Psychiatric-Mental Health NP
Polypharmacy & Drug
Interactions Exam
2025/2026
1. A 25-year-old male presents with persistent sadness, loss of
interest in activities, fatigue, and difficulty sleeping for the past 3
months. Which of the following is the most appropriate initial
diagnosis?
A. Bipolar I disorder
B. Persistent depressive disorder
C. Major depressive disorder
D. Adjustment disorder
C. Major depressive disorder
Rationale: The patient exhibits classic symptoms of major depressive
disorder (MDD) including persistent low mood, anhedonia, and sleep
disturbances for more than 2 weeks. PDD requires a longer duration of
symptoms (at least 2 years).
2. Which neurotransmitter is most closely associated with the
pathophysiology of schizophrenia?
A. Serotonin
B. Dopamine
C. Norepinephrine
D. GABA
,B. Dopamine
Rationale: Dopamine dysregulation, particularly hyperactivity in
mesolimbic pathways, is strongly implicated in positive symptoms of
schizophrenia.
3. A patient taking fluoxetine for depression reports nausea,
insomnia, and mild tremor. These symptoms are most likely:
A. Serotonin syndrome
B. Common side effects of SSRIs
C. Lithium toxicity
D. Neuroleptic malignant syndrome
B. Common side effects of SSRIs
Rationale: SSRIs commonly cause GI upset, insomnia, and tremor,
especially early in treatment. Serotonin syndrome is more severe and
involves autonomic instability and neuromuscular abnormalities.
4. A 10-year-old is brought in for hyperactivity, impulsivity, and
inattention. Which diagnostic criteria is required for ADHD?
A. Symptoms present for at least 3 months
B. Symptoms present in two or more settings
C. Onset before age 18
D. Both B and C
D. Both B and C
Rationale: ADHD requires symptoms to be present in multiple settings
and onset before age 12 (per DSM-5), not just one context.
5. Which of the following is a first-line treatment for generalized
anxiety disorder in adults?
A. Buspirone
B. Fluoxetine
, C. Lorazepam
D. Haloperidol
B. Fluoxetine
Rationale: SSRIs like fluoxetine are first-line pharmacologic
treatments for GAD due to efficacy and safety. Benzodiazepines are
second-line due to dependency risk.
6. A patient presents with delusions, hallucinations, disorganized
speech, and negative symptoms for 6 months. The most likely
diagnosis is:
A. Schizoaffective disorder
B. Schizophrenia
C. Brief psychotic disorder
D. Delusional disorder
B. Schizophrenia
Rationale: Schizophrenia is characterized by ≥6 months of continuous
symptoms, including positive and negative symptoms.
7. Which medication requires monitoring of thyroid and liver
function tests periodically?
A. Lithium
B. Valproate
C. Carbamazepine
D. Clozapine
C. Carbamazepine
Rationale: Carbamazepine can cause hepatotoxicity and rarely affect
thyroid function, so periodic monitoring is recommended.
8. A patient with bipolar disorder is experiencing acute mania.
Which is the first-line treatment?
A. Fluoxetine
, B. Lithium
C. Sertraline
D. Clozapine
B. Lithium
Rationale: Lithium is a first-line mood stabilizer for acute mania in
bipolar disorder. Antidepressants alone may worsen mania.
9. Which therapy focuses on identifying and restructuring
maladaptive thought patterns?
A. Psychodynamic therapy
B. Cognitive-behavioral therapy
C. Dialectical behavior therapy
D. Interpersonal therapy
B. Cognitive-behavioral therapy
Rationale: CBT targets distorted cognitions and replaces them with
adaptive thinking, improving mood and behavior.
10. Clozapine is reserved for which type of patient?
A. First-episode schizophrenia
B. Treatment-resistant schizophrenia
C. Bipolar depression
D. ADHD
B. Treatment-resistant schizophrenia
Rationale: Clozapine is effective for patients with schizophrenia
unresponsive to other antipsychotics but requires strict blood
monitoring due to risk of agranulocytosis.
11. A 35-year-old patient presents with panic attacks occurring
unexpectedly. Which medication class is considered first-line?
A. Benzodiazepines
B. SSRIs
Polypharmacy & Drug
Interactions Exam
2025/2026
1. A 25-year-old male presents with persistent sadness, loss of
interest in activities, fatigue, and difficulty sleeping for the past 3
months. Which of the following is the most appropriate initial
diagnosis?
A. Bipolar I disorder
B. Persistent depressive disorder
C. Major depressive disorder
D. Adjustment disorder
C. Major depressive disorder
Rationale: The patient exhibits classic symptoms of major depressive
disorder (MDD) including persistent low mood, anhedonia, and sleep
disturbances for more than 2 weeks. PDD requires a longer duration of
symptoms (at least 2 years).
2. Which neurotransmitter is most closely associated with the
pathophysiology of schizophrenia?
A. Serotonin
B. Dopamine
C. Norepinephrine
D. GABA
,B. Dopamine
Rationale: Dopamine dysregulation, particularly hyperactivity in
mesolimbic pathways, is strongly implicated in positive symptoms of
schizophrenia.
3. A patient taking fluoxetine for depression reports nausea,
insomnia, and mild tremor. These symptoms are most likely:
A. Serotonin syndrome
B. Common side effects of SSRIs
C. Lithium toxicity
D. Neuroleptic malignant syndrome
B. Common side effects of SSRIs
Rationale: SSRIs commonly cause GI upset, insomnia, and tremor,
especially early in treatment. Serotonin syndrome is more severe and
involves autonomic instability and neuromuscular abnormalities.
4. A 10-year-old is brought in for hyperactivity, impulsivity, and
inattention. Which diagnostic criteria is required for ADHD?
A. Symptoms present for at least 3 months
B. Symptoms present in two or more settings
C. Onset before age 18
D. Both B and C
D. Both B and C
Rationale: ADHD requires symptoms to be present in multiple settings
and onset before age 12 (per DSM-5), not just one context.
5. Which of the following is a first-line treatment for generalized
anxiety disorder in adults?
A. Buspirone
B. Fluoxetine
, C. Lorazepam
D. Haloperidol
B. Fluoxetine
Rationale: SSRIs like fluoxetine are first-line pharmacologic
treatments for GAD due to efficacy and safety. Benzodiazepines are
second-line due to dependency risk.
6. A patient presents with delusions, hallucinations, disorganized
speech, and negative symptoms for 6 months. The most likely
diagnosis is:
A. Schizoaffective disorder
B. Schizophrenia
C. Brief psychotic disorder
D. Delusional disorder
B. Schizophrenia
Rationale: Schizophrenia is characterized by ≥6 months of continuous
symptoms, including positive and negative symptoms.
7. Which medication requires monitoring of thyroid and liver
function tests periodically?
A. Lithium
B. Valproate
C. Carbamazepine
D. Clozapine
C. Carbamazepine
Rationale: Carbamazepine can cause hepatotoxicity and rarely affect
thyroid function, so periodic monitoring is recommended.
8. A patient with bipolar disorder is experiencing acute mania.
Which is the first-line treatment?
A. Fluoxetine
, B. Lithium
C. Sertraline
D. Clozapine
B. Lithium
Rationale: Lithium is a first-line mood stabilizer for acute mania in
bipolar disorder. Antidepressants alone may worsen mania.
9. Which therapy focuses on identifying and restructuring
maladaptive thought patterns?
A. Psychodynamic therapy
B. Cognitive-behavioral therapy
C. Dialectical behavior therapy
D. Interpersonal therapy
B. Cognitive-behavioral therapy
Rationale: CBT targets distorted cognitions and replaces them with
adaptive thinking, improving mood and behavior.
10. Clozapine is reserved for which type of patient?
A. First-episode schizophrenia
B. Treatment-resistant schizophrenia
C. Bipolar depression
D. ADHD
B. Treatment-resistant schizophrenia
Rationale: Clozapine is effective for patients with schizophrenia
unresponsive to other antipsychotics but requires strict blood
monitoring due to risk of agranulocytosis.
11. A 35-year-old patient presents with panic attacks occurring
unexpectedly. Which medication class is considered first-line?
A. Benzodiazepines
B. SSRIs
