NRNP 6665 Final 2026/2027 exam Practice 100 Questions
with Verified Answers and Brief Rationales
1. A 45-year-old patient with major depressive disorder has failed trials of sertraline,
fluoxetine, and venlafaxine. The PMHNP is considering treatment options. Which of the
following is the most appropriate next step?
• A. Start bupropion
• B. Start mirtazapine
• C. Augment with aripiprazole
• D. Refer for electroconvulsive therapy (ECT)
Answer: C. Augment with aripiprazole
Rationale: Aripiprazole is FDA-approved for augmentation in treatment-resistant depression.
ECT is generally reserved for severe, refractory cases or when rapid response is needed.
Switching to another antidepressant is less effective than augmentation after two failed trials.
2. A 28-year-old female with bipolar I disorder is currently experiencing a manic episode
with psychotic features. She is prescribed an antipsychotic and a mood stabilizer. Which of
the following medication combinations is most appropriate?
• A. Aripiprazole and lamotrigine
• B. Olanzapine and lithium
• C. Quetiapine and valproic acid
• D. Risperidone and carbamazepine
Answer: B. Olanzapine and lithium
Rationale: Lithium is first-line for acute mania, especially with classic euphoric mania.
Olanzapine has FDA approval for acute mania and provides rapid symptom control. Lamotrigine
is not effective for acute mania. Carbamazepine has significant drug interactions.
3. A 16-year-old patient is brought to the clinic by their parents due to declining grades,
social withdrawal, and irritability. The patient reports feeling sad most of the day, every
day, for the past 3 months. Which of the following screening tools should the PMHNP use?
• A. GAD-7
, • B. PHQ-9
• C. CRAFFT
• D. Vanderbilt
Answer: B. PHQ-9
Rationale: PHQ-9 is a validated screening tool for depression in adolescents and adults. It
assesses the nine DSM criteria for major depressive disorder. The patient's symptoms are
consistent with depression.
4. A 34-year-old patient with generalized anxiety disorder has been on buspirone for 6
weeks with minimal improvement. Which of the following is the most appropriate next
step?
• A. Increase buspirone dose
• B. Add a benzodiazepine
• C. Switch to sertraline
• D. Switch to hydroxyzine
Answer: C. Switch to sertraline
Rationale: SSRIs (sertraline, escitalopram) are first-line for GAD. If buspirone is ineffective
after an adequate trial (4-6 weeks), switching to an SSRI is appropriate. Buspirone has a delayed
onset and may not be effective for all patients.
5. A 52-year-old patient with schizophrenia has been stable on risperidone for 5 years. The
patient reports amenorrhea and galactorrhea. Which of the following is the most likely
cause?
• A. Risperidone-induced hyperprolactinemia
• B. Hypothyroidism
• C. Pregnancy
• D. Menopause
Answer: A. Risperidone-induced hyperprolactinemia
Rationale: Risperidone is associated with significant prolactin elevation due to D2 receptor
blockade in the pituitary. This can cause amenorrhea, galactorrhea, and sexual dysfunction.
Switching to an antipsychotic with lower prolactin elevation (e.g., aripiprazole) should be
considered.
,6. A 7-year-old child is diagnosed with ADHD, predominantly inattentive presentation.
Which of the following is a first-line medication option?
• A. Methylphenidate
• B. Guanfacine
• C. Atomoxetine
• D. Clonidine
Answer: A. Methylphenidate
Rationale: Stimulants (methylphenidate, amphetamines) are first-line for ADHD in children.
Non-stimulants (guanfacine, atomoxetine) are second-line options or adjuncts.
7. A 65-year-old patient with dementia and behavioral disturbances is started on an
antipsychotic. Which of the following is the most important safety consideration?
• A. Weight gain
• B. Sedation
• C. Increased risk of stroke and mortality
• D. Anticholinergic effects
Answer: C. Increased risk of stroke and mortality
Rationale: Antipsychotics carry a black box warning for increased risk of mortality and
cerebrovascular events in elderly patients with dementia-related psychosis. They should be used
at the lowest effective dose and for the shortest duration possible.
8. A 30-year-old patient with panic disorder is prescribed alprazolam. Which of the
following should the PMHNP include in the teaching?
• A. "This medication is safe for long-term daily use."
• B. "You may experience withdrawal if you stop suddenly."
• C. "This medication takes 4-6 weeks to work."
• D. "You should take this medication with food."
Answer: B. "You may experience withdrawal if you stop suddenly."
, Rationale: Alprazolam is a benzodiazepine with dependence potential. Abrupt discontinuation
can cause withdrawal symptoms, including rebound anxiety, insomnia, and seizures. It should be
tapered gradually. Benzodiazepines are not first-line for long-term use.
9. A patient with schizophrenia is experiencing extrapyramidal symptoms (EPS) from
haloperidol. Which of the following medications can be used to treat EPS?
• A. Benztropine
• B. Clozapine
• C. Lorazepam
• D. Fluoxetine
Answer: A. Benztropine
Rationale: Benztropine is an anticholinergic medication used to treat drug-induced
extrapyramidal symptoms, including dystonia and parkinsonism. Clozapine is an antipsychotic.
Lorazepam can be used for akathisia.
10. A 22-year-old patient presents with a first episode of psychosis. The PMHNP orders a
urine toxicology screen. Which of the following substances is most likely to cause
psychosis?
• A. Alcohol
• B. Cannabis
• C. Cocaine
• D. Methamphetamine
Answer: D. Methamphetamine
Rationale: Methamphetamine and other stimulants can cause psychosis with paranoid delusions,
hallucinations, and bizarre behavior. Cannabis can precipitate psychosis in predisposed
individuals but is less likely to be the sole cause.
11. A patient with bipolar disorder is started on valproic acid. Which of the following
laboratory tests should be monitored?
• A. CBC and LFTs
with Verified Answers and Brief Rationales
1. A 45-year-old patient with major depressive disorder has failed trials of sertraline,
fluoxetine, and venlafaxine. The PMHNP is considering treatment options. Which of the
following is the most appropriate next step?
• A. Start bupropion
• B. Start mirtazapine
• C. Augment with aripiprazole
• D. Refer for electroconvulsive therapy (ECT)
Answer: C. Augment with aripiprazole
Rationale: Aripiprazole is FDA-approved for augmentation in treatment-resistant depression.
ECT is generally reserved for severe, refractory cases or when rapid response is needed.
Switching to another antidepressant is less effective than augmentation after two failed trials.
2. A 28-year-old female with bipolar I disorder is currently experiencing a manic episode
with psychotic features. She is prescribed an antipsychotic and a mood stabilizer. Which of
the following medication combinations is most appropriate?
• A. Aripiprazole and lamotrigine
• B. Olanzapine and lithium
• C. Quetiapine and valproic acid
• D. Risperidone and carbamazepine
Answer: B. Olanzapine and lithium
Rationale: Lithium is first-line for acute mania, especially with classic euphoric mania.
Olanzapine has FDA approval for acute mania and provides rapid symptom control. Lamotrigine
is not effective for acute mania. Carbamazepine has significant drug interactions.
3. A 16-year-old patient is brought to the clinic by their parents due to declining grades,
social withdrawal, and irritability. The patient reports feeling sad most of the day, every
day, for the past 3 months. Which of the following screening tools should the PMHNP use?
• A. GAD-7
, • B. PHQ-9
• C. CRAFFT
• D. Vanderbilt
Answer: B. PHQ-9
Rationale: PHQ-9 is a validated screening tool for depression in adolescents and adults. It
assesses the nine DSM criteria for major depressive disorder. The patient's symptoms are
consistent with depression.
4. A 34-year-old patient with generalized anxiety disorder has been on buspirone for 6
weeks with minimal improvement. Which of the following is the most appropriate next
step?
• A. Increase buspirone dose
• B. Add a benzodiazepine
• C. Switch to sertraline
• D. Switch to hydroxyzine
Answer: C. Switch to sertraline
Rationale: SSRIs (sertraline, escitalopram) are first-line for GAD. If buspirone is ineffective
after an adequate trial (4-6 weeks), switching to an SSRI is appropriate. Buspirone has a delayed
onset and may not be effective for all patients.
5. A 52-year-old patient with schizophrenia has been stable on risperidone for 5 years. The
patient reports amenorrhea and galactorrhea. Which of the following is the most likely
cause?
• A. Risperidone-induced hyperprolactinemia
• B. Hypothyroidism
• C. Pregnancy
• D. Menopause
Answer: A. Risperidone-induced hyperprolactinemia
Rationale: Risperidone is associated with significant prolactin elevation due to D2 receptor
blockade in the pituitary. This can cause amenorrhea, galactorrhea, and sexual dysfunction.
Switching to an antipsychotic with lower prolactin elevation (e.g., aripiprazole) should be
considered.
,6. A 7-year-old child is diagnosed with ADHD, predominantly inattentive presentation.
Which of the following is a first-line medication option?
• A. Methylphenidate
• B. Guanfacine
• C. Atomoxetine
• D. Clonidine
Answer: A. Methylphenidate
Rationale: Stimulants (methylphenidate, amphetamines) are first-line for ADHD in children.
Non-stimulants (guanfacine, atomoxetine) are second-line options or adjuncts.
7. A 65-year-old patient with dementia and behavioral disturbances is started on an
antipsychotic. Which of the following is the most important safety consideration?
• A. Weight gain
• B. Sedation
• C. Increased risk of stroke and mortality
• D. Anticholinergic effects
Answer: C. Increased risk of stroke and mortality
Rationale: Antipsychotics carry a black box warning for increased risk of mortality and
cerebrovascular events in elderly patients with dementia-related psychosis. They should be used
at the lowest effective dose and for the shortest duration possible.
8. A 30-year-old patient with panic disorder is prescribed alprazolam. Which of the
following should the PMHNP include in the teaching?
• A. "This medication is safe for long-term daily use."
• B. "You may experience withdrawal if you stop suddenly."
• C. "This medication takes 4-6 weeks to work."
• D. "You should take this medication with food."
Answer: B. "You may experience withdrawal if you stop suddenly."
, Rationale: Alprazolam is a benzodiazepine with dependence potential. Abrupt discontinuation
can cause withdrawal symptoms, including rebound anxiety, insomnia, and seizures. It should be
tapered gradually. Benzodiazepines are not first-line for long-term use.
9. A patient with schizophrenia is experiencing extrapyramidal symptoms (EPS) from
haloperidol. Which of the following medications can be used to treat EPS?
• A. Benztropine
• B. Clozapine
• C. Lorazepam
• D. Fluoxetine
Answer: A. Benztropine
Rationale: Benztropine is an anticholinergic medication used to treat drug-induced
extrapyramidal symptoms, including dystonia and parkinsonism. Clozapine is an antipsychotic.
Lorazepam can be used for akathisia.
10. A 22-year-old patient presents with a first episode of psychosis. The PMHNP orders a
urine toxicology screen. Which of the following substances is most likely to cause
psychosis?
• A. Alcohol
• B. Cannabis
• C. Cocaine
• D. Methamphetamine
Answer: D. Methamphetamine
Rationale: Methamphetamine and other stimulants can cause psychosis with paranoid delusions,
hallucinations, and bizarre behavior. Cannabis can precipitate psychosis in predisposed
individuals but is less likely to be the sole cause.
11. A patient with bipolar disorder is started on valproic acid. Which of the following
laboratory tests should be monitored?
• A. CBC and LFTs
