6630 Final Exam Prep 2025: Targeted
Practice and Rationales
Which statement best describes a pharmacological approach to treating patients with impulsive
aggression?
A. Prescribe SSRIs to enhance mood only
B. Use benzodiazepines long-term
C. Administer antipsychotics as first-line for all patients
D. Opioid antagonists can be used to reduce drive
Rationale: Opioid antagonists like naltrexone can reduce impulsive aggression by modulating
reward and drive pathways. SSRIs may help with mood but not directly with aggression. Long-
term benzodiazepines risk dependence, and antipsychotics are reserved for severe cases.
Harold complains of pain from irritable bowel syndrome with constipation. Which medication
prevents pain signals from reaching the brain?
A. Ibuprofen
B. Amitriptyline
C. Duloxetine (Cymbalta)
D. Oxycodone
Rationale: Duloxetine, an SNRI, modulates central pain pathways and is effective for visceral
pain. NSAIDs like ibuprofen are ineffective for IBS pain, amitriptyline can help but is second-line,
and opioids address pain peripherally but risk dependence.
Slow-dose extended-release stimulants are most appropriate for which ADHD patient?
A. 16-year-old patient
B. Adult patient with ADHD
C. 12-year-old patient
D. 8-year-old patient
Rationale: Extended-release formulations are ideal for younger children who need coverage
throughout the day without multiple doses. Older children and adults may tolerate immediate-
release formulations.
,Alcohol enhances inhibition at synapses and reduces excitation at which neurotransmitters?
A. Dopamine / Serotonin
B. GABA / Glutamate
C. Norepinephrine / Acetylcholine
D. Histamine / Glycine
Rationale: Alcohol potentiates GABA (inhibitory) and inhibits glutamate (excitatory), which
contributes to its sedative and intoxicating effects. Other neurotransmitter pairs are not the
primary targets of alcohol.
A patient addicted to heroin is undergoing detox and develops autonomic hyperactivity. Which
medication is indicated?
A. Clonidine (Catapres)
B. Methadone
C. Buprenorphine
D. Naltrexone
Rationale: Clonidine reduces sympathetic hyperactivity (tachycardia, diaphoresis) during opioid
withdrawal. Methadone and buprenorphine are used for maintenance, not acute autonomic
symptoms. Naltrexone is contraindicated during active opioid use.
A 72-year-old male in early Alzheimer’s disease requires medication to improve memory. Which
option is appropriate?
A. All of these are correct
B. Donepezil
C. Rivastigmine
D. Galantamine
Rationale: All three cholinesterase inhibitors—donepezil, rivastigmine, galantamine—can
improve cognition in early Alzheimer’s. Choosing one alone is effective, but all options are valid
treatments.
Jerry is on trazodone for insomnia. How does this medication improve sleep?
A. Blocks alpha-1 and histamine-1 receptors at low doses
B. Inhibits dopamine reuptake
C. Acts as a benzodiazepine receptor agonist
D. Enhances GABA release
, Rationale: At low doses, trazodone’s antihistaminic and alpha-1 adrenergic blockade promotes
sedation and sleep. It does not act primarily on dopamine, benzodiazepine, or GABA systems.
Mrs. Rosen, 49, experiences “fibro-fog.” What approach can the PMHNP prescribe to improve
cognition?
A. Cognitive behavioral therapy only
B. Exercise only
C. Pharmacologic therapy only
D. All of the above
Rationale: Fibro-fog is best addressed with a combination of cognitive strategies, lifestyle
modifications (like exercise), and pharmacologic interventions if needed. Single approaches are
often insufficient.
An elderly woman with Alzheimer’s, CAD, and MI continues to experience mild-to-moderate
pain post-hip fixation. What is the most appropriate next step?
A. Order an X-ray because it is possible that she dislocated her hip
B. Prescribe stronger opioids immediately
C. Recommend physical therapy only
D. Refer to palliative care immediately
Rationale: Persistent pain after hip fixation warrants investigation for complications, such as
dislocation or hardware issues, before changing medications. Immediate opioids without
assessment may mask underlying problems.
A patient reports excessive nighttime arousal. Which medication could be used short-term to
shift the brain to a sleep state?
A. Duloxetine
B. Benzodiazepine
C. SSRI
D. Stimulant
Rationale: Benzodiazepines enhance GABA activity, reducing hyperarousal and facilitating sleep.
SSRIs and duloxetine do not induce immediate sleep, and stimulants would worsen arousal.
Practice and Rationales
Which statement best describes a pharmacological approach to treating patients with impulsive
aggression?
A. Prescribe SSRIs to enhance mood only
B. Use benzodiazepines long-term
C. Administer antipsychotics as first-line for all patients
D. Opioid antagonists can be used to reduce drive
Rationale: Opioid antagonists like naltrexone can reduce impulsive aggression by modulating
reward and drive pathways. SSRIs may help with mood but not directly with aggression. Long-
term benzodiazepines risk dependence, and antipsychotics are reserved for severe cases.
Harold complains of pain from irritable bowel syndrome with constipation. Which medication
prevents pain signals from reaching the brain?
A. Ibuprofen
B. Amitriptyline
C. Duloxetine (Cymbalta)
D. Oxycodone
Rationale: Duloxetine, an SNRI, modulates central pain pathways and is effective for visceral
pain. NSAIDs like ibuprofen are ineffective for IBS pain, amitriptyline can help but is second-line,
and opioids address pain peripherally but risk dependence.
Slow-dose extended-release stimulants are most appropriate for which ADHD patient?
A. 16-year-old patient
B. Adult patient with ADHD
C. 12-year-old patient
D. 8-year-old patient
Rationale: Extended-release formulations are ideal for younger children who need coverage
throughout the day without multiple doses. Older children and adults may tolerate immediate-
release formulations.
,Alcohol enhances inhibition at synapses and reduces excitation at which neurotransmitters?
A. Dopamine / Serotonin
B. GABA / Glutamate
C. Norepinephrine / Acetylcholine
D. Histamine / Glycine
Rationale: Alcohol potentiates GABA (inhibitory) and inhibits glutamate (excitatory), which
contributes to its sedative and intoxicating effects. Other neurotransmitter pairs are not the
primary targets of alcohol.
A patient addicted to heroin is undergoing detox and develops autonomic hyperactivity. Which
medication is indicated?
A. Clonidine (Catapres)
B. Methadone
C. Buprenorphine
D. Naltrexone
Rationale: Clonidine reduces sympathetic hyperactivity (tachycardia, diaphoresis) during opioid
withdrawal. Methadone and buprenorphine are used for maintenance, not acute autonomic
symptoms. Naltrexone is contraindicated during active opioid use.
A 72-year-old male in early Alzheimer’s disease requires medication to improve memory. Which
option is appropriate?
A. All of these are correct
B. Donepezil
C. Rivastigmine
D. Galantamine
Rationale: All three cholinesterase inhibitors—donepezil, rivastigmine, galantamine—can
improve cognition in early Alzheimer’s. Choosing one alone is effective, but all options are valid
treatments.
Jerry is on trazodone for insomnia. How does this medication improve sleep?
A. Blocks alpha-1 and histamine-1 receptors at low doses
B. Inhibits dopamine reuptake
C. Acts as a benzodiazepine receptor agonist
D. Enhances GABA release
, Rationale: At low doses, trazodone’s antihistaminic and alpha-1 adrenergic blockade promotes
sedation and sleep. It does not act primarily on dopamine, benzodiazepine, or GABA systems.
Mrs. Rosen, 49, experiences “fibro-fog.” What approach can the PMHNP prescribe to improve
cognition?
A. Cognitive behavioral therapy only
B. Exercise only
C. Pharmacologic therapy only
D. All of the above
Rationale: Fibro-fog is best addressed with a combination of cognitive strategies, lifestyle
modifications (like exercise), and pharmacologic interventions if needed. Single approaches are
often insufficient.
An elderly woman with Alzheimer’s, CAD, and MI continues to experience mild-to-moderate
pain post-hip fixation. What is the most appropriate next step?
A. Order an X-ray because it is possible that she dislocated her hip
B. Prescribe stronger opioids immediately
C. Recommend physical therapy only
D. Refer to palliative care immediately
Rationale: Persistent pain after hip fixation warrants investigation for complications, such as
dislocation or hardware issues, before changing medications. Immediate opioids without
assessment may mask underlying problems.
A patient reports excessive nighttime arousal. Which medication could be used short-term to
shift the brain to a sleep state?
A. Duloxetine
B. Benzodiazepine
C. SSRI
D. Stimulant
Rationale: Benzodiazepines enhance GABA activity, reducing hyperarousal and facilitating sleep.
SSRIs and duloxetine do not induce immediate sleep, and stimulants would worsen arousal.
