1|Page
# NURS 6670 APPROACHES TO TREATMENT
FINAL EXAM ## ADVANCED PRACTICE
PSYCHIATRIC MENTAL HEALTH NURSING
**2025-2026 EDITION | 150 QUESTIONS |
DETAILED RATIONALES**GRADED A+ | PMHNP
BOARD CERTIFICATION STYLE**
# SECTION I: FOUNDATIONAL PRINCIPLES OF PSYCHIATRIC
TREATMENT (Questions 1-15)
**1. A psychiatric nurse practitioner (PMHNP) is evaluating a new
patient with treatment-resistant depression. The patient has failed trials
of two SSRIs and one SNRI. According to the STAR*D trial findings,
which next step is most appropriate?**
A) Switch to a tricyclic antidepressant (TCA)
B) Augment with a second-generation antipsychotic (aripiprazole)
C) Start electroconvulsive therapy (ECT)
D) Increase the SSRI to supratherapeutic levels
**Correct Answer: B**
,2|Page
**Rationale:** The STAR*D trial demonstrated that augmentation with
aripiprazole (or other second-generation antipsychotics) is effective for
treatment-resistant depression after failed antidepressant trials. TCA
switching is an option but not first-line augmentation. ECT is reserved
for refractory or catatonic depression.
---
**2. A patient with major depressive disorder has been on paroxetine 40
mg daily for 8 weeks with minimal improvement. The patient reports
weight gain of 12 pounds and sexual dysfunction. Which action is most
appropriate?**
A) Increase paroxetine to 50 mg daily
B) Switch to bupropion XL 300 mg daily
C) Add aripiprazole 2 mg daily
D) Continue current dose for 4 more weeks
**Correct Answer: B**
**Rationale:** Bupropion is associated with less weight gain and lower
rates of sexual dysfunction compared to SSRIs. Switching to bupropion
is appropriate given intolerable side effects and inadequate response.
Further dose increase of paroxetine would worsen side effects.
,3|Page
---
**3. A patient with bipolar I disorder is currently in a manic episode.
Which medication regimen is most appropriate for acute mania?**
A) Lithium monotherapy
B) Aripiprazole monotherapy
C) Lithium plus valproate
D) Fluoxetine plus olanzapine
**Correct Answer: C**
**Rationale:** Combination therapy with lithium plus valproate (or
lithium plus an antipsychotic) is more effective than monotherapy for
severe acute mania. Fluoxetine (antidepressant) is contraindicated in
acute mania as it may worsen symptoms.
---
**4. A patient with generalized anxiety disorder (GAD) has been on
buspirone 30 mg daily for 3 weeks with no improvement. Which
statement is most accurate?**
A) Buspirone should be increased to 60 mg daily
, 4|Page
B) Buspirone may take 4-6 weeks for full effect
C) Switch to alprazolam for faster relief
D) Add propranolol for somatic symptoms
**Correct Answer: B**
**Rationale:** Buspirone has a delayed onset of action (4-6 weeks)
similar to SSRIs. The patient should continue the medication.
Alprazolam is not first-line for chronic GAD due to dependence risk.
---
**5. A patient with schizophrenia has been on clozapine for 6 months
with excellent symptom control. Which laboratory monitoring is
required at this stage?**
A) Weekly white blood cell count (WBC) for life
B) Every 2 weeks WBC for first 6 months, then monthly
C) Monthly CBC for the first year, then every 3 months
D) No further monitoring if no prior abnormalities
**Correct Answer: B**
# NURS 6670 APPROACHES TO TREATMENT
FINAL EXAM ## ADVANCED PRACTICE
PSYCHIATRIC MENTAL HEALTH NURSING
**2025-2026 EDITION | 150 QUESTIONS |
DETAILED RATIONALES**GRADED A+ | PMHNP
BOARD CERTIFICATION STYLE**
# SECTION I: FOUNDATIONAL PRINCIPLES OF PSYCHIATRIC
TREATMENT (Questions 1-15)
**1. A psychiatric nurse practitioner (PMHNP) is evaluating a new
patient with treatment-resistant depression. The patient has failed trials
of two SSRIs and one SNRI. According to the STAR*D trial findings,
which next step is most appropriate?**
A) Switch to a tricyclic antidepressant (TCA)
B) Augment with a second-generation antipsychotic (aripiprazole)
C) Start electroconvulsive therapy (ECT)
D) Increase the SSRI to supratherapeutic levels
**Correct Answer: B**
,2|Page
**Rationale:** The STAR*D trial demonstrated that augmentation with
aripiprazole (or other second-generation antipsychotics) is effective for
treatment-resistant depression after failed antidepressant trials. TCA
switching is an option but not first-line augmentation. ECT is reserved
for refractory or catatonic depression.
---
**2. A patient with major depressive disorder has been on paroxetine 40
mg daily for 8 weeks with minimal improvement. The patient reports
weight gain of 12 pounds and sexual dysfunction. Which action is most
appropriate?**
A) Increase paroxetine to 50 mg daily
B) Switch to bupropion XL 300 mg daily
C) Add aripiprazole 2 mg daily
D) Continue current dose for 4 more weeks
**Correct Answer: B**
**Rationale:** Bupropion is associated with less weight gain and lower
rates of sexual dysfunction compared to SSRIs. Switching to bupropion
is appropriate given intolerable side effects and inadequate response.
Further dose increase of paroxetine would worsen side effects.
,3|Page
---
**3. A patient with bipolar I disorder is currently in a manic episode.
Which medication regimen is most appropriate for acute mania?**
A) Lithium monotherapy
B) Aripiprazole monotherapy
C) Lithium plus valproate
D) Fluoxetine plus olanzapine
**Correct Answer: C**
**Rationale:** Combination therapy with lithium plus valproate (or
lithium plus an antipsychotic) is more effective than monotherapy for
severe acute mania. Fluoxetine (antidepressant) is contraindicated in
acute mania as it may worsen symptoms.
---
**4. A patient with generalized anxiety disorder (GAD) has been on
buspirone 30 mg daily for 3 weeks with no improvement. Which
statement is most accurate?**
A) Buspirone should be increased to 60 mg daily
, 4|Page
B) Buspirone may take 4-6 weeks for full effect
C) Switch to alprazolam for faster relief
D) Add propranolol for somatic symptoms
**Correct Answer: B**
**Rationale:** Buspirone has a delayed onset of action (4-6 weeks)
similar to SSRIs. The patient should continue the medication.
Alprazolam is not first-line for chronic GAD due to dependence risk.
---
**5. A patient with schizophrenia has been on clozapine for 6 months
with excellent symptom control. Which laboratory monitoring is
required at this stage?**
A) Weekly white blood cell count (WBC) for life
B) Every 2 weeks WBC for first 6 months, then monthly
C) Monthly CBC for the first year, then every 3 months
D) No further monitoring if no prior abnormalities
**Correct Answer: B**
