NRNP 6675 Final Exam Question Bank (Latest 2026/2027
Edition) – 100% Correct Questions, Answers & Detailed
Rationales
Q1
A 28-year-old patient with major depressive disorder has been taking sertraline 100 mg
daily for 6 weeks with minimal improvement. The patient reports persistent sadness,
anhedonia, and fatigue. According to STAR*D trial principles and current guidelines,
what is the most appropriate next step?
A) Increase sertraline to 150 mg daily and reassess in 4 weeks
B) Augment with bupropion XL 150 mg daily
C) Switch to a different SSRI such as fluoxetine 20 mg daily
D) Add lithium carbonate 300 mg twice daily
Answer: B
Rationales:
● A: Dose escalation alone after 6 weeks of partial response is less effective than
augmentation strategies supported by STAR*D data.
, ● B: Augmentation with bupropion is a well-established, evidence-based next step
for partial SSRI response in major depressive disorder.
● C: Switching to another SSRI is generally reserved for inadequate response or
intolerable side effects, not partial response after adequate trial.
● D: Lithium augmentation is effective but typically reserved for treatment-resistant
depression after multiple failed strategies, not first augmentation.
Q2
A PMHNP is evaluating a 19-year-old college student presenting with 3 weeks of
elevated mood, decreased need for sleep, racing thoughts, and reckless spending. The
patient has no prior psychiatric history. Which diagnosis is most appropriate?
A) Bipolar I Disorder, current episode manic
B) Bipolar II Disorder, current episode hypomanic
C) Cyclothymic disorder
D) Substance/medication-induced bipolar and related disorder
Answer: A
Rationales:
● A: A distinct period of abnormally elevated mood with decreased sleep, racing
thoughts, and reckless behavior lasting 3 weeks meets criteria for a manic
episode, supporting Bipolar I.
● B: Bipolar II requires a history of at least one major depressive episode and
hypomanic episodes that do not cause marked impairment, which is inconsistent
with this presentation.
, ● C: Cyclothymic disorder requires at least 2 years of numerous hypomanic and
depressive symptoms without meeting full criteria, which this acute presentation
does not satisfy.
● D: There is no evidence in the stem of substance use or medication causation,
making this diagnosis premature without further history.
Q3
A 42-year-old patient with schizophrenia is stable on risperidone 4 mg daily but reports
bothersome galactorrhea and amenorrhea. Laboratory testing reveals elevated
prolactin. Which antipsychotic would be the most appropriate switch to minimize
prolactin elevation while maintaining efficacy?
A) Haloperidol 10 mg daily
B) Olanzapine 15 mg daily
C) Aripiprazole 15 mg daily
D) Fluphenazine decanoate 25 mg IM every 2 weeks
Answer: C
Rationales:
● A: Haloperidol is a high-potency typical antipsychotic that significantly elevates
prolactin and would worsen the patient's current adverse effect.
● B: Olanzapine has lower prolactin effects than risperidone but still carries
moderate risk and significant metabolic liabilities.
● C: Aripiprazole is a partial dopamine agonist with minimal prolactin elevation and
robust efficacy for schizophrenia, making it the optimal switch.
, ● D: Fluphenazine decanoate is a depot typical antipsychotic with high prolactin
elevation and would exacerbate the patient's symptoms.
Q4
During a medication management visit, a patient prescribed clozapine reports fever,
sore throat, and malaise. The absolute neutrophil count (ANC) is 1,200/mm³. What is
the correct clinical action based on FDA REMS requirements?
A) Continue clozapine and repeat ANC in 1 week
B) Interrupt clozapine immediately and obtain ANC daily until ≥1,500/mm³
C) Reduce clozapine dose by 50% and monitor ANC twice weekly
D) Interrupt clozapine and do not rechallenge unless ANC returns to normal range
Answer: B
Rationales:
● A: Continuing clozapine with an ANC of 1,200/mm³ in the setting of infection
symptoms violates REMS protocols and risks neutropenic sepsis.
● B: An ANC between 1,000–1,499/mm³ with infection symptoms requires
immediate interruption and daily monitoring until recovery to ≥1,500/mm³ per
clozapine REMS.
● C: Dose reduction is not the REMS-specified action for moderate neutropenia
with infection symptoms; interruption is mandatory.
● D: This describes the protocol for severe neutropenia (ANC <500/mm³), not
moderate neutropenia, and overstates the restriction.
Edition) – 100% Correct Questions, Answers & Detailed
Rationales
Q1
A 28-year-old patient with major depressive disorder has been taking sertraline 100 mg
daily for 6 weeks with minimal improvement. The patient reports persistent sadness,
anhedonia, and fatigue. According to STAR*D trial principles and current guidelines,
what is the most appropriate next step?
A) Increase sertraline to 150 mg daily and reassess in 4 weeks
B) Augment with bupropion XL 150 mg daily
C) Switch to a different SSRI such as fluoxetine 20 mg daily
D) Add lithium carbonate 300 mg twice daily
Answer: B
Rationales:
● A: Dose escalation alone after 6 weeks of partial response is less effective than
augmentation strategies supported by STAR*D data.
, ● B: Augmentation with bupropion is a well-established, evidence-based next step
for partial SSRI response in major depressive disorder.
● C: Switching to another SSRI is generally reserved for inadequate response or
intolerable side effects, not partial response after adequate trial.
● D: Lithium augmentation is effective but typically reserved for treatment-resistant
depression after multiple failed strategies, not first augmentation.
Q2
A PMHNP is evaluating a 19-year-old college student presenting with 3 weeks of
elevated mood, decreased need for sleep, racing thoughts, and reckless spending. The
patient has no prior psychiatric history. Which diagnosis is most appropriate?
A) Bipolar I Disorder, current episode manic
B) Bipolar II Disorder, current episode hypomanic
C) Cyclothymic disorder
D) Substance/medication-induced bipolar and related disorder
Answer: A
Rationales:
● A: A distinct period of abnormally elevated mood with decreased sleep, racing
thoughts, and reckless behavior lasting 3 weeks meets criteria for a manic
episode, supporting Bipolar I.
● B: Bipolar II requires a history of at least one major depressive episode and
hypomanic episodes that do not cause marked impairment, which is inconsistent
with this presentation.
, ● C: Cyclothymic disorder requires at least 2 years of numerous hypomanic and
depressive symptoms without meeting full criteria, which this acute presentation
does not satisfy.
● D: There is no evidence in the stem of substance use or medication causation,
making this diagnosis premature without further history.
Q3
A 42-year-old patient with schizophrenia is stable on risperidone 4 mg daily but reports
bothersome galactorrhea and amenorrhea. Laboratory testing reveals elevated
prolactin. Which antipsychotic would be the most appropriate switch to minimize
prolactin elevation while maintaining efficacy?
A) Haloperidol 10 mg daily
B) Olanzapine 15 mg daily
C) Aripiprazole 15 mg daily
D) Fluphenazine decanoate 25 mg IM every 2 weeks
Answer: C
Rationales:
● A: Haloperidol is a high-potency typical antipsychotic that significantly elevates
prolactin and would worsen the patient's current adverse effect.
● B: Olanzapine has lower prolactin effects than risperidone but still carries
moderate risk and significant metabolic liabilities.
● C: Aripiprazole is a partial dopamine agonist with minimal prolactin elevation and
robust efficacy for schizophrenia, making it the optimal switch.
, ● D: Fluphenazine decanoate is a depot typical antipsychotic with high prolactin
elevation and would exacerbate the patient's symptoms.
Q4
During a medication management visit, a patient prescribed clozapine reports fever,
sore throat, and malaise. The absolute neutrophil count (ANC) is 1,200/mm³. What is
the correct clinical action based on FDA REMS requirements?
A) Continue clozapine and repeat ANC in 1 week
B) Interrupt clozapine immediately and obtain ANC daily until ≥1,500/mm³
C) Reduce clozapine dose by 50% and monitor ANC twice weekly
D) Interrupt clozapine and do not rechallenge unless ANC returns to normal range
Answer: B
Rationales:
● A: Continuing clozapine with an ANC of 1,200/mm³ in the setting of infection
symptoms violates REMS protocols and risks neutropenic sepsis.
● B: An ANC between 1,000–1,499/mm³ with infection symptoms requires
immediate interruption and daily monitoring until recovery to ≥1,500/mm³ per
clozapine REMS.
● C: Dose reduction is not the REMS-specified action for moderate neutropenia
with infection symptoms; interruption is mandatory.
● D: This describes the protocol for severe neutropenia (ANC <500/mm³), not
moderate neutropenia, and overstates the restriction.
