NU 673 Midterm E Complete Exam-Style Questions with Detailed
Rationales EXAM COVERAGE AREAS (MOST FREQUENTLY
TESTED)
Ace your psychiatric-mental health nurse practitioner milestone assessment with this
definitive NU 673 Midterm Exam preparation bank for the academic cycle. This
comprehensive study guide features high-yield, exam-style practice questions paired
with verified answers and explicit clinical rationales tracking the most frequently tested
coverage areas, including DSM-5-TR diagnostic criteria, advanced psychopathology,
neurobiology, and child/adolescent mental health interventions. It is an indispensable
resource for graduate nursing students looking to compress study routines, master
complex clinical case studies, and confidently secure an A+ grade.
1. A 34-year-old female with major depressive disorder has been on sertraline 50
mg daily for 6 weeks with minimal improvement. She reports she is still having
difficulty sleeping, low energy, and poor concentration. What is the most
appropriate next step in her treatment plan?
A. Discontinue sertraline and switch to bupropion
B. Increase sertraline to 100 mg daily
C. Add aripiprazole as an adjunctive treatment
D. Refer for electroconvulsive therapy (ECT)
Rationale: The patient has been on a subtherapeutic dose for only 6 weeks. The initial
response to sertraline at 50 mg is often inadequate; the dose should be titrated upward to
100-200 mg before considering augmentation or switching .
2. A 28-year-old male with schizophrenia is being treated with risperidone. He
reports painful breast enlargement and milk production. What is the most likely
cause of these symptoms?
A. Weight gain from the medication
B. Hyperprolactinemia due to D2 receptor blockade
C. Hypothyroidism
D. Testosterone deficiency
,Rationale: Risperidone causes significant hyperprolactinemia due to potent D2 receptor
blockade in the pituitary. This can lead to gynecomastia and galactorrhea. Prolactin levels
should be monitored and medication may need to be switched .
3. A 45-year-old male with generalized anxiety disorder has been on alprazolam
0.5 mg TID for 6 months. He reports he needs to take more to get the same effect
and feels anxious between doses. What is the most appropriate intervention?
A. Increase the alprazolam dose
B. Taper alprazolam and initiate an SSRI
C. Add buspirone to the alprazolam
D. Continue alprazolam and monitor
Rationale: The patient is showing signs of tolerance and dependence on alprazolam. Long-
term benzodiazepine use is not recommended for GAD. The patient should be tapered off
alprazolam and started on an SSRI for maintenance therapy .
4. A 60-year-old patient with depression and a history of falls is started on an
antidepressant. Which medication should be avoided due to the highest risk of
falls in older adults?
A. Sertraline
B. Trazodone
C. Escitalopram
D. Bupropion
Rationale: Trazodone causes significant sedation and orthostatic hypotension, increasing
fall risk in older adults. SSRIs are generally preferred, though all antidepressants carry
some fall risk .
5. A 25-year-old female with borderline personality disorder presents with severe
emotional dysregulation and self-harm behaviors. What is the most appropriate
first-line psychotherapy for this patient?
A. Cognitive-behavioral therapy (CBT)
,B. Dialectical behavior therapy (DBT)
C. Psychodynamic therapy
D. Interpersonal therapy
Rationale: Dialectical behavior therapy (DBT) is the evidence-based treatment for
borderline personality disorder. It focuses on emotion regulation, distress tolerance, and
interpersonal effectiveness .
6. A PMHNP is evaluating a patient with suspected ADHD. The patient reports
difficulty with focus, organization, and completing tasks. Symptoms began in
childhood but were never formally diagnosed. What is the most important
component of the diagnostic assessment?
A. A single self-report questionnaire
B. A comprehensive history including collateral information from parents or
teachers
C. Neuropsychological testing only
D. An IQ test
Rationale: ADHD diagnosis requires a comprehensive assessment including history of
symptoms in multiple settings (home, school, work) and collateral information from
informants who knew the patient in childhood. Symptom onset must be before age 12 .
7. A patient on clozapine has a WBC of 2,800/mm³ and ANC of 1,200/mm³. What
is the most appropriate action?
A. Continue clozapine with weekly monitoring
B. Hold clozapine and notify the provider immediately
C. Decrease the clozapine dose
D. No action is needed
Rationale: Clozapine should be held if WBC <3,000/mm³ or ANC <1,500/mm³.
Agranulocytosis is a life-threatening complication requiring immediate intervention .
, 8. A 55-year-old female with major depressive disorder is started on bupropion.
She has a history of seizures. What is the most appropriate action?
A. Start bupropion at a low dose
B. Bupropion is contraindicated; choose a different antidepressant
C. Add an anticonvulsant
D. Monitor closely for seizures
Rationale: Bupropion lowers the seizure threshold and is contraindicated in patients with
seizure disorders .
9. A patient with PTSD is experiencing hypervigilance, irritability, and difficulty
concentrating. Which medication is FDA-approved for PTSD?
A. Prazosin
B. Paroxetine
C. Propranolol
D. Quetiapine
Rationale: Paroxetine and sertraline are FDA-approved for PTSD. Prazosin is used off-label
for nightmares. Propranolol is used for performance anxiety .
10. A 32-year-old male with bipolar disorder is currently in a depressive episode.
He is already on lithium. Which antidepressant is most appropriate to add?
A. Fluoxetine as monotherapy
B. Bupropion, with caution for inducing mania
C. Venlafaxine
D. Amitriptyline
Rationale: Antidepressants can induce mania in bipolar patients. Bupropion has a lower
risk of manic switch compared to SSRIs and SNRIs. It should be used cautiously and with a
mood stabilizer .
Rationales EXAM COVERAGE AREAS (MOST FREQUENTLY
TESTED)
Ace your psychiatric-mental health nurse practitioner milestone assessment with this
definitive NU 673 Midterm Exam preparation bank for the academic cycle. This
comprehensive study guide features high-yield, exam-style practice questions paired
with verified answers and explicit clinical rationales tracking the most frequently tested
coverage areas, including DSM-5-TR diagnostic criteria, advanced psychopathology,
neurobiology, and child/adolescent mental health interventions. It is an indispensable
resource for graduate nursing students looking to compress study routines, master
complex clinical case studies, and confidently secure an A+ grade.
1. A 34-year-old female with major depressive disorder has been on sertraline 50
mg daily for 6 weeks with minimal improvement. She reports she is still having
difficulty sleeping, low energy, and poor concentration. What is the most
appropriate next step in her treatment plan?
A. Discontinue sertraline and switch to bupropion
B. Increase sertraline to 100 mg daily
C. Add aripiprazole as an adjunctive treatment
D. Refer for electroconvulsive therapy (ECT)
Rationale: The patient has been on a subtherapeutic dose for only 6 weeks. The initial
response to sertraline at 50 mg is often inadequate; the dose should be titrated upward to
100-200 mg before considering augmentation or switching .
2. A 28-year-old male with schizophrenia is being treated with risperidone. He
reports painful breast enlargement and milk production. What is the most likely
cause of these symptoms?
A. Weight gain from the medication
B. Hyperprolactinemia due to D2 receptor blockade
C. Hypothyroidism
D. Testosterone deficiency
,Rationale: Risperidone causes significant hyperprolactinemia due to potent D2 receptor
blockade in the pituitary. This can lead to gynecomastia and galactorrhea. Prolactin levels
should be monitored and medication may need to be switched .
3. A 45-year-old male with generalized anxiety disorder has been on alprazolam
0.5 mg TID for 6 months. He reports he needs to take more to get the same effect
and feels anxious between doses. What is the most appropriate intervention?
A. Increase the alprazolam dose
B. Taper alprazolam and initiate an SSRI
C. Add buspirone to the alprazolam
D. Continue alprazolam and monitor
Rationale: The patient is showing signs of tolerance and dependence on alprazolam. Long-
term benzodiazepine use is not recommended for GAD. The patient should be tapered off
alprazolam and started on an SSRI for maintenance therapy .
4. A 60-year-old patient with depression and a history of falls is started on an
antidepressant. Which medication should be avoided due to the highest risk of
falls in older adults?
A. Sertraline
B. Trazodone
C. Escitalopram
D. Bupropion
Rationale: Trazodone causes significant sedation and orthostatic hypotension, increasing
fall risk in older adults. SSRIs are generally preferred, though all antidepressants carry
some fall risk .
5. A 25-year-old female with borderline personality disorder presents with severe
emotional dysregulation and self-harm behaviors. What is the most appropriate
first-line psychotherapy for this patient?
A. Cognitive-behavioral therapy (CBT)
,B. Dialectical behavior therapy (DBT)
C. Psychodynamic therapy
D. Interpersonal therapy
Rationale: Dialectical behavior therapy (DBT) is the evidence-based treatment for
borderline personality disorder. It focuses on emotion regulation, distress tolerance, and
interpersonal effectiveness .
6. A PMHNP is evaluating a patient with suspected ADHD. The patient reports
difficulty with focus, organization, and completing tasks. Symptoms began in
childhood but were never formally diagnosed. What is the most important
component of the diagnostic assessment?
A. A single self-report questionnaire
B. A comprehensive history including collateral information from parents or
teachers
C. Neuropsychological testing only
D. An IQ test
Rationale: ADHD diagnosis requires a comprehensive assessment including history of
symptoms in multiple settings (home, school, work) and collateral information from
informants who knew the patient in childhood. Symptom onset must be before age 12 .
7. A patient on clozapine has a WBC of 2,800/mm³ and ANC of 1,200/mm³. What
is the most appropriate action?
A. Continue clozapine with weekly monitoring
B. Hold clozapine and notify the provider immediately
C. Decrease the clozapine dose
D. No action is needed
Rationale: Clozapine should be held if WBC <3,000/mm³ or ANC <1,500/mm³.
Agranulocytosis is a life-threatening complication requiring immediate intervention .
, 8. A 55-year-old female with major depressive disorder is started on bupropion.
She has a history of seizures. What is the most appropriate action?
A. Start bupropion at a low dose
B. Bupropion is contraindicated; choose a different antidepressant
C. Add an anticonvulsant
D. Monitor closely for seizures
Rationale: Bupropion lowers the seizure threshold and is contraindicated in patients with
seizure disorders .
9. A patient with PTSD is experiencing hypervigilance, irritability, and difficulty
concentrating. Which medication is FDA-approved for PTSD?
A. Prazosin
B. Paroxetine
C. Propranolol
D. Quetiapine
Rationale: Paroxetine and sertraline are FDA-approved for PTSD. Prazosin is used off-label
for nightmares. Propranolol is used for performance anxiety .
10. A 32-year-old male with bipolar disorder is currently in a depressive episode.
He is already on lithium. Which antidepressant is most appropriate to add?
A. Fluoxetine as monotherapy
B. Bupropion, with caution for inducing mania
C. Venlafaxine
D. Amitriptyline
Rationale: Antidepressants can induce mania in bipolar patients. Bupropion has a lower
risk of manic switch compared to SSRIs and SNRIs. It should be used cautiously and with a
mood stabilizer .
