NRNP 6635 Week 6 Midterm Exam Question Bank
(Latest 2026/2027 Edition) – 100% Correct Questions,
Answers & Detailed Rationales
Q1
A 28-year-old patient with bipolar I disorder presents with acute mania. The
psychiatric-mental health nurse practitioner (PMHNP) decides to initiate lithium
carbonate. Which baseline laboratory assessment is MOST critical to obtain before
starting lithium therapy?
A) Thyroid-stimulating hormone (TSH) and free T4
B) Serum creatinine, blood urea nitrogen (BUN), and electrolytes
C) Complete blood count with differential
D) Liver function tests and lipid panel
Answer: B
Rationales:
, ● A: While thyroid function monitoring is essential during ongoing lithium therapy,
renal function assessment takes precedence because lithium is entirely renally
excreted and nephrotoxicity represents the most immediate life-threatening risk.
● B: Lithium is filtered by the glomeruli without metabolism, making renal clearance
the sole elimination pathway; pre-existing renal impairment dramatically
increases toxicity risk and necessitates dose adjustment or alternative selection.
● C: Although lithium can cause leukocytosis, a baseline CBC is not the most
critical pre-treatment assessment compared to evaluating the organ responsible
for drug elimination.
● D: Lithium does not undergo hepatic metabolism, so liver function tests are not
specifically required for lithium initiation, though they may be part of a general
metabolic workup.
Q2
A 45-year-old patient with treatment-resistant major depressive disorder is being
considered for augmentation with liothyronine (T3). Which statement best describes the
evidence-based rationale for this approach?
A) T3 augmentation is FDA-approved specifically for antidepressant augmentation in all
adult patients.
B) T3 augmentation has demonstrated efficacy primarily in patients with documented
hypothyroidism.
C) T3 augmentation may enhance noradrenergic and serotonergic neurotransmission
even in euthyroid patients.
D) T3 should always be used before considering lithium augmentation due to superior
efficacy data.
Answer: C
,Rationales:
● A: T3 augmentation is not FDA-approved for antidepressant augmentation; it is
used off-label based on clinical evidence and STAR*D trial data.
● B: While T3 may benefit hypothyroid patients, its antidepressant augmentation
effect has been demonstrated in euthyroid individuals through mechanisms
involving beta-adrenergic receptor sensitization and serotonin turnover.
● C: T3 crosses the blood-brain barrier readily and modulates gene expression for
neurotransmitter receptors and transporters, potentially enhancing
antidepressant response through noradrenergic and serotonergic optimization
independent of thyroid status.
● D: The STAR*D trial showed comparable remission rates between T3 and lithium
augmentation, with neither demonstrating clear superiority; selection depends on
individual patient factors and contraindications.
Q3
A PMHNP is prescribing a second-generation antipsychotic for a 16-year-old patient
with schizophrenia. Which agent carries the FDA indication for schizophrenia in
adolescents and has the most favorable metabolic profile?
A) Olanzapine
B) Risperidone
C) Aripiprazole
D) Quetiapine
Answer: C
Rationales:
, ● A: Olanzapine is FDA-approved for adolescent schizophrenia but carries one of
the highest risks for metabolic syndrome, weight gain, and dyslipidemia among
second-generation antipsychotics.
● B: Risperidone is FDA-approved for adolescent schizophrenia but is associated
with significant prolactin elevation and weight gain, making its metabolic profile
less favorable than partial agonists.
● C: Aripiprazole is FDA-approved for schizophrenia in adolescents aged 13-17 and
functions as a partial dopamine agonist, demonstrating the most favorable
metabolic profile with minimal weight gain, prolactin elevation, or QTc
prolongation risk.
● D: While quetiapine is sometimes used off-label in adolescents, it carries
significant sedation, orthostatic hypotension, and metabolic risks without the
same evidence base for adolescent schizophrenia as aripiprazole.
Q4
A patient taking clozapine for treatment-resistant schizophrenia presents with fever,
sore throat, and malaise. The absolute neutrophil count (ANC) is 1,200/mm³. Which
action is MOST appropriate?
A) Continue clozapine and repeat ANC in one week
B) Discontinue clozapine immediately and do not rechallenge
C) Interrupt clozapine, monitor daily, and resume if ANC returns to baseline
D) Reduce clozapine dose by 50% and obtain ANC in 48 hours
Answer: C
Rationales:
(Latest 2026/2027 Edition) – 100% Correct Questions,
Answers & Detailed Rationales
Q1
A 28-year-old patient with bipolar I disorder presents with acute mania. The
psychiatric-mental health nurse practitioner (PMHNP) decides to initiate lithium
carbonate. Which baseline laboratory assessment is MOST critical to obtain before
starting lithium therapy?
A) Thyroid-stimulating hormone (TSH) and free T4
B) Serum creatinine, blood urea nitrogen (BUN), and electrolytes
C) Complete blood count with differential
D) Liver function tests and lipid panel
Answer: B
Rationales:
, ● A: While thyroid function monitoring is essential during ongoing lithium therapy,
renal function assessment takes precedence because lithium is entirely renally
excreted and nephrotoxicity represents the most immediate life-threatening risk.
● B: Lithium is filtered by the glomeruli without metabolism, making renal clearance
the sole elimination pathway; pre-existing renal impairment dramatically
increases toxicity risk and necessitates dose adjustment or alternative selection.
● C: Although lithium can cause leukocytosis, a baseline CBC is not the most
critical pre-treatment assessment compared to evaluating the organ responsible
for drug elimination.
● D: Lithium does not undergo hepatic metabolism, so liver function tests are not
specifically required for lithium initiation, though they may be part of a general
metabolic workup.
Q2
A 45-year-old patient with treatment-resistant major depressive disorder is being
considered for augmentation with liothyronine (T3). Which statement best describes the
evidence-based rationale for this approach?
A) T3 augmentation is FDA-approved specifically for antidepressant augmentation in all
adult patients.
B) T3 augmentation has demonstrated efficacy primarily in patients with documented
hypothyroidism.
C) T3 augmentation may enhance noradrenergic and serotonergic neurotransmission
even in euthyroid patients.
D) T3 should always be used before considering lithium augmentation due to superior
efficacy data.
Answer: C
,Rationales:
● A: T3 augmentation is not FDA-approved for antidepressant augmentation; it is
used off-label based on clinical evidence and STAR*D trial data.
● B: While T3 may benefit hypothyroid patients, its antidepressant augmentation
effect has been demonstrated in euthyroid individuals through mechanisms
involving beta-adrenergic receptor sensitization and serotonin turnover.
● C: T3 crosses the blood-brain barrier readily and modulates gene expression for
neurotransmitter receptors and transporters, potentially enhancing
antidepressant response through noradrenergic and serotonergic optimization
independent of thyroid status.
● D: The STAR*D trial showed comparable remission rates between T3 and lithium
augmentation, with neither demonstrating clear superiority; selection depends on
individual patient factors and contraindications.
Q3
A PMHNP is prescribing a second-generation antipsychotic for a 16-year-old patient
with schizophrenia. Which agent carries the FDA indication for schizophrenia in
adolescents and has the most favorable metabolic profile?
A) Olanzapine
B) Risperidone
C) Aripiprazole
D) Quetiapine
Answer: C
Rationales:
, ● A: Olanzapine is FDA-approved for adolescent schizophrenia but carries one of
the highest risks for metabolic syndrome, weight gain, and dyslipidemia among
second-generation antipsychotics.
● B: Risperidone is FDA-approved for adolescent schizophrenia but is associated
with significant prolactin elevation and weight gain, making its metabolic profile
less favorable than partial agonists.
● C: Aripiprazole is FDA-approved for schizophrenia in adolescents aged 13-17 and
functions as a partial dopamine agonist, demonstrating the most favorable
metabolic profile with minimal weight gain, prolactin elevation, or QTc
prolongation risk.
● D: While quetiapine is sometimes used off-label in adolescents, it carries
significant sedation, orthostatic hypotension, and metabolic risks without the
same evidence base for adolescent schizophrenia as aripiprazole.
Q4
A patient taking clozapine for treatment-resistant schizophrenia presents with fever,
sore throat, and malaise. The absolute neutrophil count (ANC) is 1,200/mm³. Which
action is MOST appropriate?
A) Continue clozapine and repeat ANC in one week
B) Discontinue clozapine immediately and do not rechallenge
C) Interrupt clozapine, monitor daily, and resume if ANC returns to baseline
D) Reduce clozapine dose by 50% and obtain ANC in 48 hours
Answer: C
Rationales:
