NR546 – Psychopharmacology for the
Psychiatric-Mental Health Nurse Practitioner
Chamberlain University Midterm Exam Review
(2026/2027 New Update) Verified Questions +
100% Correct Answers + Rationales
Question 1 Which antidepressant class is considered first-line for most patients with major
depressive disorder due to its favorable side-effect profile and safety in overdose?
A. Tricyclic antidepressants (TCAs) B. Monoamine oxidase inhibitors (MAOIs) C. Selective
serotonin reuptake inhibitors (SSRIs) D. Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Answer: C
Rationale: SSRIs remain first-line for MDD in most guidelines (APA 2023, CANMAT 2023)
because they have efficacy comparable to older classes but significantly better tolerability, lower
anticholinergic burden, and much lower lethality in overdose.
Question 2 A 34-year-old patient has failed adequate trials of sertraline, escitalopram, and
venlafaxine XR. No history of mania/psychosis. Which augmentation strategy currently carries
the strongest Level 1 evidence for treatment-resistant depression?
A. Add buspirone B. Add aripiprazole or brexpiprazole C. Add liothyronine (T3) D. Add
modafinil
Answer: B
Rationale: Atypical antipsychotic augmentation (aripiprazole, brexpiprazole, quetiapine XR) has
the most robust evidence base from STAR*D, multiple meta-analyses, and FDA approvals for
TRD after ≥2 antidepressant failures.
Question 3 A 26-year-old woman with panic disorder has failed two adequate SSRI trials.
Which medication is FDA-approved for panic disorder and is a guideline-recommended next
step?
, A. Alprazolam B. Venlafaxine XR C. Propranolol D. Hydroxyzine
Answer: B
Rationale: Venlafaxine XR is FDA-approved for panic disorder and is recommended after SSRI
failure in APA Anxiety Disorders guidelines and CANMAT.
Question 4 A veteran with chronic PTSD experiences severe, treatment-resistant nightmares
despite prazosin 10 mg hs and trauma-focused psychotherapy. Which agent has the next
strongest evidence as adjunctive therapy?
A. Trazodone 50–150 mg hs B. Quetiapine 25–50 mg hs C. Clonidine 0.1 mg hs D. Mirtazapine
15 mg hs
Answer: A
Rationale: Trazodone is the most commonly used and best-supported second-line agent for
PTSD-related sleep disturbance/nightmares when prazosin is insufficient (VA/DoD 2023 PTSD
Guideline – strong evidence).
Question 5 A 29-year-old woman with bipolar I disorder is stable on lithium 900 mg daily (level
0.8 mEq/L) but plans pregnancy in the next 4–6 months. What is the most appropriate next
management step?
A. Continue lithium and add folate 4 mg B. Taper lithium and transition to lamotrigine with
folate supplementation C. Switch to valproate immediately D. Discontinue all mood stabilizers
Answer: B
Rationale: Lithium carries significant teratogenic risk (Ebstein’s anomaly). Lamotrigine is
currently the safest mood stabilizer option in pregnancy when clinically necessary (with folate to
reduce neural tube defect risk).
Question 6 Which second-generation antipsychotic is FDA-approved for both acute
manic/mixed episodes and maintenance treatment in bipolar I disorder?
A. Lamotrigine B. Lithium C. Quetiapine D. All of the above
Answer: C
Psychiatric-Mental Health Nurse Practitioner
Chamberlain University Midterm Exam Review
(2026/2027 New Update) Verified Questions +
100% Correct Answers + Rationales
Question 1 Which antidepressant class is considered first-line for most patients with major
depressive disorder due to its favorable side-effect profile and safety in overdose?
A. Tricyclic antidepressants (TCAs) B. Monoamine oxidase inhibitors (MAOIs) C. Selective
serotonin reuptake inhibitors (SSRIs) D. Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Answer: C
Rationale: SSRIs remain first-line for MDD in most guidelines (APA 2023, CANMAT 2023)
because they have efficacy comparable to older classes but significantly better tolerability, lower
anticholinergic burden, and much lower lethality in overdose.
Question 2 A 34-year-old patient has failed adequate trials of sertraline, escitalopram, and
venlafaxine XR. No history of mania/psychosis. Which augmentation strategy currently carries
the strongest Level 1 evidence for treatment-resistant depression?
A. Add buspirone B. Add aripiprazole or brexpiprazole C. Add liothyronine (T3) D. Add
modafinil
Answer: B
Rationale: Atypical antipsychotic augmentation (aripiprazole, brexpiprazole, quetiapine XR) has
the most robust evidence base from STAR*D, multiple meta-analyses, and FDA approvals for
TRD after ≥2 antidepressant failures.
Question 3 A 26-year-old woman with panic disorder has failed two adequate SSRI trials.
Which medication is FDA-approved for panic disorder and is a guideline-recommended next
step?
, A. Alprazolam B. Venlafaxine XR C. Propranolol D. Hydroxyzine
Answer: B
Rationale: Venlafaxine XR is FDA-approved for panic disorder and is recommended after SSRI
failure in APA Anxiety Disorders guidelines and CANMAT.
Question 4 A veteran with chronic PTSD experiences severe, treatment-resistant nightmares
despite prazosin 10 mg hs and trauma-focused psychotherapy. Which agent has the next
strongest evidence as adjunctive therapy?
A. Trazodone 50–150 mg hs B. Quetiapine 25–50 mg hs C. Clonidine 0.1 mg hs D. Mirtazapine
15 mg hs
Answer: A
Rationale: Trazodone is the most commonly used and best-supported second-line agent for
PTSD-related sleep disturbance/nightmares when prazosin is insufficient (VA/DoD 2023 PTSD
Guideline – strong evidence).
Question 5 A 29-year-old woman with bipolar I disorder is stable on lithium 900 mg daily (level
0.8 mEq/L) but plans pregnancy in the next 4–6 months. What is the most appropriate next
management step?
A. Continue lithium and add folate 4 mg B. Taper lithium and transition to lamotrigine with
folate supplementation C. Switch to valproate immediately D. Discontinue all mood stabilizers
Answer: B
Rationale: Lithium carries significant teratogenic risk (Ebstein’s anomaly). Lamotrigine is
currently the safest mood stabilizer option in pregnancy when clinically necessary (with folate to
reduce neural tube defect risk).
Question 6 Which second-generation antipsychotic is FDA-approved for both acute
manic/mixed episodes and maintenance treatment in bipolar I disorder?
A. Lamotrigine B. Lithium C. Quetiapine D. All of the above
Answer: C
