NRNP 6675 EXAM ACTUAL 300 TEST BANK QUESTIONS AND
CORRECT VERIFIED QUESTIONS WITH RATIONALE
ALREADY GRADED A+ NEW!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
This comprehensive question bank contains 300 unique, designed specifically
for the NRNP 6675 (Psychiatric Mental Health Nurse Practitioner Care
Across the Lifespan II) exam. The content spans five major domains:
advanced psychopharmacology and medical monitoring, psychiatric disorders
and diagnosis, emergency psychiatry and crisis intervention, professional
practice and ethics, and advanced clinical topics. Each question includes a
correct answer and a detailed rationale explaining the clinical reasoning. The
questions are structured to test both foundational knowledge and clinical
application, preparing students for the depth and breadth of the PMHNP
certification examination.
Domain 1: Advanced Psychopharmacology and Medical Monitoring
1. Which medication is considered first-line pharmacotherapy for Generalized
Anxiety Disorder (GAD)?
A) Lorazepam
B) Sertraline
C) Haloperidol
D) Buspirone
Answer: B) Sertraline
Rationale: Sertraline, a selective serotonin reuptake inhibitor (SSRI), is a first-line
treatment for GAD due to its established efficacy in reducing anxiety symptoms
and favorable side effect profile per APA guidelines. Lorazepam is effective for
acute anxiety but carries significant dependence risks and is not recommended as
first-line monotherapy. Haloperidol is an antipsychotic with no indication for
GAD. Buspirone is a second-line option; although it lacks dependence risk, its
delayed onset and variable efficacy make it less preferred as initial therapy. SSRIs
remain the gold standard for chronic anxiety management.
,2. A patient on fluoxetine reports sexual dysfunction. What is the most appropriate
next step?
A) Increase the dose to overcome the side effect
B) Switch to a different SSRI
C) Add bupropion
D) Discontinue fluoxetine abruptly
Answer: C) Add bupropion
Rationale: Sexual dysfunction is a common SSRI side effect affecting up to 70% of
patients. Bupropion, which has low sexual side effect potential, can be added to
augment treatment and mitigate this issue. Abrupt discontinuation of fluoxetine
risks withdrawal symptoms (dizziness, nausea, anxiety) due to its moderate half-
life. Switching to another SSRI may not resolve the issue, as sexual dysfunction is
a class effect. Dose increases typically worsen rather than improve sexual side
effects.
3. Which laboratory test is required before initiating lithium therapy?
A) Complete blood count (CBC)
B) Thyroid function tests
C) Liver function tests
D) Fasting glucose
Answer: B) Thyroid function tests
Rationale: Lithium can cause hypothyroidism in up to 20% of patients, making
baseline thyroid function tests (TSH, free T4) essential before initiation, along with
renal function tests (BUN, creatinine). The APA guidelines mandate this
monitoring to establish baseline values and detect lithium-induced thyroid
dysfunction early. CBC may be relevant for other medications but is not lithium-
specific. Liver function testing is required for valproate, not lithium. Fasting
glucose is relevant for antipsychotic metabolic monitoring.
4. A patient on clozapine develops fever and sore throat. What is the priority
action?
A) Continue clozapine and monitor symptoms
B) Order a white blood cell (WBC) count immediately
C) Switch to risperidone
D) Administer antibiotics empirically
Answer: B) Order a white blood cell (WBC) count immediately
Rationale: Fever and sore throat in a patient on clozapine are warning signs of
possible agranulocytosis, a life-threatening side effect affecting 1-2% of patients.
Immediate WBC count monitoring is critical to assess for neutropenia (absolute
neutrophil count <500/mm³) per FDA-mandated monitoring guidelines. Clozapine
,should be held pending results. Empirical antibiotics without confirming infection
are inappropriate. Switching antipsychotics may be necessary but only after ruling
out agranulocytosis.
5. Which medication is contraindicated in a patient with a history of seizures?
A) Sertraline
B) Bupropion
C) Lithium
D) Olanzapine
Answer: B) Bupropion
Rationale: Bupropion lowers the seizure threshold in a dose-dependent manner,
with seizure incidence of 0.4% at doses ≤300 mg/day but up to 5% at higher doses.
It is contraindicated in patients with seizure disorders, as well as those with eating
disorders or on concurrent medications that lower seizure threshold. Sertraline,
lithium, and olanzapine have lower seizure risk profiles; lithium may actually have
anticonvulsant properties in some patients.
6. What is a common side effect of risperidone in male patients?
A) Hypoglycemia
B) Gynecomastia
C) Hypertension
D) Insomnia
Answer: B) Gynecomastia
Rationale: Risperidone, an atypical antipsychotic, can increase prolactin levels due
to potent D2 receptor antagonism in the pituitary, leading to hyperprolactinemia.
This manifests as gynecomastia, galactorrhea, and sexual dysfunction in males.
The risk is higher with risperidone and paliperidone compared to other atypical
antipsychotics like aripiprazole. Hypoglycemia is associated with some
antipsychotics (clozapine, olanzapine) but not primarily risperidone. Hypertension
is not characteristic; risperidone may cause orthostatic hypotension.
7. A patient with bipolar disorder is prescribed valproate. What is a key monitoring
parameter?
A) Blood glucose
B) Liver function tests
C) Thyroid function
D) Electrolytes
Answer: B) Liver function tests
Rationale: Valproate can cause hepatotoxicity, necessitating regular liver function
test monitoring (AST, ALT, bilirubin) to detect potential liver injury, per APA
, guidelines. Risk is highest in children under 2, patients with mitochondrial
disorders, and those on multiple anticonvulsants. Baseline and periodic liver
function monitoring is standard of care. Blood glucose monitoring is relevant for
antipsychotics. Thyroid function is relevant for lithium. Electrolytes may be
relevant for other agents but not specifically valproate.
8. Which medication is first-line for alcohol withdrawal management?
A) Fluoxetine
B) Lorazepam
C) Risperidone
D) Lithium
Answer: B) Lorazepam
Rationale: Benzodiazepines like lorazepam are the gold standard for alcohol
withdrawal management to prevent seizures and manage autonomic symptoms
(agitation, tachycardia, hypertension). Lorazepam is preferred due to its
intermediate half-life, lack of active metabolites, and safety in hepatic impairment.
Fluoxetine has no role in acute withdrawal. Risperidone might treat agitation but
does not prevent seizures. Lithium has no indication for withdrawal.
9. A patient on aripiprazole reports restlessness and inability to sit still. This side
effect is known as:
A) Tardive dyskinesia
B) Akathisia
C) Dystonia
D) Parkinsonism
Answer: B) Akathisia
Rationale: Akathisia is characterized by subjective restlessness and objective motor
agitation, including inability to sit still, pacing, and rocking. It is a common
extrapyramidal symptom associated with antipsychotics, particularly high-potency
agents and aripiprazole due to its partial D2 agonism. Onset typically occurs within
days to weeks of initiating treatment or dose increases. Tardive dyskinesia involves
involuntary choreiform movements (face, mouth, tongue) appearing after months
to years. Dystonia involves sustained muscle contractions. Parkinsonism features
bradykinesia, rigidity, and tremor.
10. The half-life of lithium is approximately:
A) 24 hours
B) 12 hours
C) 36 hours
D) 48 hours
CORRECT VERIFIED QUESTIONS WITH RATIONALE
ALREADY GRADED A+ NEW!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
This comprehensive question bank contains 300 unique, designed specifically
for the NRNP 6675 (Psychiatric Mental Health Nurse Practitioner Care
Across the Lifespan II) exam. The content spans five major domains:
advanced psychopharmacology and medical monitoring, psychiatric disorders
and diagnosis, emergency psychiatry and crisis intervention, professional
practice and ethics, and advanced clinical topics. Each question includes a
correct answer and a detailed rationale explaining the clinical reasoning. The
questions are structured to test both foundational knowledge and clinical
application, preparing students for the depth and breadth of the PMHNP
certification examination.
Domain 1: Advanced Psychopharmacology and Medical Monitoring
1. Which medication is considered first-line pharmacotherapy for Generalized
Anxiety Disorder (GAD)?
A) Lorazepam
B) Sertraline
C) Haloperidol
D) Buspirone
Answer: B) Sertraline
Rationale: Sertraline, a selective serotonin reuptake inhibitor (SSRI), is a first-line
treatment for GAD due to its established efficacy in reducing anxiety symptoms
and favorable side effect profile per APA guidelines. Lorazepam is effective for
acute anxiety but carries significant dependence risks and is not recommended as
first-line monotherapy. Haloperidol is an antipsychotic with no indication for
GAD. Buspirone is a second-line option; although it lacks dependence risk, its
delayed onset and variable efficacy make it less preferred as initial therapy. SSRIs
remain the gold standard for chronic anxiety management.
,2. A patient on fluoxetine reports sexual dysfunction. What is the most appropriate
next step?
A) Increase the dose to overcome the side effect
B) Switch to a different SSRI
C) Add bupropion
D) Discontinue fluoxetine abruptly
Answer: C) Add bupropion
Rationale: Sexual dysfunction is a common SSRI side effect affecting up to 70% of
patients. Bupropion, which has low sexual side effect potential, can be added to
augment treatment and mitigate this issue. Abrupt discontinuation of fluoxetine
risks withdrawal symptoms (dizziness, nausea, anxiety) due to its moderate half-
life. Switching to another SSRI may not resolve the issue, as sexual dysfunction is
a class effect. Dose increases typically worsen rather than improve sexual side
effects.
3. Which laboratory test is required before initiating lithium therapy?
A) Complete blood count (CBC)
B) Thyroid function tests
C) Liver function tests
D) Fasting glucose
Answer: B) Thyroid function tests
Rationale: Lithium can cause hypothyroidism in up to 20% of patients, making
baseline thyroid function tests (TSH, free T4) essential before initiation, along with
renal function tests (BUN, creatinine). The APA guidelines mandate this
monitoring to establish baseline values and detect lithium-induced thyroid
dysfunction early. CBC may be relevant for other medications but is not lithium-
specific. Liver function testing is required for valproate, not lithium. Fasting
glucose is relevant for antipsychotic metabolic monitoring.
4. A patient on clozapine develops fever and sore throat. What is the priority
action?
A) Continue clozapine and monitor symptoms
B) Order a white blood cell (WBC) count immediately
C) Switch to risperidone
D) Administer antibiotics empirically
Answer: B) Order a white blood cell (WBC) count immediately
Rationale: Fever and sore throat in a patient on clozapine are warning signs of
possible agranulocytosis, a life-threatening side effect affecting 1-2% of patients.
Immediate WBC count monitoring is critical to assess for neutropenia (absolute
neutrophil count <500/mm³) per FDA-mandated monitoring guidelines. Clozapine
,should be held pending results. Empirical antibiotics without confirming infection
are inappropriate. Switching antipsychotics may be necessary but only after ruling
out agranulocytosis.
5. Which medication is contraindicated in a patient with a history of seizures?
A) Sertraline
B) Bupropion
C) Lithium
D) Olanzapine
Answer: B) Bupropion
Rationale: Bupropion lowers the seizure threshold in a dose-dependent manner,
with seizure incidence of 0.4% at doses ≤300 mg/day but up to 5% at higher doses.
It is contraindicated in patients with seizure disorders, as well as those with eating
disorders or on concurrent medications that lower seizure threshold. Sertraline,
lithium, and olanzapine have lower seizure risk profiles; lithium may actually have
anticonvulsant properties in some patients.
6. What is a common side effect of risperidone in male patients?
A) Hypoglycemia
B) Gynecomastia
C) Hypertension
D) Insomnia
Answer: B) Gynecomastia
Rationale: Risperidone, an atypical antipsychotic, can increase prolactin levels due
to potent D2 receptor antagonism in the pituitary, leading to hyperprolactinemia.
This manifests as gynecomastia, galactorrhea, and sexual dysfunction in males.
The risk is higher with risperidone and paliperidone compared to other atypical
antipsychotics like aripiprazole. Hypoglycemia is associated with some
antipsychotics (clozapine, olanzapine) but not primarily risperidone. Hypertension
is not characteristic; risperidone may cause orthostatic hypotension.
7. A patient with bipolar disorder is prescribed valproate. What is a key monitoring
parameter?
A) Blood glucose
B) Liver function tests
C) Thyroid function
D) Electrolytes
Answer: B) Liver function tests
Rationale: Valproate can cause hepatotoxicity, necessitating regular liver function
test monitoring (AST, ALT, bilirubin) to detect potential liver injury, per APA
, guidelines. Risk is highest in children under 2, patients with mitochondrial
disorders, and those on multiple anticonvulsants. Baseline and periodic liver
function monitoring is standard of care. Blood glucose monitoring is relevant for
antipsychotics. Thyroid function is relevant for lithium. Electrolytes may be
relevant for other agents but not specifically valproate.
8. Which medication is first-line for alcohol withdrawal management?
A) Fluoxetine
B) Lorazepam
C) Risperidone
D) Lithium
Answer: B) Lorazepam
Rationale: Benzodiazepines like lorazepam are the gold standard for alcohol
withdrawal management to prevent seizures and manage autonomic symptoms
(agitation, tachycardia, hypertension). Lorazepam is preferred due to its
intermediate half-life, lack of active metabolites, and safety in hepatic impairment.
Fluoxetine has no role in acute withdrawal. Risperidone might treat agitation but
does not prevent seizures. Lithium has no indication for withdrawal.
9. A patient on aripiprazole reports restlessness and inability to sit still. This side
effect is known as:
A) Tardive dyskinesia
B) Akathisia
C) Dystonia
D) Parkinsonism
Answer: B) Akathisia
Rationale: Akathisia is characterized by subjective restlessness and objective motor
agitation, including inability to sit still, pacing, and rocking. It is a common
extrapyramidal symptom associated with antipsychotics, particularly high-potency
agents and aripiprazole due to its partial D2 agonism. Onset typically occurs within
days to weeks of initiating treatment or dose increases. Tardive dyskinesia involves
involuntary choreiform movements (face, mouth, tongue) appearing after months
to years. Dystonia involves sustained muscle contractions. Parkinsonism features
bradykinesia, rigidity, and tremor.
10. The half-life of lithium is approximately:
A) 24 hours
B) 12 hours
C) 36 hours
D) 48 hours
