6630 Study Companion 2025: Practice
Questions and Explanations
A patient with chronic insomnia and depression complains of daytime drowsiness while taking
trazodone (Oleptro). What should the PMHNP do to reduce this side effect?
A. Increase the dose in the morning
B. Switch to a stimulant
C. Give the medicine at night and lower the dose
D. Stop the medication abruptly
Rationale: Administering trazodone at night and reducing the dose helps minimize daytime
sedation. Increasing the dose or taking it in the morning worsens drowsiness, and stopping
abruptly may cause withdrawal effects.
A PMHNP supervisor is discussing how stimulants and noradrenergic agents help with ADHD
symptoms. What is the correct explanation?
A. They improve attention only
B. They reduce hyperactivity only
C. They improve executive function only
D. All of the above
Rationale: Stimulants and noradrenergic agents improve attention, reduce hyperactivity, and
enhance executive function. Focusing on only one effect is incomplete.
A female patient on lamotrigine (Lamictal) for migraine prophylaxis reaches the maximum dose
and is switched to zonisamide (Zonegran). What should the PMHNP ensure the patient
understands?
A. The medication has no side effects
B. It will cure migraines completely
C. It can be taken irregularly
D. This medication has unwanted side effects such as sedation, lack of coordination, and
drowsiness
,Rationale: Zonisamide can cause sedation, dizziness, and coordination problems. The patient
must be aware of these to manage daily activities safely. Claims of no side effects, cure, or
irregular dosing are inaccurate.
A patient is prescribed risperidone (Risperdal). Which practice demonstrates proper titration?
A. Increase the dose every 24 hours
B. Maintain the starting dose indefinitely
C. Titrating the dose by increasing it every 5-7 days
D. Stop abruptly if side effects appear
Rationale: Gradual titration every 5–7 days allows for monitoring efficacy and minimizing side
effects. Rapid changes or abrupt discontinuation can be unsafe.
Which of the following is the strongest established risk factor for bipolar disorder?
A. Trauma
B. Substance use
C. Chronic stress
D. Family history
Rationale: Genetics play the most significant role in bipolar disorder. Environmental factors
alone are insufficient to establish risk.
Which of the following medications are classified as selective serotonin reuptake inhibitors
(SSRIs)?
A. Nortriptyline
B. Citalopram
C. Duloxetine
D. Fluoxetine
E. Venlafaxine
Rationale: Citalopram and fluoxetine are SSRIs. Nortriptyline is a tricyclic antidepressant, and
duloxetine and venlafaxine are SNRIs.
A patient with schizophrenia who is non-adherent to treatment is at higher risk for which
outcomes?
A. Better overall quality of life
, B. Decreased substance use
C. Reduced victimization
D. Substance use, violence, victimization, and worse overall quality of life
Rationale: Non-adherence in schizophrenia increases risks for violence, victimization, substance
use, and poorer overall outcomes. The other options underestimate these risks.
A 72-year-old male with atrial fibrillation and COPD is newly diagnosed with major depressive
disorder. Which antidepressant is most appropriate?
A. Tricyclic antidepressant (TCA)
B. Methylphenidate
C. Bupropion
D. SSRIs or SNRIs
Rationale: TCAs are contraindicated in patients with atrial fibrillation due to cardiac risk. SSRIs
or SNRIs are safer first-line options. Stimulants like methylphenidate are not standard for
depression.
Which is an appropriate strategy for managing treatment-resistant depression?
A. Switch to antipsychotics alone
B. Use benzodiazepines as monotherapy
C. Electroconvulsive therapy only
D. SSRI and SNRI combination or augmentation strategies
Rationale: Combining or augmenting antidepressants is evidence-based for treatment-resistant
depression. Monotherapy with benzodiazepines or antipsychotics is not first-line, and ECT is
reserved for severe cases.
Which medication should be avoided in maintenance treatment of bipolar disorder and why?
A. Lithium
B. Valproate
C. Lamotrigine
D. Antidepressants, as they may increase the frequency of mood episodes
Rationale: Antidepressants can trigger mania or rapid cycling in bipolar disorder. Mood
stabilizers like lithium, valproate, and lamotrigine are safer for maintenance.
Questions and Explanations
A patient with chronic insomnia and depression complains of daytime drowsiness while taking
trazodone (Oleptro). What should the PMHNP do to reduce this side effect?
A. Increase the dose in the morning
B. Switch to a stimulant
C. Give the medicine at night and lower the dose
D. Stop the medication abruptly
Rationale: Administering trazodone at night and reducing the dose helps minimize daytime
sedation. Increasing the dose or taking it in the morning worsens drowsiness, and stopping
abruptly may cause withdrawal effects.
A PMHNP supervisor is discussing how stimulants and noradrenergic agents help with ADHD
symptoms. What is the correct explanation?
A. They improve attention only
B. They reduce hyperactivity only
C. They improve executive function only
D. All of the above
Rationale: Stimulants and noradrenergic agents improve attention, reduce hyperactivity, and
enhance executive function. Focusing on only one effect is incomplete.
A female patient on lamotrigine (Lamictal) for migraine prophylaxis reaches the maximum dose
and is switched to zonisamide (Zonegran). What should the PMHNP ensure the patient
understands?
A. The medication has no side effects
B. It will cure migraines completely
C. It can be taken irregularly
D. This medication has unwanted side effects such as sedation, lack of coordination, and
drowsiness
,Rationale: Zonisamide can cause sedation, dizziness, and coordination problems. The patient
must be aware of these to manage daily activities safely. Claims of no side effects, cure, or
irregular dosing are inaccurate.
A patient is prescribed risperidone (Risperdal). Which practice demonstrates proper titration?
A. Increase the dose every 24 hours
B. Maintain the starting dose indefinitely
C. Titrating the dose by increasing it every 5-7 days
D. Stop abruptly if side effects appear
Rationale: Gradual titration every 5–7 days allows for monitoring efficacy and minimizing side
effects. Rapid changes or abrupt discontinuation can be unsafe.
Which of the following is the strongest established risk factor for bipolar disorder?
A. Trauma
B. Substance use
C. Chronic stress
D. Family history
Rationale: Genetics play the most significant role in bipolar disorder. Environmental factors
alone are insufficient to establish risk.
Which of the following medications are classified as selective serotonin reuptake inhibitors
(SSRIs)?
A. Nortriptyline
B. Citalopram
C. Duloxetine
D. Fluoxetine
E. Venlafaxine
Rationale: Citalopram and fluoxetine are SSRIs. Nortriptyline is a tricyclic antidepressant, and
duloxetine and venlafaxine are SNRIs.
A patient with schizophrenia who is non-adherent to treatment is at higher risk for which
outcomes?
A. Better overall quality of life
, B. Decreased substance use
C. Reduced victimization
D. Substance use, violence, victimization, and worse overall quality of life
Rationale: Non-adherence in schizophrenia increases risks for violence, victimization, substance
use, and poorer overall outcomes. The other options underestimate these risks.
A 72-year-old male with atrial fibrillation and COPD is newly diagnosed with major depressive
disorder. Which antidepressant is most appropriate?
A. Tricyclic antidepressant (TCA)
B. Methylphenidate
C. Bupropion
D. SSRIs or SNRIs
Rationale: TCAs are contraindicated in patients with atrial fibrillation due to cardiac risk. SSRIs
or SNRIs are safer first-line options. Stimulants like methylphenidate are not standard for
depression.
Which is an appropriate strategy for managing treatment-resistant depression?
A. Switch to antipsychotics alone
B. Use benzodiazepines as monotherapy
C. Electroconvulsive therapy only
D. SSRI and SNRI combination or augmentation strategies
Rationale: Combining or augmenting antidepressants is evidence-based for treatment-resistant
depression. Monotherapy with benzodiazepines or antipsychotics is not first-line, and ECT is
reserved for severe cases.
Which medication should be avoided in maintenance treatment of bipolar disorder and why?
A. Lithium
B. Valproate
C. Lamotrigine
D. Antidepressants, as they may increase the frequency of mood episodes
Rationale: Antidepressants can trigger mania or rapid cycling in bipolar disorder. Mood
stabilizers like lithium, valproate, and lamotrigine are safer for maintenance.
