6630 Exam Prep 2025: Key Concepts, Test
Bank, and Quiz Review
A patient diagnosed with obsessive-compulsive disorder has been taking a high-dose SSRI and is
participating in therapy twice a week. He reports an inability to carry out responsibilities due to
persistent obsessions and compulsions. What is the next step?
A) Decrease his SSRI and add buspirone (Buspar)
B) Increase his SSRI
C) Add a TCA
D) Switch to a different SSRI
Rationale: For treatment-resistant OCD, augmentation with buspirone can be considered.
Increasing or switching SSRIs alone may not address persistent functional impairment, and TCAs
are not first-line augmentation.
The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the
teaching include?
A) The second dose should be taken at lunch
B) Give the second dose at bedtime
C) Only one dose per day
D) Give both doses in the morning
Rationale: Stimulants like Ritalin can cause insomnia; taking the second dose at lunch reduces
sleep interference. Bedtime dosing is inappropriate.
The PMHNP is assessing a patient for phentermine/topiramate (Qsymia). Which condition
requires further evaluation before prescribing?
A) Diabetes
B) Obesity
C) Cardiovascular disease
D) Hypothyroidism
Rationale: Phentermine is sympathomimetic and can increase heart rate and blood pressure, so
cardiovascular disease requires evaluation. Diabetes and obesity are considerations but not
contraindications.
,A group of nursing students asks how cholinesterase inhibitors benefit Alzheimer’s patients.
Which is correct?
A) Improves cognitive function
B) Reduces agitation
C) Slows disease progression
D) Both "A" & "C"
Rationale: Cholinesterase inhibitors improve cognition and may slow functional decline. They
do not reliably reduce agitation.
A 49-year-old male with depression, PTSD, alcoholism, malnutrition, diabetes, and hypertension
presents with peripheral edema and neuropathic pain. The PMHNP starts low-dose doxepin.
What is the next step?
A) Order liver function tests
B) Increase the dose immediately
C) Start another antidepressant
D) Prescribe NSAIDs for pain
Rationale: Doxepin is metabolized by the liver; baseline liver function tests are important,
especially in a patient with alcohol use and malnutrition. Dose escalation without labs is unsafe.
The PMHNP wants to treat chronic pain by targeting voltage-sensitive calcium channels (VSCCs)
with "use-dependent" inhibition. Which agent is appropriate?
A) Pregabalin (Lyrica)
B) Duloxetine
C) Gabapentin
D) Amitriptyline
Rationale: Pregabalin binds alpha-2-delta subunit of VSCCs, reducing excitatory
neurotransmitter release. Gabapentin is similar but pregabalin is often preferred due to
pharmacokinetics. Duloxetine and amitriptyline work through different mechanisms.
A patient with chronic insomnia asks about trying OTC medication first. What is the best
response?
A) Take a prescription hypnotic immediately
B) Try diphenhydramine nightly
, C) Use alcohol to aid sleep
D) "You can get melatonin over the counter, which will help with sleep onset."
Rationale: Melatonin is safe, OTC, and effective for sleep onset. Prescription hypnotics are not
first-line. Diphenhydramine can cause anticholinergic side effects; alcohol is contraindicated.
The PMHNP wants to prescribe a mood stabilizer for aggression and impulsivity by decreasing
dopaminergic neurotransmission. Which should be selected?
A) Lithium (Lithane)
B) Valproate
C) Carbamazepine
D) Lamotrigine
Rationale: Lithium reduces dopaminergic activity and is effective for aggression/impulsivity.
Valproate and carbamazepine have broader anticonvulsant effects; lamotrigine is less effective
for aggression.
The PMHNP prescribes an initial dose of D-amphetamine for an 8-year-old. Which dose
demonstrates proper practice?
A) 2.5 mg
B) 5 mg
C) 10 mg
D) 20 mg
Rationale: Pediatric stimulant therapy starts low (2.5 mg) to minimize side effects. Higher initial
doses increase risk of insomnia, appetite suppression, and cardiovascular effects.
Mrs. Kenner is concerned about her teenage daughter’s Internet use. Which statement reflects
accurate pharmacologic guidance?
A) Prescribe SSRI
B) Prescribe stimulant
C) Prescribe naltrexone
D) "There are no evidence-based treatments for Internet addiction, but there are behavioral
therapies your daughter can try."
Rationale: There are currently no FDA-approved pharmacologic treatments for Internet
addiction; behavioral interventions are the primary evidence-based approach.
Bank, and Quiz Review
A patient diagnosed with obsessive-compulsive disorder has been taking a high-dose SSRI and is
participating in therapy twice a week. He reports an inability to carry out responsibilities due to
persistent obsessions and compulsions. What is the next step?
A) Decrease his SSRI and add buspirone (Buspar)
B) Increase his SSRI
C) Add a TCA
D) Switch to a different SSRI
Rationale: For treatment-resistant OCD, augmentation with buspirone can be considered.
Increasing or switching SSRIs alone may not address persistent functional impairment, and TCAs
are not first-line augmentation.
The PMHNP is teaching parents about their child’s new prescription for Ritalin. What will the
teaching include?
A) The second dose should be taken at lunch
B) Give the second dose at bedtime
C) Only one dose per day
D) Give both doses in the morning
Rationale: Stimulants like Ritalin can cause insomnia; taking the second dose at lunch reduces
sleep interference. Bedtime dosing is inappropriate.
The PMHNP is assessing a patient for phentermine/topiramate (Qsymia). Which condition
requires further evaluation before prescribing?
A) Diabetes
B) Obesity
C) Cardiovascular disease
D) Hypothyroidism
Rationale: Phentermine is sympathomimetic and can increase heart rate and blood pressure, so
cardiovascular disease requires evaluation. Diabetes and obesity are considerations but not
contraindications.
,A group of nursing students asks how cholinesterase inhibitors benefit Alzheimer’s patients.
Which is correct?
A) Improves cognitive function
B) Reduces agitation
C) Slows disease progression
D) Both "A" & "C"
Rationale: Cholinesterase inhibitors improve cognition and may slow functional decline. They
do not reliably reduce agitation.
A 49-year-old male with depression, PTSD, alcoholism, malnutrition, diabetes, and hypertension
presents with peripheral edema and neuropathic pain. The PMHNP starts low-dose doxepin.
What is the next step?
A) Order liver function tests
B) Increase the dose immediately
C) Start another antidepressant
D) Prescribe NSAIDs for pain
Rationale: Doxepin is metabolized by the liver; baseline liver function tests are important,
especially in a patient with alcohol use and malnutrition. Dose escalation without labs is unsafe.
The PMHNP wants to treat chronic pain by targeting voltage-sensitive calcium channels (VSCCs)
with "use-dependent" inhibition. Which agent is appropriate?
A) Pregabalin (Lyrica)
B) Duloxetine
C) Gabapentin
D) Amitriptyline
Rationale: Pregabalin binds alpha-2-delta subunit of VSCCs, reducing excitatory
neurotransmitter release. Gabapentin is similar but pregabalin is often preferred due to
pharmacokinetics. Duloxetine and amitriptyline work through different mechanisms.
A patient with chronic insomnia asks about trying OTC medication first. What is the best
response?
A) Take a prescription hypnotic immediately
B) Try diphenhydramine nightly
, C) Use alcohol to aid sleep
D) "You can get melatonin over the counter, which will help with sleep onset."
Rationale: Melatonin is safe, OTC, and effective for sleep onset. Prescription hypnotics are not
first-line. Diphenhydramine can cause anticholinergic side effects; alcohol is contraindicated.
The PMHNP wants to prescribe a mood stabilizer for aggression and impulsivity by decreasing
dopaminergic neurotransmission. Which should be selected?
A) Lithium (Lithane)
B) Valproate
C) Carbamazepine
D) Lamotrigine
Rationale: Lithium reduces dopaminergic activity and is effective for aggression/impulsivity.
Valproate and carbamazepine have broader anticonvulsant effects; lamotrigine is less effective
for aggression.
The PMHNP prescribes an initial dose of D-amphetamine for an 8-year-old. Which dose
demonstrates proper practice?
A) 2.5 mg
B) 5 mg
C) 10 mg
D) 20 mg
Rationale: Pediatric stimulant therapy starts low (2.5 mg) to minimize side effects. Higher initial
doses increase risk of insomnia, appetite suppression, and cardiovascular effects.
Mrs. Kenner is concerned about her teenage daughter’s Internet use. Which statement reflects
accurate pharmacologic guidance?
A) Prescribe SSRI
B) Prescribe stimulant
C) Prescribe naltrexone
D) "There are no evidence-based treatments for Internet addiction, but there are behavioral
therapies your daughter can try."
Rationale: There are currently no FDA-approved pharmacologic treatments for Internet
addiction; behavioral interventions are the primary evidence-based approach.
