Psychopharmacology and Neurobiology, Mood Disorders and Antidepressant Therapy,
Anxiety Disorders and Anxiolytic Treatment, Psychotic Disorders and Antipsychotic
Medications, Bipolar Disorder and Mood Stabilizers, Attention-Deficit/Hyperactivity
Disorder and Stimulant Therapy, Substance Use Disorders and Pharmacological
Management, Sleep Disorders and Hypnotic Agents, Neurocognitive Disorders and
Cholinesterase Inhibitors, Psychiatric Assessment, Legal-Ethical Issues, and
Psychotherapy Integration.
NR 607 Final Exam Chamberlain PMHNP
Question: A patient presenting with major depressive disorder reports that the first
antidepressant trial at an adequate dose and duration produced no meaningful symptom
reduction at all, so the PMHNP should consider which of the following next best steps in
evidence-based pharmacotherapy?
A. Continue the same antidepressant at the same dose for another twelve weeks before
making any change
B. Switch to a different antidepressant class or augment with an evidence-based agent
after reassessing adherence
C. Add a benzodiazepine daily for six months to provide rapid symptom relief
D. Discontinue all pharmacotherapy and refer only for supportive psychotherapy
,Answer: B
Notes:
Adequate trial typically means 4–8 weeks at therapeutic dose; total nonresponse
warrants switch or augmentation.
Always reassess adherence, drug interactions, and substance use before changing
therapy.
Daily benzodiazepines are not first-line for MDD and carry dependence risk.
Supportive psychotherapy alone is insufficient for moderate-severe MDD after failed
pharmacotherapy.
Switching within or across classes and augmentation (e.g., bupropion, mirtazapine,
aripiprazole) are evidence-based strategies.
Question: When the PMHNP is evaluating a patient for serotonin syndrome after starting
a selective serotonin reuptake inhibitor with a serotonergic agent, which constellation of
findings most accurately reflects the classic clinical triad?
A. Bradycardia, hypothermia, and miosis
B. Hypertension, bradypnea, and hyperreflexia
,C. Mental status changes, autonomic instability, and neuromuscular hyperactivity
D. Sedation, weight gain, and hyperprolactinemia
Answer: C
Notes:
Classic triad: altered mental status, autonomic instability, and neuromuscular
abnormalities (clonus, hyperreflexia, tremor).
Bradycardia, hypothermia, and miosis suggest opioid toxicity, not serotonin syndrome.
Hypertension and bradypnea are incomplete and not the defining triad.
Sedation, weight gain, and hyperprolactinemia suggest antipsychotic adverse effects.
Serotonin syndrome is a medical emergency requiring discontinuation and supportive
care.
Question: A patient with bipolar I disorder currently in an acute manic episode with
severe agitation and insufficient oral intake is being considered for pharmacologic
management, and the PMHNP should recognize which agent as appropriate for acute
parenteral treatment?
A. Lithium carbonate oral loading
B. Intramuscular olanzapine or intramuscular haloperidol with appropriate monitoring
, C. Oral fluoxetine monotherapy
D. Oral buspirone as needed
Answer: B
Notes:
IM olanzapine or haloperidol (often with lorazepam) are used for acute agitation in
mania.
Lithium requires oral intake and laboratory monitoring; not ideal in severe agitation
with poor intake.
Fluoxetine monotherapy can worsen mania.
Buspirone is not an acute anti-manic agent.
Monitor for sedation, dystonia, QTc, and neuroleptic malignant syndrome.
Question: When initiating methylphenidate for a child with attention-deficit/hyperactivity
disorder, the PMHNP should prioritize which baseline assessment before starting
stimulant pharmacotherapy?
A. Renal function panel and liver enzymes
B. Cardiac history, blood pressure, heart rate, and personal or family history of sudden
cardiac death
Anxiety Disorders and Anxiolytic Treatment, Psychotic Disorders and Antipsychotic
Medications, Bipolar Disorder and Mood Stabilizers, Attention-Deficit/Hyperactivity
Disorder and Stimulant Therapy, Substance Use Disorders and Pharmacological
Management, Sleep Disorders and Hypnotic Agents, Neurocognitive Disorders and
Cholinesterase Inhibitors, Psychiatric Assessment, Legal-Ethical Issues, and
Psychotherapy Integration.
NR 607 Final Exam Chamberlain PMHNP
Question: A patient presenting with major depressive disorder reports that the first
antidepressant trial at an adequate dose and duration produced no meaningful symptom
reduction at all, so the PMHNP should consider which of the following next best steps in
evidence-based pharmacotherapy?
A. Continue the same antidepressant at the same dose for another twelve weeks before
making any change
B. Switch to a different antidepressant class or augment with an evidence-based agent
after reassessing adherence
C. Add a benzodiazepine daily for six months to provide rapid symptom relief
D. Discontinue all pharmacotherapy and refer only for supportive psychotherapy
,Answer: B
Notes:
Adequate trial typically means 4–8 weeks at therapeutic dose; total nonresponse
warrants switch or augmentation.
Always reassess adherence, drug interactions, and substance use before changing
therapy.
Daily benzodiazepines are not first-line for MDD and carry dependence risk.
Supportive psychotherapy alone is insufficient for moderate-severe MDD after failed
pharmacotherapy.
Switching within or across classes and augmentation (e.g., bupropion, mirtazapine,
aripiprazole) are evidence-based strategies.
Question: When the PMHNP is evaluating a patient for serotonin syndrome after starting
a selective serotonin reuptake inhibitor with a serotonergic agent, which constellation of
findings most accurately reflects the classic clinical triad?
A. Bradycardia, hypothermia, and miosis
B. Hypertension, bradypnea, and hyperreflexia
,C. Mental status changes, autonomic instability, and neuromuscular hyperactivity
D. Sedation, weight gain, and hyperprolactinemia
Answer: C
Notes:
Classic triad: altered mental status, autonomic instability, and neuromuscular
abnormalities (clonus, hyperreflexia, tremor).
Bradycardia, hypothermia, and miosis suggest opioid toxicity, not serotonin syndrome.
Hypertension and bradypnea are incomplete and not the defining triad.
Sedation, weight gain, and hyperprolactinemia suggest antipsychotic adverse effects.
Serotonin syndrome is a medical emergency requiring discontinuation and supportive
care.
Question: A patient with bipolar I disorder currently in an acute manic episode with
severe agitation and insufficient oral intake is being considered for pharmacologic
management, and the PMHNP should recognize which agent as appropriate for acute
parenteral treatment?
A. Lithium carbonate oral loading
B. Intramuscular olanzapine or intramuscular haloperidol with appropriate monitoring
, C. Oral fluoxetine monotherapy
D. Oral buspirone as needed
Answer: B
Notes:
IM olanzapine or haloperidol (often with lorazepam) are used for acute agitation in
mania.
Lithium requires oral intake and laboratory monitoring; not ideal in severe agitation
with poor intake.
Fluoxetine monotherapy can worsen mania.
Buspirone is not an acute anti-manic agent.
Monitor for sedation, dystonia, QTc, and neuroleptic malignant syndrome.
Question: When initiating methylphenidate for a child with attention-deficit/hyperactivity
disorder, the PMHNP should prioritize which baseline assessment before starting
stimulant pharmacotherapy?
A. Renal function panel and liver enzymes
B. Cardiac history, blood pressure, heart rate, and personal or family history of sudden
cardiac death
