6630 Final Exam 2025: Comprehensive Study Guide and Practice Questions

What is the strongest established risk factor for bipolar disorder? A) Environmental stressors B) Family history C) Substance use D) Childhood trauma Rationale: Family history is the strongest and most established risk factor, indicating a genetic component. Environmental stressors, substance use, and trauma can contribute but are not as predictive. Which of the following medications are classified as selective serotonin reuptake inhibitors (SSRIs)? A) Fluoxetine, Citalopram B) Nortriptyline C) Duloxetine, Venlafaxine D) All of the above Rationale: Fluoxetine and Citalopram are SSRIs. Nortriptyline is a tricyclic antidepressant, Duloxetine and Venlafaxine are SNRIs. Which disease state of a non-adherent patient is at greater risk for substance use, violence, and worse overall quality of life? A) Major depressive disorder B) Bipolar disorder C) Anxiety disorder D) Schizophrenia Rationale: Schizophrenia patients who are non-adherent have higher risk for substance use, victimization, and impaired quality of life. Other disorders carry risks but not as consistently. A 72-year-old male with atrial fibrillation and COPD is newly diagnosed with major depressive disorder. Which antidepressant is most appropriate? A) Avoid TCA due to cardiac risks and age B) Stimulant medication C) MAOI D) Any SSRI Rationale: Tricyclic antidepressants (TCAs) are contraindicated in older adults with atrial fibrillation due to cardiotoxicity. Stimulants and MAOIs are not appropriate first-line. Which strategy is appropriate for managing treatment-resistant depression? A) Monotherapy with MAOI B) Switch to TCA C) Combination of SSRI and SNRI D) Electroconvulsive therapy only Rationale: Combination therapy using SSRIs and SNRIs can be effective in treatment-resistant cases. MAOIs and TCAs are not first-line, and ECT is reserved for severe or refractory cases. Which medication is best to avoid in maintenance treatment of bipolar disorder and why? A) Antidepressants due to risk of triggering mood episodes B) Mood stabilizers C) Atypical antipsychotics D) Lithium Rationale: Antidepressants may increase frequency of manic or hypomanic episodes in bipolar disorder, whereas mood stabilizers and antipsychotics are standard. An 8-year-old patient presents with severe hyperactivity and ADHD. Which medication is most likely prescribed? A) Atomoxetine B) Methylphenidate (Ritalin, Concerta) C) Guanfacine D) Clonidine Rationale: Methylphenidate is first-line for pediatric ADHD. Atomoxetine and alpha-2 agonists are alternatives but not first-line for severe hyperactivity. Kevin, an adolescent with kleptomania, is seeking treatment. What should the PMHNP tell his parents? A) Behavioral therapy only B) SSRI therapy C) Stimulant therapy D) Naltrexone may be an appropriate option Rationale: Naltrexone can reduce impulsive behaviors in kleptomania. SSRIs, stimulants, and behavioral therapy may help, but naltrexone is the pharmacologic option specifically discussed. Which substance has the highest probability of dependence after a single use? A) Alcohol B) Cocaine C) Nicotine D) Cannabis Rationale: Nicotine is highly addictive with a high probability of dependence even after limited use. Other substances carry risk but lower probability after single use. Which approach is correct for managing agitation in dementia patients? A) Immediate pharmacologic sedation B) Physical restraints C) Assess how the environment affects mood D) Increase stimulant medications Rationale: Environmental triggers often worsen agitation; addressing these is first-line. Sedation and restraints are last-resort, and stimulants may worsen agitation. A patient on chronic opioids shows somnolence and 7 respirations per minute. What should the PMHNP do? A) Increase opioid dose B) Administer stimulant C) Order naloxone (NARCAN) D) Monitor only Rationale: Low respiratory rate indicates opioid toxicity; naloxone is the antidote. Monitoring alone or increasing dose is dangerous. A patient with chronic insomnia asks about OTC options. What is the PMHNP’s best response? A) “You can get melatonin over the counter, which will help with sleep onset.” B) Prescribe benzodiazepine immediately C) Suggest antihistamines only D) Recommend stimulants for sleep Rationale: Melatonin is safe, OTC, and aids sleep onset. Benzodiazepines carry risk, antihistamines may cause side effects, and stimulants are contraindicated. A patient reports daytime overstimulation and anxiety but does not want sedation. Which decision reflects proper treatment? A) Prescribe H1-blocking sedative B) Avoid drugs that block H1 receptors C) Prescribe benzodiazepine D) Prescribe high-dose antihistamine Rationale: Avoiding H1-blocking sedatives prevents drowsiness while treating anxiety. H1 blockers cause sedation, and benzodiazepines may over-sedate. Which statement about aripiprazole (Abilify) is correct? A) Causes severe sedation B) Is highly anticholinergic C) Sedation is unusual D) Blocks histamine strongly Rationale: Aripiprazole is activating and generally does not cause sedation. Other antipsychotics are more sedating. Before prescribing disulfiram (Antabuse) to a patient with alcohol use disorder, what must the PMHNP evaluate? A) Liver function tests only B) Patient’s pain tolerance C) Severity of withdrawal symptoms D) Patient’s willingness to abstain from alcohol Rationale: Disulfiram is effective only if the patient is motivated to abstain. Liver function is important but secondary. Withdrawal severity and pain tolerance do not determine appropriateness. Mr. Peterson, BMI 33, states he feels “addicted to food like drugs.” Which neurobiological parallel explains this? A) Increased dopamine in nucleus accumbens B) Increased activation of amygdala C) Increased prefrontal cortex activity