D343 NURS 6436
Foundations of
Advanced Psychiatric
Mental Health Practice
Proctored Objective
Assessment
2026
(Questions & Answers)
Multiple Choice (15 Questions)
1. A 35-year-old patient with major depressive disorder is non-responsive to first-line
SSRI therapy after 8 weeks. What is the best next step in treatment?
A) Increase the dose of SSRI B) Add bupropion as an augmenting agent C) Switch to an SNRI
D) Start electroconvulsive therapy (ECT)
Answer: B Rationale: Augmentation with bupropion is a common strategy when a patient is
non-responsive to SSRI monotherapy before switching to another class or starting ECT.
2. Which of the following neurotransmitter systems is most implicated in the
pathophysiology of schizophrenia?
A) Serotonergic B) Dopaminergic C) GABAergic D) Cholinergic
Answer: B Rationale: Dopamine dysregulation, especially hyperactivity in the mesolimbic
pathway, is central in schizophrenia pathophysiology.
3. In cognitive behavioral therapy (CBT), the primary goal in treating anxiety disorders is to:
A) Eliminate all anxious thoughts B) Change maladaptive thought patterns C) Suppress
physiological symptoms D) Prescribe medication
Answer: B Rationale: CBT focuses on identifying and restructuring maladaptive cognitions
contributing to anxiety.
4. Which lab value is especially important to monitor when initiating lithium therapy?
A) Liver function tests B) Thyroid function tests C) Serum sodium D) Serum creatinine
Answer: D Rationale: Lithium is renally excreted; monitoring kidney function (creatinine) is
crucial to prevent toxicity.
5. A patient with bipolar I disorder is most at risk for developing which adverse effect from
valproate?
A) Hyponatremia B) Hepatotoxicity C) QT prolongation D) Tardive dyskinesia
Answer: B Rationale: Valproate can cause hepatotoxicity, so liver enzymes should be
monitored.
6. Which psychotropic medication has the highest risk for metabolic syndrome?
, A) Clozapine B) Haloperidol C) Fluoxetine D) Lorazepam
Answer: A Rationale: Clozapine carries the highest risk for weight gain, diabetes, and lipid
abnormalities.
7. Which of the following is a hallmark symptom of borderline personality disorder?
A) Persistent delusions B) Chronic feelings of emptiness C) Obsession with orderliness D)
Social withdrawal
Answer: B Rationale: Chronic feelings of emptiness are a diagnostic criterion of borderline
personality disorder.
8. Which therapy technique involves systematic desensitization?
A) Psychoanalysis B) Dialectical behavior therapy C) Exposure therapy D) Cognitive
restructuring
Answer: C Rationale: Systematic desensitization is a form of exposure therapy used for
phobias.
9. What is the mechanism of action of SSRIs?
A) Dopamine receptor blockade B) Increasing serotonin reuptake C) Inhibiting serotonin
reuptake D) Increasing GABA activity
Answer: C Rationale: SSRIs selectively inhibit serotonin reuptake, increasing serotonin
availability in the synaptic cleft.
10. Electroconvulsive therapy is most effective for:
A) Mild anxiety B) Treatment-resistant major depression C) Borderline personality disorder D)
Acute mania
Answer: B Rationale: ECT is highly effective for severe, treatment-resistant depression.
11. Which of the following is NOT a core symptom of autism spectrum disorder?
A) Deficits in social communication B) Restricted repetitive behaviors C) Auditory
hallucinations D) Difficulty in social interaction
Answer: C Rationale: Auditory hallucinations are not core to autism but are symptoms of
psychotic disorders.
12. In managing a patient with schizophrenia experiencing acute psychosis, the preferred
initial medication route is:
A) Oral B) Intravenous C) Intramuscular D) Subcutaneous
Answer: C Rationale: Intramuscular antipsychotics allow rapid control of acute agitation and
psychosis.
13. Which factor best contributes to poor adherence in patients with chronic psychiatric
conditions?
A) Insight into the illness B) Younger age C) Side effect burden of medications D) Lack of
family history
Answer: C Rationale: Side effects often lead to medication non-compliance.
14. Which of these tools is a validated screening instrument for substance use disorders?
A) DSM-V B) CAGE questionnaire C) PHQ-9 D) GAD-7
Answer: B Rationale: The CAGE questionnaire is a commonly used screening tool for alcohol
use disorder.
15. In the neurobiological model of PTSD, which brain region is primarily responsible for
the exaggerated fear response?
A) Hippocampus B) Amygdala C) Prefrontal cortex D) Cerebellum
Answer: B Rationale: The amygdala plays a central role in fear processing and PTSD
symptoms.
True/False (8 Questions)
16. A patient with major depressive disorder should avoid abrupt discontinuation of SSRIs
due to the risk of discontinuation syndrome. True Rationale: Abrupt cessation of SSRIs can
result in symptoms like dizziness, irritability, and flu-like symptoms.
Foundations of
Advanced Psychiatric
Mental Health Practice
Proctored Objective
Assessment
2026
(Questions & Answers)
Multiple Choice (15 Questions)
1. A 35-year-old patient with major depressive disorder is non-responsive to first-line
SSRI therapy after 8 weeks. What is the best next step in treatment?
A) Increase the dose of SSRI B) Add bupropion as an augmenting agent C) Switch to an SNRI
D) Start electroconvulsive therapy (ECT)
Answer: B Rationale: Augmentation with bupropion is a common strategy when a patient is
non-responsive to SSRI monotherapy before switching to another class or starting ECT.
2. Which of the following neurotransmitter systems is most implicated in the
pathophysiology of schizophrenia?
A) Serotonergic B) Dopaminergic C) GABAergic D) Cholinergic
Answer: B Rationale: Dopamine dysregulation, especially hyperactivity in the mesolimbic
pathway, is central in schizophrenia pathophysiology.
3. In cognitive behavioral therapy (CBT), the primary goal in treating anxiety disorders is to:
A) Eliminate all anxious thoughts B) Change maladaptive thought patterns C) Suppress
physiological symptoms D) Prescribe medication
Answer: B Rationale: CBT focuses on identifying and restructuring maladaptive cognitions
contributing to anxiety.
4. Which lab value is especially important to monitor when initiating lithium therapy?
A) Liver function tests B) Thyroid function tests C) Serum sodium D) Serum creatinine
Answer: D Rationale: Lithium is renally excreted; monitoring kidney function (creatinine) is
crucial to prevent toxicity.
5. A patient with bipolar I disorder is most at risk for developing which adverse effect from
valproate?
A) Hyponatremia B) Hepatotoxicity C) QT prolongation D) Tardive dyskinesia
Answer: B Rationale: Valproate can cause hepatotoxicity, so liver enzymes should be
monitored.
6. Which psychotropic medication has the highest risk for metabolic syndrome?
, A) Clozapine B) Haloperidol C) Fluoxetine D) Lorazepam
Answer: A Rationale: Clozapine carries the highest risk for weight gain, diabetes, and lipid
abnormalities.
7. Which of the following is a hallmark symptom of borderline personality disorder?
A) Persistent delusions B) Chronic feelings of emptiness C) Obsession with orderliness D)
Social withdrawal
Answer: B Rationale: Chronic feelings of emptiness are a diagnostic criterion of borderline
personality disorder.
8. Which therapy technique involves systematic desensitization?
A) Psychoanalysis B) Dialectical behavior therapy C) Exposure therapy D) Cognitive
restructuring
Answer: C Rationale: Systematic desensitization is a form of exposure therapy used for
phobias.
9. What is the mechanism of action of SSRIs?
A) Dopamine receptor blockade B) Increasing serotonin reuptake C) Inhibiting serotonin
reuptake D) Increasing GABA activity
Answer: C Rationale: SSRIs selectively inhibit serotonin reuptake, increasing serotonin
availability in the synaptic cleft.
10. Electroconvulsive therapy is most effective for:
A) Mild anxiety B) Treatment-resistant major depression C) Borderline personality disorder D)
Acute mania
Answer: B Rationale: ECT is highly effective for severe, treatment-resistant depression.
11. Which of the following is NOT a core symptom of autism spectrum disorder?
A) Deficits in social communication B) Restricted repetitive behaviors C) Auditory
hallucinations D) Difficulty in social interaction
Answer: C Rationale: Auditory hallucinations are not core to autism but are symptoms of
psychotic disorders.
12. In managing a patient with schizophrenia experiencing acute psychosis, the preferred
initial medication route is:
A) Oral B) Intravenous C) Intramuscular D) Subcutaneous
Answer: C Rationale: Intramuscular antipsychotics allow rapid control of acute agitation and
psychosis.
13. Which factor best contributes to poor adherence in patients with chronic psychiatric
conditions?
A) Insight into the illness B) Younger age C) Side effect burden of medications D) Lack of
family history
Answer: C Rationale: Side effects often lead to medication non-compliance.
14. Which of these tools is a validated screening instrument for substance use disorders?
A) DSM-V B) CAGE questionnaire C) PHQ-9 D) GAD-7
Answer: B Rationale: The CAGE questionnaire is a commonly used screening tool for alcohol
use disorder.
15. In the neurobiological model of PTSD, which brain region is primarily responsible for
the exaggerated fear response?
A) Hippocampus B) Amygdala C) Prefrontal cortex D) Cerebellum
Answer: B Rationale: The amygdala plays a central role in fear processing and PTSD
symptoms.
True/False (8 Questions)
16. A patient with major depressive disorder should avoid abrupt discontinuation of SSRIs
due to the risk of discontinuation syndrome. True Rationale: Abrupt cessation of SSRIs can
result in symptoms like dizziness, irritability, and flu-like symptoms.
