NRNP 6675 Midterm Exam Questions and
Answers with rationales (Latest ):
Most Comprehensive to Pass the Exam,
100% Verified - UPDATED
A 25-year-old male is brought in by police after threatening a neighbor. He is
pacing, yelling at unseen people, and states, "The FBI is transmitting thoughts into
my brain." Which neurotransmitter pathway is most likely hyperactive in this
patient?
A) Nigrostriatal pathway
B) Mesolimbic pathway
C) Mesocortical pathway
D) Tuberoinfundibular pathway
Answer: B) Mesolimbic pathway
Rationale: The mesolimbic pathway is associated with positive symptoms of
schizophrenia (hallucinations, delusions). Hyperactivity of dopamine in this
pathway is the primary target of antipsychotic medications.
Which of the following antipsychotic medications requires baseline and ongoing
monitoring of absolute neutrophil count (ANC) due to a high risk of
agranulocytosis?
A) Quetiapine
B) Risperidone
C) Clozapine
D) Olanzapine
,Answer: C) Clozapine
Rationale: Clozapine carries a black box warning for agranulocytosis. The ANC
must be monitored frequently (weekly for the first 6 months, biweekly for the
next 6 months, then monthly) through the REMS program.
A patient prescribed lithium for bipolar disorder presents with coarse hand
tremors, confusion, ataxia, and severe nausea. Which of the following is the most
appropriate initial intervention?
A) Administer a beta-blocker for the tremor
B) Increase the lithium dose to achieve therapeutic levels
C) Hold the lithium and draw a stat lithium level and basic metabolic panel
D) Prescribe an antiemetic for the nausea
Answer: C) Hold the lithium and draw a stat lithium level and basic metabolic
panel
Rationale: The patient is exhibiting signs of severe lithium toxicity (neurotoxicity
and GI symptoms). Lithium has a narrow therapeutic index; the medication must
be held immediately, and levels/electrolytes must be checked.
A 32-year-old female is started on fluoxetine for major depressive disorder. She
returns after 4 weeks stating she feels "wonderful" but hasn't slept in 4 days, is
spending thousands of dollars online, and talks rapidly. What is the PMHNP’s
most likely diagnosis?
A) Antidepressant-induced mania
B) Worsening depression with agitation
C) Bipolar I disorder, current episode manic
D) Generalized anxiety disorder
Answer: A) Antidepressant-induced mania
Rationale: SSRIs can induce mania or hypomania in patients predisposed to
bipolar disorder. The symptoms (decreased need for sleep, excessive spending,
,rapid speech) emerged after starting the SSRI. The SSRI should be discontinued
immediately.
Which ethical principle is demonstrated when a PMHNP ensures a patient
understands the risks, benefits, and alternatives to a proposed medication before
starting it?
A) Justice
B) Beneficence
C) Non-maleficence
D) Autonomy
Answer: D) Autonomy
Rationale: Autonomy respects the patient's right to self-determination. Informed
consent ensures the patient has the necessary information to make an
autonomous decision about their healthcare.
A patient with schizophrenia has been on haloperidol for 5 years. They present
with lip-smacking, tongue protrusion, and facial grimacing that they cannot
control. Which medication is FDA-approved to treat this condition?
A) Benztropine
B) Propranolol
C) Valbenazine
D) Lorazepam
Answer: C) Valbenazine
Rationale: The patient is presenting with Tardive Dyskinesia (TD). VMAT2
inhibitors, such as valbenazine and deutetrabenazine, are FDA-approved to treat
TD. Benztropine is used for acute EPS, not TD, and can actually worsen it.
An 18-year-old male presents with a 6-month history of declining grades, social
withdrawal, and smelling things that aren't there. He believes his peers are
reading his mind. What phase of schizophrenia is this patient most likely
experiencing?
, A) Prodromal phase
B) Active phase
C) Residual phase
D) Chronic phase
Answer: A) Prodromal phase
Rationale: The prodromal phase precedes the active phase of psychosis. It is
characterized by functional decline, social withdrawal, and attenuated positive
symptoms (like olfactory hallucinations or ideas of reference).
A patient is prescribed phenelzine (Nardil), an MAOI. Which dietary restriction is
strictly required to prevent a hypertensive crisis?
A) Limiting intake of leafy green vegetables
B) Avoiding foods high in tyramine
C) Limiting dairy products
D) Avoiding grapefruit juice
Answer: B) Avoiding foods high in tyramine
Rationale: MAOIs inhibit the breakdown of tyramine. Tyramine-rich foods (aged
cheeses, cured meats, fermented soy products, tap beer) can cause a sudden and
potentially fatal release of norepinephrine, leading to a hypertensive crisis.
Which of the following is a primary negative symptom of schizophrenia?
A) Hallucinations
B) Delusions
C) Alogia
D) Disorganized speech
Answer: C) Alogia
Answers with rationales (Latest ):
Most Comprehensive to Pass the Exam,
100% Verified - UPDATED
A 25-year-old male is brought in by police after threatening a neighbor. He is
pacing, yelling at unseen people, and states, "The FBI is transmitting thoughts into
my brain." Which neurotransmitter pathway is most likely hyperactive in this
patient?
A) Nigrostriatal pathway
B) Mesolimbic pathway
C) Mesocortical pathway
D) Tuberoinfundibular pathway
Answer: B) Mesolimbic pathway
Rationale: The mesolimbic pathway is associated with positive symptoms of
schizophrenia (hallucinations, delusions). Hyperactivity of dopamine in this
pathway is the primary target of antipsychotic medications.
Which of the following antipsychotic medications requires baseline and ongoing
monitoring of absolute neutrophil count (ANC) due to a high risk of
agranulocytosis?
A) Quetiapine
B) Risperidone
C) Clozapine
D) Olanzapine
,Answer: C) Clozapine
Rationale: Clozapine carries a black box warning for agranulocytosis. The ANC
must be monitored frequently (weekly for the first 6 months, biweekly for the
next 6 months, then monthly) through the REMS program.
A patient prescribed lithium for bipolar disorder presents with coarse hand
tremors, confusion, ataxia, and severe nausea. Which of the following is the most
appropriate initial intervention?
A) Administer a beta-blocker for the tremor
B) Increase the lithium dose to achieve therapeutic levels
C) Hold the lithium and draw a stat lithium level and basic metabolic panel
D) Prescribe an antiemetic for the nausea
Answer: C) Hold the lithium and draw a stat lithium level and basic metabolic
panel
Rationale: The patient is exhibiting signs of severe lithium toxicity (neurotoxicity
and GI symptoms). Lithium has a narrow therapeutic index; the medication must
be held immediately, and levels/electrolytes must be checked.
A 32-year-old female is started on fluoxetine for major depressive disorder. She
returns after 4 weeks stating she feels "wonderful" but hasn't slept in 4 days, is
spending thousands of dollars online, and talks rapidly. What is the PMHNP’s
most likely diagnosis?
A) Antidepressant-induced mania
B) Worsening depression with agitation
C) Bipolar I disorder, current episode manic
D) Generalized anxiety disorder
Answer: A) Antidepressant-induced mania
Rationale: SSRIs can induce mania or hypomania in patients predisposed to
bipolar disorder. The symptoms (decreased need for sleep, excessive spending,
,rapid speech) emerged after starting the SSRI. The SSRI should be discontinued
immediately.
Which ethical principle is demonstrated when a PMHNP ensures a patient
understands the risks, benefits, and alternatives to a proposed medication before
starting it?
A) Justice
B) Beneficence
C) Non-maleficence
D) Autonomy
Answer: D) Autonomy
Rationale: Autonomy respects the patient's right to self-determination. Informed
consent ensures the patient has the necessary information to make an
autonomous decision about their healthcare.
A patient with schizophrenia has been on haloperidol for 5 years. They present
with lip-smacking, tongue protrusion, and facial grimacing that they cannot
control. Which medication is FDA-approved to treat this condition?
A) Benztropine
B) Propranolol
C) Valbenazine
D) Lorazepam
Answer: C) Valbenazine
Rationale: The patient is presenting with Tardive Dyskinesia (TD). VMAT2
inhibitors, such as valbenazine and deutetrabenazine, are FDA-approved to treat
TD. Benztropine is used for acute EPS, not TD, and can actually worsen it.
An 18-year-old male presents with a 6-month history of declining grades, social
withdrawal, and smelling things that aren't there. He believes his peers are
reading his mind. What phase of schizophrenia is this patient most likely
experiencing?
, A) Prodromal phase
B) Active phase
C) Residual phase
D) Chronic phase
Answer: A) Prodromal phase
Rationale: The prodromal phase precedes the active phase of psychosis. It is
characterized by functional decline, social withdrawal, and attenuated positive
symptoms (like olfactory hallucinations or ideas of reference).
A patient is prescribed phenelzine (Nardil), an MAOI. Which dietary restriction is
strictly required to prevent a hypertensive crisis?
A) Limiting intake of leafy green vegetables
B) Avoiding foods high in tyramine
C) Limiting dairy products
D) Avoiding grapefruit juice
Answer: B) Avoiding foods high in tyramine
Rationale: MAOIs inhibit the breakdown of tyramine. Tyramine-rich foods (aged
cheeses, cured meats, fermented soy products, tap beer) can cause a sudden and
potentially fatal release of norepinephrine, leading to a hypertensive crisis.
Which of the following is a primary negative symptom of schizophrenia?
A) Hallucinations
B) Delusions
C) Alogia
D) Disorganized speech
Answer: C) Alogia
