NU664A - ADVANCED PMHNP FINAL EXAM -
Complete Questions & Rationales -
Psychiatric-Mental Health Nurse Practitioner
Board-Ready Assessment
SECTION 1: PSYCHOPHARMACOLOGY
Questions 1–12
Q1. A 34-year-old female with generalized anxiety disorder has been on sertraline 100
mg daily for 8 weeks. She reports "60% improvement" but continues to have excessive
worry and muscle tension. She denies side effects. Which action is MOST appropriate?
A. Increase sertraline to 150 mg daily
B. Switch to duloxetine 30 mg daily
C. Add buspirone 10 mg twice daily
D. Discontinue sertraline and start clonazepam
Correct Answer: A
Rationale: Sertraline is dosed up to 200 mg/day for anxiety disorders. Partial response
at 8 weeks warrants dose optimization before augmentation or switching (APA GOLD).
B: Duloxetine is not FDA-approved for GAD. C: Augmentation is considered after
,maximizing monotherapy. D: Abrupt discontinuation risks withdrawal; benzodiazepines
are not first-line monotherapy.
Q2. A 28-year-old male with bipolar I disorder, currently euthymic on lithium 900 mg
daily, presents with a lithium level of 0.6 mEq/L. He is adherent. What is the BEST next
step?
A. Maintain current dose; recheck in 6 months
B. Increase lithium to 1200 mg daily
C. Add lamotrigine 25 mg daily
D. Obtain thyroid function studies
Correct Answer: B
Rationale: Target maintenance level for bipolar I is 0.8–1.0 mEq/L. At 0.6 mEq/L, dose
increase is indicated for relapse prevention (APA). A: Subtherapeutic level requires
intervention, not observation. C: Lamotrigine is adjunctive but does not replace
optimizing lithium. D: TSH indicated but not the immediate next step for subtherapeutic
level.
Q3. Which antipsychotic is MOST likely to prolong QTc interval and requires baseline
ECG monitoring per FDA guidelines?
A. Aripiprazole
B. Ziprasidone
C. Lurasidone
, D. Brexpiprazole
Correct Answer: B
Rationale: Ziprasidone carries the highest QTc prolongation risk among
second-generation antipsychotics; FDA advises baseline ECG in specific populations. A,
C, D have lower risk profiles.
Q4. A 45-year-old male with treatment-resistant depression is being considered for
augmentation with aripiprazole. His current regimen is sertraline 200 mg daily. Which
baseline assessment is REQUIRED before initiating aripiprazole?
A. Comprehensive metabolic panel only
B. Fasting lipid panel and glucose
C. ECG and echocardiogram
D. Liver function tests and CBC
Correct Answer: B
Rationale: Aripiprazole carries metabolic risks (weight gain, dyslipidemia, glucose
dysregulation) despite being metabolically neutral compared to other antipsychotics;
baseline metabolic monitoring is standard (ADA/APA consensus). A: Insufficient alone.
C: Not required unless cardiac history. D: Not specifically indicated for aripiprazole.
Q5. A 67-year-old male with Parkinson's disease develops psychosis. Which
antipsychotic is CONTRAINDICATED due to risk of worsening motor symptoms?
A. Quetiapine
Complete Questions & Rationales -
Psychiatric-Mental Health Nurse Practitioner
Board-Ready Assessment
SECTION 1: PSYCHOPHARMACOLOGY
Questions 1–12
Q1. A 34-year-old female with generalized anxiety disorder has been on sertraline 100
mg daily for 8 weeks. She reports "60% improvement" but continues to have excessive
worry and muscle tension. She denies side effects. Which action is MOST appropriate?
A. Increase sertraline to 150 mg daily
B. Switch to duloxetine 30 mg daily
C. Add buspirone 10 mg twice daily
D. Discontinue sertraline and start clonazepam
Correct Answer: A
Rationale: Sertraline is dosed up to 200 mg/day for anxiety disorders. Partial response
at 8 weeks warrants dose optimization before augmentation or switching (APA GOLD).
B: Duloxetine is not FDA-approved for GAD. C: Augmentation is considered after
,maximizing monotherapy. D: Abrupt discontinuation risks withdrawal; benzodiazepines
are not first-line monotherapy.
Q2. A 28-year-old male with bipolar I disorder, currently euthymic on lithium 900 mg
daily, presents with a lithium level of 0.6 mEq/L. He is adherent. What is the BEST next
step?
A. Maintain current dose; recheck in 6 months
B. Increase lithium to 1200 mg daily
C. Add lamotrigine 25 mg daily
D. Obtain thyroid function studies
Correct Answer: B
Rationale: Target maintenance level for bipolar I is 0.8–1.0 mEq/L. At 0.6 mEq/L, dose
increase is indicated for relapse prevention (APA). A: Subtherapeutic level requires
intervention, not observation. C: Lamotrigine is adjunctive but does not replace
optimizing lithium. D: TSH indicated but not the immediate next step for subtherapeutic
level.
Q3. Which antipsychotic is MOST likely to prolong QTc interval and requires baseline
ECG monitoring per FDA guidelines?
A. Aripiprazole
B. Ziprasidone
C. Lurasidone
, D. Brexpiprazole
Correct Answer: B
Rationale: Ziprasidone carries the highest QTc prolongation risk among
second-generation antipsychotics; FDA advises baseline ECG in specific populations. A,
C, D have lower risk profiles.
Q4. A 45-year-old male with treatment-resistant depression is being considered for
augmentation with aripiprazole. His current regimen is sertraline 200 mg daily. Which
baseline assessment is REQUIRED before initiating aripiprazole?
A. Comprehensive metabolic panel only
B. Fasting lipid panel and glucose
C. ECG and echocardiogram
D. Liver function tests and CBC
Correct Answer: B
Rationale: Aripiprazole carries metabolic risks (weight gain, dyslipidemia, glucose
dysregulation) despite being metabolically neutral compared to other antipsychotics;
baseline metabolic monitoring is standard (ADA/APA consensus). A: Insufficient alone.
C: Not required unless cardiac history. D: Not specifically indicated for aripiprazole.
Q5. A 67-year-old male with Parkinson's disease develops psychosis. Which
antipsychotic is CONTRAINDICATED due to risk of worsening motor symptoms?
A. Quetiapine
