1
NRNP 6665 Week 6 Midterm Exam / REAL NRNP 6665 Week 6 Midterm
Exam: Walden University | 100% Correct Q & A
1.
A 35-year-old patient is prescribed sertraline for major depressive disorder. After
two weeks, they report mild nausea and insomnia.
What should the psychiatric-mental health nurse practitioner (PMHNP) do next?
A. Discontinue sertraline immediately and switch to bupropion
B. Reassure the patient these symptoms are temporary and monitor
C. Prescribe a benzodiazepine for sleep
D. Reduce the dose by half for one week
Answer: B
Rationale: SSRIs commonly cause mild nausea or insomnia in the first few weeks;
reassurance and monitoring are appropriate since symptoms usually resolve.
2.
A client presents with symptoms of generalized anxiety disorder and has a history
of alcohol abuse.
Which medication would be most appropriate for this patient?
A. Alprazolam
B. Buspirone
C. Diazepam
D. Clonazepam
Answer: B
Rationale: Buspirone is a non-benzodiazepine anxiolytic without abuse potential,
making it safer for clients with substance use history.
, 2
3.
When prescribing fluoxetine, the PMHNP must consider its long half-life.
Which clinical implication does this have for patient management?
A. The medication requires twice-daily dosing
B. It causes withdrawal symptoms if abruptly stopped
C. It has fewer withdrawal symptoms if doses are missed
D. It requires serum level monitoring
Answer: C
Rationale: Fluoxetine’s long half-life reduces the risk of discontinuation syndrome
compared to other SSRIs.
4.
A 45-year-old patient reports dry mouth, constipation, and blurred vision after
starting amitriptyline.
Which mechanism best explains these side effects?
A. Dopamine antagonism
B. Histamine blockade
C. Muscarinic receptor blockade
D. Serotonin reuptake inhibition
Answer: C
Rationale: Tricyclic antidepressants cause anticholinergic side effects through
muscarinic receptor blockade.
5.
A patient stabilized on clozapine reports sore throat and fever.
What is the most appropriate next step?
A. Stop medication and order a complete blood count
B. Recommend saltwater gargles and rest
C. Reassure the patient and continue the same dose
D. Increase fluid intake and monitor for one week
, 3
Answer: A
Rationale: Clozapine can cause agranulocytosis; signs of infection require
immediate discontinuation and CBC monitoring.
6.
A 23-year-old patient with panic disorder is started on alprazolam.
What teaching point is most important to emphasize?
A. Avoid foods rich in tyramine
B. Do not discontinue medication abruptly
C. Take with grapefruit juice for better absorption
D. Expect therapeutic effects within four weeks
Answer: B
Rationale: Abrupt cessation of benzodiazepines can cause withdrawal symptoms
including seizures; tapering is required.
7.
A patient taking lithium for bipolar disorder presents with diarrhea, tremors, and
confusion.
What should the PMHNP suspect?
A. Lithium toxicity
B. Dehydration
C. Serotonin syndrome
D. Hypoglycemia
Answer: A
Rationale: Tremor, confusion, and gastrointestinal upset are classic signs of
lithium toxicity; serum level evaluation is required.
8.
Which antidepressant has the lowest risk of sexual side effects and may increase
energy levels?
, 4
A. Bupropion
B. Paroxetine
C. Escitalopram
D. Sertraline
Answer: A
Rationale: Bupropion enhances dopamine and norepinephrine, with minimal
sexual side effects and increased activation.
9.
A patient is started on paroxetine and develops restlessness, diaphoresis, and
hyperreflexia after also taking St. John’s Wort.
What condition should be suspected?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. SSRI withdrawal
D. Akathisia
Answer: B
Rationale: Combining serotonergic agents increases serotonin levels, causing
serotonin syndrome with autonomic and neuromuscular symptoms.
10.
Why should venlafaxine be tapered gradually upon discontinuation?
A. To prevent rebound psychosis
B. To reduce withdrawal symptoms such as dizziness and irritability
C. To avoid cardiac arrhythmias
D. To minimize serotonin syndrome
Answer: B
Rationale: SNRI discontinuation can lead to flu-like withdrawal symptoms;
gradual tapering reduces this risk.
NRNP 6665 Week 6 Midterm Exam / REAL NRNP 6665 Week 6 Midterm
Exam: Walden University | 100% Correct Q & A
1.
A 35-year-old patient is prescribed sertraline for major depressive disorder. After
two weeks, they report mild nausea and insomnia.
What should the psychiatric-mental health nurse practitioner (PMHNP) do next?
A. Discontinue sertraline immediately and switch to bupropion
B. Reassure the patient these symptoms are temporary and monitor
C. Prescribe a benzodiazepine for sleep
D. Reduce the dose by half for one week
Answer: B
Rationale: SSRIs commonly cause mild nausea or insomnia in the first few weeks;
reassurance and monitoring are appropriate since symptoms usually resolve.
2.
A client presents with symptoms of generalized anxiety disorder and has a history
of alcohol abuse.
Which medication would be most appropriate for this patient?
A. Alprazolam
B. Buspirone
C. Diazepam
D. Clonazepam
Answer: B
Rationale: Buspirone is a non-benzodiazepine anxiolytic without abuse potential,
making it safer for clients with substance use history.
, 2
3.
When prescribing fluoxetine, the PMHNP must consider its long half-life.
Which clinical implication does this have for patient management?
A. The medication requires twice-daily dosing
B. It causes withdrawal symptoms if abruptly stopped
C. It has fewer withdrawal symptoms if doses are missed
D. It requires serum level monitoring
Answer: C
Rationale: Fluoxetine’s long half-life reduces the risk of discontinuation syndrome
compared to other SSRIs.
4.
A 45-year-old patient reports dry mouth, constipation, and blurred vision after
starting amitriptyline.
Which mechanism best explains these side effects?
A. Dopamine antagonism
B. Histamine blockade
C. Muscarinic receptor blockade
D. Serotonin reuptake inhibition
Answer: C
Rationale: Tricyclic antidepressants cause anticholinergic side effects through
muscarinic receptor blockade.
5.
A patient stabilized on clozapine reports sore throat and fever.
What is the most appropriate next step?
A. Stop medication and order a complete blood count
B. Recommend saltwater gargles and rest
C. Reassure the patient and continue the same dose
D. Increase fluid intake and monitor for one week
, 3
Answer: A
Rationale: Clozapine can cause agranulocytosis; signs of infection require
immediate discontinuation and CBC monitoring.
6.
A 23-year-old patient with panic disorder is started on alprazolam.
What teaching point is most important to emphasize?
A. Avoid foods rich in tyramine
B. Do not discontinue medication abruptly
C. Take with grapefruit juice for better absorption
D. Expect therapeutic effects within four weeks
Answer: B
Rationale: Abrupt cessation of benzodiazepines can cause withdrawal symptoms
including seizures; tapering is required.
7.
A patient taking lithium for bipolar disorder presents with diarrhea, tremors, and
confusion.
What should the PMHNP suspect?
A. Lithium toxicity
B. Dehydration
C. Serotonin syndrome
D. Hypoglycemia
Answer: A
Rationale: Tremor, confusion, and gastrointestinal upset are classic signs of
lithium toxicity; serum level evaluation is required.
8.
Which antidepressant has the lowest risk of sexual side effects and may increase
energy levels?
, 4
A. Bupropion
B. Paroxetine
C. Escitalopram
D. Sertraline
Answer: A
Rationale: Bupropion enhances dopamine and norepinephrine, with minimal
sexual side effects and increased activation.
9.
A patient is started on paroxetine and develops restlessness, diaphoresis, and
hyperreflexia after also taking St. John’s Wort.
What condition should be suspected?
A. Neuroleptic malignant syndrome
B. Serotonin syndrome
C. SSRI withdrawal
D. Akathisia
Answer: B
Rationale: Combining serotonergic agents increases serotonin levels, causing
serotonin syndrome with autonomic and neuromuscular symptoms.
10.
Why should venlafaxine be tapered gradually upon discontinuation?
A. To prevent rebound psychosis
B. To reduce withdrawal symptoms such as dizziness and irritability
C. To avoid cardiac arrhythmias
D. To minimize serotonin syndrome
Answer: B
Rationale: SNRI discontinuation can lead to flu-like withdrawal symptoms;
gradual tapering reduces this risk.
