D346 NURS 6439
Advanced Psychiatric Mental Health Care
of Adults & Older Adults
Proctored Final Assessment Review
(With Solutions)
2026
1
,Multiple Choice
A 68-year-old patient with major depressive disorder is started on an
MAOI. Which dietary restriction is most critical to avoid hypertensive
crisis?
A) Avoid high-protein foods
B) Avoid tyramine-rich foods
C) Avoid caffeine
D) Avoid high-fat meals
Answer: B) Avoid tyramine-rich foods
Rationale: MAOIs inhibit breakdown of tyramine, and excess tyramine
can cause hypertensive crisis.
A patient stabilized on lithium therapy reports hand tremors and mild
nausea. Lab tests reveal a lithium level of 1.8 mEq/L. What is the best
initial action?
A) Increase lithium dose
B) Discontinue lithium immediately
C) Hold lithium and evaluate for toxicity
D) Add beta-blockers
Answer: C) Hold lithium and evaluate for toxicity
Rationale: Therapeutic lithium range is 0.6-1.2 mEq/L. 1.8 mEq/L
indicates toxicity, so hold dose and evaluate.
Which pharmacokinetic change most commonly affects
psychotropic dosing in older adults?
A) Increased hepatic metabolism
B) Decreased renal clearance
C) Increased plasma protein binding
D) Increased blood-brain barrier permeability
Answer: B) Decreased renal clearance
Rationale: Aging reduces renal function, affecting clearance of
renally-excreted drugs.
A patient with schizophrenia develops extrapyramidal symptoms
2
, (EPS) after starting risperidone. Which medication would be
appropriate to manage EPS?
A) Clozapine
B) Benztropine
C) Haloperidol
D) Fluoxetine
Answer: B) Benztropine
Rationale: Benztropine is an anticholinergic used to treat EPS.
Which drug class has the highest risk of QT prolongation?
A) SSRIs
B) Atypical antipsychotics
C) Benzodiazepines
D) Mood stabilizers
Answer: B) Atypical antipsychotics
Rationale: Several atypical antipsychotics (e.g., ziprasidone) have
known QT prolongation risk.
True/False
T/F: The onset of action for long-acting injectable antipsychotics is
immediate.
Answer: False
Rationale: Long-acting injectables take days to weeks to reach
therapeutic levels.
T/F: Elderly patients are more sensitive to benzodiazepine effects due
to changes in GABA receptor density.
Answer: True
Rationale: Aging increases benzodiazepine sensitivity through
receptor changes and altered metabolism.
T/F: Serotonin syndrome is more likely if an SSRI is combined with an
MAOI.
Answer: True
3
Advanced Psychiatric Mental Health Care
of Adults & Older Adults
Proctored Final Assessment Review
(With Solutions)
2026
1
,Multiple Choice
A 68-year-old patient with major depressive disorder is started on an
MAOI. Which dietary restriction is most critical to avoid hypertensive
crisis?
A) Avoid high-protein foods
B) Avoid tyramine-rich foods
C) Avoid caffeine
D) Avoid high-fat meals
Answer: B) Avoid tyramine-rich foods
Rationale: MAOIs inhibit breakdown of tyramine, and excess tyramine
can cause hypertensive crisis.
A patient stabilized on lithium therapy reports hand tremors and mild
nausea. Lab tests reveal a lithium level of 1.8 mEq/L. What is the best
initial action?
A) Increase lithium dose
B) Discontinue lithium immediately
C) Hold lithium and evaluate for toxicity
D) Add beta-blockers
Answer: C) Hold lithium and evaluate for toxicity
Rationale: Therapeutic lithium range is 0.6-1.2 mEq/L. 1.8 mEq/L
indicates toxicity, so hold dose and evaluate.
Which pharmacokinetic change most commonly affects
psychotropic dosing in older adults?
A) Increased hepatic metabolism
B) Decreased renal clearance
C) Increased plasma protein binding
D) Increased blood-brain barrier permeability
Answer: B) Decreased renal clearance
Rationale: Aging reduces renal function, affecting clearance of
renally-excreted drugs.
A patient with schizophrenia develops extrapyramidal symptoms
2
, (EPS) after starting risperidone. Which medication would be
appropriate to manage EPS?
A) Clozapine
B) Benztropine
C) Haloperidol
D) Fluoxetine
Answer: B) Benztropine
Rationale: Benztropine is an anticholinergic used to treat EPS.
Which drug class has the highest risk of QT prolongation?
A) SSRIs
B) Atypical antipsychotics
C) Benzodiazepines
D) Mood stabilizers
Answer: B) Atypical antipsychotics
Rationale: Several atypical antipsychotics (e.g., ziprasidone) have
known QT prolongation risk.
True/False
T/F: The onset of action for long-acting injectable antipsychotics is
immediate.
Answer: False
Rationale: Long-acting injectables take days to weeks to reach
therapeutic levels.
T/F: Elderly patients are more sensitive to benzodiazepine effects due
to changes in GABA receptor density.
Answer: True
Rationale: Aging increases benzodiazepine sensitivity through
receptor changes and altered metabolism.
T/F: Serotonin syndrome is more likely if an SSRI is combined with an
MAOI.
Answer: True
3
