**Psychiatric-Mental Health NP Surge: 2024
Certification Readiness** (Theme: Psychiatric-
Mental Health Nurse Practitioner Exam 2024)
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1. Pt with bipolar I disorder, acute mania, aggressive, psychotic. First-line pharmacotherapy?
💫RATIONALE✔️✔️: Lithium or valproate plus second-generation antipsychotic (olanzapine,
risperidone).
💫ANSWER✔️✔️: C. Olanzapine + valproate.
---
2. Pt with major depressive disorder, failed 2 SSRIs (sertraline, escitalopram) at adequate doses. Next
step?
💫RATIONALE✔️✔️: Switch to venlafaxine (SNRI) or augment with aripiprazole/bupropion.
💫ANSWER✔️✔️: B. Venlafaxine XR.
---
3. Pt with panic disorder, agoraphobia, on paroxetine 40 mg daily for 8 weeks, partial response. Next?
💫RATIONALE✔️✔️: Increase to 50-60 mg or add CBT; clonazepam for acute symptoms.
💫ANSWER✔️✔️: D. Increase paroxetine to 50 mg.
---
4. Pt with generalized anxiety disorder, on buspirone 15 mg BID for 4 weeks, no improvement. Next?
💫RATIONALE✔️✔️: Increase to 30 mg BID; buspirone takes 4-6 weeks and requires TID dosing.
💫ANSWER✔️✔️: A. Increase to 30 mg BID.
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5. Pt with social anxiety disorder, failed paroxetine and sertraline. Which SNRI is FDA-approved?
💫RATIONALE✔️✔️: Venlafaxine XR 75-225 mg daily is FDA-approved for SAD.
, 💫ANSWER✔️✔️: C. Venlafaxine.
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6. Pt with PTSD, nightmares, hypervigilance, on sertraline 200 mg for 12 weeks, partial response. Which
add-on reduces nightmares?
💫RATIONALE✔️✔️: Prazosin 1-10 mg at bedtime for trauma-related nightmares.
💫ANSWER✔️✔️: B. Prazosin.
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7. Pt with obsessive-compulsive disorder (OCD), on fluoxetine 80 mg daily for 12 weeks, Y-BOCS score 28
(severe). Next?
💫RATIONALE✔️✔️: Add atypical antipsychotic (risperidone, aripiprazole) or switch to clomipramine.
💫ANSWER✔️✔️: D. Add aripiprazole.
---
8. Pt with bulimia nervosa, binge-purge 4x/week, normal weight. First-line pharmacotherapy?
💫RATIONALE✔️✔️: Fluoxetine 60 mg daily reduces binge-purge cycles.
💫ANSWER✔️✔️: A. Fluoxetine 60 mg.
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9. Pt with anorexia nervosa, BMI 16, refeeding started. Which medication augments weight gain?
💫RATIONALE✔️✔️: Olanzapine 2.5-10 mg increases weight and reduces obsessive thoughts.
💫ANSWER✔️✔️: C. Olanzapine.
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10. Pt with ADHD, combined type, on methylphenidate LA 36 mg daily, good response but insomnia.
Next?
💫RATIONALE✔️✔️: Switch to shorter-acting preparation or add guanfacine at night.
💫ANSWER✔️✔️: B. Add guanfacine 1 mg at bedtime.
---
11. Pt with narcolepsy with cataplexy, on modafinil 400 mg for sleepiness, cataplexy persists. Add-on?
💫RATIONALE✔️✔️: Sodium oxybate (Xyrem) or venlafaxine for cataplexy.
💫ANSWER✔️✔️: D. Sodium oxybate.
---
Certification Readiness** (Theme: Psychiatric-
Mental Health Nurse Practitioner Exam 2024)
---
1. Pt with bipolar I disorder, acute mania, aggressive, psychotic. First-line pharmacotherapy?
💫RATIONALE✔️✔️: Lithium or valproate plus second-generation antipsychotic (olanzapine,
risperidone).
💫ANSWER✔️✔️: C. Olanzapine + valproate.
---
2. Pt with major depressive disorder, failed 2 SSRIs (sertraline, escitalopram) at adequate doses. Next
step?
💫RATIONALE✔️✔️: Switch to venlafaxine (SNRI) or augment with aripiprazole/bupropion.
💫ANSWER✔️✔️: B. Venlafaxine XR.
---
3. Pt with panic disorder, agoraphobia, on paroxetine 40 mg daily for 8 weeks, partial response. Next?
💫RATIONALE✔️✔️: Increase to 50-60 mg or add CBT; clonazepam for acute symptoms.
💫ANSWER✔️✔️: D. Increase paroxetine to 50 mg.
---
4. Pt with generalized anxiety disorder, on buspirone 15 mg BID for 4 weeks, no improvement. Next?
💫RATIONALE✔️✔️: Increase to 30 mg BID; buspirone takes 4-6 weeks and requires TID dosing.
💫ANSWER✔️✔️: A. Increase to 30 mg BID.
---
5. Pt with social anxiety disorder, failed paroxetine and sertraline. Which SNRI is FDA-approved?
💫RATIONALE✔️✔️: Venlafaxine XR 75-225 mg daily is FDA-approved for SAD.
, 💫ANSWER✔️✔️: C. Venlafaxine.
---
6. Pt with PTSD, nightmares, hypervigilance, on sertraline 200 mg for 12 weeks, partial response. Which
add-on reduces nightmares?
💫RATIONALE✔️✔️: Prazosin 1-10 mg at bedtime for trauma-related nightmares.
💫ANSWER✔️✔️: B. Prazosin.
---
7. Pt with obsessive-compulsive disorder (OCD), on fluoxetine 80 mg daily for 12 weeks, Y-BOCS score 28
(severe). Next?
💫RATIONALE✔️✔️: Add atypical antipsychotic (risperidone, aripiprazole) or switch to clomipramine.
💫ANSWER✔️✔️: D. Add aripiprazole.
---
8. Pt with bulimia nervosa, binge-purge 4x/week, normal weight. First-line pharmacotherapy?
💫RATIONALE✔️✔️: Fluoxetine 60 mg daily reduces binge-purge cycles.
💫ANSWER✔️✔️: A. Fluoxetine 60 mg.
---
9. Pt with anorexia nervosa, BMI 16, refeeding started. Which medication augments weight gain?
💫RATIONALE✔️✔️: Olanzapine 2.5-10 mg increases weight and reduces obsessive thoughts.
💫ANSWER✔️✔️: C. Olanzapine.
---
10. Pt with ADHD, combined type, on methylphenidate LA 36 mg daily, good response but insomnia.
Next?
💫RATIONALE✔️✔️: Switch to shorter-acting preparation or add guanfacine at night.
💫ANSWER✔️✔️: B. Add guanfacine 1 mg at bedtime.
---
11. Pt with narcolepsy with cataplexy, on modafinil 400 mg for sleepiness, cataplexy persists. Add-on?
💫RATIONALE✔️✔️: Sodium oxybate (Xyrem) or venlafaxine for cataplexy.
💫ANSWER✔️✔️: D. Sodium oxybate.
---
