NURS 6630 Midterm Exam
Question 1
When an unstable patient asks why it is necessary to add medications to his current regimen, the
PMHNP’s best response would be:
A. “Adding medications is often just a temporary solution.”
B. “It’s important to follow the same treatment plan consistently.”
C. “Many psychiatric illnesses involve several dys-functioning neurotransmitter systems in the brain.
Often, a single medication may only affect one or two of the dys-functioning systems. The addition of
another medication can work with the current medication in stabilizing multiple neurotransmitter
systems and help to alleviate your symptoms.”
D. “The goal is to eliminate all your symptoms as quickly as possible.”
Answer: C. “Many psychiatric illnesses involve several dys-functioning neurotransmitter systems in the
brain. Often, a single medication may only affect one or two of the dys-functioning systems. The
addition of another medication can work with the current medication in stabilizing multiple
neurotransmitter systems and help to alleviate your symptoms.”
Question 2
The PMHNP is meeting with a new mother who would like to begin taking medication again to treat her
bipolar depression; she is breastfeeding her 2-month old daughter. The PMHNP recognizes that which
of the following medications is contraindicated for this patient?
A. Sertraline (Zoloft)
B. Fluoxetine (Prozac)
C. Lithium (Lithobid)
D. Lamotrigine (Lamictal)
Answer: C. Lithium (Lithobid)
Question 3
Mr. Gordon is a middle-aged client who was started on antidepressant monotherapy for depression.
After beginning this medication, the PMHNP noticed that this client seemed to swing into a hypomanic
episode. What can the PMHNP infer from this behavior change?
A. This client may have Bipolar III disorder.
B. This client is experiencing a common side effect of antidepressants.
C. This client may require a higher dose of the antidepressant.
D. This client is not adhering to the treatment plan.
Answer: A. This client may have Bipolar III disorder.
Question 4
A patient presents with frequent episodes of mania. Which statement describes an appropriate treatment
approach for this patient?
A. “The patient should be started on an SSRI.”
B. “The patient could benefit from an anticonvulsant.”
C. “Benzodiazepines would be the best choice for immediate relief.”
D. “Mood stabilizers are not effective in treating mania.”
Answer: B. “The patient could benefit from an anticonvulsant.”
Question 5
The student inquiries about antipsychotic medications. Which response by the PMHNP describes the
factors that contribute to reduced risk of extrapyramidal symptoms (EPS) for patients who take
antipsychotics?
A. Those that are first-generation antipsychotics.
B. Those that are potent D2 antagonists with 5HT2A antagonism properties.
C. Those that are low-potency D2 antagonists.
D. Those that only block serotonin receptors.
Answer: B. Those that are potent D2 antagonists with 5HT2A antagonism properties.
Question 6
After ordering flumazenil (Rumazicon), the PMHNP cautions the staff to monitor for which possible
effect?
A. Seizures
B. Withdrawal symptoms
C. Reversal of sedation
D. All of the above
Answer: D. All of the above
Question 7
The PMHNP is caring for a patient who is taking antipsychotics. The psychiatrist tells the patient that
they will be placed on a different antipsychotic agent called an atypical antipsychotic. What
neurotransmitters will this new medication work on?
A. Dopamine and serotonin
B. Norepinephrine and GABA
C. Acetylcholine and histamine
D. Serotonin and endorphins
Answer: A. Dopamine and serotonin
Question 8
While genes have the potential to modify behavior, behavior can also modify genes. How do genes
impact this process?
A. Genes dictate every behavior without influence from the environment.
B. Changes made to proteins lead to changes in behavior.
C. Genes have no effect on behavior.
D. Genes only impact behavior during critical developmental periods.
Answer: B. Changes made to proteins lead to changes in behavior.
Question 9
Mrs. Schwartzman is a 52-year-old client with schizophrenia and no established history of depression.
When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she
reports a loss of joy from enjoyable activities since starting her new medication. What does the PMHNP
infer from this encounter with the client?
A. The new medication is ineffective.
B. The client is experiencing negative symptoms of schizophrenia.
C. The new medication is blocking D2 receptors in the mesolimbic system.
D. The client has developed a new psychiatric condition.
Answer: C. The new medication is blocking D2 receptors in the mesolimbic system.
Question 10
A nursing student is seeking clarification on the use of anticonvulsants to treat depression and is unclear
about most effective outcomes. Which of the following agents does the PMHNP convey as having
uncertain outcomes?
A. Lamotrigine (Lamictal)
B. Gabapentin (Neurontin)
C. Valproate (Depakote)
D. Topiramate (Topamax)
Answer: B. Gabapentin (Neurontin)
Question 11
As it relates to G-protein linked receptors, what does the PMHNP understand about medications that are
used in practice?
A. Most medications that act on G-protein linked receptors have antagonistic traits.
B. All medications are agonists at these receptors.
C. These medications have no significant effect on neurotransmitter release.
D. G-protein linked receptors are only targeted by psychostimulants.
Answer: A. Most medications that act on G-protein linked receptors have antagonistic traits.
Question 12
A patient is seeking pharmacological treatment for smoking cessation. Which drug class does the
PMHNP prescribe to the patient?
A. Bupropion (Wellbutrin)
B. Nicotine replacement therapy
C. Antidepressants
D. Varenicline (Chantix)
Answer: D. Varenicline (Chantix)
Question 13
The PMHNP is caring for a patient with schizophrenia and is considering a variety of treatment
approaches. The PMHNP selects a viable treatment that is consistent with the “dopamine hypothesis of
schizophrenia.” What action does the PMHNP anticipate this treatment having on the patient?
A. Decreased serotonin activity improves negative symptoms.
B. Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of
schizophrenia.
C. The treatment will increase dopamine levels in the prefrontal cortex.
D. Dopamine antagonism will lead to improved cognitive functioning.
Answer: B. Hyperactivity in the mesolimbic dopamine pathway mediates the positive symptoms of
schizophrenia.
Question 14
Though medications have the ability to target neurotransmitter release into the synapse by the
presynaptic neuron, it is not always necessary. The PMHNP understands that this is because:
A. Neurotransmitters are only effective when actively released.
B. All neurotransmitters require reuptake to function properly.
C. Neurotransmitters can spread by diffusion.
D. Receptors can become desensitized over time.
Answer: C. Neurotransmitters can spread by diffusion.
Question 15
A patient is being prescribed a sedating antidepressant but is concerned about weight gain. Which
medication is most likely to be prescribed to address the patient’s concerns?
A. Paroxetine (Paxil)
B. Mirtazapine (Remeron)
C. Amitriptyline (Elavil)
D. Trazodone (Oleptro)
Answer: D. Trazodone (Oleptro)
Question 16
The PMHNP is caring for several patients who present with various symptoms and health issues. For
which patient does the PMHNP prescribe pregabalin (Lyrica)?
A. Patient with generalized anxiety disorder
B. Patient with partial seizures
C. Patient with major depressive disorder
D. Patient with bipolar disorder
Answer: B. Patient with partial seizures
Question 17
Which statement about neurotransmitters and medications is true?
A. Neurotransmitters have no impact on medication efficacy.
B. Several psychiatric medications have been developed after discoveries of endogenous
neurotransmitters and defining their function in the brain.
C. All psychiatric medications are based on dopamine activity.
D. Neurotransmitters are only relevant for understanding physical health.
Answer: B. Several psychiatric medications have been developed after discoveries of endogenous
neurotransmitters and defining their function in the brain.
Question 18
A patient is prescribed 50 mg of desvenlafaxine to take every other day for major depressive disorder.
What does the PMHNP understand about this patient?
A. The patient has a history of substance abuse.
B. The patient has mild renal impairment.
C. The patient has severe renal impairment.
D. The patient is not adhering to the treatment regimen.
Answer: C. The patient has severe renal impairment.
Question 19
A patient with schizophrenia is given an inverse agonist that acts on the receptor 5HT and
neurotransmitter serotonin. What is the rationale for prescribing a medication such as this?
A. To promote the availability of serotonin
B. To inhibit serotonin receptor activity
C. To increase dopamine levels
D. To enhance serotonin receptor sensitivity
Answer: A. To promote the availability of serotonin
Question 20
A patient who was prescribed an MAO inhibitor is learning about dietary modifications. Which
statement made by the PMHNP demonstrates proper teaching of the food-drug interactions for MAO
inhibitors?
A. “You must avoid soy products, such as tofu.”
B. “You can eat any food as long as it's not processed.”
C. “You should increase your intake of aged cheeses.”
D. “All foods are safe as long as they are fresh.”
Answer: A. “You must avoid soy products, such as tofu.”
Question 21
The PMHNP evaluates the patient for “fear conditioning” when he asks:
A. Have you ever experienced any type of trauma?
B. How do you feel about your past experiences?
C. Do you have any phobias?
D. What do you think about your current situation?
Answer: A. Have you ever experienced any type of trauma?
Question 22
The PMHNP recognizes that which patient would be contraindicated for antidepressant monotherapy?
A. Patient with a bipolar I designation
B. Patient with major depressive disorder
C. Patient with generalized anxiety disorder
D. Patient with a history of substance abuse
Answer: A. Patient with a bipolar I designation
Question 23
When completing this exam, did you comply with Walden University’s Code of Conduct including the
expectations for academic integrity?
A. Yes
B. No
Answer: A. Yes
Question 24
Mr. Gordon is a middle-aged patient who is taking antipsychotics. When meeting with the PMHNP, he
reports positive responses to the medication, stating, “I really feel as though the effects of my depression
are going away.” Which receptor action in antipsychotic medications is believed to be the most
beneficial in producing the effects described by Mr. Gordon?
A. D1 agonist
B. D2 antagonist
C. 5HT2A antagonist
D. D2 partial agonist
Answer: D. D2 partial agonist
Question 25
The PMHNP understands that which mechanism contributes to a worse tolerability profile for patients
taking tricyclic antidepressants (TCAs)?
A. Histamine H1 receptor blockade causes sedation.
B. Muscarinic M1 receptor blockade causes blurred vision.
C. Alpha-1 receptor blockade causes orthostatic hypotension.
D. Serotonin reuptake inhibition leads to sexual dysfunction.
Answer: B. Muscarinic M1 receptor blockade causes blurred vision.
Question 26
The PMHNP is assessing a client in the emergency room. The client shares that he has been on lithium
for many years. What blood test does the PMHNP order?
A. Thyroid Stimulating Hormone
B. Complete Blood Count
C. Liver Function Tests
D. Serum Lithium Level
Answer: A. Thyroid Stimulating Hormone
Question 27
A noncompliant patient states, “Why do you want me to put this poison in my body?” Identify the best
response made by the psychiatric-mental health nurse practitioner (PMHNP).
A. “You must trust me; I am the expert.”
B. “Medications are harmful to your health.”
C. “Most medications that work in the brain will restore an imbalance of one or more neurotransmitters
that your body already produces, helping to alleviate your symptoms.”
D. “You have no choice; this is what is prescribed.”
Answer: C. “Most medications that work in the brain will restore an imbalance of one or more
neurotransmitters that your body already produces, helping to alleviate your symptoms.”
Question 28
Mrs. Trevor is a 44-year-old patient who does not have a diagnosis of schizophrenia but occasionally
reports symptoms of psychosis, followed by severe fatigue. Mrs. Trevor inquiries about the use of
amphetamines to help with her energy levels. Which response made by the PMHNP is most
appropriate?
A. “Amphetamines are the best choice for energy.”
B. “They will definitely help you feel better.”
C. “Amphetamines can cause hallucinations, so I would advise against this type of prescription.”
D. “You should try them; they are safe.”
Answer: C. “Amphetamines can cause hallucinations, so I would advise against this type of
prescription.”
Question 29
A patient is diagnosed with bipolar disorder and is currently taking carbamazepine (Tegretol),
aripiprazole (Abilify), and melatonin. The PMHNP has just written an order to discontinue the
carbamazepine (Tegretol) for drug-induced thrombocytopenia. The PMHNP is aware that his next best
action is to:
A. Increase the dose of carbamazepine.
B. Start a new medication.
C. Decrease the amount prescribed for aripiprazole (Abilify).
D. Continue with the current regimen.
Answer: C. Decrease the amount prescribed for aripiprazole (Abilify).
Question 30
A 25-year-old female patient is being prescribed milnacipran to treat fibromyalgia and expresses
concern regarding “how she will feel and look” from taking the medicine. Which statement correctly
describes the side effects as a result of taking this medication?
A. Weight gain is common.
B. Weight loss is expected.
C. Side effects are severe.
D. Weight gain is unusual.
Answer: D. Weight gain is unusual.
Question 31
What is accurate about the clinical description of psychosis?
A. It is a condition that only affects adolescents.
B. It is a permanent state that requires long-term hospitalization.
C. It is a syndrome that can be associated with a number of psychiatric disorders.
D. It is solely caused by substance abuse.
Answer: C. It is a syndrome that can be associated with a number of psychiatric disorders.
Question 32
The nurse educator knows that teaching was effective when one of the students compares fluvoxamine
to sertraline and notes which of the following similarities?
A. Both are first-generation antidepressants.
B. Both have a high potential for abuse.
C. Both are approved for use in children only.
D. Both have actions at sigma receptors which contribute to both anxiolytic and antipsychotic effects.
Answer: D. Both have actions at sigma receptors which contribute to both anxiolytic and antipsychotic
effects.
Question 33
The PMHNP is considering prescribing clozapine (Clozaril) to a 49-year-old male to treat his
schizophrenia and suicidal ideations. The PMHNP is aware that which factor may impact the dose
needed to effectively treat his condition:
A. The patient smokes cigarettes.
B. The patient has a history of substance use.
C. The patient is taking other psychiatric medications.
D. The patient has a low body mass index (BMI).
Answer: A. The patient smokes cigarettes.
Question 34
Mr. Gutier is 72 years old with anxiety and depressive symptoms. His PMHNP is prescribing lorazepam
(Ativan). What does the PMHNP understand regarding this prescription?
A. The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.
B. Lorazepam is contraindicated in elderly patients.
C. Higher doses are safer for elderly patients.
D. The patient should take it only as needed.
Answer: A. The PMHNP will prescribe less than 2-6 mg for Mr. Gutier to take daily.
Question 35
A patient diagnosed with PTSD is prescribed propranolol (Inderal) and the PMHNP understands that he
was prescribed this medication for what purpose:
A. To enhance mood and decrease anxiety.
B. Beta blockers are linked to reconsolidation.
C. To directly treat the symptoms of PTSD.
D. To increase heart rate during exposure therapy.
Answer: B. Beta blockers are linked to reconsolidation.
Question 36
A patient recently transferred following a suicide attempt has a history of schizophrenia, depression, and
fibromyalgia. He is currently taking amitriptyline (Elavil), lisinopril, aspirin, and fluoxetine (Prozac).
When assessing the psychiatric medications and the reason for admission, what would be the best
course of action for the PMHNP with this client?
A. Review amitriptyline (Elavil) level
B. Increase fluoxetine (Prozac) dosage
C. Discontinue all medications immediately
D. Refer the patient for psychotherapy only
Answer: A. Review amitriptyline (Elavil) level
Question 37
Which statement made by the PMHNP exemplifies correct teaching of physiological effects in the
body?
A. D2 antagonists are the only effective treatment for schizophrenia.
B. Serotonin reuptake inhibitors only affect mood.
C. All antipsychotics have the same mechanism of action.
D. D2 partial agonists are associated with increased efficacy in treating positive symptoms of
schizophrenia.
Answer: D. D2 partial agonists are associated with increased efficacy in treating positive symptoms of
schizophrenia.
Question 38
During assessment, a patient states, “Why are you asking me about my heart? I am here for my head.”
The PMHNP’s best response is:
A. “Some medications can cause heart issues, so it is necessary to rule those out before you begin
medication.”
B. “Heart health is unrelated to mental health.”
C. “I need to gather all relevant information.”
D. “It’s just standard procedure; don’t worry about it.”
Answer: A. “Some medications can cause heart issues, so it is necessary to rule those out before you
begin medication.”
Question 39
Mrs. Schwartzman is a 52-year-old patient with schizophrenia and no established history of depression.
When meeting with the PMHNP, she presents with apathy and withdrawn social behavior, and she
reports a loss of joy from enjoyable activities. What does the PMHNP infer from this encounter with the
patient?
A. The medication is effective in treating her symptoms.
B. The recent change from a 2nd generation antipsychotic to a conventional one.
C. She is experiencing side effects from fluoxetine.
D. She has developed a new psychiatric condition.
Answer: B. The recent change from a 2nd generation antipsychotic to a conventional one.
Question 40
The PMHNP is meeting with a new mother who would like to begin taking medication again to treat her
bipolar depression; she is breastfeeding her 2-month-old daughter. The PMHNP recognizes that which
of the following medications is contraindicated for this client?
A. Sertraline (Zoloft)
B. Quetiapine (Seroquel)
C. Lithium (Lithobid)
D. Lamotrigine (Lamictal)
Answer: C. Lithium (Lithobid)
Question 41
A nursing student is seeking clarification on the use of anticonvulsants to treat bipolar depression and is
unclear about which anticonvulsants have the most effective outcomes in treating bipolar depression.
Which of the following anticonvulsants is NOT used for treating bipolar depression?
A. Lamotrigine (Lamictal)
B. Gabapentin (Neurontin)
C. Valproate (Depakote)
D. Carbamazepine (Tegretol)
Answer: B. Gabapentin (Neurontin)
Question 42
There are a number of endocrine reactions that accompany fear. A quick boost of cortisol may enhance
survival when encountering a real but short-term threat. However, chronic elevations in cortisol can lead
to increased medical comorbidities. Which of the following medical conditions may be related to these
persistent cortisol elevations?
A. Hypertension
B. Diabetes
C. Obesity
D. All of the above
Answer: D. All of the above
Question 43
Ms. Harlow is a 42-year-old patient who is prescribed a drug that acts on ionotropic receptors. She is
curious about the effects of the drug and how it will act on her symptoms. Which statement made by the
PMHNP demonstrates proper understanding of Ms. Harlow’s prescription?
A. “The drug will have an almost immediate effect.”
B. “It may take weeks for the drug to work.”
C. “The effects will be subtle and difficult to notice.”
D. “You should only take this medication when you feel anxious.”
Answer: A. “The drug will have an almost immediate effect.”
Question 44
A patient is prescribed sertraline to treat panic disorder. Knowing that sertraline can initially cause
anxiety or insomnia, what should the PMHNP do?
A. Increase the dose of sertraline immediately.
B. Prescribe a short-acting benzodiazepine for 2 weeks, then discontinue.
C. Suggest that the patient stop taking the sertraline.
D. Reassure the patient that these effects will resolve on their own.
Answer: B. Prescribe a short-acting benzodiazepine for 2 weeks, then discontinue.
Question 45
A patient who was diagnosed with bipolar disorder without mania asks the PMHNP why he is being
prescribed a mood stabilizer. What is the appropriate response?
A. “Mood stabilizers only prevent manic episodes.”
B. “Mood stabilizers are not effective for bipolar disorder without mania.”
C. “Mood stabilizers can target mania and mania relapse and also reduce symptoms of bipolar
depression and relapse of bipolar depression symptoms, but no drug has been proven to target all four
therapeutic actions.”
D. “You will feel better immediately after starting the medication.”
Answer: C. “Mood stabilizers can target mania and mania relapse and also reduce symptoms of bipolar
depression and relapse of bipolar depression symptoms, but no drug has been proven to target all four
therapeutic actions.”
Question 46
The PMHNP is caring for four patients. Which patient statement indicates that benzodiazepines would
be beneficial?
A. “I have trouble sleeping at night.”
B. “I feel sad and hopeless.”
C. “I have no motivation to do anything.”
D. “I feel nervous to go outside and be in large crowds.”
Answer: D. “I feel nervous to go outside and be in large crowds.”
Question 47
Ms. Boeckh is a 42-year-old client who is taking an antidepressant therapy. The PMHNP understands
that this medication can have substantial food interactions that can cause Ms. Boeckh to develop a
hypertensive crisis. Which antidepressant class is Ms. Boeckh’s medication in?
A. SSRIs
B. MAO inhibitors
C. SNRIs
D. TCA (Tricyclic Antidepressants)
Answer: B. MAO inhibitors
Question 48
A client is prescribed fluoxetine but is concerned about side effects. Which statement demonstrates
accurate client teaching when discussing the side effects associated with fluoxetine?
A. “Weight gain is very common with fluoxetine.”
B. “You may feel more tired than usual.”
C. “Sedation is unusual.”
D. “You might experience increased anxiety.”
Answer: C. “Sedation is unusual.”
Question 49
The PMHNP spends a session with a client and notices behaviors correlating with a potential manic
episode. All of the following are possible manic symptoms the PMHNP could observe except:
A. Increased energy
B. Decreased need for sleep
C. Racing thoughts
D. A low self-esteem
Answer: D. A low self-esteem
Question 50
The PMHNP is assessing a 29-year-old client who takes antipsychotics that block D2 receptors. This
client has begun to develop a common side effect of this medication. What is this side effect?
A. Akathisia
B. Acute dystonia
C. Neuroleptic malignant syndrome
D. Tardive dyskinesia
Answer: D. Tardive dyskinesia
Question 51
Mr. McCullin is 64 years old with Parkinson’s disease. The PMHNP caring for Mr. McCullin wants to
start him on a dopamine agonist to help manage and treat his condition. The PMHNP selects this agent
because of which action it has on patients like Mr. McCullin?
A. Dopamine agonists primarily block D2 receptors.
B. Dopamine agonists increase the degradation of dopamine.
C. D2 receptors are not significantly affected by dopamine agonists.
D. D2 receptors are the primary binding site for dopamine agonists.
Answer: D. D2 receptors are the primary binding site for dopamine agonists.
Question 52
A patient is diagnosed with schizophrenia. What increases the patient’s potential to mediate the
cognitive symptoms of the disease?
A. Reducing serotonin levels in the brain.
B. Achieving overactivity of the mesocortical projections to the ventromedial prefrontal cortex.
C. Increasing dopamine levels in the striatum.
D. Blocking glutamate receptors.
Answer: B. Achieving overactivity of the mesocortical projections to the ventromedial prefrontal
cortex.
Question 53
A patient is prescribed fluoxetine but is concerned about the side effects. Which statement demonstrates
accurate patient teaching when discussing the side effects associated with fluoxetine?
A. Weight gain is a common side effect.
B. Induction of mania is common in all patients.
C. Induction of mania is rare.
D. Sexual dysfunction occurs in all patients.
Answer: C. Induction of mania is rare.
Question 54
A patient who is prescribed MAO inhibitors asks about whether he can continue taking pseudoephedrine
to relieve his congestion. Which response by the PMHNP indicates proper understanding of drug-drug
interactions?
A. “It’s fine to take pseudoephedrine; it’s safe with MAO inhibitors.”
B. “You can take pseudoephedrine in moderation.”
C. “Decongestants are usually safe with MAO inhibitors.”
D. “Decongestants should be avoided due to risk of hypertensive crisis.”
Answer: D. “Decongestants should be avoided due to risk of hypertensive crisis.”
Question 55
The PMHNP is assessing a patient in the psychiatric emergency room. The patient tells the PMHNP that
he does not understand why his depression has not lifted after being on four different antidepressants
over the course of a year. Which of the following symptoms can be residual symptoms for patients who
do not achieve remission with major depressive disorder?
A. Sleep disturbances
B. Low energy
C. Anxiety
D. A and C
Answer: D. A and C
Question 56
The PMHNP is caring for a patient with the s genotype of SERT. What does the PMHNP understand
regarding this patient’s response to selective serotonin reuptake inhibitor (SSRI)/SNRI treatment?
A. The patient will be highly responsive to treatment.
B. The patient will have no response to treatment.
C. The patient may be more tolerant to treatment.
D. The patient may be less responsive or tolerant to the treatment.
Answer: D. The patient may be less responsive or tolerant to the treatment.
Question 57
Ms. Hill is currently being treated for schizophrenia but has stopped taking her medications due to some
side effects she claims she was experiencing. She presents to the clinic today with worsening symptoms.
She is experiencing anhedonia, agitation, attentional impairment, and affective blunting. Which one of
the symptoms mentioned is considered a positive symptom of schizophrenia?
A. Anhedonia
B. Agitation
C. Affective blunting
D. Attentional impairment
Answer: B. Agitation
Question 58
The PMHNP understands that the potential for alcohol abuse in the anxious client is higher for the
following reasons:
A. Alcohol exerts an effect on GABAA receptors.
B. Alcohol reduces anxiety immediately.
C. Alcohol has no side effects.
D. Alcohol increases dopamine levels.
Answer: A. Alcohol exerts an effect on GABAA receptors.
Question 59
A nurse overhears that a patient has failed single therapy with an SSRI and SNRI. She also learns that
the patient has been on dual SSRI/SNRI therapy without adequate symptom control. She approaches the
PMHNP and asks what the next treatment option could be in this seemingly treatment-resistant patient.
The PMHNP tells the nurse she will treat the patient with the following regimen:
A. Dual SSRI therapy
B. SSRI/SNRI plus NDRI
C. Increase the SNRI dose
D. Augment with an atypical antipsychotic
Answer: B. SSRI/SNRI plus NDRI
Question 60
During gene expression, what must occur prior to a gene being expressed?
A. Transcription factor must bind to the regulatory region within the cell’s nucleus.
B. The gene must be replicated.
C. The cell must undergo mitosis.
D. mRNA must be transported out of the nucleus.
Answer: A. Transcription factor must bind to the regulatory region within the cell’s nucleus.
Question 61
Fluoxetine (Prozac) has been prescribed for a client with depression. Which of the following statements
is true regarding the action of this medication?
A. Fluoxetine increases dopamine levels in the brain.
B. Fluoxetine inhibits the serotonin transporter (SERT).
C. Fluoxetine has no effect on serotonin levels.
D. Fluoxetine is a stimulant.
Answer: B. Fluoxetine inhibits the serotonin transporter (SERT).
Question 62
A 45-year-old female client with allergic rhinitis and normal blood pressure has had no reduction in
depressive symptoms after trying bupropion, paroxetine, and venlafaxine. What precautions are needed
when considering phenelzine in treating her depression?
A. The client needs regular blood tests to monitor her kidney function.
B. The client will need to minimize dietary intake of foods that are high in tyramine.
C. The client should avoid exercise.
D. The client needs to increase her caffeine intake.
Answer: B. The client will need to minimize dietary intake of foods that are high in tyramine.
Question 63
Why is the cytochrome P450 enzyme system of significance to the PMHNP?
A. It is involved in neurotransmitter synthesis.
B. The bioavailability of the medication after it passes through the stomach and liver can be altered.
C. It directly affects heart rate.
D. It has no relevance to psychiatric medications.
Answer: B. The bioavailability of the medication after it passes through the stomach and liver can be
altered.
Question 64
Mr. Ruby is a 33-year-old single father who is requesting pharmacological intervention to treat his
fibromyalgia. The PMHNP sees in the medical chart that he has a recent diagnosis of arrhythmia and a
BMI of 29. During his assessment, the PMHNP learns that Mr. Ruby works 40–50 hours a week as a
contractor and “manages his stress” by smoking 3–4 cigarettes a day and having 8–10 drinks of alcohol
each week. Why would duloxetine be contraindicated for Mr. Ruby?
A. He has a high BMI.
B. He has a diagnosis of arrhythmia.
C. He uses alcohol.
D. He works long hours.
Answer: C. He uses alcohol.
Question 65
Ms. Boeckh is a 42-year-old patient with major depression. The PMHNP understands that which action
of norepinephrine will affect Ms. Boeckh’s serotonin levels?
A. Norepinephrine enhances 5HT release through β receptors.
B. Norepinephrine inhibits 5HT release through α2 receptors.
C. Norepinephrine has no effect on serotonin.
D. Norepinephrine promotes dopamine release.
Answer: B. Norepinephrine inhibits 5HT release through α2 receptors.
Question 66
Which statement made by the patient suggests the patient will need to be treated with antipsychotics that
target paranoid psychosis?
A. “I feel like I am being watched all the time.”
B. “I have to talk to the President because I’m the only one who can help him.”
C. “People are talking about me behind my back.”
D. “I don’t need any help; I can handle this on my own.”
Answer: B. “I have to talk to the President because I’m the only one who can help him.”
Question 67
A patient was diagnosed with GAD 4 weeks ago and was placed on clonazepam (Klonopin) twice a day
and citalopram (Celexa) once daily. When he asks the PMHNP why it is necessary to wean him off of
the clonazepam (Klonopin), the best response is:
A. Clonazepam is not effective for your anxiety.
B. Clonazepam can cause severe withdrawal symptoms if stopped suddenly.
C. Clonazepam was used as an aid to treat your condition while you were adjusting to citalopram
(Celexa).
D. Clonazepam is not necessary anymore.
Answer: C. Clonazepam was used as an aid to treat your condition while you were adjusting to
citalopram (Celexa).
Question 68
It is important for the PMHNP to recognize differences in pharmacokinetics to safely prescribe and
monitor medications. Which of the following statements does the competent PMHNP identify as true?
A. About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and
antipsychotics.
B. All patients metabolize drugs at the same rate.
C. Pharmacokinetics is irrelevant to psychiatric treatment.
D. Genetic factors have no impact on drug metabolism.
Answer: A. About 1 out of 5 Asians requires lower-than-normal doses of some antidepressants and
antipsychotics.
Question 69
Ms. Skidmore presents for a follow-up appointment after being prescribed phenelzine (Nardil), and
reports “I take my 45 mg pill, three times a day, just like I’m supposed to.” What does the PMHNP
understand about this patient?
A. Ms. Skidmore is taking the correct dose of phenelzine.
B. Ms. Skidmore should be taking 135 mg daily.
C. Ms. Skidmore is taking too much of the phenelzine; she should be taking the 45 mg in three doses.
D. Ms. Skidmore is not taking enough of the phenelzine.
Answer: C. Ms. Skidmore is taking too much of the phenelzine; she should be taking the 45 mg in three
doses.
Question 70
A client who was diagnosed with bipolar disorder without mania asks the PMHNP why he is being
prescribed a mood stabilizer. What is the appropriate response?
A. Mood stabilizers are only for manic episodes.
B. Mood stabilizers can prevent manic episodes only.
C. Mood stabilizers can treat either manic phases or depressive phases of bipolar disorder.
D. Mood stabilizers are not necessary for your condition.
Answer: C. Mood stabilizers can treat either manic phases or depressive phases of bipolar disorder.
Question 71
A nurse overhears that a client has failed monotherapy with an SSRI and an SNRI. She also learns that
the client has failed dual SSRI + SNRI therapy. The nurse approaches the PMHNP and asks what
treatment options should be considered in this treatment-resistant client. The PMHNP tells the nurse that
she will treat the client with the following regimen.
A. SSRI + mood stabilizer
B. SSRI + NDRI
C. SNRI + antipsychotic
D. MAO inhibitor
Answer: B. SSRI + NDRI
Question 72
What characteristics do the nicotinic, cholinergic, serotonin 3, and glycine receptors all have in
common?
A. Ligand-gated ion channels with a pentameric structure
B. G-protein coupled receptors
C. Ionotropic receptors with a homomeric structure
D. Receptors that only modulate neurotransmitter release
Answer: A. Ligand-gated ion channels with a pentameric structure
Question 73
Ms. Ryerson is a 28-year-old patient with a mood disorder. She recently requested to transfer to a new
PMHNP after not getting along well with her previous provider. The new PMHNP is reviewing Ms.
Ryerson’s medical chart prior to their first appointment. Upon review, the PMHNP sees that the former
provider last documented “patient had rapid poop out.” What does the PMHNP infer about the patient’s
prescription based on this documentation?
A. The patient has an unsustained response to antidepressants.
B. The patient has not been compliant with medications.
C. The patient has developed a tolerance to the medications.
D. The patient requires a higher dosage of antidepressants.
Answer: A. The patient has an unsustained response to antidepressants.
Question 74
A 51-year-old female patient presents with symptoms of depression, including lack of motivation and
difficulty sleeping. What risk factors would increase her vulnerability for a diagnosis of depression?
A. Personal history of depression
B. Family history of mental illness
C. Chronic medical conditions
D. A and C
Answer: D. A and C
Question 75
The PMHNP is caring for a new patient who has been transferred from another office. When meeting
with the new patient, the patient reports, “I feel like I am improving with the stabilizers.” The PMHNP
immediately recognizes that the patient is describing which kind of drug?
A. Antidepressants
B. Full agonists
C. Partial agonists
D. Antipsychotics
Answer: C. Partial agonists
Question 76
Fluoxetine (Prozac) has been prescribed for a patient. Which of the following statements is true
regarding the action of this medication?
A. Fluoxetine acts primarily as a dopamine reuptake inhibitor.
B. Fluoxetine increases serotonin levels by inhibiting the serotonin transporter (SERT).
C. Fluoxetine is a monoamine oxidase inhibitor.
D. Fluoxetine is a benzodiazepine.
Answer: B. Fluoxetine increases serotonin levels by inhibiting the serotonin transporter (SERT).
