NR605 Week 8 Final Exam Due 22nd
December 2025 Complete Actual
Exam Questions 1- 75 NR605
Diagnosis Management in Psychiatric
Mental Health NR 605 Midterm and
Finals Examplify Online Proctored
Exam Questions and Answers | 100%
Pass Guaranteed | Graded A+
Section 1: Psychopharmacology (Questions 1-20)
1. A 35-year-old female with major depressive disorder has been on fluoxetine
20 mg daily for 8 weeks with minimal improvement. She reports side effects of
nausea and insomnia. The PMHNP decides to switch to another
antidepressant. Which of the following would be the most appropriate switch
strategy to minimize withdrawal and side effects?
a) Stop fluoxetine abruptly and start bupropion the next day
b) Cross-taper: decrease fluoxetine to 10 mg daily for 1 week while starting
low-dose bupropion, then stop fluoxetine
c) Add aripiprazole as augmentation
d) Increase fluoxetine to 40 mg daily
,Rationale: Fluoxetine has a long half-life (4-6 days, with active metabolite
norfluoxetine up to 16 days). Cross-tapering is recommended to minimize
withdrawal and potential drug interactions. Abrupt discontinuation risks
withdrawal symptoms (dizziness, paresthesias, mood lability).
2. A patient with schizophrenia has been stable on risperidone 4 mg daily for 6
months. The patient now reports galactorrhea and amenorrhea. Which of the
following is the most likely cause?
a) Weight gain from risperidone
b) Hyperprolactinemia due to dopamine D2 blockade in the pituitary
c) Hypothyroidism
d) Pregnancy
Rationale: Risperidone is a potent D2 antagonist at the pituitary, causing elevated
prolactin (hyperprolactinemia), leading to galactorrhea, gynecomastia, and sexual
dysfunction.
3. A 45-year-old male with major depressive disorder is started on venlafaxine
XR 75 mg daily. He returns 2 weeks later reporting he missed 2 days of doses
and experienced "brain zaps," dizziness, and nausea. Which best describes
this phenomenon?
a) Serotonin syndrome
b) Antidepressant discontinuation syndrome
c) Worsening of depression
d) Opioid withdrawal
Rationale: Venlafaxine (short half-life) has a high risk of discontinuation
syndrome when doses are missed or tapered rapidly. Symptoms include "brain
zaps" (electric shock-like sensations), dizziness, nausea, headache, fatigue, and
irritability.
,4. A patient with bipolar II disorder is prescribed lamotrigine for
maintenance treatment. Which of the following is a critical safety warning
that must be discussed with the patient?
a) Risk of agranulocytosis
b) Risk of Stevens-Johnson syndrome (SJS), especially during rapid titration
c) Risk of QT prolongation
d) Risk of weight gain
Rationale: Lamotrigine has a black box warning for Stevens-Johnson syndrome
and toxic epidermal necrolysis, life-threatening skin reactions. Risk is increased
with rapid dose titration, concomitant valproate use, and in children. Slow titration
is mandatory.
5. A patient with treatment-resistant schizophrenia has been started on
clozapine. Which laboratory monitoring is required for this medication?
a) Absolute neutrophil count (ANC) weekly for first 6 months
b) Liver function tests monthly
c) Serum creatinine weekly
d) Thyroid function tests monthly
Rationale: Clozapine has a black box warning for severe neutropenia
(agranulocytosis). ANC must be monitored weekly for the first 6 months, biweekly
for months 6-12, and monthly thereafter (REMS program).
6. A patient with social anxiety disorder is prescribed paroxetine. Which
statement regarding the use of SSRIs in social anxiety is correct?
a) SSRIs are first-line treatment for social anxiety disorder
b) Paroxetine is FDA-approved for social anxiety disorder
c) Onset of action for anxiety symptoms is typically 2-4 weeks
d) All of the above
, Rationale: SSRIs (paroxetine, sertraline, escitalopram, fluvoxamine) are first-line
for social anxiety disorder. Paroxetine is FDA-approved for this indication. Onset
of therapeutic effect for anxiety is typically 2-4 weeks.
7. A patient with bipolar I disorder is prescribed lithium. Which baseline
laboratory tests are required before starting lithium?
a) CBC, CMP, TSH, pregnancy test (if applicable), BUN/Cr
b) EKG only
c) Liver function tests only
d) Glucose tolerance test
Rationale: Lithium requires baseline and periodic monitoring of renal function
(BUN, Cr), thyroid (TSH), electrolytes, calcium, and pregnancy test in women of
childbearing potential.
8. A patient with PTSD reports nightmares and hypervigilance. Which
medication is FDA-approved for the treatment of PTSD?
a) Fluoxetine
b) Paroxetine and sertraline
c) Venlafaxine
d) Prazosin
Rationale: Paroxetine and sertraline are FDA-approved for PTSD. Prazosin is
used off-label for nightmares but is not FDA-approved for PTSD.
9. A patient presents with acute agitation and aggression. The PMHNP needs
to administer an intramuscular medication for rapid tranquilization. Which
of the following combinations is most appropriate?
a) Haloperidol 5 mg IM + lorazepam 2 mg IM
b) Olanzapine 10 mg IM alone
December 2025 Complete Actual
Exam Questions 1- 75 NR605
Diagnosis Management in Psychiatric
Mental Health NR 605 Midterm and
Finals Examplify Online Proctored
Exam Questions and Answers | 100%
Pass Guaranteed | Graded A+
Section 1: Psychopharmacology (Questions 1-20)
1. A 35-year-old female with major depressive disorder has been on fluoxetine
20 mg daily for 8 weeks with minimal improvement. She reports side effects of
nausea and insomnia. The PMHNP decides to switch to another
antidepressant. Which of the following would be the most appropriate switch
strategy to minimize withdrawal and side effects?
a) Stop fluoxetine abruptly and start bupropion the next day
b) Cross-taper: decrease fluoxetine to 10 mg daily for 1 week while starting
low-dose bupropion, then stop fluoxetine
c) Add aripiprazole as augmentation
d) Increase fluoxetine to 40 mg daily
,Rationale: Fluoxetine has a long half-life (4-6 days, with active metabolite
norfluoxetine up to 16 days). Cross-tapering is recommended to minimize
withdrawal and potential drug interactions. Abrupt discontinuation risks
withdrawal symptoms (dizziness, paresthesias, mood lability).
2. A patient with schizophrenia has been stable on risperidone 4 mg daily for 6
months. The patient now reports galactorrhea and amenorrhea. Which of the
following is the most likely cause?
a) Weight gain from risperidone
b) Hyperprolactinemia due to dopamine D2 blockade in the pituitary
c) Hypothyroidism
d) Pregnancy
Rationale: Risperidone is a potent D2 antagonist at the pituitary, causing elevated
prolactin (hyperprolactinemia), leading to galactorrhea, gynecomastia, and sexual
dysfunction.
3. A 45-year-old male with major depressive disorder is started on venlafaxine
XR 75 mg daily. He returns 2 weeks later reporting he missed 2 days of doses
and experienced "brain zaps," dizziness, and nausea. Which best describes
this phenomenon?
a) Serotonin syndrome
b) Antidepressant discontinuation syndrome
c) Worsening of depression
d) Opioid withdrawal
Rationale: Venlafaxine (short half-life) has a high risk of discontinuation
syndrome when doses are missed or tapered rapidly. Symptoms include "brain
zaps" (electric shock-like sensations), dizziness, nausea, headache, fatigue, and
irritability.
,4. A patient with bipolar II disorder is prescribed lamotrigine for
maintenance treatment. Which of the following is a critical safety warning
that must be discussed with the patient?
a) Risk of agranulocytosis
b) Risk of Stevens-Johnson syndrome (SJS), especially during rapid titration
c) Risk of QT prolongation
d) Risk of weight gain
Rationale: Lamotrigine has a black box warning for Stevens-Johnson syndrome
and toxic epidermal necrolysis, life-threatening skin reactions. Risk is increased
with rapid dose titration, concomitant valproate use, and in children. Slow titration
is mandatory.
5. A patient with treatment-resistant schizophrenia has been started on
clozapine. Which laboratory monitoring is required for this medication?
a) Absolute neutrophil count (ANC) weekly for first 6 months
b) Liver function tests monthly
c) Serum creatinine weekly
d) Thyroid function tests monthly
Rationale: Clozapine has a black box warning for severe neutropenia
(agranulocytosis). ANC must be monitored weekly for the first 6 months, biweekly
for months 6-12, and monthly thereafter (REMS program).
6. A patient with social anxiety disorder is prescribed paroxetine. Which
statement regarding the use of SSRIs in social anxiety is correct?
a) SSRIs are first-line treatment for social anxiety disorder
b) Paroxetine is FDA-approved for social anxiety disorder
c) Onset of action for anxiety symptoms is typically 2-4 weeks
d) All of the above
, Rationale: SSRIs (paroxetine, sertraline, escitalopram, fluvoxamine) are first-line
for social anxiety disorder. Paroxetine is FDA-approved for this indication. Onset
of therapeutic effect for anxiety is typically 2-4 weeks.
7. A patient with bipolar I disorder is prescribed lithium. Which baseline
laboratory tests are required before starting lithium?
a) CBC, CMP, TSH, pregnancy test (if applicable), BUN/Cr
b) EKG only
c) Liver function tests only
d) Glucose tolerance test
Rationale: Lithium requires baseline and periodic monitoring of renal function
(BUN, Cr), thyroid (TSH), electrolytes, calcium, and pregnancy test in women of
childbearing potential.
8. A patient with PTSD reports nightmares and hypervigilance. Which
medication is FDA-approved for the treatment of PTSD?
a) Fluoxetine
b) Paroxetine and sertraline
c) Venlafaxine
d) Prazosin
Rationale: Paroxetine and sertraline are FDA-approved for PTSD. Prazosin is
used off-label for nightmares but is not FDA-approved for PTSD.
9. A patient presents with acute agitation and aggression. The PMHNP needs
to administer an intramuscular medication for rapid tranquilization. Which
of the following combinations is most appropriate?
a) Haloperidol 5 mg IM + lorazepam 2 mg IM
b) Olanzapine 10 mg IM alone
