NR546 – Psychopharmacology for the Psychiatric-
Mental Health Nurse Practitioner Midterm Exam –
Chamberlain University 2026/2027 Verified Questions
& 100% Correct Answers with Rationales High-Yield |
Graded A | Complete Coverage
Question 1 Which class of antidepressants is considered first-line for major depressive
disorder in most patients due to its favorable side-effect profile?
A. Tricyclic antidepressants (TCAs) B. Monoamine oxidase inhibitors (MAOIs) C.
Selective serotonin reuptake inhibitors (SSRIs) D. Serotonin-norepinephrine reuptake
inhibitors (SNRIs)
Answer: C
Rationale: SSRIs (e.g., sertraline, escitalopram, fluoxetine) are first-line for MDD due to
better tolerability, lower risk of overdose, fewer anticholinergic and cardiac effects
compared to TCAs and MAOIs (APA 2023 Depression Guideline).
Question 2 A patient with treatment-resistant depression has failed adequate trials of two
SSRIs and one SNRI. Which augmentation strategy has the strongest Level 1 evidence?
A. Add buspirone B. Add aripiprazole or brexpiprazole C. Add thyroid hormone
(liothyronine / T3) D. Add lithium
Answer: B
Rationale: Atypical antipsychotic augmentation (aripiprazole, brexpiprazole, quetiapine
XR) has the strongest evidence from STAR*D, meta-analyses, and FDA approvals for
TRD after ≥2 antidepressant failures.
Question 3 A 28-year-old female with panic disorder has failed sertraline and
escitalopram. Which medication is FDA-approved for panic disorder and recommended
after SSRI failure?
A. Alprazolam B. Venlafaxine XR C. Propranolol D. Buspirone
Answer: B
, Rationale: Venlafaxine XR (SNRI) is FDA-approved for panic disorder and is a guideline-
recommended next step after SSRI failure (APA Anxiety Disorders Guideline).
Question 4 A patient with PTSD has persistent nightmares despite trauma-focused
psychotherapy. Which medication has Level A evidence specifically for reducing PTSD-
related nightmares?
A. Trazodone B. Prazosin C. Quetiapine D. Mirtazapine
Answer: B
Rationale: Prazosin (alpha-1 antagonist) has the strongest evidence (Level A) for PTSD
nightmares per VA/DoD 2023 Clinical Practice Guideline.
Question 5 A patient with bipolar I disorder is euthymic on lithium 900 mg daily (level 0.8
mEq/L) but plans pregnancy in 3–6 months. Most appropriate next step?
A. Continue lithium and monitor closely B. Discuss switching to lamotrigine and begin
folic acid supplementation C. Switch to valproate D. Discontinue all mood stabilizers
Answer: B
Rationale: Lithium carries significant teratogenic risk (Ebstein’s anomaly). Lamotrigine is
considered the safest mood stabilizer in pregnancy when clinically necessary.
Question 6 Which medication is FDA-approved for both acute manic/mixed episodes and
maintenance treatment in bipolar I disorder?
A. Lamotrigine B. Lithium C. Quetiapine D. All of the above
Answer: C
Rationale: Quetiapine has FDA indications for acute mania/mixed, bipolar depression,
and maintenance in bipolar I disorder.
Question 7 A 19-year-old presents with 6 months of social withdrawal, auditory
hallucinations, flattened affect, and poor hygiene. Most likely diagnosis?
A. Schizoaffective disorder B. Schizophrenia C. Brief psychotic disorder D.
Schizophreniform disorder
Answer: B
Mental Health Nurse Practitioner Midterm Exam –
Chamberlain University 2026/2027 Verified Questions
& 100% Correct Answers with Rationales High-Yield |
Graded A | Complete Coverage
Question 1 Which class of antidepressants is considered first-line for major depressive
disorder in most patients due to its favorable side-effect profile?
A. Tricyclic antidepressants (TCAs) B. Monoamine oxidase inhibitors (MAOIs) C.
Selective serotonin reuptake inhibitors (SSRIs) D. Serotonin-norepinephrine reuptake
inhibitors (SNRIs)
Answer: C
Rationale: SSRIs (e.g., sertraline, escitalopram, fluoxetine) are first-line for MDD due to
better tolerability, lower risk of overdose, fewer anticholinergic and cardiac effects
compared to TCAs and MAOIs (APA 2023 Depression Guideline).
Question 2 A patient with treatment-resistant depression has failed adequate trials of two
SSRIs and one SNRI. Which augmentation strategy has the strongest Level 1 evidence?
A. Add buspirone B. Add aripiprazole or brexpiprazole C. Add thyroid hormone
(liothyronine / T3) D. Add lithium
Answer: B
Rationale: Atypical antipsychotic augmentation (aripiprazole, brexpiprazole, quetiapine
XR) has the strongest evidence from STAR*D, meta-analyses, and FDA approvals for
TRD after ≥2 antidepressant failures.
Question 3 A 28-year-old female with panic disorder has failed sertraline and
escitalopram. Which medication is FDA-approved for panic disorder and recommended
after SSRI failure?
A. Alprazolam B. Venlafaxine XR C. Propranolol D. Buspirone
Answer: B
, Rationale: Venlafaxine XR (SNRI) is FDA-approved for panic disorder and is a guideline-
recommended next step after SSRI failure (APA Anxiety Disorders Guideline).
Question 4 A patient with PTSD has persistent nightmares despite trauma-focused
psychotherapy. Which medication has Level A evidence specifically for reducing PTSD-
related nightmares?
A. Trazodone B. Prazosin C. Quetiapine D. Mirtazapine
Answer: B
Rationale: Prazosin (alpha-1 antagonist) has the strongest evidence (Level A) for PTSD
nightmares per VA/DoD 2023 Clinical Practice Guideline.
Question 5 A patient with bipolar I disorder is euthymic on lithium 900 mg daily (level 0.8
mEq/L) but plans pregnancy in 3–6 months. Most appropriate next step?
A. Continue lithium and monitor closely B. Discuss switching to lamotrigine and begin
folic acid supplementation C. Switch to valproate D. Discontinue all mood stabilizers
Answer: B
Rationale: Lithium carries significant teratogenic risk (Ebstein’s anomaly). Lamotrigine is
considered the safest mood stabilizer in pregnancy when clinically necessary.
Question 6 Which medication is FDA-approved for both acute manic/mixed episodes and
maintenance treatment in bipolar I disorder?
A. Lamotrigine B. Lithium C. Quetiapine D. All of the above
Answer: C
Rationale: Quetiapine has FDA indications for acute mania/mixed, bipolar depression,
and maintenance in bipolar I disorder.
Question 7 A 19-year-old presents with 6 months of social withdrawal, auditory
hallucinations, flattened affect, and poor hygiene. Most likely diagnosis?
A. Schizoaffective disorder B. Schizophrenia C. Brief psychotic disorder D.
Schizophreniform disorder
Answer: B
