NRNP6675 PMHNP Care Across Lifespan I
CUMULATIVE FINAL EXAM PRACTICE - 2026/2027
| 100% Evidence-Based Answers | Lifespan
Psychiatric Mastery
1. 45-y/o executive; 2 mo fatigue, anhedonia, poor concentration, insomnia; ↑ alcohol to
“unwind”; MSE: flat affect, psychomotor retardation, denies SI but “what’s the point?”;
PHQ-9 = 18. Most appropriate initial diagnostic formulation & action?
A. Adjustment Disorder; supportive therapy only
B. Alcohol Use Disorder; detox referral
C. Major Depressive Disorder, moderate; initiate SSRI + assess alcohol severity
D. GAD; start buspirone
Verified Answer: C
Synthesis Rationale: PHQ-9 ≥ 15 = moderate-severe MDD (DSM-5-TR Criterion A met).
Alcohol appears self-medication (secondary). APA 2026: treat mood first-line with SSRI
while evaluating AUD severity (Domain 2 & 3). Adjustment (A) too mild; detox alone (B)
misses mood; no worry data for GAD (D).
2. (SATA) 72-y/o F; MDD; starting sertraline. ESSENTIAL teaching: (Select all)
A. Therapeutic lag 4-6 wks
B. Report ↑ anxiety/activation/SI early
,C. Avoid aged cheeses
D. Orthostasis likely; rise slowly
E. Do not stop abruptly
Verified Answers: A, B, E
Synthesis Rationale: Standard SSRI counseling (Domain 2). Black-box monitor (B) vital
across lifespan. Dietary tyramine (C) = MAOI, not SSRI. Orthostasis (D) uncommon with
SSRIs vs TCAs.
3. 28-y/o; panic attacks weekly, anticipatory anxiety, agoraphobia; no medical
comorbidities; no current meds. Most accurate first-line pharmacologic choice?
A. Sertraline 25 mg daily
B. Lorazepam 1 mg PRN
C. Propranolol 20 mg TID
D. Buspirone 15 mg BID
Verified Answer: A
Synthesis Rationale: APA 2026 Panic Disorder: SSRI first-line (sertraline, paroxetine,
fluoxetine). Start low to avoid activation. Benzo (B) short-term bridge only; propranolol
(C) performance-only; buspirone (D) lacks efficacy in panic.
4. Urinary drug screen positive for cannabis; patient admits nightly use for sleep; no
withdrawal symptoms; wants to quit. Best initial approach?
A. Recommend inpatient detox
,B. Brief intervention + motivational interviewing + CBT-I referral
C. Prescribe dronabinol taper
D. Order liver function tests
Verified Answer: B
Synthesis Rationale: Cannabis use disorder = outpatient unless complications.
Motivational interviewing + CBT-I = Grade A (NIH 2026). No FDA meds for cannabis
withdrawal; LFTs (D) not indicated.
5. 60-y/o; HTN, hyperlipidemia; BP 148/92, HR 98; reports worry most days, muscle
tension, sleep-onset difficulty; GAD-7 = 14. Which medication choice addresses both
conditions?
A. Duloxetine 30 mg daily
B. Hydroxyzine 25 mg qhs
C. Clonidine 0.1 mg BID
D. Atenolol 50 mg daily
Verified Answer: A
Synthesis Rationale: Duloxetine (SNRI) = FDA GAD, also ↓ musculoskeletal pain, no HR
increase (Domain 2 & 3). Hydroxyzine (B) = high anticholinergic; clonidine (C) = no
anxiolytic evidence; atenolol (D) = performance-only anxiety.
6. Patient on sertraline 100 mg × 8 wks; PHQ-9 12 → 8; fatigue persists; no SI; wants
more energy. Next evidence-based option?
, A. Increase sertraline to 150 mg
B. Augment bupropion 150 mg morning
C. Switch to venlafaxine
D. Add methylphenidate
Verified Answer: B
Synthesis Rationale: Partial response + fatigue → bupropion (activating, dopaminergic)
= APA Level 1 augmentation; less sexual side effects. Dose escalation (A) if < 50 % ↓;
stimulant (D) = later line.
7. (SATA) Older adult (78 y) starting sertraline. Age-specific considerations: (Select all)
A. Start ½ adult dose (12.5 mg)
B. Monitor Na⁺ q 2-4 wks × 2 mo (SIADH risk)
C. Fall-risk counseling
D. EKG before each dose
E. Avoid if CrCl < 30
Verified Answers: A, B, C
Synthesis Rationale: Start low, go slow (A); SIADH ↑ > 65 y (B); SSRI ↑ fall risk (C). EKG
(D) unnecessary; renal impairment (E) = adjust dose, not contraindicated.
8. PTSD – nightmares, hypervigilance, avoidance; failed SSRIs; BP 110/70. Next
pharmacologic option:
CUMULATIVE FINAL EXAM PRACTICE - 2026/2027
| 100% Evidence-Based Answers | Lifespan
Psychiatric Mastery
1. 45-y/o executive; 2 mo fatigue, anhedonia, poor concentration, insomnia; ↑ alcohol to
“unwind”; MSE: flat affect, psychomotor retardation, denies SI but “what’s the point?”;
PHQ-9 = 18. Most appropriate initial diagnostic formulation & action?
A. Adjustment Disorder; supportive therapy only
B. Alcohol Use Disorder; detox referral
C. Major Depressive Disorder, moderate; initiate SSRI + assess alcohol severity
D. GAD; start buspirone
Verified Answer: C
Synthesis Rationale: PHQ-9 ≥ 15 = moderate-severe MDD (DSM-5-TR Criterion A met).
Alcohol appears self-medication (secondary). APA 2026: treat mood first-line with SSRI
while evaluating AUD severity (Domain 2 & 3). Adjustment (A) too mild; detox alone (B)
misses mood; no worry data for GAD (D).
2. (SATA) 72-y/o F; MDD; starting sertraline. ESSENTIAL teaching: (Select all)
A. Therapeutic lag 4-6 wks
B. Report ↑ anxiety/activation/SI early
,C. Avoid aged cheeses
D. Orthostasis likely; rise slowly
E. Do not stop abruptly
Verified Answers: A, B, E
Synthesis Rationale: Standard SSRI counseling (Domain 2). Black-box monitor (B) vital
across lifespan. Dietary tyramine (C) = MAOI, not SSRI. Orthostasis (D) uncommon with
SSRIs vs TCAs.
3. 28-y/o; panic attacks weekly, anticipatory anxiety, agoraphobia; no medical
comorbidities; no current meds. Most accurate first-line pharmacologic choice?
A. Sertraline 25 mg daily
B. Lorazepam 1 mg PRN
C. Propranolol 20 mg TID
D. Buspirone 15 mg BID
Verified Answer: A
Synthesis Rationale: APA 2026 Panic Disorder: SSRI first-line (sertraline, paroxetine,
fluoxetine). Start low to avoid activation. Benzo (B) short-term bridge only; propranolol
(C) performance-only; buspirone (D) lacks efficacy in panic.
4. Urinary drug screen positive for cannabis; patient admits nightly use for sleep; no
withdrawal symptoms; wants to quit. Best initial approach?
A. Recommend inpatient detox
,B. Brief intervention + motivational interviewing + CBT-I referral
C. Prescribe dronabinol taper
D. Order liver function tests
Verified Answer: B
Synthesis Rationale: Cannabis use disorder = outpatient unless complications.
Motivational interviewing + CBT-I = Grade A (NIH 2026). No FDA meds for cannabis
withdrawal; LFTs (D) not indicated.
5. 60-y/o; HTN, hyperlipidemia; BP 148/92, HR 98; reports worry most days, muscle
tension, sleep-onset difficulty; GAD-7 = 14. Which medication choice addresses both
conditions?
A. Duloxetine 30 mg daily
B. Hydroxyzine 25 mg qhs
C. Clonidine 0.1 mg BID
D. Atenolol 50 mg daily
Verified Answer: A
Synthesis Rationale: Duloxetine (SNRI) = FDA GAD, also ↓ musculoskeletal pain, no HR
increase (Domain 2 & 3). Hydroxyzine (B) = high anticholinergic; clonidine (C) = no
anxiolytic evidence; atenolol (D) = performance-only anxiety.
6. Patient on sertraline 100 mg × 8 wks; PHQ-9 12 → 8; fatigue persists; no SI; wants
more energy. Next evidence-based option?
, A. Increase sertraline to 150 mg
B. Augment bupropion 150 mg morning
C. Switch to venlafaxine
D. Add methylphenidate
Verified Answer: B
Synthesis Rationale: Partial response + fatigue → bupropion (activating, dopaminergic)
= APA Level 1 augmentation; less sexual side effects. Dose escalation (A) if < 50 % ↓;
stimulant (D) = later line.
7. (SATA) Older adult (78 y) starting sertraline. Age-specific considerations: (Select all)
A. Start ½ adult dose (12.5 mg)
B. Monitor Na⁺ q 2-4 wks × 2 mo (SIADH risk)
C. Fall-risk counseling
D. EKG before each dose
E. Avoid if CrCl < 30
Verified Answers: A, B, C
Synthesis Rationale: Start low, go slow (A); SIADH ↑ > 65 y (B); SSRI ↑ fall risk (C). EKG
(D) unnecessary; renal impairment (E) = adjust dose, not contraindicated.
8. PTSD – nightmares, hypervigilance, avoidance; failed SSRIs; BP 110/70. Next
pharmacologic option:
