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NRNP6665 MIDTERM CERTIFICATION TEST
2026 COMPREHENSIVE STUDY GUIDE
◉ Clonidine Hydrochloride Answer: Catapres, Catapres TTS, Kapvay (Antihypertensive) ◉ Dexmethylphenidate Hydrochloride Answer: Focalin; Focalin XR Tablet, capsule CNS Stimulant ADHD ◉ Guanfacine Hydrochloride Answer: Tenex, Intuniv Antihypertensive/Antipsychotic ◉ Lisdexamfetamine Answer: Vyvanse (ADHD, binge eating disorder) ◉ Methylphenidate Answer: Concerta, Ritalin, Metadate, Methylin CNS Agent for ADHD Yes ◉ methylphenidate hydrocholoride Answer: Methylphenidate
Common brand names: Ritalin, Daytrana This medication is used to treat attention deficit hyperactivity disorder - ADHD. Brand names: Ritalin · Daytrana · Metadate ER · Methylin · Quillivant XR Drug classes: Central Nervous System Stimulant · CNS Stimulant ◉ Dissociative disorders Answer: =A group of disorders that cause an impaired awareness of your own actions, thoughts, physical sensations, and even identity, which is a sense of who you are. ◉ Dissociative disorders Answer: Divided into three main types: depersonalization/derealization disorder, dissociative amnesia, and dissociative identity disorder. ◉ Dissociative disorders Answer: Each of these disorders fall along a spectrum of severity:
- depersonalization/derealization= the least severe of the dissociative disorders,
- dissociative amnesia= somewhere in the middle of least severe and severe,
- dissociative identity disorder= the most severe.
- Alzheimer's /disease ◉ Rivastigmine Answer: • Acetylcholinesterase inhibitor
- Used to tx Alzheimer's
- Increases amount of ACh in presynaptic terminals
- Orally available
- Very short T 1/2 (1.5 hrs)
- Metab. by plasma cholinesterase **
- Adverse effects: mostly safe (tremors, bradycardia, nausea, vomiting, etc. due to peripheral ACh stimulation) ◉ Nuplazid Answer: pimavanserin Parkinsons Dx-hallucinations and delusions ◉ Rivastigmine Answer: • Acetylcholinesterase inhibitor
- Used to tx Alzheimer's
- Increases amount of ACh in presynaptic terminals
- Orally available
- Very short T 1/2 (1.5 hrs)
- Metab. by plasma cholinesterase **
- Adverse effects: mostly safe (tremors, bradycardia, nausea, vomiting, etc. due to peripheral ACh stimulation)
◉ Pimavanserin Answer: Nuplazid Atypical antipsychotic used in Parkinson's Disease High affinity for serotonin 2A receptors ◉ Question 3: In which demographic is depression twice as prevalent in girls as compared to boys? Answer: A. Preschoolers B. School aged C. Adolescents D. All children ◉ Which of the following is not a true statement with respect to confidentiality of the child or adolescent client? Answer: A. The PMHNP should not be concerned with consent for disclosure when child abuse or maltreatment has occurred. B. In 1979, the American Psychiatric Association (APA) stated that children 12 years of age or older can give consent for disclosure. C. The American Academy of Child and Adolescent Psychiatry (AACAP) Code of Ethics states that consent is not required for disclosure. D. Regardless of code or position statement by any organization, the best approach is when the child and PMHNP agree on disclosure.
C. variety of tutors who will offer a variety of writing techniques, composition strategies, and critiques D. Intensive, continuous administration of individually tailored, one- on-one expressive and creative writing therapy ◉ Aripiprazole Answer: abilify/ antipsychotic (atypical) S/sx: drowsiness ◉ Risperidone Answer: Atypical antipsychotic causing high prolactin levels with lots of extrapyramidal SE ◉ Amphetamine IR Answer: Adderall CNS Stimulant ◉ Amphetamine XR Answer: Adderall (XR) CNS Stimulant ◉ Dextroamphetamine Answer: CNS stimulant Mech: Inc catecholamines at the synaptic cleft, especially NE and dopamine. Use: ADHD, narcolepsy, apetite control ◉ Atomoxetine (Strattera) Answer: - BBW
> Risk of suicidal ideation; monitor for suicidal thinking or behavior, worsening, or unusual behavior
- Contraindications > Glaucoma, pheochromocytoma, MAO I use within past 14 days
- Warning > Rare, but severe hepatotoxicity (most within 120 days of start of treatment) SE > Headache, insomnia, somnolence, dry mouth, nausea, abdominal pain, decrease in appetite, nausea, etc. > Priapism NOTE > * do not open capsule * - irritant > CYPD 2D6 substrate > watch out for *LIVER PROBLEMS * ◉ Clonidine Answer: alpha 2 agonist
- treatment for hypertension and opioid withdrawal
- side effects of bradycardia and hypotension ◉ Dexmethylphenidate Answer: ADHD stimulant
D. Physical findings consistent with neuromuscular disease such as muscular dystrophy ◉ Question 8: Children with gender dysphoria typically have higher rates of all the following except: Answer: A. Depression B. Impulse control disorders C. Anxiety disorders D. Eating disorder ◉ Question 9: Eileen is a 23-month-old girl who is being evaluated for autism spectrum disorder because her pediatrician is concerned about the presence of developmental red flags. She has just a few words of speech and has not put together any meaningful two-word phrases. While taking a history from Eileen's mother the PMHNP learns that for approximately the last 2 months Eileen has been seen eating paint chips that are peeling off the baseboard and window sills in the family home; when she sees one she puts it in her mouth. This is a concern because they live in an old farmhouse and there may be lead-based paint in some of the paint layers. The PMHNP considers that which of the following is not consistent with a diagnosis of pica? Answer: A. A diagnosis of autism spectrum disorder B. Symptoms < 6 months duration C. The pattern of eating
D. Lack of potential consequences ◉ Question 12 Which of the following symptom clusters is most likely in a 16-year- old male with major depressive disorder? Answer: A. Disturbance of mood, loss of interest, and mood-congruent hallucinations B. Irritability, persistent abdominal complaints, and insomnia C. Decreased concentration, social withdrawal, and substance abuse D. Pervasive anhedonia, hopelessness, and severe psychomotor retardation ◉ Question 10: The current scholarly consensus is that the etiology of bulimia nervosa is multifactorial to include biological, sociocultural, family, cognitive-behavioral, and psychodynamic factors. When considering the etiology of bulimia nervosa, the PMHNP understands that: Answer: A. Family factors contributing to bulimia nervosa include emotional restraint, tight parental control of behavior, and avoidance of conflict. B. Lowered serotonin activity is seen in the brains of patients with bulimia nervosa. C. There is a disproportionate incidence in childhood sexual abuse in patients with bulimia nervosa. D. Cultural influences are much less implicit in the development of bulimia nervosa as compared to anorexia nervosa.
An astute pediatrician has referred Kyle, a 5-month-old infant, for evaluation of rumination disorder. His mother was concerned because he seemed to "want" to regurgitate every time he ate and would even seem to "put his hand down his throat" in order to stimulate regurgitation. Kyle had a thorough evaluation and according to the pediatrician did not have gastroesophageal reflux or hiatal hernia. The mother-infant relationship appeared to be healthy and, via assessment, the PMHNP could not identify any clear emotional issues. The primary treatment strategy for Kyle will likely focus on: Answer: A. Aversive therapies, e.g., squirting lemon juice into Kyle's mouth when he ruminates B. Medication therapies to include trials of first-line agents such as metoclopramide, cimetidine, or haloperidol C. Psychotherapy for the parents D. Habit-reversal therapies ◉ Question 15: The literature indicates that boys whose fathers died before the age of 13 are at a greater risk for the development of depression as compared to controls. This is consistent with which general theory of depression etiology? Answer: A. Molecular-genetic B. Biologic C. Psychosocial D. Stress-diathesis
◉ Question 16: Katelyn is a 16-year-old girl who presents for therapy with her mother and father. Katelyn was born with male genitalia but has felt like a female "all of her life." She says she knew something was different as far back as she can remember. She always wanted to wear her mother's clothes and makeup and play with other girls. Katelyn started dressing and openly identifying as a girl when she was 13 years old, and her parents are trying to be supportive but they are struggling. Most recently Katelyn has developed an intimate partner relationship with Jennifer, a 15-year- old girl who was gender-assigned female at birth and identifies as a female. Katelyn's father does not understand the relationship. The PMHNP explains that Katelyn: Answer: A. Is responding to the male hormonal surges of puberty and will ultimately identify with her physiologic gender B. Does not have a clear sense of gender identity and may be a candidate for reparative therapy to correct her gender identity issues C. Is a transgender female who identifies as lesbian D. Is a heterosexual male with transvestic disorder ◉ Question 17: All of the following are proposed etiologies of pica except: Answer: A. Nutritional deficiencies B. Parental neglect C. Compensation for oral needs D. Autism spectrum disorder
D. Adoptions into families as an only child are more successful than those into families with biological children ◉ Question 21: Mel is a 15-year-old male with a complex psychiatric assessment. He has a long history of mood instability, behavior problems, and trouble with schoolwork. He was an extremely active child who, at one time, was put on medication for hyperactivity. After a comprehensive evaluation, the PMHP recognizes that he meets diagnostic criteria for both bipolar I disorder and attention deficit hyperactivity disorder (ADHD). The most successful approach to his management is likely to begin with: Answer: A. Pharmacotherapy for ADHD B. Pharmacotherapy for bipolar I C. Parental training and behavioral interventions for ADHD D. Family-focused psychoeducational (FFT-A) for bipolar I ◉ Question 22: Bruce and Debbie have made an appointment for a psychiatric consultation for what amounts to psychiatric genetic counseling. Bruce is 31 years old and Debbie is 28 years old. They have been married for 3 years and want to have children. Debbie is worried because she has a diagnosis of schizophrenia. Her symptoms first became evident when she was in her junior year of college; fortunately, she knew about the disease due to family history and sought care quickly. She has been very open with Bruce, and they are
both well informed about the disease. Debbie is an only child and her father had schizophrenia that was not well controlled. He committed suicide when she was 15 years old. Debbie takes olanzapine and feels well overall. She has a part-time job, functions well, but is concerned about the genetic nature of her disease. Counseling for Bruce and Debbie includes which of the following pieces of informati Answer: A. Schizophrenia is up to eight times more prevalent in first-degree relatives as compared to the general population. B. Schizophrenia has been isolated to chromosome number 5 and antenatal testing is available to predict genetic predisposition of the fetus. C. Debbie's age of onset is more highly correlated with incidence in her offspring as compared to early-onset schizophrenia. D. Environment is at least as important as genetics with respect to expression of schizophrenic symptoms. ◉ Question 23: The PMHNP is working with a pediatrician colleague on a journal article to increase awareness and improve diagnostic strategies for early-onset bipolar disorder. Based upon a review of the longitudinal research on this disorder, the literature review of this article should include all the following except: Answer: A. Recovery rates are lower when bipolar disorder has an early-childhood onset B. Early-onset bipolar disorder presents a greater likelihood of mixed states and rapid cycling as compared to adolescent and adult onset
things that are not there, and other times he actually talks with and plays with imaginary people. The PMHNP continues to gather information from the mother and Benjamin and plans to do some observation of Benjamin during play. When considering a diagnosis of early-onset schizophrenia, the PMHNP considers all of the following except: Answer: A. B. Hallucinations are significantly more predictive of schizophrenia than delusions in young children C. Benjamin's symptoms are more likely a consequence of developmental immaturity D. Benjamin's family history should always be considered, but at this point the diagnosis is very unlikely ◉ Question 26: While counseling the parents of Joshua, a 9-year-old patient with developmental coordination disorder, the PMHNP advised that the treatment will include: Answer: A. Modified physical education B. Cognitive behavioral interventions C. Group sports participation D. Computer-generated developmental exercises ◉ Question 27: Maria is an 11-year-old girl who has been diagnosed with early- onset schizophrenia. In writing up her case report for publication, the PMHNP makes it a point to highlight which of the following
historical features that are often seen in schizophrenia of middle childhood? Answer: A. Onset of hallucinations and delusions before age 6 B. Symptoms easily confused with attention deficit hyperactivity disorder C. Delayed motor milestones and language acquisition D. High expressed emotion characterized by overly critical family response ◉ Question 28: Ramon is a 12-year-old male who was started on fluoxetine, 40 mg daily, for major depressive disorder 6 weeks ago. At his 2-week follow-up, he was feeling well with no adverse drug effects, and his dose was elevated from 20 to 40 mg. Today he presents for a routine follow-up visit. He reports that he has been "all wound up" and is frequently agitated. He cannot sleep well and has trouble focusing at school. His friends say that he gets upset quickly, and they are starting to avoid him. The most appropriate approach is to: Answer: A. Taper the fluoxetine off and see if these symptoms improve B. Add a mood stabilizer to the fluoxetine C. Increase his dose of fluoxetine to 60 mg daily D. Continue the current dose and reassess in 2 weeks ◉ Question 29: Taryn is a 14-year-old female who is being evaluated as a condition to return to the private school in which she has been enrolled since
