Walden University NURS 6670 Midterm Exam (pdf) | 2026/2027 |
PMHNP Q&A |
**1. A 65-year-old patient presents with progressive memory loss, difficulty
with executive functioning, and personality changes over the past 2 years.
The patient's spouse reports that the patient has become apathetic and has
difficulty with daily tasks. Which of the following is the most likely diagnosis?
**
A) Delirium
B) Major neurocognitive disorder (Alzheimer's disease)
C) Major depressive disorder with psychotic features
D) Frontotemporal dementia
**Correct Answer: B**
**Rationale:** Alzheimer's disease is the most common cause of major
neurocognitive disorder, characterized by progressive memory loss,
executive dysfunction, and gradual personality changes. The gradual onset
over 2 years distinguishes it from delirium (acute onset). Frontotemporal
dementia typically presents with prominent behavioral changes earlier in the
course.
---
**2. A 72-year-old patient is brought to the clinic by his daughter who reports
that over the past 3 days, he has become confused, agitated, and is seeing
"bugs crawling on the walls." He has a urinary tract infection. Which of the
following is the most likely diagnosis?**
A) Alzheimer's disease
B) Delirium
,C) Schizophrenia
D) Bipolar disorder
**Correct Answer: B**
**Rationale:** Delirium is characterized by acute onset (hours to days),
fluctuating course, attention deficits, and changes in consciousness. It is
often caused by an underlying medical condition such as infection (UTI). The
acute onset and visual hallucinations distinguish it from dementia.
---
**3. In prescribing an antidepressant for a geriatric patient with major
depressive disorder, which of the following is the most appropriate first-line
medication?**
A) Amitriptyline
B) Fluoxetine
C) Sertraline
D) Nortriptyline
**Correct Answer: C**
**Rationale:** SSRIs such as sertraline are first-line antidepressants in
geriatric patients due to their favorable side effect profile and lower risk of
anticholinergic effects compared to TCAs (amitriptyline, nortriptyline).
Fluoxetine has a long half-life and may be less preferred in older adults due
to drug interactions.
---
,**4. A 68-year-old patient with Parkinson's disease is experiencing
hallucinations. Which of the following antipsychotic medications is most
appropriate?**
A) Haloperidol
B) Olanzapine
C) Quetiapine
D) Pimavanserin
**Correct Answer: D**
**Rationale:** Pimavanserin is a selective serotonin inverse agonist approved
for hallucinations and delusions associated with Parkinson's disease
psychosis. It does not affect dopamine receptors and does not worsen motor
symptoms. Atypical antipsychotics like quetiapine may be used but carry a
black box warning for increased mortality in elderly patients with dementia-
related psychosis.
---
**5. A 55-year-old patient with a history of alcohol use disorder is admitted
for detoxification. Which of the following is the most appropriate medication
for managing alcohol withdrawal?**
A) Naltrexone
B) Lorazepam
C) Disulfiram
D) Acamprosate
, **Correct Answer: B**
**Rationale:** Benzodiazepines such as lorazepam are the mainstay of
alcohol withdrawal management, reducing the risk of seizures and delirium
tremens. Naltrexone, disulfiram, and acamprosate are used for relapse
prevention after detoxification.
---
**6. A 62-year-old patient is being evaluated for depression. The patient
reports feeling sad, having low energy, and difficulty sleeping. Which of the
following is the most appropriate screening tool for depression in older
adults?**
A) PHQ-9
B) Geriatric Depression Scale (GDS)
C) Beck Depression Inventory (BDI)
D) Hamilton Depression Rating Scale (HAM-D)
**Correct Answer: B**
**Rationale:** The Geriatric Depression Scale (GDS) is a validated screening
tool specifically designed for depression in older adults. It uses a yes/no
format that is easier for elderly patients. The PHQ-9 and BDI are also used
but the GDS is preferred in geriatric populations.
---
**7. A 58-year-old female patient presents with a 2-week history of elevated
mood, decreased need for sleep, rapid speech, and increased goal-directed
PMHNP Q&A |
**1. A 65-year-old patient presents with progressive memory loss, difficulty
with executive functioning, and personality changes over the past 2 years.
The patient's spouse reports that the patient has become apathetic and has
difficulty with daily tasks. Which of the following is the most likely diagnosis?
**
A) Delirium
B) Major neurocognitive disorder (Alzheimer's disease)
C) Major depressive disorder with psychotic features
D) Frontotemporal dementia
**Correct Answer: B**
**Rationale:** Alzheimer's disease is the most common cause of major
neurocognitive disorder, characterized by progressive memory loss,
executive dysfunction, and gradual personality changes. The gradual onset
over 2 years distinguishes it from delirium (acute onset). Frontotemporal
dementia typically presents with prominent behavioral changes earlier in the
course.
---
**2. A 72-year-old patient is brought to the clinic by his daughter who reports
that over the past 3 days, he has become confused, agitated, and is seeing
"bugs crawling on the walls." He has a urinary tract infection. Which of the
following is the most likely diagnosis?**
A) Alzheimer's disease
B) Delirium
,C) Schizophrenia
D) Bipolar disorder
**Correct Answer: B**
**Rationale:** Delirium is characterized by acute onset (hours to days),
fluctuating course, attention deficits, and changes in consciousness. It is
often caused by an underlying medical condition such as infection (UTI). The
acute onset and visual hallucinations distinguish it from dementia.
---
**3. In prescribing an antidepressant for a geriatric patient with major
depressive disorder, which of the following is the most appropriate first-line
medication?**
A) Amitriptyline
B) Fluoxetine
C) Sertraline
D) Nortriptyline
**Correct Answer: C**
**Rationale:** SSRIs such as sertraline are first-line antidepressants in
geriatric patients due to their favorable side effect profile and lower risk of
anticholinergic effects compared to TCAs (amitriptyline, nortriptyline).
Fluoxetine has a long half-life and may be less preferred in older adults due
to drug interactions.
---
,**4. A 68-year-old patient with Parkinson's disease is experiencing
hallucinations. Which of the following antipsychotic medications is most
appropriate?**
A) Haloperidol
B) Olanzapine
C) Quetiapine
D) Pimavanserin
**Correct Answer: D**
**Rationale:** Pimavanserin is a selective serotonin inverse agonist approved
for hallucinations and delusions associated with Parkinson's disease
psychosis. It does not affect dopamine receptors and does not worsen motor
symptoms. Atypical antipsychotics like quetiapine may be used but carry a
black box warning for increased mortality in elderly patients with dementia-
related psychosis.
---
**5. A 55-year-old patient with a history of alcohol use disorder is admitted
for detoxification. Which of the following is the most appropriate medication
for managing alcohol withdrawal?**
A) Naltrexone
B) Lorazepam
C) Disulfiram
D) Acamprosate
, **Correct Answer: B**
**Rationale:** Benzodiazepines such as lorazepam are the mainstay of
alcohol withdrawal management, reducing the risk of seizures and delirium
tremens. Naltrexone, disulfiram, and acamprosate are used for relapse
prevention after detoxification.
---
**6. A 62-year-old patient is being evaluated for depression. The patient
reports feeling sad, having low energy, and difficulty sleeping. Which of the
following is the most appropriate screening tool for depression in older
adults?**
A) PHQ-9
B) Geriatric Depression Scale (GDS)
C) Beck Depression Inventory (BDI)
D) Hamilton Depression Rating Scale (HAM-D)
**Correct Answer: B**
**Rationale:** The Geriatric Depression Scale (GDS) is a validated screening
tool specifically designed for depression in older adults. It uses a yes/no
format that is easier for elderly patients. The PHQ-9 and BDI are also used
but the GDS is preferred in geriatric populations.
---
**7. A 58-year-old female patient presents with a 2-week history of elevated
mood, decreased need for sleep, rapid speech, and increased goal-directed
