NRNP 6665
Week 11 Final Exam
PMHNP Care Across the Lifespan I
Actual Questions & Answers
,1. A PMHNP is selecting a first-line SSRI for a 28-year-old client with
major depressive disorder and no other medical history. Which
mechanism of action best describes SSRIs?
A. Blockade of dopamine reuptake in the mesolimbic pathway
B. Selective inhibition of serotonin reuptake at the presynaptic neuron,
increasing synaptic serotonin availability
C. Antagonism of NMDA glutamate receptors
D. Inhibition of monoamine oxidase enzyme activity
Answer: B. Selective inhibition of serotonin reuptake at the presynaptic
neuron, increasing synaptic serotonin availability
Rationale: SSRIs work by selectively blocking the serotonin transporter
(SERT) on the presynaptic neuron, preventing reuptake of serotonin and
increasing its availability in the synaptic cleft, which over time leads to
receptor downregulation and antidepressant effect.
2. A client taking fluoxetine for 3 weeks reports agitation, diaphoresis,
tremor, and diarrhea after starting an over-the-counter St. John's Wort
supplement. The PMHNP suspects:
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Discontinuation syndrome
D. Anticholinergic toxicity
Answer: B. Serotonin syndrome
Rationale: St. John's Wort has serotonergic activity, and combining it with an
SSRI can precipitate serotonin syndrome, presenting with autonomic
instability, neuromuscular abnormalities (tremor, clonus), and altered mental
status. This is a medical emergency requiring discontinuation of serotonergic
agents.
,3. A PMHNP prescribes lithium for a client with bipolar I disorder. Which
baseline laboratory test is essential before initiating therapy?
A. Liver function tests only
B. Renal function (BUN/creatinine) and thyroid function tests
C. Complete blood count only
D. Lipid panel only
Answer: B. Renal function (BUN/creatinine) and thyroid function tests
Rationale: Lithium is renally excreted and can cause both nephrogenic
diabetes insipidus and hypothyroidism with long-term use, so baseline and
periodic monitoring of renal and thyroid function is essential throughout
treatment.
4. A client on clozapine presents with sore throat, fever, and malaise.
The PMHNP's priority action is to:
A. Reassure the client this is a common, benign side effect
B. Order a STAT absolute neutrophil count (ANC) and hold the medication
pending results
C. Increase the clozapine dose to manage symptoms
D. Refer to dentistry for the sore throat
Answer: B. Order a STAT absolute neutrophil count (ANC) and hold the
medication pending results
Rationale: Sore throat and fever in a client on clozapine are red-flag
symptoms for agranulocytosis. An immediate ANC must be obtained, and the
medication should be held until results confirm the neutrophil count is not
critically low.
, 5. A PMHNP is starting a client on bupropion for depression. Which
client history is a contraindication?
A. History of hypertension, well-controlled
B. History of seizure disorder or eating disorder with purging behaviors
C. History of tension headaches
D. History of mild seasonal allergies
Answer: B. History of seizure disorder or eating disorder with purging
behaviors
Rationale: Bupropion lowers the seizure threshold and is contraindicated in
clients with a seizure disorder or a current/prior diagnosis of anorexia or
bulimia nervosa due to electrolyte disturbances from purging that further
increase seizure risk.
6. A client taking a monoamine oxidase inhibitor (MAOI) is being
switched to an SSRI. What is the required washout period between
discontinuing the MAOI and starting the SSRI?
A. 24 hours
B. At least 14 days
C. 48 hours
D. No washout period needed
Answer: B. At least 14 days
Rationale: A minimum 14-day washout period is required after discontinuing
an MAOI before starting an SSRI (and vice versa, with fluoxetine requiring an
even longer washout due to its long half-life) to prevent life-threatening
serotonin syndrome.
Week 11 Final Exam
PMHNP Care Across the Lifespan I
Actual Questions & Answers
,1. A PMHNP is selecting a first-line SSRI for a 28-year-old client with
major depressive disorder and no other medical history. Which
mechanism of action best describes SSRIs?
A. Blockade of dopamine reuptake in the mesolimbic pathway
B. Selective inhibition of serotonin reuptake at the presynaptic neuron,
increasing synaptic serotonin availability
C. Antagonism of NMDA glutamate receptors
D. Inhibition of monoamine oxidase enzyme activity
Answer: B. Selective inhibition of serotonin reuptake at the presynaptic
neuron, increasing synaptic serotonin availability
Rationale: SSRIs work by selectively blocking the serotonin transporter
(SERT) on the presynaptic neuron, preventing reuptake of serotonin and
increasing its availability in the synaptic cleft, which over time leads to
receptor downregulation and antidepressant effect.
2. A client taking fluoxetine for 3 weeks reports agitation, diaphoresis,
tremor, and diarrhea after starting an over-the-counter St. John's Wort
supplement. The PMHNP suspects:
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Discontinuation syndrome
D. Anticholinergic toxicity
Answer: B. Serotonin syndrome
Rationale: St. John's Wort has serotonergic activity, and combining it with an
SSRI can precipitate serotonin syndrome, presenting with autonomic
instability, neuromuscular abnormalities (tremor, clonus), and altered mental
status. This is a medical emergency requiring discontinuation of serotonergic
agents.
,3. A PMHNP prescribes lithium for a client with bipolar I disorder. Which
baseline laboratory test is essential before initiating therapy?
A. Liver function tests only
B. Renal function (BUN/creatinine) and thyroid function tests
C. Complete blood count only
D. Lipid panel only
Answer: B. Renal function (BUN/creatinine) and thyroid function tests
Rationale: Lithium is renally excreted and can cause both nephrogenic
diabetes insipidus and hypothyroidism with long-term use, so baseline and
periodic monitoring of renal and thyroid function is essential throughout
treatment.
4. A client on clozapine presents with sore throat, fever, and malaise.
The PMHNP's priority action is to:
A. Reassure the client this is a common, benign side effect
B. Order a STAT absolute neutrophil count (ANC) and hold the medication
pending results
C. Increase the clozapine dose to manage symptoms
D. Refer to dentistry for the sore throat
Answer: B. Order a STAT absolute neutrophil count (ANC) and hold the
medication pending results
Rationale: Sore throat and fever in a client on clozapine are red-flag
symptoms for agranulocytosis. An immediate ANC must be obtained, and the
medication should be held until results confirm the neutrophil count is not
critically low.
, 5. A PMHNP is starting a client on bupropion for depression. Which
client history is a contraindication?
A. History of hypertension, well-controlled
B. History of seizure disorder or eating disorder with purging behaviors
C. History of tension headaches
D. History of mild seasonal allergies
Answer: B. History of seizure disorder or eating disorder with purging
behaviors
Rationale: Bupropion lowers the seizure threshold and is contraindicated in
clients with a seizure disorder or a current/prior diagnosis of anorexia or
bulimia nervosa due to electrolyte disturbances from purging that further
increase seizure risk.
6. A client taking a monoamine oxidase inhibitor (MAOI) is being
switched to an SSRI. What is the required washout period between
discontinuing the MAOI and starting the SSRI?
A. 24 hours
B. At least 14 days
C. 48 hours
D. No washout period needed
Answer: B. At least 14 days
Rationale: A minimum 14-day washout period is required after discontinuing
an MAOI before starting an SSRI (and vice versa, with fluoxetine requiring an
even longer washout due to its long half-life) to prevent life-threatening
serotonin syndrome.
