NRNP 6630 MIDTERM EXAM
• Question 1
What is the strongest established risk factor for bipolar disorder? Family History
Response Feedback: “The strongest established risk factor for BPD is a family history of BPD.”
• Question 2
Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)? i.
Nortriptyline
ii. Citalopram
iii.
Duloxetine
iv. Fluoxetine
v. Venlafaxine
• Question 3
Which disease state of a non-adherent patient is at greater risk for substance use, violence, and
victimization as well as worse overall quality of life? Schizophrenia
Response “Moreover, non-adherent patients with schizophrenia are at greater risk for substance
Feedback: use, violence, and victimization as well as worse overall quality of life.”
• Question 4
Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a
new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant
would you recommend as first-line? Atomoxetine
Response (Options C & D are both TCA antidepressants and, based on the patient’s age and
Feedback: comorbid conditions, a TCA would likely result in more side effects, such as increased fall
risk due to potential for orthostatic hypotension and anticholinergic-related side effects.
In addition, patient has a history for cardiac abnormalities due to A. fib diagnosis - TCAs
result in electrocardiographic changes in susceptible individuals, therefore, would likely
avoid. Choice B is used more for ADHD purposes than as an antidepressant)
, Page numbers used: Page 39 for TCA side-effect profile
• Question 5
Which of the following is an appropriate strategy for managing treatment-resistant depression?
Use both SSRI and SNRI
• Question 6
Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and
why?
Response “As noted previously, antidepressants may contribute to an increase in mood Feedback:
episode frequency.”
• Question 7
With second-generation antipsychotics, what is the main side effect that requires frequent monitoring?
Response table 7-6 & page 80, table 7-7; Page 78: “However, attention over the past decade has
Feedback: focused on effect of second-generation antipsychotics on glucose metabolism and lipids
and associated metabolic syndrome.”
• Question 8
Which amino acid is involved in the synthesis of both norepinephrine and dopamine?
• Question 9
An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision, and
constipation. He has a past medical history significant for hypertension, heart failure, and depression. Of
the following medications, which one is likely contributing to these side effects?
Response Only TCA is listed with most anticholinergic effects; Page 39 for TCA side effect profile:
Feedback: “dry mouth, blurred vision, constipation, urinary hesitancy, tachycardia, memory
difficulties, and ejaculatory difficulties”
• Question 10
, Which medication has been studied and recommended in patients with a social anxiety disorder who also
suffer from an alcohol use disorder?
Response “Suggested that treatment with the SSRI paroxetine decreased the anxiety and may
Feedback: have reduced the alcohol use as well”
• Question 11
M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is needed. Which of the
following would be a first-line treatment option for M. B.?
I. Duloxetine
II. Quetiapine
III. Diazepam
IV. Escitalopram
Response “As is true for panic and the other anxiety disorders, the SSRIs and SNRIS are generally
Feedback: considered first-line agents for the treatment of GAD because of their favorable side
effect profile….”
• Question 12
The serotonin system is involved in many processes in psychiatry, including, most prominently, mood,
sleep, and psychosis. Of the following neurons listed, from where is serotonin synthesized?
Response Feedback: under serotonin subheading and figure 1-18 on page 16:
Locus Coeruleus: Norepinephrine
Nucleus basalis: cholinergic neurons
Substantia Nigra: dopamine Ventral
Tegmental area: dopamine
• Question 13
Which of the followi ng symptoms is NOT part of the diagnostic features for bipolar disorder?
“Psychosis is not represented in the diagnostic features for BPD.”
Response - “Psychosis typically resolves along with the mood symptoms, though diagnostic
Feedback: criteria acknowledge that psychotic symptoms may linger beyond the end of the
episode.”
• Question 14
A 32-year-old males calls you complaining of decreased libido since starting Paroxetine 20 mg 2 weeks
ago. He reported stopping the medication 1 day ago and is now experiencing extreme irritability and
nervousness. He wishes to stop this medication due to side effects. What do you recommend?
• Question 1
What is the strongest established risk factor for bipolar disorder? Family History
Response Feedback: “The strongest established risk factor for BPD is a family history of BPD.”
• Question 2
Which of the following medications are known as selective serotonin re-uptake inhibitors (SSRIs)? i.
Nortriptyline
ii. Citalopram
iii.
Duloxetine
iv. Fluoxetine
v. Venlafaxine
• Question 3
Which disease state of a non-adherent patient is at greater risk for substance use, violence, and
victimization as well as worse overall quality of life? Schizophrenia
Response “Moreover, non-adherent patients with schizophrenia are at greater risk for substance
Feedback: use, violence, and victimization as well as worse overall quality of life.”
• Question 4
Patient is a 72-year-old male with a past medical history significant for atrial fibrillation and COPD with a
new diagnosis of major depression disorder. Based on his comorbid conditions, what antidepressant
would you recommend as first-line? Atomoxetine
Response (Options C & D are both TCA antidepressants and, based on the patient’s age and
Feedback: comorbid conditions, a TCA would likely result in more side effects, such as increased fall
risk due to potential for orthostatic hypotension and anticholinergic-related side effects.
In addition, patient has a history for cardiac abnormalities due to A. fib diagnosis - TCAs
result in electrocardiographic changes in susceptible individuals, therefore, would likely
avoid. Choice B is used more for ADHD purposes than as an antidepressant)
, Page numbers used: Page 39 for TCA side-effect profile
• Question 5
Which of the following is an appropriate strategy for managing treatment-resistant depression?
Use both SSRI and SNRI
• Question 6
Which of the following medications is best to AVOID in maintenance treatment of bipolar disorder and
why?
Response “As noted previously, antidepressants may contribute to an increase in mood Feedback:
episode frequency.”
• Question 7
With second-generation antipsychotics, what is the main side effect that requires frequent monitoring?
Response table 7-6 & page 80, table 7-7; Page 78: “However, attention over the past decade has
Feedback: focused on effect of second-generation antipsychotics on glucose metabolism and lipids
and associated metabolic syndrome.”
• Question 8
Which amino acid is involved in the synthesis of both norepinephrine and dopamine?
• Question 9
An 81-year-old male comes to your clinic today complaining of dry mouth, blurred vision, and
constipation. He has a past medical history significant for hypertension, heart failure, and depression. Of
the following medications, which one is likely contributing to these side effects?
Response Only TCA is listed with most anticholinergic effects; Page 39 for TCA side effect profile:
Feedback: “dry mouth, blurred vision, constipation, urinary hesitancy, tachycardia, memory
difficulties, and ejaculatory difficulties”
• Question 10
, Which medication has been studied and recommended in patients with a social anxiety disorder who also
suffer from an alcohol use disorder?
Response “Suggested that treatment with the SSRI paroxetine decreased the anxiety and may
Feedback: have reduced the alcohol use as well”
• Question 11
M. B. was just diagnosed with Generalized Anxiety Disorder and pharmacotherapy is needed. Which of the
following would be a first-line treatment option for M. B.?
I. Duloxetine
II. Quetiapine
III. Diazepam
IV. Escitalopram
Response “As is true for panic and the other anxiety disorders, the SSRIs and SNRIS are generally
Feedback: considered first-line agents for the treatment of GAD because of their favorable side
effect profile….”
• Question 12
The serotonin system is involved in many processes in psychiatry, including, most prominently, mood,
sleep, and psychosis. Of the following neurons listed, from where is serotonin synthesized?
Response Feedback: under serotonin subheading and figure 1-18 on page 16:
Locus Coeruleus: Norepinephrine
Nucleus basalis: cholinergic neurons
Substantia Nigra: dopamine Ventral
Tegmental area: dopamine
• Question 13
Which of the followi ng symptoms is NOT part of the diagnostic features for bipolar disorder?
“Psychosis is not represented in the diagnostic features for BPD.”
Response - “Psychosis typically resolves along with the mood symptoms, though diagnostic
Feedback: criteria acknowledge that psychotic symptoms may linger beyond the end of the
episode.”
• Question 14
A 32-year-old males calls you complaining of decreased libido since starting Paroxetine 20 mg 2 weeks
ago. He reported stopping the medication 1 day ago and is now experiencing extreme irritability and
nervousness. He wishes to stop this medication due to side effects. What do you recommend?
