NURS 5432 Psychiatric-Mental Health NP
Exam Questions and Answers and Rationale
Top Rated Latest
1. A 28-year-old woman presents with 6 weeks of depressed mood, anhedonia, insomnia,
weight loss of 8 lb, fatigue, and feelings of worthlessness. She reports no suicidal
ideation and continues to work. Which diagnosis is most appropriate?
A. Major depressive disorder, single episode, moderate
B. Persistent depressive disorder (dysthymia)
C. Adjustment disorder with depressed mood
D. Bereavement
Answer: A. Major depressive disorder, single episode, moderate
Rationale: Symptoms lasting 6 weeks with significant functional impairment (weight loss,
insomnia, worthlessness) meet criteria for a major depressive episode (≥2 weeks, five or more
symptoms). Dysthymia (persistent depressive disorder) requires ≥2 years. Adjustment disorder
occurs within 3 months of identifiable stressor and are less severe. Bereavement is tied to loss
and follows characteristic course.
2. A 40-year-old man with schizophrenia stabilized on haloperidol for 6 months develops
restlessness, an inability to sit still, and pacing. What is the most likely diagnosis?
A. Tardive dyskinesia
B. Akathisia
C. Parkinsonism
D. Neuroleptic malignant syndrome
Answer: B. Akathisia
Rationale: Akathisia presents as subjective and objective motor restlessness and is a common
early extrapyramidal side effect of antipsychotics. Parkinsonism involves tremor, rigidity,
bradykinesia. Tardive dyskinesia causes involuntary choreoathetoid movements, often later
onset. NMS is life-threatening with rigidity, hyperthermia, autonomic instability.
3. A 55-year-old woman with major depressive disorder has partial response to sertraline
100 mg after 8 weeks. Which next step is best supported by guidelines?
A. Switch to an SNRI (e.g., venlafaxine)
B. Augment with low-dose atypical antipsychotic (e.g., aripiprazole)
C. Increase sertraline to 200 mg
D. Add mirtazapine
Answer: B. Augment with low-dose atypical antipsychotic (e.g., aripiprazole)
Rationale: In partial response after adequate trial, options include augmentation (with atypical
antipsychotics, lithium, thyroid hormone) or switching. Increasing dose may be considered if not
,at max, but many guidelines support augmentation for partial response. Choice may vary by side
effects and comorbidities; augmentation with aripiprazole is evidence-based.
4. A 22-year-old college student presents with panic attacks for 3 months and persistent
worry about future attacks. He avoids crowded places. Best diagnosis:
A. Panic disorder with agoraphobia
B. Social anxiety disorder
C. Specific phobia
D. Generalized anxiety disorder
Answer: A. Panic disorder with agoraphobia
Rationale: Recurrent unexpected panic attacks with subsequent persistent worry about additional
attacks and avoidance of situations (crowded places) indicates panic disorder with agoraphobia.
Social anxiety involves fear of social/performance situations; GAD is excessive worry across
domains without discrete panic attacks.
5. Which medication is first-line for treating obsessive-compulsive disorder (OCD)?
A. Sertraline
B. Buspirone
C. Benzodiazepines
D. Bupropion
Answer: A. Sertraline
Rationale: SSRIs (sertraline, fluvoxamine, fluoxetine, paroxetine) at higher doses are first-line
for OCD, often combined with cognitive-behavioral therapy (exposure and response prevention).
Buspirone and bupropion are not first-line; benzodiazepines are generally not effective for core
OCD symptoms.
6. A patient on lithium presents with coarse tremor, ataxia, vomiting, and confusion. Serum
lithium is 2.0 mEq/L (normal 0.6–1.2). What is the most appropriate immediate action?
A. Continue lithium and observe
B. Discontinue lithium and begin IV fluids; obtain serial levels
C. Begin hemodialysis immediately
D. Add propranolol for tremor
Answer: B. Discontinue lithium and begin IV fluids; obtain serial levels
Rationale: Serum lithium 2.0 with neurological symptoms indicates moderate-to-severe toxicity.
Immediate discontinuation and supportive care with hydration and monitoring are indicated;
hemodialysis is reserved for very high levels or severe neurologic/cardiac compromise (e.g., >2.5
or if severe symptoms). Propranolol treats tremor but not toxicity.
7. Which psychotherapy has the strongest evidence base for treatment of bipolar disorder
maintenance to reduce relapse?
A. Interpersonal therapy (IPT)
B. Family-focused therapy (FFT)
, C. Motivational interviewing
D. Exposure and response prevention
Answer: B. Family-focused therapy (FFT)
Rationale: For bipolar disorder, adjunctive psychotherapies with evidence include family-
focused therapy, cognitive-behavioral therapy, and psychoeducation. FFT has evidence for
relapse prevention by improving family communication and medication adherence. IPT is used
for depression, not specifically bipolar maintenance. Exposure therapy is for anxiety/OCD.
8. A 30-year-old pregnant woman develops major depression. Which antidepressant has the
most favorable safety data in pregnancy?
A. Paroxetine
B. Fluoxetine
C. Sertraline
D. Bupropion
Answer: C. Sertraline
Rationale: Sertraline has a relatively favorable pregnancy safety profile and is commonly
recommended. Paroxetine is associated with cardiac malformations and is generally avoided.
Fluoxetine is sometimes used but has longer half-life and may have neonatal adaptation
syndrome. Bupropion is used for smoking cessation but not first-line for depression in pregnancy
compared with SSRIs.
9. A patient with alcohol use disorder is started on naltrexone. What is required before
initiating treatment?
A. Liver function tests and confirmation patient is opioid-free
B. Baseline EKG
C. Urine drug screen for benzodiazepines
D. Baseline creatinine only
Answer: A. Liver function tests and confirmation patient is opioid-free
Rationale: Naltrexone is hepatically metabolized and can cause hepatotoxicity; baseline LFTs are
recommended. It is an opioid antagonist — must confirm patient is opioid-free to avoid
precipitating withdrawal. EKG and creatinine are not routine requirements.
10. A 45-year-old man on sertraline presents with sexual dysfunction (decreased libido,
delayed ejaculation). Which management strategy is evidence-based?
A. Add bupropion
B. Switch to paroxetine
C. Increase sertraline dose
D. Stop SSRI abruptly
Answer: A. Add bupropion
Rationale: Bupropion augmentation can mitigate SSRI-induced sexual dysfunction. Switching to
paroxetine would likely worsen sexual side effects. Increasing the SSRI dose would likely
worsen side effects. Abrupt discontinuation risks discontinuation syndrome.
Exam Questions and Answers and Rationale
Top Rated Latest
1. A 28-year-old woman presents with 6 weeks of depressed mood, anhedonia, insomnia,
weight loss of 8 lb, fatigue, and feelings of worthlessness. She reports no suicidal
ideation and continues to work. Which diagnosis is most appropriate?
A. Major depressive disorder, single episode, moderate
B. Persistent depressive disorder (dysthymia)
C. Adjustment disorder with depressed mood
D. Bereavement
Answer: A. Major depressive disorder, single episode, moderate
Rationale: Symptoms lasting 6 weeks with significant functional impairment (weight loss,
insomnia, worthlessness) meet criteria for a major depressive episode (≥2 weeks, five or more
symptoms). Dysthymia (persistent depressive disorder) requires ≥2 years. Adjustment disorder
occurs within 3 months of identifiable stressor and are less severe. Bereavement is tied to loss
and follows characteristic course.
2. A 40-year-old man with schizophrenia stabilized on haloperidol for 6 months develops
restlessness, an inability to sit still, and pacing. What is the most likely diagnosis?
A. Tardive dyskinesia
B. Akathisia
C. Parkinsonism
D. Neuroleptic malignant syndrome
Answer: B. Akathisia
Rationale: Akathisia presents as subjective and objective motor restlessness and is a common
early extrapyramidal side effect of antipsychotics. Parkinsonism involves tremor, rigidity,
bradykinesia. Tardive dyskinesia causes involuntary choreoathetoid movements, often later
onset. NMS is life-threatening with rigidity, hyperthermia, autonomic instability.
3. A 55-year-old woman with major depressive disorder has partial response to sertraline
100 mg after 8 weeks. Which next step is best supported by guidelines?
A. Switch to an SNRI (e.g., venlafaxine)
B. Augment with low-dose atypical antipsychotic (e.g., aripiprazole)
C. Increase sertraline to 200 mg
D. Add mirtazapine
Answer: B. Augment with low-dose atypical antipsychotic (e.g., aripiprazole)
Rationale: In partial response after adequate trial, options include augmentation (with atypical
antipsychotics, lithium, thyroid hormone) or switching. Increasing dose may be considered if not
,at max, but many guidelines support augmentation for partial response. Choice may vary by side
effects and comorbidities; augmentation with aripiprazole is evidence-based.
4. A 22-year-old college student presents with panic attacks for 3 months and persistent
worry about future attacks. He avoids crowded places. Best diagnosis:
A. Panic disorder with agoraphobia
B. Social anxiety disorder
C. Specific phobia
D. Generalized anxiety disorder
Answer: A. Panic disorder with agoraphobia
Rationale: Recurrent unexpected panic attacks with subsequent persistent worry about additional
attacks and avoidance of situations (crowded places) indicates panic disorder with agoraphobia.
Social anxiety involves fear of social/performance situations; GAD is excessive worry across
domains without discrete panic attacks.
5. Which medication is first-line for treating obsessive-compulsive disorder (OCD)?
A. Sertraline
B. Buspirone
C. Benzodiazepines
D. Bupropion
Answer: A. Sertraline
Rationale: SSRIs (sertraline, fluvoxamine, fluoxetine, paroxetine) at higher doses are first-line
for OCD, often combined with cognitive-behavioral therapy (exposure and response prevention).
Buspirone and bupropion are not first-line; benzodiazepines are generally not effective for core
OCD symptoms.
6. A patient on lithium presents with coarse tremor, ataxia, vomiting, and confusion. Serum
lithium is 2.0 mEq/L (normal 0.6–1.2). What is the most appropriate immediate action?
A. Continue lithium and observe
B. Discontinue lithium and begin IV fluids; obtain serial levels
C. Begin hemodialysis immediately
D. Add propranolol for tremor
Answer: B. Discontinue lithium and begin IV fluids; obtain serial levels
Rationale: Serum lithium 2.0 with neurological symptoms indicates moderate-to-severe toxicity.
Immediate discontinuation and supportive care with hydration and monitoring are indicated;
hemodialysis is reserved for very high levels or severe neurologic/cardiac compromise (e.g., >2.5
or if severe symptoms). Propranolol treats tremor but not toxicity.
7. Which psychotherapy has the strongest evidence base for treatment of bipolar disorder
maintenance to reduce relapse?
A. Interpersonal therapy (IPT)
B. Family-focused therapy (FFT)
, C. Motivational interviewing
D. Exposure and response prevention
Answer: B. Family-focused therapy (FFT)
Rationale: For bipolar disorder, adjunctive psychotherapies with evidence include family-
focused therapy, cognitive-behavioral therapy, and psychoeducation. FFT has evidence for
relapse prevention by improving family communication and medication adherence. IPT is used
for depression, not specifically bipolar maintenance. Exposure therapy is for anxiety/OCD.
8. A 30-year-old pregnant woman develops major depression. Which antidepressant has the
most favorable safety data in pregnancy?
A. Paroxetine
B. Fluoxetine
C. Sertraline
D. Bupropion
Answer: C. Sertraline
Rationale: Sertraline has a relatively favorable pregnancy safety profile and is commonly
recommended. Paroxetine is associated with cardiac malformations and is generally avoided.
Fluoxetine is sometimes used but has longer half-life and may have neonatal adaptation
syndrome. Bupropion is used for smoking cessation but not first-line for depression in pregnancy
compared with SSRIs.
9. A patient with alcohol use disorder is started on naltrexone. What is required before
initiating treatment?
A. Liver function tests and confirmation patient is opioid-free
B. Baseline EKG
C. Urine drug screen for benzodiazepines
D. Baseline creatinine only
Answer: A. Liver function tests and confirmation patient is opioid-free
Rationale: Naltrexone is hepatically metabolized and can cause hepatotoxicity; baseline LFTs are
recommended. It is an opioid antagonist — must confirm patient is opioid-free to avoid
precipitating withdrawal. EKG and creatinine are not routine requirements.
10. A 45-year-old man on sertraline presents with sexual dysfunction (decreased libido,
delayed ejaculation). Which management strategy is evidence-based?
A. Add bupropion
B. Switch to paroxetine
C. Increase sertraline dose
D. Stop SSRI abruptly
Answer: A. Add bupropion
Rationale: Bupropion augmentation can mitigate SSRI-induced sexual dysfunction. Switching to
paroxetine would likely worsen sexual side effects. Increasing the SSRI dose would likely
worsen side effects. Abrupt discontinuation risks discontinuation syndrome.
