Walden University
MAXE • LANIF
PMHNP
✦ ✦
NRNP 6675 PMHNP Program · NRNP 6675
A HIGHER DEGREE OF NURSING
WALDEN
NRNP 6675 FINAL EXAM LAST EXAM EVERRRRR
(minus boards)
P SYC H O P H A R M A CO LO G Y · P E R S O N A L I TY D I S O R D E R S · B I P O L A R · L I T H I U M · A N T I P SYC H OT I CS ·
E T H I CS
INSTITUTION Walden University · PMHNP Program COURSE CODE NRNP 6675
PROGRAM PMHNP (Psychiatric Mental Health Nurse ACADEMIC YEAR
Practitioner)
EXAM TITLE NRNP 6675 — Final Examination TOTAL QUESTIONS 50 Questions
SUBJECT AREAS Psychopharmacology · PD Clusters · FORMAT Multiple Choice — Select the Single Best
Lithium · Ethics · DV · Geriatrics Answer
FINAL EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless "Select all that apply" is specified.
▸ Content covers: psychopharmacology (lithium, antipsychotics, anticonvulsants, SSRIs), personality disorders, bipolar disorder,
Lewy body dementia, DV cycle, and ethical/legal principles.
▸ Each question includes the correct answer with a detailed clinical rationale.
SECTION I — PSYCHOPHARMACOLOGY, PDS, BIPOLAR & CLINICAL Questions 1 –
PEARLS 50
1. The half-life of lithium is approximately:
A. 6 hours
B. 12 hours
C. 24 hours
D. 48 hours
CORRECT ANSWER C — 24 hours
RATIONALE Lithium has a half-life of approximately 24 hours. It reaches steady state after 5 half-lives (approximately 5
days). Lithium levels should be drawn at trough (just before the next dose) after steady state has been
achieved. If drawn earlier, the trough level will UNDERESTIMATE the actual level the patient is maintained on.
Therapeutic range: 0.3–1.2 mEq/L. Toxicity begins above 1.5 mEq/L. Mild toxicity symptoms: fine tremor,
lightheadedness, lack of coordination, weakness. Moderate toxicity: ataxia, dizziness, slurred speech,
abdominal pain. Severe toxicity (>2.0–2.5 mEq/L): generalized convulsions, oliguria, and renal failure.
, 2. Which SSRI has the LOWEST risk of withdrawal syndrome due to its long half-life?
A. Paroxetine (Paxil)
B. Fluoxetine (Prozac)
C. Citalopram (Celexa)
D. Sertraline (Zoloft)
CORRECT ANSWER B — Fluoxetine (Prozac)
RATIONALE Fluoxetine has the LOWEST withdrawal risk among SSRIs because of its extremely long half-life
(approximately 2 weeks for the parent drug and its active metabolite norfluoxetine). It takes approximately
2.5 months to achieve steady state. This long half-life means the drug self-tapers when discontinued,
minimizing withdrawal symptoms. In contrast, paroxetine (Paxil) has the HIGHEST withdrawal risk due to its
24-hour half-life and its unique property of inhibiting its own metabolism (CYP2D6), which effectively
shortens its half-life and hastens withdrawal. Venlafaxine (Effexor) is ranked #2 for withdrawal severity with a
half-life of only 5 hours.
3. Which antipsychotics are preferred for patients who frequently miss doses of their medications?
A. Antipsychotics with short half-lives for quick clearance
B. Antipsychotics with long half-lives, such as cariprazine (Vrylar), aripiprazole (Abilify), and brexpiprazole (Rexulti)
C. Immediate-release formulations only
D. All antipsychotics are equally effective for missed doses
CORRECT ANSWER B — Antipsychotics with long half-lives (cariprazine, aripiprazole, brexpiprazole, pimozide,
pimavanserin)
RATIONALE For patients with poor medication adherence, antipsychotics with long half-lives provide a "forgiveness
window." Cariprazine (Vrylar): 2–4 day half-life with active metabolites lasting up to 3 weeks. Aripiprazole
(Abilify): 3-day half-life. Brexpiprazole (Rexulti): 4-day half-life. Pimozide: 4–5 day half-life. Pimavanserin
(Nuplazid): 2-day half-life with active metabolites lasting 8 days. These long half-lives mean that missing a
dose does not result in rapid loss of therapeutic effect. Long-acting injectable (LAI) formulations are another
strategy for adherence-challenged patients.
4. Disulfiram's (Antabuse) alcohol interaction can persist for up to how long after the medication is stopped?
A. 24 hours
B. 3–4 days
C. Up to 2 weeks
D. 1 month
CORRECT ANSWER C — Up to 2 weeks
RATIONALE Disulfiram irreversibly inhibits aldehyde dehydrogenase, and its effects persist until new enzyme is
synthesized — which takes approximately 2 weeks. Patients must be counseled that even small amounts of
alcohol (including in mouthwash, cooking wine, or cologne) can trigger a disulfiram-ethanol reaction
(flushing, tachycardia, nausea, vomiting, and potentially hypotension and cardiovascular collapse) for up to
14 days after the last dose. The half-life of disulfiram is 2–3 days, but the pharmacodynamic effect far outlasts
the pharmacokinetic half-life due to irreversible enzyme inhibition.
MAXE • LANIF
PMHNP
✦ ✦
NRNP 6675 PMHNP Program · NRNP 6675
A HIGHER DEGREE OF NURSING
WALDEN
NRNP 6675 FINAL EXAM LAST EXAM EVERRRRR
(minus boards)
P SYC H O P H A R M A CO LO G Y · P E R S O N A L I TY D I S O R D E R S · B I P O L A R · L I T H I U M · A N T I P SYC H OT I CS ·
E T H I CS
INSTITUTION Walden University · PMHNP Program COURSE CODE NRNP 6675
PROGRAM PMHNP (Psychiatric Mental Health Nurse ACADEMIC YEAR
Practitioner)
EXAM TITLE NRNP 6675 — Final Examination TOTAL QUESTIONS 50 Questions
SUBJECT AREAS Psychopharmacology · PD Clusters · FORMAT Multiple Choice — Select the Single Best
Lithium · Ethics · DV · Geriatrics Answer
FINAL EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless "Select all that apply" is specified.
▸ Content covers: psychopharmacology (lithium, antipsychotics, anticonvulsants, SSRIs), personality disorders, bipolar disorder,
Lewy body dementia, DV cycle, and ethical/legal principles.
▸ Each question includes the correct answer with a detailed clinical rationale.
SECTION I — PSYCHOPHARMACOLOGY, PDS, BIPOLAR & CLINICAL Questions 1 –
PEARLS 50
1. The half-life of lithium is approximately:
A. 6 hours
B. 12 hours
C. 24 hours
D. 48 hours
CORRECT ANSWER C — 24 hours
RATIONALE Lithium has a half-life of approximately 24 hours. It reaches steady state after 5 half-lives (approximately 5
days). Lithium levels should be drawn at trough (just before the next dose) after steady state has been
achieved. If drawn earlier, the trough level will UNDERESTIMATE the actual level the patient is maintained on.
Therapeutic range: 0.3–1.2 mEq/L. Toxicity begins above 1.5 mEq/L. Mild toxicity symptoms: fine tremor,
lightheadedness, lack of coordination, weakness. Moderate toxicity: ataxia, dizziness, slurred speech,
abdominal pain. Severe toxicity (>2.0–2.5 mEq/L): generalized convulsions, oliguria, and renal failure.
, 2. Which SSRI has the LOWEST risk of withdrawal syndrome due to its long half-life?
A. Paroxetine (Paxil)
B. Fluoxetine (Prozac)
C. Citalopram (Celexa)
D. Sertraline (Zoloft)
CORRECT ANSWER B — Fluoxetine (Prozac)
RATIONALE Fluoxetine has the LOWEST withdrawal risk among SSRIs because of its extremely long half-life
(approximately 2 weeks for the parent drug and its active metabolite norfluoxetine). It takes approximately
2.5 months to achieve steady state. This long half-life means the drug self-tapers when discontinued,
minimizing withdrawal symptoms. In contrast, paroxetine (Paxil) has the HIGHEST withdrawal risk due to its
24-hour half-life and its unique property of inhibiting its own metabolism (CYP2D6), which effectively
shortens its half-life and hastens withdrawal. Venlafaxine (Effexor) is ranked #2 for withdrawal severity with a
half-life of only 5 hours.
3. Which antipsychotics are preferred for patients who frequently miss doses of their medications?
A. Antipsychotics with short half-lives for quick clearance
B. Antipsychotics with long half-lives, such as cariprazine (Vrylar), aripiprazole (Abilify), and brexpiprazole (Rexulti)
C. Immediate-release formulations only
D. All antipsychotics are equally effective for missed doses
CORRECT ANSWER B — Antipsychotics with long half-lives (cariprazine, aripiprazole, brexpiprazole, pimozide,
pimavanserin)
RATIONALE For patients with poor medication adherence, antipsychotics with long half-lives provide a "forgiveness
window." Cariprazine (Vrylar): 2–4 day half-life with active metabolites lasting up to 3 weeks. Aripiprazole
(Abilify): 3-day half-life. Brexpiprazole (Rexulti): 4-day half-life. Pimozide: 4–5 day half-life. Pimavanserin
(Nuplazid): 2-day half-life with active metabolites lasting 8 days. These long half-lives mean that missing a
dose does not result in rapid loss of therapeutic effect. Long-acting injectable (LAI) formulations are another
strategy for adherence-challenged patients.
4. Disulfiram's (Antabuse) alcohol interaction can persist for up to how long after the medication is stopped?
A. 24 hours
B. 3–4 days
C. Up to 2 weeks
D. 1 month
CORRECT ANSWER C — Up to 2 weeks
RATIONALE Disulfiram irreversibly inhibits aldehyde dehydrogenase, and its effects persist until new enzyme is
synthesized — which takes approximately 2 weeks. Patients must be counseled that even small amounts of
alcohol (including in mouthwash, cooking wine, or cologne) can trigger a disulfiram-ethanol reaction
(flushing, tachycardia, nausea, vomiting, and potentially hypotension and cardiovascular collapse) for up to
14 days after the last dose. The half-life of disulfiram is 2–3 days, but the pharmacodynamic effect far outlasts
the pharmacokinetic half-life due to irreversible enzyme inhibition.
