NU 673 MIDTERM EXAM ACTUAL EXAM 2026/2027 – COMPLETE EXAM-STYLE QUESTIONS AND ANSWERS
ALREADY GRADED A+| 100% VERIFIED SOLUTIONS………...
Core Domains:
Advanced Psychopharmacology and Neurobiology
Psychiatric Assessment and Diagnostic Formulation
Psychotherapy and Therapeutic Modalities
Legal, Ethical, and Regulatory Standards in Psychiatric Practice
Crisis Intervention and Suicide Risk Assessment
Substance Use Disorders and Co-Occurring Conditions
Child, Adolescent, and Geriatric Psychiatric Nursing
Trauma-Informed Care and PTSD Management
Quality Improvement and Evidence-Based Practice
Cultural Competence and Health Equity in Mental Health
Introduction:
This comprehensive midterm examination is designed to evaluate advanced practice nursing knowledge and
clinical reasoning in psychiatric-mental health care. It assesses foundational and applied competencies across
psychopharmacology, diagnostic assessment, psychotherapy, and ethical-legal frameworks. The exam employs
multiple-choice and scenario-based questions that challenge students to synthesize complex patient data,
prioritize interventions, and apply evidence-based guidelines. Emphasis is placed on real-world clinical decision-
,making, risk assessment, and the integration of biopsychosocial principles necessary for safe, effective, and
culturally responsive psychiatric-mental health nurse practitioner practice.
Section One: Questions 1–100
1. A 28-year-old patient with major depressive disorder has been taking fluoxetine 20 mg daily for 6 weeks
with partial response. The patient reports persistent insomnia and decreased appetite. Which is the most
appropriate next step in medication management?
A. Increase fluoxetine to 40 mg daily.
B. Add trazodone 50 mg at bedtime.
C. Switch to escitalopram 10 mg daily.
D. Augment with aripiprazole 2 mg daily.
🟢 B. Add trazodone 50 mg at bedtime.
🔴 RATIONALE: Trazodone at low doses is commonly used as an adjunctive agent for sleep disturbance in
patients on SSRIs. It targets insomnia without significant serotonin syndrome risk at this dose. Increasing
fluoxetine may exacerbate insomnia. Switching to another SSRI is premature and unlikely to address sleep
specifically. Augmentation with an antipsychotic is typically reserved for treatment-resistant depression after
adequate trials.
,2. A 45-year-old patient with bipolar I disorder is being maintained on lithium carbonate 900 mg/day. The
patient's serum lithium level is 1.2 mEq/L, and they report mild hand tremors, polyuria, and polydipsia. What
is the most appropriate nursing action?
A. Decrease lithium dose to 600 mg/day.
B. Encourage increased oral fluid intake.
C. Monitor for signs of toxicity and educate about side effects.
D. Obtain a prescription for an anticholinergic agent.
🟢 C. Monitor for signs of toxicity and educate about side effects.
🔴 RATIONALE: A lithium level of 1.2 mEq/L is within the therapeutic range (0.6–1.2 mEq/L) for maintenance
therapy. Mild tremors, polyuria, and polydipsia are common side effects. The priority is to monitor for
progression to toxicity and educate the patient about managing side effects. Decreasing the dose is not
indicated at a therapeutic level. Encouraging fluid intake is appropriate but not the priority over monitoring and
education.
3. A 16-year-old patient is brought to the emergency department after ingesting an unknown amount of
acetaminophen. The patient is somnolent but arousable. Which laboratory value is most critical to assess
immediately?
A. Serum acetaminophen level.
B. Serum creatinine.
C. Aspartate aminotransferase (AST).
D. International normalized ratio (INR).
, 🟢 A. Serum acetaminophen level.
🔴 RATIONALE: The serum acetaminophen level, measured 4 hours post-ingestion, is the most critical value to
guide treatment with N-acetylcysteine. While AST and INR assess liver damage, they may be normal early in the
course. Creatinine is important but secondary. The antidote decision is based on the drug level plotted on the
Rumack-Matthew nomogram.
4. A nurse practitioner is evaluating a 60-year-old patient with treatment-resistant depression. The patient
has a history of hypertension controlled with lisinopril. Which augmentation strategy would have the highest
risk of drug-drug interaction?
A. Adding bupropion 150 mg daily.
B. Adding mirtazapine 15 mg daily.
C. Adding aripiprazole 2 mg daily.
D. Adding lamotrigine 25 mg daily.
🟢 A. Adding bupropion 150 mg daily.
🔴 RATIONALE: Bupropion is metabolized by CYP2D6 and may increase blood pressure, potentially interacting
with lisinopril's antihypertensive effect. The risk of hypertension is dose-dependent. Mirtazapine, aripiprazole,
and lamotrigine have fewer significant interactions with ACE inhibitors. However, the most concerning potential
interaction with bupropion is its seizure threshold-lowering effect, but the question specifies the highest risk of
drug-drug interaction, which is most pronounced with bupropion due to its noradrenergic effects.
ALREADY GRADED A+| 100% VERIFIED SOLUTIONS………...
Core Domains:
Advanced Psychopharmacology and Neurobiology
Psychiatric Assessment and Diagnostic Formulation
Psychotherapy and Therapeutic Modalities
Legal, Ethical, and Regulatory Standards in Psychiatric Practice
Crisis Intervention and Suicide Risk Assessment
Substance Use Disorders and Co-Occurring Conditions
Child, Adolescent, and Geriatric Psychiatric Nursing
Trauma-Informed Care and PTSD Management
Quality Improvement and Evidence-Based Practice
Cultural Competence and Health Equity in Mental Health
Introduction:
This comprehensive midterm examination is designed to evaluate advanced practice nursing knowledge and
clinical reasoning in psychiatric-mental health care. It assesses foundational and applied competencies across
psychopharmacology, diagnostic assessment, psychotherapy, and ethical-legal frameworks. The exam employs
multiple-choice and scenario-based questions that challenge students to synthesize complex patient data,
prioritize interventions, and apply evidence-based guidelines. Emphasis is placed on real-world clinical decision-
,making, risk assessment, and the integration of biopsychosocial principles necessary for safe, effective, and
culturally responsive psychiatric-mental health nurse practitioner practice.
Section One: Questions 1–100
1. A 28-year-old patient with major depressive disorder has been taking fluoxetine 20 mg daily for 6 weeks
with partial response. The patient reports persistent insomnia and decreased appetite. Which is the most
appropriate next step in medication management?
A. Increase fluoxetine to 40 mg daily.
B. Add trazodone 50 mg at bedtime.
C. Switch to escitalopram 10 mg daily.
D. Augment with aripiprazole 2 mg daily.
🟢 B. Add trazodone 50 mg at bedtime.
🔴 RATIONALE: Trazodone at low doses is commonly used as an adjunctive agent for sleep disturbance in
patients on SSRIs. It targets insomnia without significant serotonin syndrome risk at this dose. Increasing
fluoxetine may exacerbate insomnia. Switching to another SSRI is premature and unlikely to address sleep
specifically. Augmentation with an antipsychotic is typically reserved for treatment-resistant depression after
adequate trials.
,2. A 45-year-old patient with bipolar I disorder is being maintained on lithium carbonate 900 mg/day. The
patient's serum lithium level is 1.2 mEq/L, and they report mild hand tremors, polyuria, and polydipsia. What
is the most appropriate nursing action?
A. Decrease lithium dose to 600 mg/day.
B. Encourage increased oral fluid intake.
C. Monitor for signs of toxicity and educate about side effects.
D. Obtain a prescription for an anticholinergic agent.
🟢 C. Monitor for signs of toxicity and educate about side effects.
🔴 RATIONALE: A lithium level of 1.2 mEq/L is within the therapeutic range (0.6–1.2 mEq/L) for maintenance
therapy. Mild tremors, polyuria, and polydipsia are common side effects. The priority is to monitor for
progression to toxicity and educate the patient about managing side effects. Decreasing the dose is not
indicated at a therapeutic level. Encouraging fluid intake is appropriate but not the priority over monitoring and
education.
3. A 16-year-old patient is brought to the emergency department after ingesting an unknown amount of
acetaminophen. The patient is somnolent but arousable. Which laboratory value is most critical to assess
immediately?
A. Serum acetaminophen level.
B. Serum creatinine.
C. Aspartate aminotransferase (AST).
D. International normalized ratio (INR).
, 🟢 A. Serum acetaminophen level.
🔴 RATIONALE: The serum acetaminophen level, measured 4 hours post-ingestion, is the most critical value to
guide treatment with N-acetylcysteine. While AST and INR assess liver damage, they may be normal early in the
course. Creatinine is important but secondary. The antidote decision is based on the drug level plotted on the
Rumack-Matthew nomogram.
4. A nurse practitioner is evaluating a 60-year-old patient with treatment-resistant depression. The patient
has a history of hypertension controlled with lisinopril. Which augmentation strategy would have the highest
risk of drug-drug interaction?
A. Adding bupropion 150 mg daily.
B. Adding mirtazapine 15 mg daily.
C. Adding aripiprazole 2 mg daily.
D. Adding lamotrigine 25 mg daily.
🟢 A. Adding bupropion 150 mg daily.
🔴 RATIONALE: Bupropion is metabolized by CYP2D6 and may increase blood pressure, potentially interacting
with lisinopril's antihypertensive effect. The risk of hypertension is dose-dependent. Mirtazapine, aripiprazole,
and lamotrigine have fewer significant interactions with ACE inhibitors. However, the most concerning potential
interaction with bupropion is its seizure threshold-lowering effect, but the question specifies the highest risk of
drug-drug interaction, which is most pronounced with bupropion due to its noradrenergic effects.
