NU 673 Midterm Exam 2026 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 2026/2027 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 32-year-old female presents with symptoms of depression that began
approximately 3 weeks after the birth of her first child. She reports feeling
overwhelmed, having difficulty sleeping even when the baby sleeps, and
experiencing intrusive thoughts about harming the baby. What is the most
appropriate initial action for the PMHNP?
A. Prescribe sertraline and schedule a follow-up in 4 weeks
B. Recommend increased social support and sleep hygiene
C. Conduct a thorough risk assessment for harm to self or infant
D. Reassure the patient that postpartum mood changes are normal
Rationale: Postpartum depression with intrusive thoughts of harming the infant requires
immediate risk assessment to ensure patient and infant safety. This is a psychiatric
emergency that takes priority over other interventions .
2. A 45-year-old male with a history of alcohol use disorder is 48 hours into
withdrawal. He is diaphoretic, tremulous, and has a heart rate of 115 bpm. He
reports seeing "bugs crawling on the walls." What is the most appropriate
diagnosis and intervention?
,A. Alcohol intoxication; administer thiamine
B. Delirium tremens; administer benzodiazepines and transfer to ICU
C. Wernicke encephalopathy; administer IV fluids
D. Korsakoff syndrome; initiate haloperidol
Rationale: Delirium tremens is characterized by autonomic instability (tachycardia,
diaphoresis), tremors, and hallucinations. It is a medical emergency requiring
benzodiazepines and ICU-level care. Thiamine is given prophylactically but does not treat
DTs .
3. A PMHNP is evaluating a 28-year-old female with a history of bipolar I disorder
who is currently euthymic on lithium. She reports she is planning to become
pregnant. Which of the following is the most appropriate recommendation
regarding her medication?
A. Discontinue lithium immediately due to teratogenic risks
B. Discuss risks and benefits of lithium continuation during pregnancy
C. Switch to valproic acid, which is safer in pregnancy
D. Discontinue all psychiatric medications during pregnancy
Rationale: Lithium has risks in pregnancy (Ebstein's anomaly) but discontinuing it
increases the risk of mood episodes. The decision should involve a risk-benefit discussion.
Valproic acid has higher teratogenic risks than lithium and should be avoided .
4. A 55-year-old male with major depressive disorder has failed two SSRI trials. He
is now started on venlafaxine. Which side effect is most important to monitor in
this patient?
A. Weight gain
B. Hypertension
C. Sedation
D. Sexual dysfunction
Rationale: Venlafaxine (SNRI) can cause dose-dependent hypertension. Blood pressure
should be monitored at baseline and regularly during treatment .
,5. A 22-year-old female presents with acute onset of confusion, fever, and muscle
rigidity. She was recently started on fluoxetine and had taken an over-the-counter
cold medication containing dextromethorphan. What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Malignant hyperthermia
D. Anticholinergic delirium
Rationale: Serotonin syndrome is caused by excessive serotonergic activity, often from
combining SSRIs with other serotonergic agents (dextromethorphan). Symptoms include
confusion, fever, muscle rigidity, and autonomic instability. Neuroleptic malignant
syndrome is caused by antipsychotics .
6. A 60-year-old patient with Parkinson's disease is experiencing hallucinations
and paranoia. Which antipsychotic is the safest choice for this patient?
A. Haloperidol
B. Quetiapine
C. Risperidone
D. Olanzapine
Rationale: Quetiapine has the lowest risk of extrapyramidal symptoms (EPS) among
atypical antipsychotics, making it the safest choice for Parkinson's patients. Haloperidol
(typical antipsychotic) has a high risk of EPS .
7. A PMHNP is treating a 16-year-old male with major depressive disorder. The
patient reports suicidal ideation with no plan. What is the most appropriate initial
intervention?
A. Hospitalize the patient immediately
B. Conduct a thorough suicide risk assessment and develop a safety plan
C. Prescribe fluoxetine and schedule weekly follow-up
D. Notify the parents and recommend outpatient therapy
Rationale: Suicidal ideation without plan requires a thorough risk assessment and safety
planning. Hospitalization may be needed if risk is high, but the first step is assessment.
SSRIs can be initiated, but safety comes first .
, 8. A 40-year-old female with generalized anxiety disorder is started on buspirone.
Which statement accurately describes the onset of action for this medication?
A. It provides immediate relief of anxiety symptoms
B. It takes 2-4 weeks to achieve therapeutic effect
C. It works within 24-48 hours
D. It is effective only for acute panic attacks
Rationale: Buspirone has a delayed onset of action, typically 2-4 weeks. It is not effective
for acute anxiety and is not a benzodiazepine .
9. A patient with schizophrenia is started on clozapine. Which monitoring schedule
is required for this medication?
A. Weekly CBC for the first 6 months, then biweekly
B. Weekly ANC for the first 6 months, then biweekly for 6 months, then monthly
C. Monthly LFTs only
D. No monitoring is required
Rationale: Clozapine requires mandatory monitoring of Absolute Neutrophil Count (ANC)
due to risk of agranulocytosis. The schedule is weekly for 6 months, biweekly for 6 months,
then monthly .
10. A 25-year-old male with bipolar disorder is in a manic episode. He is prescribed
valproic acid. What baseline laboratory tests should be obtained before starting
this medication?
A. Serum lithium level
B. Liver function tests (LFTs) and complete blood count (CBC)
C. Thyroid function tests
D. Renal function tests
Rationale: Valproic acid can cause hepatotoxicity and thrombocytopenia. Baseline LFTs
and CBC are required. Serum levels are also monitored during treatment .
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 2026/2027 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 32-year-old female presents with symptoms of depression that began
approximately 3 weeks after the birth of her first child. She reports feeling
overwhelmed, having difficulty sleeping even when the baby sleeps, and
experiencing intrusive thoughts about harming the baby. What is the most
appropriate initial action for the PMHNP?
A. Prescribe sertraline and schedule a follow-up in 4 weeks
B. Recommend increased social support and sleep hygiene
C. Conduct a thorough risk assessment for harm to self or infant
D. Reassure the patient that postpartum mood changes are normal
Rationale: Postpartum depression with intrusive thoughts of harming the infant requires
immediate risk assessment to ensure patient and infant safety. This is a psychiatric
emergency that takes priority over other interventions .
2. A 45-year-old male with a history of alcohol use disorder is 48 hours into
withdrawal. He is diaphoretic, tremulous, and has a heart rate of 115 bpm. He
reports seeing "bugs crawling on the walls." What is the most appropriate
diagnosis and intervention?
,A. Alcohol intoxication; administer thiamine
B. Delirium tremens; administer benzodiazepines and transfer to ICU
C. Wernicke encephalopathy; administer IV fluids
D. Korsakoff syndrome; initiate haloperidol
Rationale: Delirium tremens is characterized by autonomic instability (tachycardia,
diaphoresis), tremors, and hallucinations. It is a medical emergency requiring
benzodiazepines and ICU-level care. Thiamine is given prophylactically but does not treat
DTs .
3. A PMHNP is evaluating a 28-year-old female with a history of bipolar I disorder
who is currently euthymic on lithium. She reports she is planning to become
pregnant. Which of the following is the most appropriate recommendation
regarding her medication?
A. Discontinue lithium immediately due to teratogenic risks
B. Discuss risks and benefits of lithium continuation during pregnancy
C. Switch to valproic acid, which is safer in pregnancy
D. Discontinue all psychiatric medications during pregnancy
Rationale: Lithium has risks in pregnancy (Ebstein's anomaly) but discontinuing it
increases the risk of mood episodes. The decision should involve a risk-benefit discussion.
Valproic acid has higher teratogenic risks than lithium and should be avoided .
4. A 55-year-old male with major depressive disorder has failed two SSRI trials. He
is now started on venlafaxine. Which side effect is most important to monitor in
this patient?
A. Weight gain
B. Hypertension
C. Sedation
D. Sexual dysfunction
Rationale: Venlafaxine (SNRI) can cause dose-dependent hypertension. Blood pressure
should be monitored at baseline and regularly during treatment .
,5. A 22-year-old female presents with acute onset of confusion, fever, and muscle
rigidity. She was recently started on fluoxetine and had taken an over-the-counter
cold medication containing dextromethorphan. What is the most likely diagnosis?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. Malignant hyperthermia
D. Anticholinergic delirium
Rationale: Serotonin syndrome is caused by excessive serotonergic activity, often from
combining SSRIs with other serotonergic agents (dextromethorphan). Symptoms include
confusion, fever, muscle rigidity, and autonomic instability. Neuroleptic malignant
syndrome is caused by antipsychotics .
6. A 60-year-old patient with Parkinson's disease is experiencing hallucinations
and paranoia. Which antipsychotic is the safest choice for this patient?
A. Haloperidol
B. Quetiapine
C. Risperidone
D. Olanzapine
Rationale: Quetiapine has the lowest risk of extrapyramidal symptoms (EPS) among
atypical antipsychotics, making it the safest choice for Parkinson's patients. Haloperidol
(typical antipsychotic) has a high risk of EPS .
7. A PMHNP is treating a 16-year-old male with major depressive disorder. The
patient reports suicidal ideation with no plan. What is the most appropriate initial
intervention?
A. Hospitalize the patient immediately
B. Conduct a thorough suicide risk assessment and develop a safety plan
C. Prescribe fluoxetine and schedule weekly follow-up
D. Notify the parents and recommend outpatient therapy
Rationale: Suicidal ideation without plan requires a thorough risk assessment and safety
planning. Hospitalization may be needed if risk is high, but the first step is assessment.
SSRIs can be initiated, but safety comes first .
, 8. A 40-year-old female with generalized anxiety disorder is started on buspirone.
Which statement accurately describes the onset of action for this medication?
A. It provides immediate relief of anxiety symptoms
B. It takes 2-4 weeks to achieve therapeutic effect
C. It works within 24-48 hours
D. It is effective only for acute panic attacks
Rationale: Buspirone has a delayed onset of action, typically 2-4 weeks. It is not effective
for acute anxiety and is not a benzodiazepine .
9. A patient with schizophrenia is started on clozapine. Which monitoring schedule
is required for this medication?
A. Weekly CBC for the first 6 months, then biweekly
B. Weekly ANC for the first 6 months, then biweekly for 6 months, then monthly
C. Monthly LFTs only
D. No monitoring is required
Rationale: Clozapine requires mandatory monitoring of Absolute Neutrophil Count (ANC)
due to risk of agranulocytosis. The schedule is weekly for 6 months, biweekly for 6 months,
then monthly .
10. A 25-year-old male with bipolar disorder is in a manic episode. He is prescribed
valproic acid. What baseline laboratory tests should be obtained before starting
this medication?
A. Serum lithium level
B. Liver function tests (LFTs) and complete blood count (CBC)
C. Thyroid function tests
D. Renal function tests
Rationale: Valproic acid can cause hepatotoxicity and thrombocytopenia. Baseline LFTs
and CBC are required. Serum levels are also monitored during treatment .
