1|Page
NU 671 FINAL ACTUAL EXAM PREP 2026
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK |NEW AND REVISED|
CURRENTLY TESTING
1. A 32-year-old female presents with depressed mood, anhedonia,
fatigue, and difficulty concentrating for the past 8 weeks. She reports
that her symptoms are worse in the morning and that she has lost 10
pounds unintentionally. She denies any history of mania. The most
appropriate initial screening tool is:
A) GAD-7
B) PHQ-9
C) C-SSRS
D) MDQ
Rationale: The PHQ-9 is a validated screening tool for depression and
assesses severity. The GAD-7 screens for anxiety. The C-SSRS screens
for suicide risk; the MDQ screens for bipolar disorder. The patient’s
symptoms are consistent with major depressive disorder without
indications of bipolarity, so PHQ-9 is the best initial choice.
2. A 45-year-old male with major depressive disorder has failed
adequate trials of sertraline and venlafaxine. He now reports anhedonia
and low energy. His PHQ-9 score is 18. Which medication is most
appropriate as a third-line augmentation strategy?
A) Fluoxetine
B) Aripiprazole
,2|Page
C) Bupropion
D) Trazodone
Rationale: For treatment-resistant depression, augmentation with a
second-generation antipsychotic (e.g., aripiprazole, brexpiprazole,
quetiapine) is FDA-approved and evidence-based. Fluoxetine is
another SSRI and not an augmentation. Bupropion can be added but
is not FDA-approved for augmentation in this context; aripiprazole
has stronger evidence.
3. A 28-year-old woman with bipolar I disorder is euthymic on lithium.
She is planning to become pregnant. Which medication adjustment is
most appropriate?
A) Discontinue lithium immediately
B) Discuss risks and benefits; lithium can be continued with close
monitoring of serum levels and fetal echocardiography
C) Switch to valproate for mood stabilization
D) Add an antipsychotic to replace lithium
Rationale: Lithium is a first-line treatment for bipolar disorder and
can be used in pregnancy, though it carries a small risk of Ebstein‘s
anomaly. Discontinuation greatly increases risk of relapse. Valproate
is contraindicated in pregnancy due to neural tube defects. Shared
decision-making and monitoring are essential.
4. A 20-year-old college student presents with recurrent, unexpected
panic attacks, followed by persistent worry about having another attack.
She avoids the campus gym because she fears a panic attack in that
setting. The most appropriate first-line pharmacotherapy is:
A) Clonazepam 0.5 mg twice daily as needed
B) Sertraline 50 mg daily
C) Propranolol 20 mg before stressful events
D) Hydroxyzine 25 mg every 6 hours as needed
,3|Page
Rationale: Panic disorder is treated with first-line SSRIs (sertraline,
paroxetine, fluoxetine). Benzodiazepines (clonazepam) are effective
but have abuse potential and are not first-line. Propranolol is used for
performance anxiety, not panic disorder. Hydroxyzine may be used for
generalized anxiety but is not first-line for panic.
5. A 55-year-old male with generalized anxiety disorder (GAD) has been
on alprazolam 2 mg daily for 3 years. He reports needing higher doses to
achieve the same effect. He wants to discontinue the medication. The
most appropriate next step is:
A) Abrupt discontinuation with close monitoring
B) Gradual taper over several weeks to months with possible
substitution of a long-acting benzodiazepine (e.g., diazepam)
C) Switch to buspirone without tapering
D) Add hydroxyzine and continue alprazolam
Rationale: Alprazolam is a short-acting benzodiazepine with high
dependence potential. Abrupt withdrawal can cause seizures. A
gradual taper, often using a long-acting benzodiazepine (diazepam), is
the standard of care. Buspirone does not prevent withdrawal.
6. A 34-year-old female with borderline personality disorder presents
with chronic emptiness, unstable relationships, and self-cutting. The
most evidence-based psychotherapy for this condition is:
A) Supportive therapy
B) Dialectical behavior therapy (DBT)
C) Cognitive-behavioral therapy (CBT) for depression
D) Interpersonal therapy (IPT)
Rationale: DBT is the gold standard, evidence-based psychotherapy
for borderline personality disorder, focusing on emotion regulation,
distress tolerance, interpersonal effectiveness, and mindfulness. CBT
and IPT are less specifically targeted.
, 4|Page
7. A 68-year-old male with Parkinson’s disease and major depression is
prescribed paroxetine. Which adverse effect is of particular concern in
this population?
A) Weight gain
B) Worsening of parkinsonism (due to mild extrapyramidal side
effects)
C) Hyponatremia
D) QT prolongation
Rationale: SSRIs, including paroxetine, can cause extrapyramidal
symptoms, which may exacerbate Parkinson’s disease. Paroxetine also
has strong anticholinergic effects. Weight gain and hyponatremia are
concerns but not as specific to Parkinson’s. QT prolongation is more
associated with citalopram.
8. A 26-year-old male with schizophrenia has been stable on risperidone
for 1 year. He now reports new onset of galactorrhea and decreased
libido. Which laboratory test is most appropriate?
A) Thyroid function tests
B) Prolactin level
C) Testosterone level
D) Comprehensive metabolic panel
Rationale: Risperidone is a potent D2 antagonist that frequently
causes hyperprolactinemia, leading to galactorrhea, gynecomastia,
and sexual dysfunction. A prolactin level should be drawn. If elevated,
switching to a prolactin-sparing antipsychotic (e.g., aripiprazole) may
be considered.
9. A 40-year-old female with posttraumatic stress disorder (PTSD) from
a motor vehicle accident reports frequent nightmares and hypervigilance.
She has tried sertraline with partial response. Which medication is
FDA-approved for PTSD and may help with nightmares?
A) Prazosin
B) Paroxetine
NU 671 FINAL ACTUAL EXAM PREP 2026
ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK |NEW AND REVISED|
CURRENTLY TESTING
1. A 32-year-old female presents with depressed mood, anhedonia,
fatigue, and difficulty concentrating for the past 8 weeks. She reports
that her symptoms are worse in the morning and that she has lost 10
pounds unintentionally. She denies any history of mania. The most
appropriate initial screening tool is:
A) GAD-7
B) PHQ-9
C) C-SSRS
D) MDQ
Rationale: The PHQ-9 is a validated screening tool for depression and
assesses severity. The GAD-7 screens for anxiety. The C-SSRS screens
for suicide risk; the MDQ screens for bipolar disorder. The patient’s
symptoms are consistent with major depressive disorder without
indications of bipolarity, so PHQ-9 is the best initial choice.
2. A 45-year-old male with major depressive disorder has failed
adequate trials of sertraline and venlafaxine. He now reports anhedonia
and low energy. His PHQ-9 score is 18. Which medication is most
appropriate as a third-line augmentation strategy?
A) Fluoxetine
B) Aripiprazole
,2|Page
C) Bupropion
D) Trazodone
Rationale: For treatment-resistant depression, augmentation with a
second-generation antipsychotic (e.g., aripiprazole, brexpiprazole,
quetiapine) is FDA-approved and evidence-based. Fluoxetine is
another SSRI and not an augmentation. Bupropion can be added but
is not FDA-approved for augmentation in this context; aripiprazole
has stronger evidence.
3. A 28-year-old woman with bipolar I disorder is euthymic on lithium.
She is planning to become pregnant. Which medication adjustment is
most appropriate?
A) Discontinue lithium immediately
B) Discuss risks and benefits; lithium can be continued with close
monitoring of serum levels and fetal echocardiography
C) Switch to valproate for mood stabilization
D) Add an antipsychotic to replace lithium
Rationale: Lithium is a first-line treatment for bipolar disorder and
can be used in pregnancy, though it carries a small risk of Ebstein‘s
anomaly. Discontinuation greatly increases risk of relapse. Valproate
is contraindicated in pregnancy due to neural tube defects. Shared
decision-making and monitoring are essential.
4. A 20-year-old college student presents with recurrent, unexpected
panic attacks, followed by persistent worry about having another attack.
She avoids the campus gym because she fears a panic attack in that
setting. The most appropriate first-line pharmacotherapy is:
A) Clonazepam 0.5 mg twice daily as needed
B) Sertraline 50 mg daily
C) Propranolol 20 mg before stressful events
D) Hydroxyzine 25 mg every 6 hours as needed
,3|Page
Rationale: Panic disorder is treated with first-line SSRIs (sertraline,
paroxetine, fluoxetine). Benzodiazepines (clonazepam) are effective
but have abuse potential and are not first-line. Propranolol is used for
performance anxiety, not panic disorder. Hydroxyzine may be used for
generalized anxiety but is not first-line for panic.
5. A 55-year-old male with generalized anxiety disorder (GAD) has been
on alprazolam 2 mg daily for 3 years. He reports needing higher doses to
achieve the same effect. He wants to discontinue the medication. The
most appropriate next step is:
A) Abrupt discontinuation with close monitoring
B) Gradual taper over several weeks to months with possible
substitution of a long-acting benzodiazepine (e.g., diazepam)
C) Switch to buspirone without tapering
D) Add hydroxyzine and continue alprazolam
Rationale: Alprazolam is a short-acting benzodiazepine with high
dependence potential. Abrupt withdrawal can cause seizures. A
gradual taper, often using a long-acting benzodiazepine (diazepam), is
the standard of care. Buspirone does not prevent withdrawal.
6. A 34-year-old female with borderline personality disorder presents
with chronic emptiness, unstable relationships, and self-cutting. The
most evidence-based psychotherapy for this condition is:
A) Supportive therapy
B) Dialectical behavior therapy (DBT)
C) Cognitive-behavioral therapy (CBT) for depression
D) Interpersonal therapy (IPT)
Rationale: DBT is the gold standard, evidence-based psychotherapy
for borderline personality disorder, focusing on emotion regulation,
distress tolerance, interpersonal effectiveness, and mindfulness. CBT
and IPT are less specifically targeted.
, 4|Page
7. A 68-year-old male with Parkinson’s disease and major depression is
prescribed paroxetine. Which adverse effect is of particular concern in
this population?
A) Weight gain
B) Worsening of parkinsonism (due to mild extrapyramidal side
effects)
C) Hyponatremia
D) QT prolongation
Rationale: SSRIs, including paroxetine, can cause extrapyramidal
symptoms, which may exacerbate Parkinson’s disease. Paroxetine also
has strong anticholinergic effects. Weight gain and hyponatremia are
concerns but not as specific to Parkinson’s. QT prolongation is more
associated with citalopram.
8. A 26-year-old male with schizophrenia has been stable on risperidone
for 1 year. He now reports new onset of galactorrhea and decreased
libido. Which laboratory test is most appropriate?
A) Thyroid function tests
B) Prolactin level
C) Testosterone level
D) Comprehensive metabolic panel
Rationale: Risperidone is a potent D2 antagonist that frequently
causes hyperprolactinemia, leading to galactorrhea, gynecomastia,
and sexual dysfunction. A prolactin level should be drawn. If elevated,
switching to a prolactin-sparing antipsychotic (e.g., aripiprazole) may
be considered.
9. A 40-year-old female with posttraumatic stress disorder (PTSD) from
a motor vehicle accident reports frequent nightmares and hypervigilance.
She has tried sertraline with partial response. Which medication is
FDA-approved for PTSD and may help with nightmares?
A) Prazosin
B) Paroxetine
