychosis are indistinguishable without neuroimaging
CORRECT ANSWER B. Patients with OCD can almost always acknowledge the unreasonable nature of their symptoms
RATIONALE A key differentiator is insight: most OCD patients recognize their obsessions and compulsions are excessive or
unreasonable (though some may have poor insight). In psychotic disorders, patients typically lack insight and
firmly believe in their delusions despite contrary evidence. This distinction is critical for accurate diagnosis and
treatment planning.
7. Abnormal involuntary movements in a rhythmic pattern affecting the face, mouth, tongue, and jaw is known as:
A. Akathisia
B. Dystonia
C. Tardive dyskinesia
D. EPS (extrapyramidal symptoms — general)
CORRECT ANSWER C. Tardive dyskinesia
RATIONALE Tardive dyskinesia (TD) is characterized by rhythmic, involuntary movements predominantly of the face, mouth
(tongue protrusion, lip smacking), and jaw. It is a late-onset, potentially irreversible side effect of long-term
antipsychotic use. Akathisia is motor restlessness. Dystonia involves sustained muscle contractions. EPS is a
broader category encompassing all drug-induced movement disorders.
