NRNP 6665 FINAL EXAM 3 LATEST VERSIONS A, B & C 2025,
EACH VERSION CONTAINS 100 QUESTIONS AND CORRECT
DETAILED ANSWERS/ WALDEN UNIVERSITY
1. A psychiatric-mental health nurse practitioner (PMHNP) is conducting an initial
assessment of a 7-year-old child. Which of the following developmental theories would
be most relevant for understanding the child's stage of industry versus inferiority?
A) Freud's psychosexual stages.
B) Piaget's cognitive development stages.
C) Erikson's psychosocial stages.
D) Kohlberg's stages of moral development.
E) Bowlby's attachment theory.
Correct Answer: C) Erikson's psychosocial stages.
Rationale: Erik Erikson's theory describes eight stages of psychosocial development,
with "Industry vs. Inferiority" being characteristic of the school-age period
(approximately 6-12 years), focusing on developing competence and achievement.
2. A 15-year-old adolescent is brought to the clinic by their parents due to recent onset of
severe irritability, decreased need for sleep, rapid speech, and impulsive behaviors.
Which of the following DSM-5 diagnoses should the PMHNP consider as a primary
differential?
A) Major Depressive Disorder (MDD).
B) Generalized Anxiety Disorder (GAD).
C) Bipolar I Disorder, manic episode.
D) Attention-Deficit/Hyperactivity Disorder (ADHD).
E) Oppositional Defiant Disorder (ODD).
Correct Answer: C) Bipolar I Disorder, manic episode.
Rationale: The symptoms described (severe irritability, decreased need for sleep, rapid
speech, impulsivity) are classic indicators of a manic episode, which is characteristic of
Bipolar I Disorder. While ADHD and ODD involve impulsivity and irritability, the
episodic nature and decreased sleep strongly point to mania.
3. When prescribing an antidepressant to an adolescent, the PMHNP must inform the
family about which significant black box warning?
A) Risk of weight gain.
B) Risk of sexual dysfunction.
C) Increased risk of suicidal ideation and behavior in children and adolescents.
D) Risk of insomnia.
E) Potential for serotonin syndrome.
Correct Answer: C) Increased risk of suicidal ideation and behavior in children and
adolescents.
Rationale: The FDA has issued a black box warning for all antidepressants, stating an
, increased risk of suicidal ideation and behavior in children, adolescents, and young adults
(up to age 24) when starting or changing antidepressant dosage. This is a critical safety
consideration.
4. A 10-year-old child with a diagnosis of Attention-Deficit/Hyperactivity Disorder
(ADHD) is prescribed methylphenidate. The PMHNP should prioritize education on
which potential adverse effect?
A) Sedation.
B) Weight gain.
C) Insomnia and decreased appetite.
D) Bradycardia.
E) Hypoglycemia.
Correct Answer: C) Insomnia and decreased appetite.
Rationale: Methylphenidate is a stimulant. Common side effects include difficulty
sleeping (insomnia), especially if given late in the day, and a reduction in appetite, which
can lead to weight loss or slower weight gain.
5. A PMHNP is conducting a suicide risk assessment for a 16-year-old client. Which of the
following is the most significant risk factor?
A) Recent breakup with a girlfriend.
B) History of previous suicide attempts.
C) Poor academic performance.
D) Increased isolation from peers.
E) Family history of depression.
Correct Answer: B) History of previous suicide attempts.
Rationale: A history of previous suicide attempts is consistently identified as the single
strongest predictor of future suicide attempts. While other factors are important, a
prior attempt significantly elevates risk.
6. Which therapeutic modality is specifically designed to treat Borderline Personality
Disorder in adolescents by focusing on emotion regulation, distress tolerance, and
interpersonal effectiveness?
A) Cognitive Behavioral Therapy (CBT).
B) Psychodynamic Therapy.
C) Dialectical Behavior Therapy (DBT).
D) Play Therapy.
E) Solution-Focused Brief Therapy (SFBT).
Correct Answer: C) Dialectical Behavior Therapy (DBT).
Rationale: DBT, developed by Marsha Linehan, has been adapted for adolescents
(DBT-A) and is highly effective for individuals with severe emotion dysregulation,
impulsivity, and self-harm, which are core features of Borderline Personality Disorder.
, 7. A 5-year-old child is displaying significant aggression, defiance, and temper tantrums in
multiple settings for over 6 months. The behaviors are clearly outside of normal age-
appropriate behavior. The PMHNP would primarily consider a diagnosis of:
A) Conduct Disorder.
B) Oppositional Defiant Disorder (ODD).
C) Disruptive Mood Dysregulation Disorder (DMDD).
D) Autism Spectrum Disorder (ASD).
E) Separation Anxiety Disorder.
Correct Answer: B) Oppositional Defiant Disorder (ODD).
Rationale: ODD is characterized by a pattern of angry/irritable mood,
argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling. The severity and
duration fit the description for ODD. DMDD would involve more chronic, severe
temper outbursts. Conduct Disorder involves more serious violations of rights.
8. When assessing an adolescent for substance use disorder, which of the following is the
most important consideration for the PMHNP?
A) Focusing solely on legal consequences.
B) Obtaining information only from the adolescent, not their parents.
C) Screening for co-occurring mental health disorders.
D) Immediately reporting all substance use to legal authorities.
E) Assuming substance use is a normal part of adolescence.
Correct Answer: C) Screening for co-occurring mental health disorders.
Rationale: Adolescents with substance use disorders frequently have co-occurring
mental health disorders (e.g., depression, anxiety, ADHD). Addressing both
concurrently is crucial for effective treatment.
9. A PMHNP is working with parents of a child who refuses to attend school due to
intense anxiety about separation from them. This pattern has persisted for over a
month and significantly impairs the child's academic and social functioning. This
presentation is most consistent with:
A) Social Anxiety Disorder.
B) Generalized Anxiety Disorder.
C) Separation Anxiety Disorder.
D) Agoraphobia.
E) School Refusal Disorder (a symptom, not a DSM diagnosis).
Correct Answer: C) Separation Anxiety Disorder.
Rationale: Separation Anxiety Disorder is characterized by developmentally
inappropriate and excessive fear or anxiety concerning separation from those to whom
the individual is attached. School refusal is a common manifestation.
EACH VERSION CONTAINS 100 QUESTIONS AND CORRECT
DETAILED ANSWERS/ WALDEN UNIVERSITY
1. A psychiatric-mental health nurse practitioner (PMHNP) is conducting an initial
assessment of a 7-year-old child. Which of the following developmental theories would
be most relevant for understanding the child's stage of industry versus inferiority?
A) Freud's psychosexual stages.
B) Piaget's cognitive development stages.
C) Erikson's psychosocial stages.
D) Kohlberg's stages of moral development.
E) Bowlby's attachment theory.
Correct Answer: C) Erikson's psychosocial stages.
Rationale: Erik Erikson's theory describes eight stages of psychosocial development,
with "Industry vs. Inferiority" being characteristic of the school-age period
(approximately 6-12 years), focusing on developing competence and achievement.
2. A 15-year-old adolescent is brought to the clinic by their parents due to recent onset of
severe irritability, decreased need for sleep, rapid speech, and impulsive behaviors.
Which of the following DSM-5 diagnoses should the PMHNP consider as a primary
differential?
A) Major Depressive Disorder (MDD).
B) Generalized Anxiety Disorder (GAD).
C) Bipolar I Disorder, manic episode.
D) Attention-Deficit/Hyperactivity Disorder (ADHD).
E) Oppositional Defiant Disorder (ODD).
Correct Answer: C) Bipolar I Disorder, manic episode.
Rationale: The symptoms described (severe irritability, decreased need for sleep, rapid
speech, impulsivity) are classic indicators of a manic episode, which is characteristic of
Bipolar I Disorder. While ADHD and ODD involve impulsivity and irritability, the
episodic nature and decreased sleep strongly point to mania.
3. When prescribing an antidepressant to an adolescent, the PMHNP must inform the
family about which significant black box warning?
A) Risk of weight gain.
B) Risk of sexual dysfunction.
C) Increased risk of suicidal ideation and behavior in children and adolescents.
D) Risk of insomnia.
E) Potential for serotonin syndrome.
Correct Answer: C) Increased risk of suicidal ideation and behavior in children and
adolescents.
Rationale: The FDA has issued a black box warning for all antidepressants, stating an
, increased risk of suicidal ideation and behavior in children, adolescents, and young adults
(up to age 24) when starting or changing antidepressant dosage. This is a critical safety
consideration.
4. A 10-year-old child with a diagnosis of Attention-Deficit/Hyperactivity Disorder
(ADHD) is prescribed methylphenidate. The PMHNP should prioritize education on
which potential adverse effect?
A) Sedation.
B) Weight gain.
C) Insomnia and decreased appetite.
D) Bradycardia.
E) Hypoglycemia.
Correct Answer: C) Insomnia and decreased appetite.
Rationale: Methylphenidate is a stimulant. Common side effects include difficulty
sleeping (insomnia), especially if given late in the day, and a reduction in appetite, which
can lead to weight loss or slower weight gain.
5. A PMHNP is conducting a suicide risk assessment for a 16-year-old client. Which of the
following is the most significant risk factor?
A) Recent breakup with a girlfriend.
B) History of previous suicide attempts.
C) Poor academic performance.
D) Increased isolation from peers.
E) Family history of depression.
Correct Answer: B) History of previous suicide attempts.
Rationale: A history of previous suicide attempts is consistently identified as the single
strongest predictor of future suicide attempts. While other factors are important, a
prior attempt significantly elevates risk.
6. Which therapeutic modality is specifically designed to treat Borderline Personality
Disorder in adolescents by focusing on emotion regulation, distress tolerance, and
interpersonal effectiveness?
A) Cognitive Behavioral Therapy (CBT).
B) Psychodynamic Therapy.
C) Dialectical Behavior Therapy (DBT).
D) Play Therapy.
E) Solution-Focused Brief Therapy (SFBT).
Correct Answer: C) Dialectical Behavior Therapy (DBT).
Rationale: DBT, developed by Marsha Linehan, has been adapted for adolescents
(DBT-A) and is highly effective for individuals with severe emotion dysregulation,
impulsivity, and self-harm, which are core features of Borderline Personality Disorder.
, 7. A 5-year-old child is displaying significant aggression, defiance, and temper tantrums in
multiple settings for over 6 months. The behaviors are clearly outside of normal age-
appropriate behavior. The PMHNP would primarily consider a diagnosis of:
A) Conduct Disorder.
B) Oppositional Defiant Disorder (ODD).
C) Disruptive Mood Dysregulation Disorder (DMDD).
D) Autism Spectrum Disorder (ASD).
E) Separation Anxiety Disorder.
Correct Answer: B) Oppositional Defiant Disorder (ODD).
Rationale: ODD is characterized by a pattern of angry/irritable mood,
argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited
during interaction with at least one individual who is not a sibling. The severity and
duration fit the description for ODD. DMDD would involve more chronic, severe
temper outbursts. Conduct Disorder involves more serious violations of rights.
8. When assessing an adolescent for substance use disorder, which of the following is the
most important consideration for the PMHNP?
A) Focusing solely on legal consequences.
B) Obtaining information only from the adolescent, not their parents.
C) Screening for co-occurring mental health disorders.
D) Immediately reporting all substance use to legal authorities.
E) Assuming substance use is a normal part of adolescence.
Correct Answer: C) Screening for co-occurring mental health disorders.
Rationale: Adolescents with substance use disorders frequently have co-occurring
mental health disorders (e.g., depression, anxiety, ADHD). Addressing both
concurrently is crucial for effective treatment.
9. A PMHNP is working with parents of a child who refuses to attend school due to
intense anxiety about separation from them. This pattern has persisted for over a
month and significantly impairs the child's academic and social functioning. This
presentation is most consistent with:
A) Social Anxiety Disorder.
B) Generalized Anxiety Disorder.
C) Separation Anxiety Disorder.
D) Agoraphobia.
E) School Refusal Disorder (a symptom, not a DSM diagnosis).
Correct Answer: C) Separation Anxiety Disorder.
Rationale: Separation Anxiety Disorder is characterized by developmentally
inappropriate and excessive fear or anxiety concerning separation from those to whom
the individual is attached. School refusal is a common manifestation.
