, NR 547 Midterm Exam 2026-2027 – 300 verified
Q&A with Rationales
1.What is the first-line screening tool for generalized anxiety disorder in primary
care?
a) PHQ-9
b) GAD-7
c) PANSS
d) HAM-D
Correct Answer: b) GAD-7
Rationale: The GAD-7 is a validated 7-item screening tool specifically designed to screen
for generalized anxiety disorder and assess its severity in clinical practice.
2. A patient on fluoxetine reports bruising and gum bleeding. What is the most likely
cause?
a) Thrombocytopenia
b) Platelet dysfunction
c) Vitamin K deficiency
d) Liver failure
Correct Answer: b) Platelet dysfunction
Rationale: SSRIs like fluoxetine inhibit serotonin reuptake in platelets, impairing platelet
aggregation and increasing bleeding risk, particularly when combined with NSAIDs or
anticoagulants.
3. Which lab test must be monitored routinely in a patient taking valproic acid?
a) Serum creatinine
b) Liver function tests (LFTs)
c) CBC with differential
d) Fasting glucose
, Correct Answer: b) Liver function tests (LFTs)
Rationale: Valproic acid carries a black box warning for hepatotoxicity, requiring baseline
and periodic LFT monitoring, especially during the first 6 months of therapy.
4. A 30-year-old female presents with amenorrhea, galactorrhea, and visual field defects.
She is on risperidone. What is the most appropriate next step?
a) Obtain serum prolactin level
b) Order MRI of the pituitary
c) Switch to aripiprazole
d) Start bromocriptine
Correct Answer: c) Switch to aripiprazole
Rationale: Risperidone causes significant prolactin elevation. Aripiprazole is a partial D2
agonist that does not elevate prolactin and is often used to resolve hyperprolactinemia
symptoms.
5. A 68-year-old male with depression has a TSH of 8.5 mIU/L. What is the most
appropriate next step?
a) Start sertraline
b) Start levothyroxine
c) Repeat TSH in 6 weeks
d) Order free T4
Correct Answer: d) Order free T4
Rationale: An elevated TSH requires confirmation with free T4 to determine if the patient
has overt or subclinical hypothyroidism, which can present as depression and must be
treated before starting an antidepressant.
6. Which medication is most associated with QTc prolongation and requires baseline EKG
monitoring?
a) Fluoxetine
b) Sertraline
, c) Citalopram
d) Escitalopram
Correct Answer: c) Citalopram
Rationale: Citalopram has a dose-dependent risk of QTc prolongation, with a maximum
recommended dose of 40 mg/day (20 mg/day for patients over 60 or with hepatic
impairment).
7. A patient with schizophrenia has akathisia from haloperidol. Which agent is most
appropriate to add?
a) Benztropine
b) Diphenhydramine
c) Propranolol
d) Lorazepam
Correct Answer: c) Propranolol
Rationale: Akathisia is a dystonic reaction best treated with beta-blockers like propranolol.
Benztropine and diphenhydramine are for acute dystonias, and lorazepam is for agitation.
8. What is the most common cause of delirium in hospitalized elderly patients?
a) Urinary tract infection
b) Polypharmacy
c) Dehydration
d) Electrolyte imbalance
Correct Answer: a) Urinary tract infection
Rationale: UTI is the most common infectious cause of delirium in the elderly, often
presenting with confusion without fever or urinary symptoms.
9. A patient with bipolar disorder is started on lamotrigine. What is the most important
teaching point?
a) Monitor for weight gain
Q&A with Rationales
1.What is the first-line screening tool for generalized anxiety disorder in primary
care?
a) PHQ-9
b) GAD-7
c) PANSS
d) HAM-D
Correct Answer: b) GAD-7
Rationale: The GAD-7 is a validated 7-item screening tool specifically designed to screen
for generalized anxiety disorder and assess its severity in clinical practice.
2. A patient on fluoxetine reports bruising and gum bleeding. What is the most likely
cause?
a) Thrombocytopenia
b) Platelet dysfunction
c) Vitamin K deficiency
d) Liver failure
Correct Answer: b) Platelet dysfunction
Rationale: SSRIs like fluoxetine inhibit serotonin reuptake in platelets, impairing platelet
aggregation and increasing bleeding risk, particularly when combined with NSAIDs or
anticoagulants.
3. Which lab test must be monitored routinely in a patient taking valproic acid?
a) Serum creatinine
b) Liver function tests (LFTs)
c) CBC with differential
d) Fasting glucose
, Correct Answer: b) Liver function tests (LFTs)
Rationale: Valproic acid carries a black box warning for hepatotoxicity, requiring baseline
and periodic LFT monitoring, especially during the first 6 months of therapy.
4. A 30-year-old female presents with amenorrhea, galactorrhea, and visual field defects.
She is on risperidone. What is the most appropriate next step?
a) Obtain serum prolactin level
b) Order MRI of the pituitary
c) Switch to aripiprazole
d) Start bromocriptine
Correct Answer: c) Switch to aripiprazole
Rationale: Risperidone causes significant prolactin elevation. Aripiprazole is a partial D2
agonist that does not elevate prolactin and is often used to resolve hyperprolactinemia
symptoms.
5. A 68-year-old male with depression has a TSH of 8.5 mIU/L. What is the most
appropriate next step?
a) Start sertraline
b) Start levothyroxine
c) Repeat TSH in 6 weeks
d) Order free T4
Correct Answer: d) Order free T4
Rationale: An elevated TSH requires confirmation with free T4 to determine if the patient
has overt or subclinical hypothyroidism, which can present as depression and must be
treated before starting an antidepressant.
6. Which medication is most associated with QTc prolongation and requires baseline EKG
monitoring?
a) Fluoxetine
b) Sertraline
, c) Citalopram
d) Escitalopram
Correct Answer: c) Citalopram
Rationale: Citalopram has a dose-dependent risk of QTc prolongation, with a maximum
recommended dose of 40 mg/day (20 mg/day for patients over 60 or with hepatic
impairment).
7. A patient with schizophrenia has akathisia from haloperidol. Which agent is most
appropriate to add?
a) Benztropine
b) Diphenhydramine
c) Propranolol
d) Lorazepam
Correct Answer: c) Propranolol
Rationale: Akathisia is a dystonic reaction best treated with beta-blockers like propranolol.
Benztropine and diphenhydramine are for acute dystonias, and lorazepam is for agitation.
8. What is the most common cause of delirium in hospitalized elderly patients?
a) Urinary tract infection
b) Polypharmacy
c) Dehydration
d) Electrolyte imbalance
Correct Answer: a) Urinary tract infection
Rationale: UTI is the most common infectious cause of delirium in the elderly, often
presenting with confusion without fever or urinary symptoms.
9. A patient with bipolar disorder is started on lamotrigine. What is the most important
teaching point?
a) Monitor for weight gain
