NURS 6540 FINAL EXAM /NURS 6540 FINAL EXAM
PRACTICE LATEST EXAM COMPLETE QUESTIONS AND
CORRECT ANSWERS|ALREADY GRADED A +(WALDEN)
Question 1
A 35-year-old client with Major Depressive Disorder (MDD) is prescribed
sertraline. After 6 weeks, the client reports improved mood but also
significant anorgasmia. The PMHNP considers switching to an antidepressant
with a lower risk of sexual dysfunction. Which of the following would be the
most appropriate alternative?
A) Paroxetine
B) Venlafaxine
C) Fluoxetine
D) Bupropion
E) Citalopram
Correct Answer: D) Bupropion
Rationale: Bupropion, a norepinephrine-dopamine reuptake inhibitor
(NDRI), is often associated with a lower incidence of sexual
dysfunction compared to SSRIs (sertraline, paroxetine, fluoxetine,
citalopram) and SNRIs (venlafaxine).
Question 2
A 68-year-old client with newly diagnosed Generalized Anxiety Disorder has a
history of mild cognitive impairment and falls. Which anxiolytic medication
should the PMHNP use with extreme caution due to increased risk of
cognitive impairment and falls in older adults?
A) Buspirone
B) Sertraline
C) Diazepam
D) Hydroxyzine
E) Gabapentin
Correct Answer: C) Diazepam
Rationale: Benzodiazepines like diazepam carry significant risks in
older adults, including increased sedation, cognitive impairment,
and a higher risk of falls and fractures. Buspirone, SSRIs
(sertraline), hydroxyzine, and gabapentin are generally considered
safer alternatives for anxiety in this population, though each has its
own considerations.
Question 3
Which neurotransmitter system is primarily targeted by benzodiazepines to
exert their anxiolytic and sedative effects?
,A) Dopamine
B) Serotonin
C) Norepinephrine
D) Gamma-aminobutyric acid (GABA)
E) Acetylcholine
Correct Answer: D) Gamma-aminobutyric acid (GABA)
Rationale: Benzodiazepines are positive allosteric modulators of the
GABA-A receptor, enhancing the inhibitory effects of GABA, leading
to decreased neuronal excitability and thus anxiolytic, sedative,
hypnotic, anticonvulsant, and muscle relaxant effects.
Question 4
A client prescribed lithium for Bipolar I Disorder reports persistent thirst,
increased urination, and has a serum lithium level of 1.8 mEq/L. The PMHNP
notes mild tremor. Which intervention is the most appropriate initial action?
A) Administer an additional dose of lithium.
B) Recommend reducing fluid intake.
C) Hold the next dose of lithium and assess for further signs of toxicity.
D) Order a thyroid function test.
E) Increase the client's sodium intake.
Correct Answer: C) Hold the next dose of lithium and assess for
further signs of toxicity.
Rationale: A lithium level of 1.8 mEq/L is in the toxic range
(therapeutic range is typically 0.6-1.2 mEq/L, or up to 1.5 mEq/L for
acute mania). Increased thirst, urination, and tremor are common
early signs of toxicity. Holding the dose and monitoring for
worsening symptoms (e.g., lethargy, confusion, coarse tremor, GI
upset, ataxia) is the immediate priority. Renal function should also
be checked.
Question 5
Before initiating a Selective Serotonin Reuptake Inhibitor (SSRI) for Major
Depressive Disorder, the PMHNP should screen for which of the following
conditions due to its potential for worsening or inducing mania?
A) Generalized Anxiety Disorder
B) Panic Disorder
C) Bipolar Disorder
D) Obsessive-Compulsive Disorder
E) Post-Traumatic Stress Disorder
Correct Answer: C) Bipolar Disorder
Rationale: Antidepressants, especially SSRIs, can induce hypomania
, or mania in individuals with undiagnosed Bipolar Disorder.
Therefore, a thorough screen for bipolar symptoms and family
history is crucial before initiating antidepressant monotherapy.
Question 6
A 40-year-old client with Schizophrenia, prescribed haloperidol, presents with
a fever of 102.5°F, severe muscle rigidity, altered mental status, and labile
blood pressure. The PMHNP suspects Neuroleptic Malignant Syndrome (NMS).
Which intervention is the highest priority?
A) Administer a benzodiazepine for agitation.
B) Discontinue the haloperidol immediately.
C) Administer IV fluids.
D) Order a head CT scan.
E) Administer an anticholinergic medication.
Correct Answer: B) Discontinue the haloperidol immediately.
Rationale: The immediate and most critical intervention for suspected
NMS is to discontinue the offending antipsychotic medication.
Supportive care (e.g., cooling, hydration, muscle relaxants like
dantrolene or bromocriptine) is then initiated.
Question 7
Which of the following adverse effects is a significant concern with long-term
use of conventional (first-generation) antipsychotics due to irreversible
movements?
A) Acute dystonia
B) Akathisia
C) Parkinsonism
D) Neuroleptic Malignant Syndrome (NMS)
E) Tardive dyskinesia
Correct Answer: E) Tardive dyskinesia
Rationale: Tardive dyskinesia (TD) is a potentially irreversible
movement disorder characterized by involuntary, repetitive
movements (often of the face, mouth, tongue, trunk, and limbs) that
can develop after chronic use of dopamine receptor blocking agents,
particularly conventional antipsychotics.
Question 8
A client with Opioid Use Disorder is prescribed buprenorphine/naloxone
(Suboxone). The PMHNP educates the client that the naloxone component is
included to:
A) Enhance the analgesic effects of buprenorphine.
PRACTICE LATEST EXAM COMPLETE QUESTIONS AND
CORRECT ANSWERS|ALREADY GRADED A +(WALDEN)
Question 1
A 35-year-old client with Major Depressive Disorder (MDD) is prescribed
sertraline. After 6 weeks, the client reports improved mood but also
significant anorgasmia. The PMHNP considers switching to an antidepressant
with a lower risk of sexual dysfunction. Which of the following would be the
most appropriate alternative?
A) Paroxetine
B) Venlafaxine
C) Fluoxetine
D) Bupropion
E) Citalopram
Correct Answer: D) Bupropion
Rationale: Bupropion, a norepinephrine-dopamine reuptake inhibitor
(NDRI), is often associated with a lower incidence of sexual
dysfunction compared to SSRIs (sertraline, paroxetine, fluoxetine,
citalopram) and SNRIs (venlafaxine).
Question 2
A 68-year-old client with newly diagnosed Generalized Anxiety Disorder has a
history of mild cognitive impairment and falls. Which anxiolytic medication
should the PMHNP use with extreme caution due to increased risk of
cognitive impairment and falls in older adults?
A) Buspirone
B) Sertraline
C) Diazepam
D) Hydroxyzine
E) Gabapentin
Correct Answer: C) Diazepam
Rationale: Benzodiazepines like diazepam carry significant risks in
older adults, including increased sedation, cognitive impairment,
and a higher risk of falls and fractures. Buspirone, SSRIs
(sertraline), hydroxyzine, and gabapentin are generally considered
safer alternatives for anxiety in this population, though each has its
own considerations.
Question 3
Which neurotransmitter system is primarily targeted by benzodiazepines to
exert their anxiolytic and sedative effects?
,A) Dopamine
B) Serotonin
C) Norepinephrine
D) Gamma-aminobutyric acid (GABA)
E) Acetylcholine
Correct Answer: D) Gamma-aminobutyric acid (GABA)
Rationale: Benzodiazepines are positive allosteric modulators of the
GABA-A receptor, enhancing the inhibitory effects of GABA, leading
to decreased neuronal excitability and thus anxiolytic, sedative,
hypnotic, anticonvulsant, and muscle relaxant effects.
Question 4
A client prescribed lithium for Bipolar I Disorder reports persistent thirst,
increased urination, and has a serum lithium level of 1.8 mEq/L. The PMHNP
notes mild tremor. Which intervention is the most appropriate initial action?
A) Administer an additional dose of lithium.
B) Recommend reducing fluid intake.
C) Hold the next dose of lithium and assess for further signs of toxicity.
D) Order a thyroid function test.
E) Increase the client's sodium intake.
Correct Answer: C) Hold the next dose of lithium and assess for
further signs of toxicity.
Rationale: A lithium level of 1.8 mEq/L is in the toxic range
(therapeutic range is typically 0.6-1.2 mEq/L, or up to 1.5 mEq/L for
acute mania). Increased thirst, urination, and tremor are common
early signs of toxicity. Holding the dose and monitoring for
worsening symptoms (e.g., lethargy, confusion, coarse tremor, GI
upset, ataxia) is the immediate priority. Renal function should also
be checked.
Question 5
Before initiating a Selective Serotonin Reuptake Inhibitor (SSRI) for Major
Depressive Disorder, the PMHNP should screen for which of the following
conditions due to its potential for worsening or inducing mania?
A) Generalized Anxiety Disorder
B) Panic Disorder
C) Bipolar Disorder
D) Obsessive-Compulsive Disorder
E) Post-Traumatic Stress Disorder
Correct Answer: C) Bipolar Disorder
Rationale: Antidepressants, especially SSRIs, can induce hypomania
, or mania in individuals with undiagnosed Bipolar Disorder.
Therefore, a thorough screen for bipolar symptoms and family
history is crucial before initiating antidepressant monotherapy.
Question 6
A 40-year-old client with Schizophrenia, prescribed haloperidol, presents with
a fever of 102.5°F, severe muscle rigidity, altered mental status, and labile
blood pressure. The PMHNP suspects Neuroleptic Malignant Syndrome (NMS).
Which intervention is the highest priority?
A) Administer a benzodiazepine for agitation.
B) Discontinue the haloperidol immediately.
C) Administer IV fluids.
D) Order a head CT scan.
E) Administer an anticholinergic medication.
Correct Answer: B) Discontinue the haloperidol immediately.
Rationale: The immediate and most critical intervention for suspected
NMS is to discontinue the offending antipsychotic medication.
Supportive care (e.g., cooling, hydration, muscle relaxants like
dantrolene or bromocriptine) is then initiated.
Question 7
Which of the following adverse effects is a significant concern with long-term
use of conventional (first-generation) antipsychotics due to irreversible
movements?
A) Acute dystonia
B) Akathisia
C) Parkinsonism
D) Neuroleptic Malignant Syndrome (NMS)
E) Tardive dyskinesia
Correct Answer: E) Tardive dyskinesia
Rationale: Tardive dyskinesia (TD) is a potentially irreversible
movement disorder characterized by involuntary, repetitive
movements (often of the face, mouth, tongue, trunk, and limbs) that
can develop after chronic use of dopamine receptor blocking agents,
particularly conventional antipsychotics.
Question 8
A client with Opioid Use Disorder is prescribed buprenorphine/naloxone
(Suboxone). The PMHNP educates the client that the naloxone component is
included to:
A) Enhance the analgesic effects of buprenorphine.
