NSG 552 Exam 2 | Questions, Answer Key and Rationales | 2025/26 Updates | 100% Correct – Wilkes University.

NSG 552 Exam 2 | Questions, Answer Key and Rationales | 2025/26 Updates | 100% Correct – Wilkes University. 1. A 38-year-old male reports excessive daytime sleepiness for the last 2 weeks in the setting of restructuring at his job. He is unable to tell if he is having more trouble falling asleep or staying asleep. Sometimes he wakes up at 4 a.m. and is unable to fall back asleep. What should the PMHNP do first? A. Prescribe zolpidem 10 mg at bedtime as needed B. Prescribe a mirtazapine 15 mg at bedtime C. Request the patient complete a sleep log D. Add an extra blanket to his bed covers 2. A 45-year-old female reports that she has difficulty falling back asleep after she wakes up at 4 a.m. for the last month. She understands that it is better to get out of bed rather than lay in bed awake. She uses this time to catch up on her reading but as a result is very sleepy during the day. What should the PMHNP recommend? A. Intermezzo 1.75 mg when she awakes at 4 a.m. B. Mop the kitchen floor as soon as she wakes up at 4 a.m. C. Diphenhydramine 25 mg at bedtime D. Sleep diary for 2 weeks 3. A 44-year-old male with type 2 diabetes is becoming increasingly irritable, inattentive, and forgetful, and frequently falls asleep in front of his computer at work. He is worried he will get fired and lose his benefits, which he needs to cover his diabetic supplies. He says, “I am so worried that my blood sugars are as high as 300 and on occasion have wet the bed.” What should the PMHNP do during this visit? A. Provigil 100 mg daily B. Order a sleep study C. Mirtazapine 15 mg at bedtime D. Refer him back to primary care for glycemic control 4. A 25-year-old woman reports frequently falling asleep during the day for the last 6 months. This has been affecting her work as a computer help desk agent, noting she sometimes nods off during calls but also during times of high volume. When her head hits the back of the chair she wakes up and realizes what has happened. She insists she consistently sleeps 8 hours each night. This is most consistent with which of the following? A. Narcolepsy B. Circadian rhythm sleep disorder C. Hypersomnia D. Night terrors 5. John is a 22-year-old RN who has started his first job in 15th9e cardiothoracic ICU. After his orientation he began his full-time position working three 12-hour night shifts per week. On his days off he reports excessive fatigue during the day with periods of falling asleep while driving. He also reports difficulty staying awake at work during his first night back to work. Which of the following is the most likely diagnosis? A. Narcolepsy B. Circadian rhythm sleep disorder C. Hypersomnia D. Night terrors 6. Ella is trying to help her 3-year-old son sleep through the night but reports recently he has had three episodes of waking up within 3 hours of falling asleep with inconsolable screaming and crying. He then falls back asleep on his own and has no memory of what happened. What would be the best intervention? A. Recommend diphenhydramine 12.5 mg at bedtime B. Create and maintain bedtime routine and reduce stimuli C. Order polysomnography and EEG D. Prescribe desmopressin nasal spray 7. A 45-year-old man reports difficulty falling asleep and early morning awakening. He reports excessive daytime sleepiness as a result of his unrestful sleep. What should the PMHNP do first? A. Prescribe trazadone 100 mg at bedtime B. Administer Patient Health Questionnaire (PHQ)-9 C. Order a sleep study D. Have the patient complete a sleep diary 8. A 22-year-old male has been referred by the employee assistance program at his job for poor work performance. The patient reports that 160 no matter how much coffee he drinks he remains sleepy throughout the day and will doze off at meetings. He notes that he will often awake when his head hits the back of his chair when at a meeting. On occasion he has dropped his cup of coffee in front of everyone and now he feels he is under constant scrutiny and thinks people are speculating he is using drugs. What is the most likely diagnosis? A. Primary hypersomnia B. Hypnagogic hallucinations C. Hypnopompic hallucinations D. Narcolepsy 9. A 48-year-old obese woman experiences excessive daytime sleepiness, fatigue, anhedonia, and apathy. Her husband reports that she snores loudly when sleeping, and often will wake up drenched in sweat. The patient has no prior psychiatric history and denies substance abuse. Which of the following is the most likely cause of her symptoms? A. Airway obstruction B. Major depression C. Perimenopause D. Narcolepsy 10. A 52-year-old obese man with type 2 diabetes reports dozing off while driving, watching TV, or reading, with increased apathy and fatigue. The PMHNP ordered a sleep study, which revealed 10 episodes of apnea lasting 15 to 20 seconds each per hour of sleep. Based on these findings, what should the PMHNP prescribe for his condition? A. Antidepressant medications B. Referral to otolaryngology for uvuloplasty C. Referral to otolaryngology for rhinoplasty D. Continuous positive airway pressure 11. A father brings his 6-year-old son to you because he is worried about him. He states that the son sits up in bed shortly after falling asleep and screams. He says he is inconsolable and unable to be awakened during these episodes but eventually he falls back asleep. The father states he is not able to fall back asleep after those episodes and is exhausted and falling asleep at work during the day. The child is energetic and playful during the day and has no memory of the episodes. What is the most appropriate response? A. “Are you worried you are doing something wrong?” B. “I can see you’re upset, but really you are overreacting.” C. “I can see this is upsetting for you.” D. “Tell me why you can’t fall back asleep after your son does?” 12. The PMHNP is providing psychoeducation and anticipatory guidance to the concerned parent regarding night terrors. At which stage of sleep is this most likely to occur? A. Any stage of sleep B. Stage 1 C. Stage 2 D. Stage 3 to 4 13. Sam is 11 years old without past psychiatric history. He was born by normal spontaneous vaginal delivery with normal APGAR scores. He has met all of his developmental milestones. He began sixth grade this year and has had increased trouble falling asleep. He has always had bedtime rituals but lately they are extending in complexity and length. Most of his time in the evening is spent checking that the lights are turned off and that the windows are locked. As a result, he is only getting 5 hours of sleep at night and now has excessive daytime sleepiness with decreased interest in socialization and failing grades. Which of the following infectious diseases may contribute to this clinical presentation? A. Treponema B. Human immunodeficiency virus C. Streptococcus D. Congenital herpes simplex virus 14. The PMHNP is covering for the vacationing psychiatrist and is conducting a follow-up visit for a 24-year-old man diagnosed with major depressive disorder. Which type of sleep disturbance is most consistent with this diagnosis? A. Early morning awakening B. Sleeping too deeply C. Easily awakened/sleeping too lightly D. Decreased effect of trazadone 15. A patient with major depression and early morning awakening is likely to have which of the following hormonal states accounting for his symptoms? A. Elevated testosterone B. Elevated cortisol C. Elevated catecholamine D. Decreased cortisol 16. A 30-year-old man has been started on sertraline 50 mg daily for major depression 1 week ago. He presents for follow-up. Which of the following sleep patterns is he expected to report? A. No change in sleep pattern B. Increased sleep latency C. Decreased sleep latency D. Increased sleepiness earlier in the evening 17. A 56-year-old woman with depressed mood reports a decrease in weight, libido, and ability to sleep. In addition, she reports intermittent episodes of constipation. Which neurovegetative symptom should be targeted first when prescribing a psychopharmacological agent? A. Constipation B. Sleep C. Weight loss D. Depressed mood 18. The PMHNP is consulting on a 79-year-old female in a long-term care facility with history of hypertension, coronary artery disease, and atrial fibrillation. The patient is having difficulty sleeping and was started on lorazepam 2 mg at bedtime. The patient has become increasingly agitated and wandering and has been further prescribed lorazepam 2 mg every 6 hours. The patient is also prescribed hydrochlorothiazide 25 mg daily, digoxin 0.125 mg every other day, diltiazem sustained release 360 mg daily, and isosorbide 30 mg daily. What should the PMHNP do first? A. Begin lorazepam taper B. Delirium workup C. Start the patient on mirtazapine 15 mg at bedtime D. Change lorazepam to alprazolam 1 mg every 4 hours as needed 19. A 68-year-old man presents with his wife for evaluation of sleep disorder. The wife reports he does not sleep well at night and wanders around the house. He then sleeps much of the day. Which of the following medications is preferred to control this behavior? A. Chlorpromazine B. Haloperidol C. Trazodone D. Lorazepam 20. A 55-year-old man with poorly controlled type 2 diabetes was referred for evaluation of medication noncompliance. Upon evaluation you realize that the patient has increased sleep latency, anhedonia, poor appetite, and persistent depressed mood. In addition, he reports chronic neuropathic pain in the feet unrelieved by analgesics. Which of the following medications may address the patient’s symptoms of poor sleep, depressed mood, poor appetite, and neuropathic pain? A. Lorazepam B. Escitalopram C. Trazodone D. Amitriptyline QUESTIONS 1. A 25-year-old female presents to the emergency department, having just witnessed an accident. Her speech is pressured. She states, “There were a lot of people in need of care at the scene, and I should know because I have traveled to many Third World countries. I know how bad needs can get. The people were injured, and she was hit by a car before but did not suffer any injuries. There were a lot of police cars and ambulances.” The patient was triaged to psychiatry. The PMHNP describes her thought process as: A. Circumstantial B. Tangential C. Flight of ideas D. Loose associations 2. A 45-year-old man is reporting chest pressure, difficulty breathing, numbness, and tingling in his hands and lips. He has been seen in the emergency department in which he underwent a negative cardiac workup. He was subsequently triaged to psychiatry for evaluation. The PMHNP asks how he came to the hospital. He states, “I felt awful, my heart was pounding, I was sweating so much, I thought I was going to die. My father had a similar problem, but he died 10 years ago.” Which of the following best describes the thought pattern? A. Circumstantial B. Tangential C. Flight of ideas D. Loose associations 3. A 29-year-old man presents to the emergency department stating he is very anxious and feels his heart is going to beat out of his chest. He is diaphoretic, with pressured speech and unable to be calmed. A psychiatric consult was called because the patient seems uncooperative and a proper history cannot be obtained. Which of the following conditions must be excluded first? A. Hypochondriasis B. Phobia C. Cocaine-induced mood disorder D. Panic attack 4. A 22-year-old medical student has had several episodes of impending doom over the last 4 months. The events last 10 to 20 minutes and are associated with tremor, sweating, dizziness, and being unable to concentrate. He is now perpetually worried that these attacks will happen when doing his clerkship. The PMHNP in the student health center diagnoses him with panic disorder without agoraphobia. Which medication is the first choice for this condition? A. Klonopin B. Fluoxetine C. Chlordiazepoxide D. Lithium 5. An 18-year-old girl was visiting colleges with her family and was involved in a fatal car accident 2 weeks ago. Since that time, she continually has flashbacks, difficulty sleeping, persistent ruminations, and is afraid to drive. She has become apprehensive about her family members driving as well. What is the most appropriate diagnosis? A. Posttraumatic stress disorder B. Generalized anxiety disorder C. Adjustment disorder D. Acute stress disorder 6. A 34-year-old woman comes to an appointment because she is bothered by disturbing and recurrent thoughts of harming her 7-month-old infant. She reports that her thoughts are distressing enough that she has removed all sharp objects from the kitchen so that she cannot stab her baby with a knife. She has not shared these thoughts with her husband for fear of how he may react to her. Which of the following is the most likely diagnosis? A. Obsessive compulsive disorder B. Generalized anxiety disorder C. Bipolar disorder with peripartum onset D. Acute stress disorder 7. A 38-year-old Middle Eastern male veteran of Operation Iraqi Freedom is evaluated at the mental health clinic. He reports that he saw many of his battle buddies get killed in action. He has been stateside for 2 years, but since that time he has had trouble sleeping and as such he is very irritable to be around. He reports ongoing nightmares and flashbacks to an explosion and he feels on edge most of the time. He avoids large crowds and loud noises. He finds that having a few beers helps calm him and makes him more pleasant to be around and allows him to socialize rather than isolate himself. Which of the following medications should the PMHNP prescribe? A. Risperdal B. Lorazepam C. Sertraline D. Imipramine 8. A 32-year-old man presents on referral from his primary care provider. He reports a 6-month history of recurrent bouts of anxiety associated with chest pain, tachycardia, tremors, nausea, diaphoresis, and an impending sense of doom. The episodes last approximately 20 minutes and he is unable to identify a precipitating event. The patient has become increasingly isolated for fear of not wanting to have this sort of episode in public. The primary care provider started him on a selective serotonin reuptake inhibitor (SSRI) 6 months ago but he continues to have the symptoms. Which adjunctive psychotherapy would be most appropriate for this patient? A. Eye movement desensitization and reprocessing (EMDR) therapy B. Interpersonal therapy C. Supportive psychotherapy D. Cognitive behavioral therapy 9. The PMHNP is rounding on the inpatient psychiatric unit. During the meeting with a 32-year-old patient with a history of substance use disorder, she informs the patient that her rehabilitation bed is ready, and she will be discharged today. Nursing staff reports that the patient has a heart rate of 120 and a blood pressure of 150/80. In evaluating the patient, the mental health worker informs you that the patient was running in place vigorously before having her vital signs checked. What is the most likely diagnosis to account for this patient’s behavior? A. Hypochondriasis B. Malingering C. Factitious disorder D. Somatoform disorder 10. A 32-year-old male was referred from the urologist for erectile dysfunction. He has been prescribed a phosphodiesterase-5 inhibitor (PD5-I) with variable success despite a negative physiological workup. Which form of therapy is indicated for this sexual dysfunction? A. Cognitive behavioral therapy B. Interpersonal therapy C. Supportive psychotherapy D. Eye movement desensitization reprocessing (EMDR) therapy 11. A 29-year-old woman with a history of panic disorder requests a psychiatric home visit because she continues to experience feelings that her environment is not real. She states that this is very unsettling and, as a result, has stopped going out of her home. In formulating her case, the PMHNP would describe this symptom as the persistence of: A. Depersonalization B. Derealization C. Psychosis D. Depressive symptoms 12. A 34-year-old Korean male pediatric dentist is referred to psychiatry for persistent anxiety. Upon further assessment, he reveals that his penis is shrinking into his abdomen. Despite the reassurance he has received from numerous health care providers in the past he remains convinced of this belief. This culture-bound delusion is known as: A. Zar B. Taijin kyofusho C. Koro D. Kuru 13. A 25-year-old female presents with symptoms of nausea, headache, and backache. Despite consultation with her primary care provider, gastroenterologist, neurologist, and ED visit no identifiable cause has been found for her symptoms. She has been referred to psychiatry but insists she should go to rheumatology. What should the PMHNP do? A. Refer the patient to rheumatology B. Inquire as to the most bothersome symptom and when it occurs C. Order a whole body CT scan D. Prescribe a selective serotonin reuptake inhibitor (SSRI) 14. A patient presents to the emergency department reporting sudden onset blindness. Her physical exam is unremarkable. The patient is referred to psychiatry for disposition because the patient insists she cannot care for herself. What is the most likely diagnosis? A. Somatoform disorder B. Conversion disorder 191 C. Hypochondriasis D. Factitious disorder 15. A 32-year-old White male was formerly employed as a corporate lawyer and has recently started his own business. He has started experiencing symptoms of intense anxiety when taking the subway to work. The symptoms include feeling short of breath, chest pressure, sweaty, irritable, and an impending sense of doom. The symptoms have persisted and worsened over time to where he has everything delivered and cannot leave the house. What is the most likely diagnosis? A. Malingering B. Delusional disorder C. Agoraphobia D. Hypochondriasis 16. A 62-year-old billionaire was recently arrested on charges of pedophilia and child pornography. He was denied bail at his hearing and is waiting in jail pending his trial. The next morning the patient was found passed out on the ground and transferred to the emergency department. He was evaluated, and the work up was negative. Upon discharge, he tells the emergency department attending he is suicidal and wants to hang himself. The patient is referred to psychiatry for evaluation of suicidal ideation. Which of the following conditions must be considered in the differential diagnosis? A. Malingering B. Delusional disorder C. Agoraphobia D. Hypochondriasis 17. A 28-year-old woman is admitted with sepsis. Her condition responds to antibiotics but then nearing the end of the course of her treatment, she seems to spike a fever again and requires further antibiotics. The patient tells her team that she is very depressed, and they order a psychiatric consultation. The PMHNP evaluates the patient in the semiprivate room and upon leaving the roommate passes a note to the PMHNP, informing her that she observed the patient roommate injecting her IV with tap water. What is the most likely diagnosis? A. Factitious disorder B. Malingering C. Conversion disorder D. Delusional disorder 18. A 50-year-old woman referred from the surgical service is described as a “frequent flyer.” She reports vague complaints that have no apparent cause or objective clinical findings. Most recently, she complains of vaginal pain, headache, and stomachache. Upon interview she is tearful, guarded, and withdrawn. What is the most likely psychiatric diagnosis? A. Malingering B. Conversion disorder C. Somatization disorder D. Factitious disorder 19. A 30-year-old female is referred by her women’s health nurse practitioner for vaginismus. The woman is distraught and embarrassed because she has not been able to consummate her marriage. Which therapeutic technique would be most helpful? A. Systematic desensitization B. Exposure therapy C. Distraction D. Group therapy 20. A 15-year-old boy has refused to go to school for the past month. Every morning he has a new symptom or develops one and has to be picked up from school. When he is home, the symptoms disappear. On weekends the symptoms never present. What is the most likely diagnosis? A. Separation anxiety B. Social anxiety C. Agoraphobia D. Panic disorder Q BANKS Anxiolytics, panic disorder, SAD, and GAD 1. A 32-year-old patient with Generalized Anxiety Disorder (GAD) is started on sertraline (Zoloft). Which of the following is the most important education point for the PMHNP to provide regarding the initiation of this medication? a) The patient should expect immediate relief of anxiety symptoms. b) It may take several weeks to notice the full therapeutic effect. c) The medication should be taken at bedtime to induce sleep. d) It is essential to avoid tyramine-rich foods while on this medication. 2. A 45-year-old patient with a new diagnosis of Panic Disorder is prescribed a benzodiazepine for short-term use. The PMHNP should prioritize patient education on which of the following risks? a) Weight gain and metabolic syndrome. b) Potential for tolerance and physical dependence. c) Hypothyroidism. d) Serotonin syndrome. 3. Which of the following medications is a first-line treatment for Social Anxiety Disorder (SAD)? a) Quetiapine (Seroquel). b) Lorazepam (Ativan). c) Paroxetine (Paxil). d) Haloperidol (Haldol). 4. A PMHNP is managing a 60-year-old patient with GAD. The patient has a history of alcohol use disorder. Which medication would be the safest choice for long-term anxiety management in this patient? a) Alprazolam (Xanax). b) Clonazepam (Klonopin). c) Buspirone (Buspar). d) Diazepam (Valium). Obsessive-Compulsive Disorder (OCD) 5. A patient with OCD is not responding to a high-dose SSRI. The PMHNP considers augmenting the treatment. Which of the following is a common augmentation strategy for treatment-refractory OCD? a) Adding a mood stabilizer. b) Adding a second-generation antipsychotic. c) Increasing the SSRI to supratherapeutic levels. d) Initiating a monoamine oxidase inhibitor (MAOI). 6. The PMHNP is treating a patient with OCD who is taking fluoxetine. The patient reports a significant decrease in obsessive thoughts and compulsive behaviors but has residual symptoms. The PMHNP should first consider: a) Switching to a different class of medication. b) Increasing the dose of fluoxetine. c) Adding a stimulant. d) Referring the patient for electroconvulsive therapy (ECT). Sleep/Wake disorders, Insomnia, RLS, and Narcolepsy 7. A 70-year-old patient with chronic insomnia requests a hypnotic medication. The PMHNP considers the patient's age and potential side effects. Which of the following is an appropriate short-term hypnotic with less risk of daytime sedation in the elderly? a) Zaleplon (Sonata). b) Flurazepam (Dalmane). c) Temazepam (Restoril). d) Zolpidem (Ambien). 8. A patient with Narcolepsy is prescribed modafinil (Provigil). The PMHNP should explain that the primary purpose of this medication is to: a) Reduce cataplexy. b) Improve nighttime sleep. c) Promote daytime wakefulness. d) Suppress dreaming. 9. Which medication is a first-line treatment for Restless Legs Syndrome (RLS)? a) Pramipexole (Mirapex). b) Diphenhydramine (Benadryl). c) Bupropion (Wellbutrin). d) Olanzapine (Zyprexa). 10. A patient reports insomnia with frequent nighttime awakenings. Which of the following hypnotics has a long half-life and is most likely to cause next-day residual effects, such as grogginess? a) Triazolam (Halcion). b) Zaleplon (Sonata). c) Temazepam (Restoril). d) Eszopiclone (Lunesta). Dissociative Disorders and PTSD 11. What is the most widely recommended first-line pharmacological treatment for the symptom cluster of re- experiencing in Post-Traumatic Stress Disorder (PTSD)? a) Benzodiazepines. b) SSRIs (e.g., sertraline, paroxetine). c) Beta-blockers. d) Mood stabilizers. 12. A veteran with PTSD is prescribed prazosin (Minipress). The PMHNP educates the patient that this medication is primarily used to treat which symptom? a) Hypervigilance. b) Nightmares. c) Avoidance. d) Flashbacks. 13. For a patient with a dissociative disorder, pharmacotherapy is typically used to: a) Treat the core dissociative symptoms. b) Address co-occurring symptoms like anxiety or depression. c) Induce a state of amnesia for traumatic events. d) Serve as the sole treatment modality. 14. A PMHNP is working with a patient with PTSD. The patient's symptom profile is primarily composed of nightmares and hyperarousal. Which medication might be added to their treatment regimen to specifically target the nightmares? a) Venlafaxine (Effexor). b) Lamotrigine (Lamictal). c) Prazosin (Minipress). d) Clonidine (Catapres). Eating Disorders 15. What is the recommended pharmacological treatment for a patient with anorexia nervosa? a) SSRIs, as they have been proven effective in treating the core symptoms. b) No specific medication has been proven effective for treating core anorexia symptoms. c) Olanzapine (Zyprexa) to help with weight restoration. d) Stimulants to suppress appetite. 16. A patient with bulimia nervosa is being treated by a PMHNP. Which medication is FDA-approved for bulimia nervosa? a) Fluoxetine (Prozac). b) Bupropion (Wellbutrin). c) Sertraline (Zoloft). d) Lorazepam (Ativan). 17. Which of the following is a contraindication for using bupropion in a patient with an eating disorder? a) A history of binge eating. b) A history of depression. c) The presence of a low body mass index (BMI). d) A history of obsessive-compulsive symptoms. Somatic Symptom Disorder (SSD) 18. A 35-year-old patient with SSD is struggling with persistent, disproportionate thoughts about her physical symptoms. The PMHNP decides to initiate pharmacotherapy. Which class of medication is generally considered first-line for SSD? a) Benzodiazepines. b) Stimulants. c) SSRIs. d) Antipsychotics. 19. When managing a patient with SSD, the PMHNP should be aware that: a) The patient is consciously faking the symptoms. b) The goal of treatment is to cure the physical symptoms. c) A strong therapeutic alliance is crucial for managing symptoms and distress. d) High-dose analgesics are the standard of care. SSRIs 20. A patient has been taking an SSRI for 6 months and is experiencing sexual dysfunction. Which of the following strategies might the PMHNP employ to manage this side effect? a) Advise the patient to stop the medication immediately. b) Increase the dose of the SSRI. c) Switch to a different antidepressant with a lower incidence of sexual side effects, such as bupropion. d) Augment the current SSRI with an antipsychotic. 21. A patient on sertraline develops a fever, tachycardia, diaphoresis, and altered mental status. The PMHNP suspects serotonin syndrome. What is the immediate intervention? a) Administer diazepam. b) Discontinue the sertraline. c) Administer IV fluids. d) Administer an MAOI. 22. Which SSRI is known to have the longest half-life, which can be advantageous in patients who have difficulty with medication adherence? a) Fluoxetine (Prozac). b) Sertraline (Zoloft). c) Paroxetine (Paxil). d) Citalopram (Celexa). 23. Which of the following SSRIs is most likely to cause discontinuation syndrome upon abrupt cessation due to its short half-life? a) Fluoxetine (Prozac). b) Paroxetine (Paxil). c) Escitalopram (Lexapro). d) Citalopram (Celexa). Hypnotics and other related meds 24. A patient with a history of alcohol use disorder and insomnia is asking for medication. The PMHNP should be cautious with prescribing which class of medication due to the risk of cross- tolerance and abuse? a) Melatonin agonists. b) Nonbenzodiazepine hypnotics (Z-drugs). c) Antidepressants with sedative properties (e.g., trazodone). d) Dopamine agonists. 25. A PMHNP is providing patient education on the use of zolpidem (Ambien). The patient should be warned about which of the following potential side effects? a) Weight gain. b) Night eating and sleep-walking. c) Increased libido. d) Orthostatic hypotension. 26. Which medication is a melatonin receptor agonist and is approved for the treatment of insomnia characterized by difficulty with sleep onset? a) Eszopiclone (Lunesta). b) Ramelteon (Rozerem). c) Trazodone (Desyrel). d) Suvorexant (Belsomra). 27. A patient with persistent insomnia and depression is a candidate for medication. The PMHNP considers an antidepressant that also has sedative properties. Which medication is often used off-label for insomnia due to its mechanism? a) Bupropion (Wellbutrin). b) Venlafaxine (Effexor). c) Trazodone (Desyrel). d) Duloxetine (Cymbalta). 28. Which of the following is a potential side effect of using benzodiazepines for insomnia, especially in older adults? a) Increased focus. b) Decreased appetite. c) Increased risk of falls and cognitive impairment. d) Improved motor coordination. Mixed topics 29. A 28-year-old patient with GAD is experiencing significant sexual side effects with escitalopram. The PMHNP decides to switch to a different medication. Which of the following would be an appropriate alternative to avoid sexual side effects? a) Venlafaxine (Effexor). b) Duloxetine (Cymbalta). c) Bupropion (Wellbutrin). d) Paroxetine (Paxil). 30. A PMHNP is reviewing a patient's medication list and notes the patient is on an SSRI and has recently been prescribed a cough medication containing dextromethorphan. The PMHNP should be concerned about the potential for: a) Neuroleptic malignant syndrome. b) Hypertensive crisis. c) Serotonin syndrome. d) Tardive dyskinesia. 31. A patient with severe anxiety and an opioid use disorder requires anxiety management. The PMHNP should avoid which class of medication due to the high potential for abuse and dependence? a) Buspirone. b) SSRIs. c) Benzodiazepines. d) Beta-blockers. 32. The mechanism of action for SSRIs is primarily the inhibition of the reuptake of which neurotransmitter? a) Dopamine. b) Serotonin. c) Norepinephrine. d) Gamma-aminobutyric acid (GABA). 33. A patient with PTSD and comorbid depression is not responding to a single SSRI. The PMHNP considers augmenting the treatment with a medication that can help with both mood and sleep. Which medication might be a good choice? a) Mirtazapine (Remeron). b) Lithium (Eskalith). c) Valproic Acid (Depakote). d) Methylphenidate (Ritalin). 34. A PMHNP is prescribing a long-term medication for a patient with GAD. The patient has a history of a single episode of hypomania. The PMHNP should be cautious with which class of medication? a) Benzodiazepines. b) SSRIs. c) Beta-blockers. d) Alpha-2 agonists. 35. Which of the following is a common side effect of SSRIs, especially during the initial phase of treatment? a) Weight gain. b) Insomnia, anxiety, and nausea. c) Sedation. d) Constipation. 36. A PMHNP is managing a patient with OCD. Which SSRI is considered a first-line agent for this condition and is often prescribed at higher doses than for depression? a) Citalopram (Celexa). b) Escitalopram (Lexapro). c) Sertraline (Zoloft). d) Fluvoxamine (Luvox). 37. A patient with GAD is being tapered off lorazepam after several months of use. The PMHNP should monitor the patient for which of the following withdrawal symptoms? a) Psychosis. b) Increased anxiety, insomnia, and tremors. c) Hypothermia. d) Bradycardia. 38. Which medication is a non-amphetamine stimulant used for the treatment of narcolepsy? a) Dextroamphetamine. b) Methylphenidate. c) Modafinil (Provigil). d) Methamphetamine. 39. A patient with somatic symptom disorder is experiencing anxiety related to their physical complaints. What is the most effective approach for the PMHNP to take? a) Continually reassure the patient that they are physically healthy. b) Focus solely on treating the physical symptoms. c) Use SSRIs to treat the underlying anxiety and distress. d) Insist that the patient's symptoms are all in their head. 40. When considering pharmacotherapy for sleep disturbances in an elderly patient, which medication poses the greatest risk for cognitive impairment and dependence? a) Trazodone. b) Diphenhydramine. c) Zolpidem. d) Ramelteon.