Western Governors University
3 CES · 543D
W
College of Health Professions
EST. 1997
A NEW KIND OF U
WGU D345 Psychopharmacology Section 3
R E CO M M E N D M E D I C AT I O N S FO R M E N TA L H E A LT H — C L I N I C A L S C E N A R I O S
INSTITUTION Western Governors University COURSE CODE D345
PROGRAM PMHNP — Psychopharmacology ACADEMIC YEAR
EXAM TITLE WGU D345 Psychopharmacology TOTAL QUESTIONS 100+ Questions
Section 3
COURSE TITLE Advanced Psychopharmacology FORMAT Multiple Choice — Select the
for the PMHNP Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each clinical scenario.
▸ Anxiety disorders, insomnia, bipolar disorder, depression, ADHD, schizophrenia, dementia, substance
use disorders, and prescribing during pregnancy/lactation are all testable content.
▸ Clinical decision-making, medication selection, adverse effect management, and patient education are
emphasized.
▸ Correct answers and detailed clinical rationales appear below each question for comprehensive OA
preparation.
▸ All content reflects WGU D345 Section 3 competencies and PMHNP board examination standards.
, SECTION III — CLINICAL SCENARIOS: ASSESSMENT,
Questions 1 – 100+
DIAGNOSIS & PHARMACOTHERAPY
1. What is true regarding anxiety disorders?
A. Anxiety disorders never co-occur with major depression
B. Anxiety disorders have symptoms that overlap with major depression, such as sleep
disturbance, fatigue, poor concentration, and psychomotor symptoms
C. Anxiety disorders only present with physical symptoms
D. Anxiety disorders always require benzodiazepine treatment
CORRECT ANSWER B — Anxiety disorders have symptoms that overlap with major depression
RATIONALE Anxiety disorders and major depressive disorder share significant symptom
overlap including sleep disturbance, fatigue, poor concentration, and
psychomotor agitation or retardation. This overlap explains why SSRIs and SNRIs
are first-line treatments for both conditions — they address the shared
neurotransmitter dysfunction (serotonin and norepinephrine). The high
comorbidity rate (approximately 50% of patients with anxiety also have
depression) necessitates comprehensive assessment. Anxiety disorders do NOT
always require benzodiazepines (Choice D) — SSRIs/SNRIs are first-line, with
benzodiazepines reserved for short-term use or acute exacerbations due to
dependence risk. Choice A is incorrect (they frequently co-occur). Choice C is
incorrect (cognitive and emotional symptoms are prominent).
,2. A 56-year-old male patient is diagnosed with schizophrenia and is taking olanzapine 20
mg po qhs. The patient continues to hear voices that agitate him. He has failed adequate
haloperidol, quetiapine, aripiprazole, and risperidone trials. What would be the best
treatment choice for this patient?
A. Increase olanzapine to 30 mg
B. Switch to clozapine (Clozaril)
C. Add fluoxetine to olanzapine
D. Switch to lurasidone
CORRECT ANSWER B — Switch to clozapine (Clozaril)
RATIONALE This patient meets criteria for treatment-resistant schizophrenia — failure of two
or more adequate antipsychotic trials (in this case, haloperidol, quetiapine,
aripiprazole, and risperidone). Clozapine is the only antipsychotic with proven
efficacy for treatment-resistant schizophrenia and is the recommended next step
after two failed trials. It requires REMS monitoring (weekly CBC for 6 months, then
every 2 weeks for 6 months, then monthly) due to agranulocytosis risk. Increasing
olanzapine (Choice A) or switching to lurasidone (Choice D) would be unlikely to
succeed given multiple prior failures. Adding fluoxetine (Choice C) treats
depression, not refractory psychosis. Clozapine also uniquely reduces suicidality
in schizophrenia.
, 3. A patient with bipolar disorder is currently presenting with mixed features. The patient is
noneuphoric and has psychomotor agitation, impulsivity, irritability, racing thoughts, and
depressive symptoms. What should a PMHNP be most concerned about?
A. Weight gain from medications
B. Suicidality — patients with mixed bipolar symptoms have a four times greater risk of a
suicide attempt
C. Development of tardive dyskinesia
D. Metabolic syndrome
CORRECT ANSWER B — Suicidality — patients with mixed bipolar symptoms have a four times
greater risk of a suicide attempt
RATIONALE Mixed features in bipolar disorder — simultaneous presence of manic/hypomanic
symptoms (agitation, impulsivity, racing thoughts) and depressive symptoms —
represent a psychiatric emergency due to dramatically elevated suicide risk. The
combination of depressive despair with manic energy and impulsivity creates a
"perfect storm" for acting on suicidal thoughts. Lithium is the gold standard for
reducing suicidality in bipolar disorder. While weight gain (Choice A), tardive
dyskinesia (Choice C), and metabolic syndrome (Choice D) are important long-
term monitoring concerns, acute suicide risk assessment and prevention take
immediate priority. Any patient with mixed features requires urgent safety
evaluation, possible hospitalization, and aggressive mood stabilization.
3 CES · 543D
W
College of Health Professions
EST. 1997
A NEW KIND OF U
WGU D345 Psychopharmacology Section 3
R E CO M M E N D M E D I C AT I O N S FO R M E N TA L H E A LT H — C L I N I C A L S C E N A R I O S
INSTITUTION Western Governors University COURSE CODE D345
PROGRAM PMHNP — Psychopharmacology ACADEMIC YEAR
EXAM TITLE WGU D345 Psychopharmacology TOTAL QUESTIONS 100+ Questions
Section 3
COURSE TITLE Advanced Psychopharmacology FORMAT Multiple Choice — Select the
for the PMHNP Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each clinical scenario.
▸ Anxiety disorders, insomnia, bipolar disorder, depression, ADHD, schizophrenia, dementia, substance
use disorders, and prescribing during pregnancy/lactation are all testable content.
▸ Clinical decision-making, medication selection, adverse effect management, and patient education are
emphasized.
▸ Correct answers and detailed clinical rationales appear below each question for comprehensive OA
preparation.
▸ All content reflects WGU D345 Section 3 competencies and PMHNP board examination standards.
, SECTION III — CLINICAL SCENARIOS: ASSESSMENT,
Questions 1 – 100+
DIAGNOSIS & PHARMACOTHERAPY
1. What is true regarding anxiety disorders?
A. Anxiety disorders never co-occur with major depression
B. Anxiety disorders have symptoms that overlap with major depression, such as sleep
disturbance, fatigue, poor concentration, and psychomotor symptoms
C. Anxiety disorders only present with physical symptoms
D. Anxiety disorders always require benzodiazepine treatment
CORRECT ANSWER B — Anxiety disorders have symptoms that overlap with major depression
RATIONALE Anxiety disorders and major depressive disorder share significant symptom
overlap including sleep disturbance, fatigue, poor concentration, and
psychomotor agitation or retardation. This overlap explains why SSRIs and SNRIs
are first-line treatments for both conditions — they address the shared
neurotransmitter dysfunction (serotonin and norepinephrine). The high
comorbidity rate (approximately 50% of patients with anxiety also have
depression) necessitates comprehensive assessment. Anxiety disorders do NOT
always require benzodiazepines (Choice D) — SSRIs/SNRIs are first-line, with
benzodiazepines reserved for short-term use or acute exacerbations due to
dependence risk. Choice A is incorrect (they frequently co-occur). Choice C is
incorrect (cognitive and emotional symptoms are prominent).
,2. A 56-year-old male patient is diagnosed with schizophrenia and is taking olanzapine 20
mg po qhs. The patient continues to hear voices that agitate him. He has failed adequate
haloperidol, quetiapine, aripiprazole, and risperidone trials. What would be the best
treatment choice for this patient?
A. Increase olanzapine to 30 mg
B. Switch to clozapine (Clozaril)
C. Add fluoxetine to olanzapine
D. Switch to lurasidone
CORRECT ANSWER B — Switch to clozapine (Clozaril)
RATIONALE This patient meets criteria for treatment-resistant schizophrenia — failure of two
or more adequate antipsychotic trials (in this case, haloperidol, quetiapine,
aripiprazole, and risperidone). Clozapine is the only antipsychotic with proven
efficacy for treatment-resistant schizophrenia and is the recommended next step
after two failed trials. It requires REMS monitoring (weekly CBC for 6 months, then
every 2 weeks for 6 months, then monthly) due to agranulocytosis risk. Increasing
olanzapine (Choice A) or switching to lurasidone (Choice D) would be unlikely to
succeed given multiple prior failures. Adding fluoxetine (Choice C) treats
depression, not refractory psychosis. Clozapine also uniquely reduces suicidality
in schizophrenia.
, 3. A patient with bipolar disorder is currently presenting with mixed features. The patient is
noneuphoric and has psychomotor agitation, impulsivity, irritability, racing thoughts, and
depressive symptoms. What should a PMHNP be most concerned about?
A. Weight gain from medications
B. Suicidality — patients with mixed bipolar symptoms have a four times greater risk of a
suicide attempt
C. Development of tardive dyskinesia
D. Metabolic syndrome
CORRECT ANSWER B — Suicidality — patients with mixed bipolar symptoms have a four times
greater risk of a suicide attempt
RATIONALE Mixed features in bipolar disorder — simultaneous presence of manic/hypomanic
symptoms (agitation, impulsivity, racing thoughts) and depressive symptoms —
represent a psychiatric emergency due to dramatically elevated suicide risk. The
combination of depressive despair with manic energy and impulsivity creates a
"perfect storm" for acting on suicidal thoughts. Lithium is the gold standard for
reducing suicidality in bipolar disorder. While weight gain (Choice A), tardive
dyskinesia (Choice C), and metabolic syndrome (Choice D) are important long-
term monitoring concerns, acute suicide risk assessment and prevention take
immediate priority. Any patient with mixed features requires urgent safety
evaluation, possible hospitalization, and aggressive mood stabilization.
