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NU 671 MIDTERM ACTUAL EXAM PREP
2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK |NEW AND REVISED|
CURRENTLY TESTING
1. A 28-year-old female presents with depressed mood, anhedonia,
fatigue, and difficulty concentrating for the past 6 weeks. Her PHQ-9
score is 18. She denies any history of mania. The most appropriate
first-line pharmacotherapy is:
A) Bupropion
B) Sertraline
C) Venlafaxine
D) Amitriptyline
Rationale: SSRIs (sertraline, fluoxetine, escitalopram) are first-line
for major depressive disorder due to their favorable side effect profile
and safety. Bupropion is also first-line but is not an SSRI; however,
SSRIs are the most commonly used first-line agents. Venlafaxine is an
SNRI, also first-line but with more side effects. Amitriptyline is a TCA
with higher risk of toxicity.
2. A 32-year-old male with generalized anxiety disorder has been on
alprazolam 1 mg three times daily for 2 years. He reports needing higher
doses and wants to stop. The most appropriate next step is:
A) Abrupt discontinuation with close monitoring
B) Switch to a long-acting benzodiazepine (e.g., diazepam) and taper
slowly
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C) Add buspirone and continue alprazolam
D) Increase alprazolam to 2 mg three times daily
Rationale: Alprazolam is a short-acting benzodiazepine with high
dependence potential. A slow taper using a long-acting benzodiazepine
(diazepam) is the standard of care to prevent withdrawal seizures and
rebound anxiety.
3. The monoamine hypothesis of depression proposes that depression is
caused by:
A) Excess dopamine in the mesolimbic pathway
B) Deficiency of serotonin, norepinephrine, and/or dopamine in the
central nervous system
C) Excess acetylcholine in the basal ganglia
D) Deficiency of GABA in the prefrontal cortex
Rationale: The monoamine hypothesis suggests that depression results
from reduced availability of monoamines (serotonin, norepinephrine,
dopamine). This is the basis for the mechanism of action of most
antidepressants.
4. A 45-year-old female with major depression and a history of seizures
is prescribed an antidepressant. Which medication should be avoided?
A) Sertraline
B) Bupropion
C) Escitalopram
D) Venlafaxine
Rationale: Bupropion lowers the seizure threshold and is
contraindicated in patients with a known seizure disorder. SSRIs and
SNRIs are safer.
5. A 22-year-old male with a first episode of psychosis is started on
risperidone. After 3 days, he develops torticollis and oculogyric crisis.
The most appropriate treatment is:
A) Diphenhydramine 50 mg IM
,3|Page
B) Benztropine 2 mg IM
C) Lorazepam 2 mg IM
D) Propranolol 20 mg PO
Rationale: Acute dystonia is an extrapyramidal side effect of
antipsychotics. It is treated with IM anticholinergics such as
benztropine or antihistamines such as diphenhydramine. Benztropine
is a classic answer.
6. A 30-year-old female with panic disorder is started on sertraline. She
asks how long it will take to work. The correct answer is:
A) 1-2 hours
B) 4-6 weeks for full effect, but some improvement may be seen
within 2 weeks
C) 24 hours
D) 3-5 days
Rationale: SSRIs have a delayed onset of action for panic disorder and
depression, typically requiring 4-6 weeks for maximum therapeutic
effect. Early improvement may occur but is not guaranteed.
7. The primary mechanism of action of selective serotonin reuptake
inhibitors (SSRIs) is:
A) Blockade of norepinephrine reuptake
B) Inhibition of the serotonin transporter, increasing synaptic
serotonin
C) Antagonism of postsynaptic dopamine receptors
D) Blockade of voltage-gated sodium channels
Rationale: SSRIs selectively inhibit the serotonin transporter (SERT),
preventing reuptake of serotonin from the synaptic cleft, thereby
increasing serotonergic neurotransmission.
8. A 55-year-old male with major depression and benign prostatic
hyperplasia (BPH) is started on an antidepressant. Which antidepressant
is most likely to worsen urinary retention?
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A) Sertraline
B) Paroxetine
C) Escitalopram
D) Fluoxetine
Rationale: Paroxetine has the highest anticholinergic burden among
SSRIs, which can exacerbate urinary retention in patients with BPH.
Sertraline and escitalopram are less anticholinergic.
9. A 26-year-old female with borderline personality disorder presents
with chronic emptiness, unstable relationships, and recurrent
self-cutting. The most evidence-based psychotherapy for this condition
is:
A) Cognitive-behavioral therapy (CBT)
B) Dialectical behavior therapy (DBT)
C) Interpersonal therapy (IPT)
D) Psychodynamic therapy
Rationale: DBT is the gold standard, evidence-based psychotherapy
for borderline personality disorder, focusing on emotion regulation,
distress tolerance, interpersonal effectiveness, and mindfulness.
10. A 35-year-old male with alcohol use disorder is 2 days abstinent and
develops tremors, diaphoresis, tachycardia, and visual hallucinations. He
is oriented. The most appropriate pharmacotherapy is:
A) Naltrexone 50 mg daily
B) Lorazepam 2 mg IV as needed for symptoms (symptom-triggered
regimen)
C) Disulfiram 250 mg daily
D) Acamprosate 666 mg three times daily
Rationale: The patient is experiencing alcohol withdrawal
(hallucinosis). Benzodiazepines (lorazepam, diazepam,
chlordiazepoxide) are first-line to prevent seizures and delirium
NU 671 MIDTERM ACTUAL EXAM PREP
2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK |NEW AND REVISED|
CURRENTLY TESTING
1. A 28-year-old female presents with depressed mood, anhedonia,
fatigue, and difficulty concentrating for the past 6 weeks. Her PHQ-9
score is 18. She denies any history of mania. The most appropriate
first-line pharmacotherapy is:
A) Bupropion
B) Sertraline
C) Venlafaxine
D) Amitriptyline
Rationale: SSRIs (sertraline, fluoxetine, escitalopram) are first-line
for major depressive disorder due to their favorable side effect profile
and safety. Bupropion is also first-line but is not an SSRI; however,
SSRIs are the most commonly used first-line agents. Venlafaxine is an
SNRI, also first-line but with more side effects. Amitriptyline is a TCA
with higher risk of toxicity.
2. A 32-year-old male with generalized anxiety disorder has been on
alprazolam 1 mg three times daily for 2 years. He reports needing higher
doses and wants to stop. The most appropriate next step is:
A) Abrupt discontinuation with close monitoring
B) Switch to a long-acting benzodiazepine (e.g., diazepam) and taper
slowly
,2|Page
C) Add buspirone and continue alprazolam
D) Increase alprazolam to 2 mg three times daily
Rationale: Alprazolam is a short-acting benzodiazepine with high
dependence potential. A slow taper using a long-acting benzodiazepine
(diazepam) is the standard of care to prevent withdrawal seizures and
rebound anxiety.
3. The monoamine hypothesis of depression proposes that depression is
caused by:
A) Excess dopamine in the mesolimbic pathway
B) Deficiency of serotonin, norepinephrine, and/or dopamine in the
central nervous system
C) Excess acetylcholine in the basal ganglia
D) Deficiency of GABA in the prefrontal cortex
Rationale: The monoamine hypothesis suggests that depression results
from reduced availability of monoamines (serotonin, norepinephrine,
dopamine). This is the basis for the mechanism of action of most
antidepressants.
4. A 45-year-old female with major depression and a history of seizures
is prescribed an antidepressant. Which medication should be avoided?
A) Sertraline
B) Bupropion
C) Escitalopram
D) Venlafaxine
Rationale: Bupropion lowers the seizure threshold and is
contraindicated in patients with a known seizure disorder. SSRIs and
SNRIs are safer.
5. A 22-year-old male with a first episode of psychosis is started on
risperidone. After 3 days, he develops torticollis and oculogyric crisis.
The most appropriate treatment is:
A) Diphenhydramine 50 mg IM
,3|Page
B) Benztropine 2 mg IM
C) Lorazepam 2 mg IM
D) Propranolol 20 mg PO
Rationale: Acute dystonia is an extrapyramidal side effect of
antipsychotics. It is treated with IM anticholinergics such as
benztropine or antihistamines such as diphenhydramine. Benztropine
is a classic answer.
6. A 30-year-old female with panic disorder is started on sertraline. She
asks how long it will take to work. The correct answer is:
A) 1-2 hours
B) 4-6 weeks for full effect, but some improvement may be seen
within 2 weeks
C) 24 hours
D) 3-5 days
Rationale: SSRIs have a delayed onset of action for panic disorder and
depression, typically requiring 4-6 weeks for maximum therapeutic
effect. Early improvement may occur but is not guaranteed.
7. The primary mechanism of action of selective serotonin reuptake
inhibitors (SSRIs) is:
A) Blockade of norepinephrine reuptake
B) Inhibition of the serotonin transporter, increasing synaptic
serotonin
C) Antagonism of postsynaptic dopamine receptors
D) Blockade of voltage-gated sodium channels
Rationale: SSRIs selectively inhibit the serotonin transporter (SERT),
preventing reuptake of serotonin from the synaptic cleft, thereby
increasing serotonergic neurotransmission.
8. A 55-year-old male with major depression and benign prostatic
hyperplasia (BPH) is started on an antidepressant. Which antidepressant
is most likely to worsen urinary retention?
, 4|Page
A) Sertraline
B) Paroxetine
C) Escitalopram
D) Fluoxetine
Rationale: Paroxetine has the highest anticholinergic burden among
SSRIs, which can exacerbate urinary retention in patients with BPH.
Sertraline and escitalopram are less anticholinergic.
9. A 26-year-old female with borderline personality disorder presents
with chronic emptiness, unstable relationships, and recurrent
self-cutting. The most evidence-based psychotherapy for this condition
is:
A) Cognitive-behavioral therapy (CBT)
B) Dialectical behavior therapy (DBT)
C) Interpersonal therapy (IPT)
D) Psychodynamic therapy
Rationale: DBT is the gold standard, evidence-based psychotherapy
for borderline personality disorder, focusing on emotion regulation,
distress tolerance, interpersonal effectiveness, and mindfulness.
10. A 35-year-old male with alcohol use disorder is 2 days abstinent and
develops tremors, diaphoresis, tachycardia, and visual hallucinations. He
is oriented. The most appropriate pharmacotherapy is:
A) Naltrexone 50 mg daily
B) Lorazepam 2 mg IV as needed for symptoms (symptom-triggered
regimen)
C) Disulfiram 250 mg daily
D) Acamprosate 666 mg three times daily
Rationale: The patient is experiencing alcohol withdrawal
(hallucinosis). Benzodiazepines (lorazepam, diazepam,
chlordiazepoxide) are first-line to prevent seizures and delirium
