NRNP 6665 MIDTERM EXAM QUESTIONS
AND 100% VERIFIED ANSWERS WITH
RATIONALES GRADED A+ LATEST
WALDEN UNIVERSITY
1. A 34-year-old patient with major depressive disorder has not responded to two
adequate SSRI trials. Which next-step medication strategy is most appropriate?
A. Switch to another SSRI
B. Add bupropion
C. Discontinue pharmacotherapy
D. Add benzodiazepine
Correct Answer: B
Rationale: Augmentation with bupropion is evidence-based after two failed SSRI
trials and targets residual symptoms such as fatigue and poor concentration.
2. Which neurotransmitter system is most directly associated with the positive
symptoms of schizophrenia?
A. Serotonin
B. GABA
C. Dopamine
D. Norepinephrine
Correct Answer: C
Rationale: Hyperactivity of dopamine in the mesolimbic pathway is strongly
associated with positive symptoms such as hallucinations and delusions.
,3. A patient stabilized on lithium presents with nausea, coarse tremor, and ataxia.
Which action is the priority?
A. Continue lithium and reassess in one week
B. Check serum lithium level
C. Increase fluid restriction
D. Add propranolol
Correct Answer: B
Rationale: These symptoms suggest lithium toxicity; immediate serum level
assessment is required to guide management.
4. Which medication requires baseline and ongoing ANC monitoring due to risk of
agranulocytosis?
A. Risperidone
B. Clozapine
C. Quetiapine
D. Olanzapine
Correct Answer: B
Rationale: Clozapine carries a significant risk of agranulocytosis, necessitating
strict hematologic monitoring.
5. A child with ADHD and comorbid anxiety is least likely to benefit initially from
which medication?
A. Atomoxetine
B. Methylphenidate
C. Guanfacine
D. Behavioral therapy
Correct Answer: B
Rationale: Stimulants may exacerbate anxiety symptoms; non-stimulant options
are often preferred initially.
,6. Which adverse effect is most associated with long-term SSRI use?
A. Agranulocytosis
B. Sexual dysfunction
C. Tardive dyskinesia
D. Hypertensive crisis
Correct Answer: B
Rationale: Sexual dysfunction is a common and persistent adverse effect of
SSRIs.
7. A patient taking MAOIs consumes aged cheese and develops headache,
diaphoresis, and hypertension. This reaction is due to excess:
A. Dopamine
B. Tyramine
C. Serotonin
D. Acetylcholine
Correct Answer: B
Rationale: Tyramine ingestion with MAOIs leads to hypertensive crisis due to
excessive catecholamine release.
8. Which antidepressant is most activating and useful in patients with hypersomnia
and fatigue?
A. Paroxetine
B. Mirtazapine
C. Bupropion
D. Amitriptyline
Correct Answer: C
Rationale: Bupropion’s dopaminergic and noradrenergic activity contributes to its
activating profile.
, 9. A 70-year-old patient is started on an antipsychotic. Which principle best guides
medication choice?
A. Use maximum recommended dose
B. Avoid atypical antipsychotics
C. Start low and titrate slowly
D. Prefer first-generation agents
Correct Answer: C
Rationale: Older adults are more sensitive to side effects; conservative dosing
reduces adverse outcomes.
10. Which medication is FDA-approved for maintenance treatment of bipolar I
disorder?
A. Fluoxetine
B. Lamotrigine
C. Buspirone
D. Venlafaxine
Correct Answer: B
Rationale: Lamotrigine is effective for bipolar maintenance, particularly in
preventing depressive episodes.
11. A patient taking sertraline develops agitation, diaphoresis, hyperreflexia, and
diarrhea after starting linezolid. What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Anticholinergic toxicity
C. Serotonin syndrome
D. Acute dystonia
Correct Answer: C
Rationale: Combining serotonergic agents can precipitate serotonin syndrome,
characterized by autonomic instability, neuromuscular abnormalities, and GI
symptoms.
AND 100% VERIFIED ANSWERS WITH
RATIONALES GRADED A+ LATEST
WALDEN UNIVERSITY
1. A 34-year-old patient with major depressive disorder has not responded to two
adequate SSRI trials. Which next-step medication strategy is most appropriate?
A. Switch to another SSRI
B. Add bupropion
C. Discontinue pharmacotherapy
D. Add benzodiazepine
Correct Answer: B
Rationale: Augmentation with bupropion is evidence-based after two failed SSRI
trials and targets residual symptoms such as fatigue and poor concentration.
2. Which neurotransmitter system is most directly associated with the positive
symptoms of schizophrenia?
A. Serotonin
B. GABA
C. Dopamine
D. Norepinephrine
Correct Answer: C
Rationale: Hyperactivity of dopamine in the mesolimbic pathway is strongly
associated with positive symptoms such as hallucinations and delusions.
,3. A patient stabilized on lithium presents with nausea, coarse tremor, and ataxia.
Which action is the priority?
A. Continue lithium and reassess in one week
B. Check serum lithium level
C. Increase fluid restriction
D. Add propranolol
Correct Answer: B
Rationale: These symptoms suggest lithium toxicity; immediate serum level
assessment is required to guide management.
4. Which medication requires baseline and ongoing ANC monitoring due to risk of
agranulocytosis?
A. Risperidone
B. Clozapine
C. Quetiapine
D. Olanzapine
Correct Answer: B
Rationale: Clozapine carries a significant risk of agranulocytosis, necessitating
strict hematologic monitoring.
5. A child with ADHD and comorbid anxiety is least likely to benefit initially from
which medication?
A. Atomoxetine
B. Methylphenidate
C. Guanfacine
D. Behavioral therapy
Correct Answer: B
Rationale: Stimulants may exacerbate anxiety symptoms; non-stimulant options
are often preferred initially.
,6. Which adverse effect is most associated with long-term SSRI use?
A. Agranulocytosis
B. Sexual dysfunction
C. Tardive dyskinesia
D. Hypertensive crisis
Correct Answer: B
Rationale: Sexual dysfunction is a common and persistent adverse effect of
SSRIs.
7. A patient taking MAOIs consumes aged cheese and develops headache,
diaphoresis, and hypertension. This reaction is due to excess:
A. Dopamine
B. Tyramine
C. Serotonin
D. Acetylcholine
Correct Answer: B
Rationale: Tyramine ingestion with MAOIs leads to hypertensive crisis due to
excessive catecholamine release.
8. Which antidepressant is most activating and useful in patients with hypersomnia
and fatigue?
A. Paroxetine
B. Mirtazapine
C. Bupropion
D. Amitriptyline
Correct Answer: C
Rationale: Bupropion’s dopaminergic and noradrenergic activity contributes to its
activating profile.
, 9. A 70-year-old patient is started on an antipsychotic. Which principle best guides
medication choice?
A. Use maximum recommended dose
B. Avoid atypical antipsychotics
C. Start low and titrate slowly
D. Prefer first-generation agents
Correct Answer: C
Rationale: Older adults are more sensitive to side effects; conservative dosing
reduces adverse outcomes.
10. Which medication is FDA-approved for maintenance treatment of bipolar I
disorder?
A. Fluoxetine
B. Lamotrigine
C. Buspirone
D. Venlafaxine
Correct Answer: B
Rationale: Lamotrigine is effective for bipolar maintenance, particularly in
preventing depressive episodes.
11. A patient taking sertraline develops agitation, diaphoresis, hyperreflexia, and
diarrhea after starting linezolid. What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Anticholinergic toxicity
C. Serotonin syndrome
D. Acute dystonia
Correct Answer: C
Rationale: Combining serotonergic agents can precipitate serotonin syndrome,
characterized by autonomic instability, neuromuscular abnormalities, and GI
symptoms.
