NURS 6630 Final Exam Psychopharmacologic Approaches
to Treatment of Psychopathology Practice Questions &
Answers | Walden University Latest Update 2026
QUESTIONS WITH RATIONALE
SECTION 1: ANTIDEPRESSANTS & MOOD DISORDERS (Questions 1-20)
QUESTION 1:
A 45-year-old female with major depressive disorder has failed two SSRIs at
adequate doses and duration. The PMHNP is considering switching to an MAOI.
Which of the following is the MOST important consideration before initiating
MAOI therapy?
A) Baseline liver function tests
B) A 14-day washout period after stopping SSRIs
C) Baseline ECG
D) Genetic testing for CYP2D6 polymorphisms
Rationale: MAOIs require a 14-day washout period after stopping SSRIs to
prevent serotonin syndrome. Fluoxetine requires a 5-week washout due to its long
half-life. While baseline labs and ECG may be appropriate, the washout period is
the most critical safety consideration.
QUESTION 2:
Which statement BEST describes a pharmacological approach to treating
impulsive aggression?
A) Mood stabilizers and atypical antipsychotics are first-line options
B) Benzodiazepines are the treatment of choice
C) Stimulants are first-line for impulsive aggression
D) Antihistamines are preferred
Rationale: Impulsive aggression is often treated with mood stabilizers (lithium,
valproate) and atypical antipsychotics (risperidone, aripiprazole). Benzodiazepines
,may disinhibit and worsen aggression. Stimulants are used for ADHD but can
exacerbate aggression.
QUESTION 3:
A 28-year-old male with treatment-resistant depression is started on phenelzine
(Nardil). Which dietary restriction is MOST critical?
A) Low-sodium diet
B) Avoidance of tyramine-rich foods
C) High-fiber diet
D) Low-carbohydrate diet
Rationale: MAOIs inhibit the breakdown of tyramine, which can precipitate a
hypertensive crisis when consumed with tyramine-rich foods (aged cheeses, cured
meats, fermented products). This is a life-threatening interaction.
QUESTION 4:
A patient with bipolar depression is currently on lamotrigine. The PMHNP should
be MOST concerned about which potential adverse effect?
A) Weight gain
B) Stevens-Johnson syndrome
C) Sedation
D) Hyperglycemia
Rationale: Lamotrigine carries a boxed warning for Stevens-Johnson syndrome, a
severe skin reaction. The risk is increased with rapid titration, so a slow titration
schedule is essential. Weight gain and sedation are less common with lamotrigine.
QUESTION 5:
A patient with major depressive disorder is started on bupropion. Which of the
following is a CONTRAINDICATION to bupropion use?
A) Hypertension
B) Seizure disorder
C) Obesity
D) Insomnia
,Rationale: Bupropion lowers the seizure threshold and is contraindicated in
patients with seizure disorders, eating disorders, or those abruptly discontinuing
benzodiazepines or alcohol. The maximum dose is 450 mg/day.
QUESTION 6:
Which of the following SSRIs has the SHORTEST half-life and is associated with
the highest risk of withdrawal symptoms?
A) Fluoxetine
B) Paroxetine
C) Sertraline
D) Escitalopram
Rationale: Paroxetine has the shortest half-life (21 hours) among SSRIs and is
most associated with withdrawal/discontinuation syndrome. Fluoxetine has the
longest half-life (4-6 days) and lowest withdrawal risk.
QUESTION 7:
A patient on fluoxetine reports sexual dysfunction. The PMHNP considers which
of the following strategies?
A) Increase the fluoxetine dose
B) Add bupropion
C) Add a benzodiazepine
D) Switch to aripiprazole
Rationale: Bupropion can be added to SSRIs to improve sexual dysfunction and
augment antidepressant effect. Dose reduction may also help. Adding aripiprazole
is an augmentation strategy but does not specifically address sexual dysfunction.
QUESTION 8:
A 60-year-old patient with depression and chronic pain is started on duloxetine.
Which of the following is a concern with this medication?
A) Weight loss
B) Hyponatremia
, C) Hyperglycemia
D) Bradycardia
Rationale: SNRIs like duloxetine can cause hyponatremia, especially in older
adults, due to SIADH. Blood pressure may increase (not decrease). Weight loss
may occur but is less concerning than hyponatremia.
QUESTION 9:
A patient with bipolar disorder is started on quetiapine. The PMHNP should
monitor for which metabolic side effect?
A) Hyperthyroidism
B) Weight gain and dyslipidemia
C) Hyponatremia
D) Hypoglycemia
Rationale: Quetiapine and other atypical antipsychotics are associated with
metabolic syndrome, including weight gain, dyslipidemia, and hyperglycemia.
Monitoring weight, lipids, and blood glucose is essential.
QUESTION 10:
Which of the following is a BLACK BOX warning for all antidepressants?
A) Hepatotoxicity
B) Suicidal ideation in children, adolescents, and young adults
C) Cardiac arrhythmias
D) Seizures
Rationale: All antidepressants carry a black box warning for increased risk of
suicidal ideation in children, adolescents, and young adults (ages 18-24). This is
most prominent in the first weeks of treatment.
QUESTION 11:
A patient with treatment-resistant depression has been on an SSRI for 8 weeks with
minimal response. The PMHNP decides to augment with aripiprazole. What is the
mechanism of action of aripiprazole?
to Treatment of Psychopathology Practice Questions &
Answers | Walden University Latest Update 2026
QUESTIONS WITH RATIONALE
SECTION 1: ANTIDEPRESSANTS & MOOD DISORDERS (Questions 1-20)
QUESTION 1:
A 45-year-old female with major depressive disorder has failed two SSRIs at
adequate doses and duration. The PMHNP is considering switching to an MAOI.
Which of the following is the MOST important consideration before initiating
MAOI therapy?
A) Baseline liver function tests
B) A 14-day washout period after stopping SSRIs
C) Baseline ECG
D) Genetic testing for CYP2D6 polymorphisms
Rationale: MAOIs require a 14-day washout period after stopping SSRIs to
prevent serotonin syndrome. Fluoxetine requires a 5-week washout due to its long
half-life. While baseline labs and ECG may be appropriate, the washout period is
the most critical safety consideration.
QUESTION 2:
Which statement BEST describes a pharmacological approach to treating
impulsive aggression?
A) Mood stabilizers and atypical antipsychotics are first-line options
B) Benzodiazepines are the treatment of choice
C) Stimulants are first-line for impulsive aggression
D) Antihistamines are preferred
Rationale: Impulsive aggression is often treated with mood stabilizers (lithium,
valproate) and atypical antipsychotics (risperidone, aripiprazole). Benzodiazepines
,may disinhibit and worsen aggression. Stimulants are used for ADHD but can
exacerbate aggression.
QUESTION 3:
A 28-year-old male with treatment-resistant depression is started on phenelzine
(Nardil). Which dietary restriction is MOST critical?
A) Low-sodium diet
B) Avoidance of tyramine-rich foods
C) High-fiber diet
D) Low-carbohydrate diet
Rationale: MAOIs inhibit the breakdown of tyramine, which can precipitate a
hypertensive crisis when consumed with tyramine-rich foods (aged cheeses, cured
meats, fermented products). This is a life-threatening interaction.
QUESTION 4:
A patient with bipolar depression is currently on lamotrigine. The PMHNP should
be MOST concerned about which potential adverse effect?
A) Weight gain
B) Stevens-Johnson syndrome
C) Sedation
D) Hyperglycemia
Rationale: Lamotrigine carries a boxed warning for Stevens-Johnson syndrome, a
severe skin reaction. The risk is increased with rapid titration, so a slow titration
schedule is essential. Weight gain and sedation are less common with lamotrigine.
QUESTION 5:
A patient with major depressive disorder is started on bupropion. Which of the
following is a CONTRAINDICATION to bupropion use?
A) Hypertension
B) Seizure disorder
C) Obesity
D) Insomnia
,Rationale: Bupropion lowers the seizure threshold and is contraindicated in
patients with seizure disorders, eating disorders, or those abruptly discontinuing
benzodiazepines or alcohol. The maximum dose is 450 mg/day.
QUESTION 6:
Which of the following SSRIs has the SHORTEST half-life and is associated with
the highest risk of withdrawal symptoms?
A) Fluoxetine
B) Paroxetine
C) Sertraline
D) Escitalopram
Rationale: Paroxetine has the shortest half-life (21 hours) among SSRIs and is
most associated with withdrawal/discontinuation syndrome. Fluoxetine has the
longest half-life (4-6 days) and lowest withdrawal risk.
QUESTION 7:
A patient on fluoxetine reports sexual dysfunction. The PMHNP considers which
of the following strategies?
A) Increase the fluoxetine dose
B) Add bupropion
C) Add a benzodiazepine
D) Switch to aripiprazole
Rationale: Bupropion can be added to SSRIs to improve sexual dysfunction and
augment antidepressant effect. Dose reduction may also help. Adding aripiprazole
is an augmentation strategy but does not specifically address sexual dysfunction.
QUESTION 8:
A 60-year-old patient with depression and chronic pain is started on duloxetine.
Which of the following is a concern with this medication?
A) Weight loss
B) Hyponatremia
, C) Hyperglycemia
D) Bradycardia
Rationale: SNRIs like duloxetine can cause hyponatremia, especially in older
adults, due to SIADH. Blood pressure may increase (not decrease). Weight loss
may occur but is less concerning than hyponatremia.
QUESTION 9:
A patient with bipolar disorder is started on quetiapine. The PMHNP should
monitor for which metabolic side effect?
A) Hyperthyroidism
B) Weight gain and dyslipidemia
C) Hyponatremia
D) Hypoglycemia
Rationale: Quetiapine and other atypical antipsychotics are associated with
metabolic syndrome, including weight gain, dyslipidemia, and hyperglycemia.
Monitoring weight, lipids, and blood glucose is essential.
QUESTION 10:
Which of the following is a BLACK BOX warning for all antidepressants?
A) Hepatotoxicity
B) Suicidal ideation in children, adolescents, and young adults
C) Cardiac arrhythmias
D) Seizures
Rationale: All antidepressants carry a black box warning for increased risk of
suicidal ideation in children, adolescents, and young adults (ages 18-24). This is
most prominent in the first weeks of treatment.
QUESTION 11:
A patient with treatment-resistant depression has been on an SSRI for 8 weeks with
minimal response. The PMHNP decides to augment with aripiprazole. What is the
mechanism of action of aripiprazole?
