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NR 605 Psychiatric Mental Health Midterm Newest
Exam Preparation With Complete Questions And
Correct Answers With Rationales Already Graded
A+Brand New Version!!
Question 1
A 32-year-old female presents with a one-week history of depressed
mood, anhedonia, insomnia, and fatigue. She reports that these
symptoms began shortly after the birth of her first child. Which of the
following best describes the most appropriate initial screening tool for
this patient?
A) Hamilton Depression Rating Scale
B) Edinburgh Postnatal Depression Scale
C) Beck Depression Inventory-II
D) Patient Health Questionnaire-9
Answer: B) Edinburgh Postnatal Depression Scale
Explanation: The Edinburgh Postnatal Depression Scale (EPDS) is
specifically designed for screening perinatal depression. It includes
items that address anxiety and emotional lability common in the
postpartum period. While the PHQ-9, BDI-II, and HAM-D are all
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validated depression scales, the EPDS is the most contextually
appropriate for a postpartum patient due to its focus on perinatal-
specific symptoms such as self-blame and coping difficulties related to
motherhood.
Question 2
A 45-year-old male with a history of alcohol use disorder is started on
naltrexone. What is the primary mechanism of action of naltrexone in
the treatment of alcohol dependence?
A) Partial agonism at the GABA-A receptor
B) Antagonism at the mu-opioid receptor
C) Inhibition of aldehyde dehydrogenase
D) Modulation of glutamate release via NMDA receptor antagonism
Answer: B) Antagonism at the mu-opioid receptor
Explanation: Naltrexone is a competitive antagonist at the mu-opioid
receptor. It reduces the rewarding effects of alcohol by blocking the
endogenous opioid release that contributes to the pleasurable
sensations associated with drinking. Disulfiram (C) inhibits aldehyde
dehydrogenase, while acamprosate (D) modulates glutamate. A is
incorrect because benzodiazepines act on GABA-A receptors.
Question 3
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A 28-year-old woman with bipolar I disorder is prescribed lamotrigine.
She asks about the most serious adverse effect associated with this
medication. You inform her that the risk is:
A) Stevens-Johnson syndrome
B) Weight gain and metabolic syndrome
C) Nephrogenic diabetes insipidus
D) QTc prolongation
Answer: A) Stevens-Johnson syndrome
Explanation: Lamotrigine carries a black-box warning for serious rashes,
including Stevens-Johnson syndrome and toxic epidermal necrolysis. The
risk is increased with rapid titration, concomitant valproate use, and in
pediatric populations. Weight gain is more common with valproate and
atypical antipsychotics. Nephrogenic diabetes insipidus is associated
with lithium, and QTc prolongation is a concern with certain
antipsychotics like ziprasidone.
Question 4
In the context of motivational interviewing, which of the following is an
example of a "change talk" statement?
A) "I know I should quit smoking, but I enjoy it too much."
B) "If I cut down on drinking, my relationship with my kids might
improve."
C) "My doctor thinks I need to lose weight, but I don't see the point."
D) "I tried quitting before and it didn't work."
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Answer: B) "If I cut down on drinking, my relationship with my kids
might improve."
Explanation: Change talk refers to statements made by the patient that
indicate motivation or desire for change. In motivational interviewing,
change talk includes expressions of desire, ability, reasons, need, or
commitment to change. Option B reflects a reason for change
(improved relationships). Options A, C, and D represent sustain talk,
which are arguments against change or ambivalence.
Question 5
A 60-year-old male with major depressive disorder and comorbid
generalized anxiety disorder is started on venlafaxine. Which of the
following is a unique consideration when prescribing this medication?
A) It requires dietary restrictions regarding tyramine.
B) It has a dose-dependent effect on blood pressure.
C) It is contraindicated in patients with hepatic impairment.
D) It must be tapered slowly due to anticholinergic rebound.
Answer: B) It has a dose-dependent effect on blood pressure.
Explanation: Venlafaxine, an SNRI, is known to cause sustained diastolic
hypertension at higher doses (typically above 300 mg/day). Blood
pressure monitoring is recommended. Tyramine restriction applies to
MAOIs (A). Venlafaxine is not contraindicated in hepatic impairment but
requires dose adjustment (C). Anticholinergic rebound is more
characteristic of TCAs and paroxetine (D).
NR 605 Psychiatric Mental Health Midterm Newest
Exam Preparation With Complete Questions And
Correct Answers With Rationales Already Graded
A+Brand New Version!!
Question 1
A 32-year-old female presents with a one-week history of depressed
mood, anhedonia, insomnia, and fatigue. She reports that these
symptoms began shortly after the birth of her first child. Which of the
following best describes the most appropriate initial screening tool for
this patient?
A) Hamilton Depression Rating Scale
B) Edinburgh Postnatal Depression Scale
C) Beck Depression Inventory-II
D) Patient Health Questionnaire-9
Answer: B) Edinburgh Postnatal Depression Scale
Explanation: The Edinburgh Postnatal Depression Scale (EPDS) is
specifically designed for screening perinatal depression. It includes
items that address anxiety and emotional lability common in the
postpartum period. While the PHQ-9, BDI-II, and HAM-D are all
,2|Page
validated depression scales, the EPDS is the most contextually
appropriate for a postpartum patient due to its focus on perinatal-
specific symptoms such as self-blame and coping difficulties related to
motherhood.
Question 2
A 45-year-old male with a history of alcohol use disorder is started on
naltrexone. What is the primary mechanism of action of naltrexone in
the treatment of alcohol dependence?
A) Partial agonism at the GABA-A receptor
B) Antagonism at the mu-opioid receptor
C) Inhibition of aldehyde dehydrogenase
D) Modulation of glutamate release via NMDA receptor antagonism
Answer: B) Antagonism at the mu-opioid receptor
Explanation: Naltrexone is a competitive antagonist at the mu-opioid
receptor. It reduces the rewarding effects of alcohol by blocking the
endogenous opioid release that contributes to the pleasurable
sensations associated with drinking. Disulfiram (C) inhibits aldehyde
dehydrogenase, while acamprosate (D) modulates glutamate. A is
incorrect because benzodiazepines act on GABA-A receptors.
Question 3
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A 28-year-old woman with bipolar I disorder is prescribed lamotrigine.
She asks about the most serious adverse effect associated with this
medication. You inform her that the risk is:
A) Stevens-Johnson syndrome
B) Weight gain and metabolic syndrome
C) Nephrogenic diabetes insipidus
D) QTc prolongation
Answer: A) Stevens-Johnson syndrome
Explanation: Lamotrigine carries a black-box warning for serious rashes,
including Stevens-Johnson syndrome and toxic epidermal necrolysis. The
risk is increased with rapid titration, concomitant valproate use, and in
pediatric populations. Weight gain is more common with valproate and
atypical antipsychotics. Nephrogenic diabetes insipidus is associated
with lithium, and QTc prolongation is a concern with certain
antipsychotics like ziprasidone.
Question 4
In the context of motivational interviewing, which of the following is an
example of a "change talk" statement?
A) "I know I should quit smoking, but I enjoy it too much."
B) "If I cut down on drinking, my relationship with my kids might
improve."
C) "My doctor thinks I need to lose weight, but I don't see the point."
D) "I tried quitting before and it didn't work."
, 4|Page
Answer: B) "If I cut down on drinking, my relationship with my kids
might improve."
Explanation: Change talk refers to statements made by the patient that
indicate motivation or desire for change. In motivational interviewing,
change talk includes expressions of desire, ability, reasons, need, or
commitment to change. Option B reflects a reason for change
(improved relationships). Options A, C, and D represent sustain talk,
which are arguments against change or ambivalence.
Question 5
A 60-year-old male with major depressive disorder and comorbid
generalized anxiety disorder is started on venlafaxine. Which of the
following is a unique consideration when prescribing this medication?
A) It requires dietary restrictions regarding tyramine.
B) It has a dose-dependent effect on blood pressure.
C) It is contraindicated in patients with hepatic impairment.
D) It must be tapered slowly due to anticholinergic rebound.
Answer: B) It has a dose-dependent effect on blood pressure.
Explanation: Venlafaxine, an SNRI, is known to cause sustained diastolic
hypertension at higher doses (typically above 300 mg/day). Blood
pressure monitoring is recommended. Tyramine restriction applies to
MAOIs (A). Venlafaxine is not contraindicated in hepatic impairment but
requires dose adjustment (C). Anticholinergic rebound is more
characteristic of TCAs and paroxetine (D).
