NRNP 6665 Midterm Exam Questions and Answers with
Explanation (Latest ): Most Comprehensive to
Pass the Exam, 100% Verified
Multiple-Choice Questions
Question 1: A 32-year-old female presents with persistent sadness, anhedonia, and insomnia for 6
weeks. She denies suicidal ideation. What is the most likely diagnosis?
A. Adjustment disorder
B. Major depressive disorder
C. Persistent depressive disorder
D. Bipolar II disorder
Answer: B. Major depressive disorder
Explanation: Major depressive disorder (MDD) is diagnosed based on DSM-5 criteria,
requiring at least 5 symptoms for 2 weeks, including depressed mood or anhedonia.
The patients 6-week duration of sadness, anhedonia, and insomnia meets these criteria.
Adjustment disorder requires a clear stressor with symptoms not meeting MDD criteria.
Persistent depressive disorder requires symptoms for 2 years. Bipolar II disorder requires
hypomanic episodes, which are not reported.
Question 2: Which medication is first-line for generalized anxiety disorder in a 40-year-old male with
no comorbidities?
A. Alprazolam
B. Sertraline
C. Buspirone
D. Propranolol
Answer: B. Sertraline
Explanation: SSRIs, such as sertraline, are first-line for generalized anxiety disorder
(GAD) due to their efficacy, safety, and low risk of dependence, per APA guidelines. Al-
prazolam (benzodiazepine) is reserved for acute anxiety due to addiction risk. Buspirone
is second-line, and propranolol is used for performance anxiety, not GAD.
Question 3: A 25-year-old male reports auditory hallucinations and paranoia for 3 months. What is
the most appropriate initial treatment?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Clozapine
Answer: B. Risperidone
Explanation: Risperidone, a second-generation antipsychotic, is first-line for schizophre-
nia or schizophreniform disorder due to its efficacy in managing positive symptoms (hal-
lucinations, paranoia) and favorable side effect profile. Haloperidol is effective but has
higher extrapyramidal side effects (EPS). Quetiapine is less preferred for acute psychosis,
and clozapine is reserved for treatment-resistant cases.
Question 4: A 45-year-old female with bipolar I disorder is manic. Which medication is most appro-
priate to initiate?
A. Lithium
1
, B. Fluoxetine
C. Amitriptyline
D. Bupropion
Answer: A. Lithium
Explanation: Lithium is a first-line mood stabilizer for acute mania in bipolar I disorder,
per APA guidelines, due to its efficacy in controlling manic symptoms. Antidepressants
like fluoxetine, amitriptyline, or bupropion can precipitate or worsen mania and are not
indicated as monotherapy in acute mania.
Question 5: What is the most common side effect of sertraline in a 30-year-old female with depres-
sion?
A. Weight gain
B. Nausea
C. QT prolongation
D. Hyponatremia
Answer: B. Nausea
Explanation: Nausea is the most common side effect of SSRIs like sertraline, typically
occurring early in treatment and often resolving within weeks. Weight gain is less com-
mon with sertraline compared to other antidepressants. Hyponatremia is a risk in older
adults, and QT prolongation is rare with sertraline.
Question 6: A 28-year-old male with ADHD is prescribed methylphenidate. What is the most impor-
tant monitoring parameter?
A. Blood pressure
B. Liver function
C. Renal function
D. Thyroid function
Answer: A. Blood pressure
Explanation: Stimulants like methylphenidate can increase heart rate and blood pres-
sure, necessitating regular monitoring, especially in adults. Liver, renal, and thyroid
function are not typically affected by methylphenidate, making them less critical for rou-
tine monitoring.
Question 7: A 50-year-old male with alcohol use disorder wants to maintain sobriety. Which medi-
cation is most appropriate?
A. Disulfiram
B. Naltrexone
C. Lorazepam
D. Buprenorphine
Answer: B. Naltrexone
Explanation: Naltrexone, an opioid antagonist, is first-line for alcohol use disorder to
reduce cravings and relapse risk, per APA guidelines. Disulfiram is less preferred due to
adherence issues. Lorazepam is for withdrawal, not maintenance. Buprenorphine is for
opioid use disorder.
Question 8: A 35-year-old female with PTSD reports nightmares. Which medication is most effec-
tive for this symptom?
A. Sertraline
B. Prazosin
C. Clonazepam
2
, D. Venlafaxine
Answer: B. Prazosin
Explanation: Prazosin, an alpha-1 blocker, is specifically effective for PTSD-related
nightmares by reducing hyperarousal. SSRIs like sertraline and SNRIs like venlafax-
ine are first-line for PTSD but less effective for nightmares. Clonazepam is not recom-
mended due to dependence risk.
Question 9: A 22-year-old female with anorexia nervosa has a BMI of 16. What is the most appro-
priate initial intervention?
A. Start fluoxetine
B. Refer for nutritional counseling
C. Initiate olanzapine
D. Prescribe lorazepam
Answer: B. Refer for nutritional counseling
Explanation: Nutritional rehabilitation is the cornerstone of anorexia nervosa treatment
to restore weight and address medical complications. Fluoxetine may help with comor-
bid depression but is not first-line. Olanzapine may aid weight gain but is secondary.
Lorazepam is inappropriate.
Question 10: A 40-year-old male with schizophrenia develops rigidity and tremor. Which medication
is likely responsible?
A. Clozapine
B. Olanzapine
C. Haloperidol
D. Aripiprazole
Answer: C. Haloperidol
Explanation: Haloperidol, a first-generation antipsychotic, commonly causes extrapyra-
midal symptoms (EPS) like rigidity and tremor due to dopamine blockade. Second-
generation antipsychotics (clozapine, olanzapine, aripiprazole) have lower EPS risk.
Question 11: A 29-year-old female with borderline personality disorder reports impulsivity. What is
the most effective treatment?
A. Dialectical behavior therapy
B. Sertraline
C. Lithium
D. Haloperidol
Answer: A. Dialectical behavior therapy
Explanation: Dialectical behavior therapy (DBT) is the gold standard for borderline
personality disorder, targeting impulsivity and emotional dysregulation. Medications
like sertraline, lithium, or haloperidol may address symptoms but are not first-line, as
psychotherapy is most effective.
Question 12: A 45-year-old male with OCD reports intrusive thoughts. Which medication is first-line?
A. Fluoxetine
B. Buspirone
C. Lorazepam
D. Bupropion
Answer: A. Fluoxetine
Explanation: SSRIs like fluoxetine are first-line for OCD due to their efficacy in reduc-
ing intrusive thoughts and compulsions, per APA guidelines. Buspirone and lorazepam
3
Explanation (Latest ): Most Comprehensive to
Pass the Exam, 100% Verified
Multiple-Choice Questions
Question 1: A 32-year-old female presents with persistent sadness, anhedonia, and insomnia for 6
weeks. She denies suicidal ideation. What is the most likely diagnosis?
A. Adjustment disorder
B. Major depressive disorder
C. Persistent depressive disorder
D. Bipolar II disorder
Answer: B. Major depressive disorder
Explanation: Major depressive disorder (MDD) is diagnosed based on DSM-5 criteria,
requiring at least 5 symptoms for 2 weeks, including depressed mood or anhedonia.
The patients 6-week duration of sadness, anhedonia, and insomnia meets these criteria.
Adjustment disorder requires a clear stressor with symptoms not meeting MDD criteria.
Persistent depressive disorder requires symptoms for 2 years. Bipolar II disorder requires
hypomanic episodes, which are not reported.
Question 2: Which medication is first-line for generalized anxiety disorder in a 40-year-old male with
no comorbidities?
A. Alprazolam
B. Sertraline
C. Buspirone
D. Propranolol
Answer: B. Sertraline
Explanation: SSRIs, such as sertraline, are first-line for generalized anxiety disorder
(GAD) due to their efficacy, safety, and low risk of dependence, per APA guidelines. Al-
prazolam (benzodiazepine) is reserved for acute anxiety due to addiction risk. Buspirone
is second-line, and propranolol is used for performance anxiety, not GAD.
Question 3: A 25-year-old male reports auditory hallucinations and paranoia for 3 months. What is
the most appropriate initial treatment?
A. Haloperidol
B. Risperidone
C. Quetiapine
D. Clozapine
Answer: B. Risperidone
Explanation: Risperidone, a second-generation antipsychotic, is first-line for schizophre-
nia or schizophreniform disorder due to its efficacy in managing positive symptoms (hal-
lucinations, paranoia) and favorable side effect profile. Haloperidol is effective but has
higher extrapyramidal side effects (EPS). Quetiapine is less preferred for acute psychosis,
and clozapine is reserved for treatment-resistant cases.
Question 4: A 45-year-old female with bipolar I disorder is manic. Which medication is most appro-
priate to initiate?
A. Lithium
1
, B. Fluoxetine
C. Amitriptyline
D. Bupropion
Answer: A. Lithium
Explanation: Lithium is a first-line mood stabilizer for acute mania in bipolar I disorder,
per APA guidelines, due to its efficacy in controlling manic symptoms. Antidepressants
like fluoxetine, amitriptyline, or bupropion can precipitate or worsen mania and are not
indicated as monotherapy in acute mania.
Question 5: What is the most common side effect of sertraline in a 30-year-old female with depres-
sion?
A. Weight gain
B. Nausea
C. QT prolongation
D. Hyponatremia
Answer: B. Nausea
Explanation: Nausea is the most common side effect of SSRIs like sertraline, typically
occurring early in treatment and often resolving within weeks. Weight gain is less com-
mon with sertraline compared to other antidepressants. Hyponatremia is a risk in older
adults, and QT prolongation is rare with sertraline.
Question 6: A 28-year-old male with ADHD is prescribed methylphenidate. What is the most impor-
tant monitoring parameter?
A. Blood pressure
B. Liver function
C. Renal function
D. Thyroid function
Answer: A. Blood pressure
Explanation: Stimulants like methylphenidate can increase heart rate and blood pres-
sure, necessitating regular monitoring, especially in adults. Liver, renal, and thyroid
function are not typically affected by methylphenidate, making them less critical for rou-
tine monitoring.
Question 7: A 50-year-old male with alcohol use disorder wants to maintain sobriety. Which medi-
cation is most appropriate?
A. Disulfiram
B. Naltrexone
C. Lorazepam
D. Buprenorphine
Answer: B. Naltrexone
Explanation: Naltrexone, an opioid antagonist, is first-line for alcohol use disorder to
reduce cravings and relapse risk, per APA guidelines. Disulfiram is less preferred due to
adherence issues. Lorazepam is for withdrawal, not maintenance. Buprenorphine is for
opioid use disorder.
Question 8: A 35-year-old female with PTSD reports nightmares. Which medication is most effec-
tive for this symptom?
A. Sertraline
B. Prazosin
C. Clonazepam
2
, D. Venlafaxine
Answer: B. Prazosin
Explanation: Prazosin, an alpha-1 blocker, is specifically effective for PTSD-related
nightmares by reducing hyperarousal. SSRIs like sertraline and SNRIs like venlafax-
ine are first-line for PTSD but less effective for nightmares. Clonazepam is not recom-
mended due to dependence risk.
Question 9: A 22-year-old female with anorexia nervosa has a BMI of 16. What is the most appro-
priate initial intervention?
A. Start fluoxetine
B. Refer for nutritional counseling
C. Initiate olanzapine
D. Prescribe lorazepam
Answer: B. Refer for nutritional counseling
Explanation: Nutritional rehabilitation is the cornerstone of anorexia nervosa treatment
to restore weight and address medical complications. Fluoxetine may help with comor-
bid depression but is not first-line. Olanzapine may aid weight gain but is secondary.
Lorazepam is inappropriate.
Question 10: A 40-year-old male with schizophrenia develops rigidity and tremor. Which medication
is likely responsible?
A. Clozapine
B. Olanzapine
C. Haloperidol
D. Aripiprazole
Answer: C. Haloperidol
Explanation: Haloperidol, a first-generation antipsychotic, commonly causes extrapyra-
midal symptoms (EPS) like rigidity and tremor due to dopamine blockade. Second-
generation antipsychotics (clozapine, olanzapine, aripiprazole) have lower EPS risk.
Question 11: A 29-year-old female with borderline personality disorder reports impulsivity. What is
the most effective treatment?
A. Dialectical behavior therapy
B. Sertraline
C. Lithium
D. Haloperidol
Answer: A. Dialectical behavior therapy
Explanation: Dialectical behavior therapy (DBT) is the gold standard for borderline
personality disorder, targeting impulsivity and emotional dysregulation. Medications
like sertraline, lithium, or haloperidol may address symptoms but are not first-line, as
psychotherapy is most effective.
Question 12: A 45-year-old male with OCD reports intrusive thoughts. Which medication is first-line?
A. Fluoxetine
B. Buspirone
C. Lorazepam
D. Bupropion
Answer: A. Fluoxetine
Explanation: SSRIs like fluoxetine are first-line for OCD due to their efficacy in reduc-
ing intrusive thoughts and compulsions, per APA guidelines. Buspirone and lorazepam
3
