Georgette Review. PMHNP- 388 2024 QUESTIONS- WITH COMPLETE SOLUTIONS
Course
PMHNP
1. Question:
A 55-year-old female with a history of depression presents with significant fatigue, sleep
disturbances, and a lack of interest in activities she once enjoyed. She states, “I feel hopeless and
don’t know how to keep going.” The nurse practitioner suspects major depressive disorder
(MDD). Which of the following is the most appropriate initial treatment?
A. Cognitive-behavioral therapy (CBT) alone
B. A selective serotonin reuptake inhibitor (SSRI)
C. A tricyclic antidepressant (TCA)
D. Electroconvulsive therapy (ECT)
Correct Answer: B. A selective serotonin reuptake inhibitor (SSRI)
Rationale: SSRIs are considered the first-line pharmacologic treatment for major depressive
disorder due to their efficacy and favorable side effect profile compared to older antidepressants
like TCAs. CBT can be an effective adjunct, but pharmacological treatment is typically initiated
first for moderate-to-severe cases.
2. Question:
A 42-year-old male diagnosed with generalized anxiety disorder (GAD) presents to the clinic. He
reports persistent, excessive worry and anxiety that affects his ability to focus at work. He also
experiences physical symptoms such as muscle tension and restlessness. Which of the following
medications is most appropriate to initiate for this patient?
A. Fluoxetine (Prozac)
B. Clonazepam (Klonopin)
C. Buspirone (Buspar)
D. Mirtazapine (Remeron)
Correct Answer: C. Buspirone (Buspar)
Rationale: Buspirone is a non-benzodiazepine anxiolytic medication that is often used for the
treatment of generalized anxiety disorder (GAD). It does not carry the risk of dependence that
benzodiazepines such as clonazepam do, and it is preferred for long-term management of GAD.
3. Question:
,A patient diagnosed with bipolar disorder is prescribed lithium. Which of the following is the
most important lab value for the nurse practitioner to monitor during treatment?
A. Blood glucose levels
B. Serum sodium levels
C. Liver function tests
D. Serum lithium levels
Correct Answer: D. Serum lithium levels
Rationale: Lithium has a narrow therapeutic index, meaning there is a fine line between
therapeutic and toxic levels. Monitoring serum lithium levels is critical to ensure they are within
the therapeutic range (0.6–1.2 mEq/L) to avoid toxicity, which can lead to life-threatening
conditions.
4. Question:
A 30-year-old male with schizophrenia is prescribed an atypical antipsychotic medication.
Which of the following side effects is most commonly associated with atypical antipsychotics?
A. Extrapyramidal symptoms (EPS)
B. Weight gain and metabolic syndrome
C. Tardive dyskinesia
D. Hypertension
Correct Answer: B. Weight gain and metabolic syndrome
Rationale: Atypical antipsychotics, such as risperidone and olanzapine, are associated with a
higher risk of weight gain, hyperlipidemia, and insulin resistance, which can lead to metabolic
syndrome. While EPS and tardive dyskinesia are more commonly seen with typical
antipsychotics, atypical antipsychotics have a different side effect profile.
5. Question:
A 17-year-old female presents with symptoms of bulimia nervosa, including binge eating
followed by purging behaviors. Which of the following is the first-line treatment for bulimia
nervosa?
A. Cognitive-behavioral therapy (CBT)
B. Selective serotonin reuptake inhibitors (SSRIs)
C. Family therapy
D. Antipsychotic medications
,Correct Answer: A. Cognitive-behavioral therapy (CBT)
Rationale: Cognitive-behavioral therapy (CBT) is the first-line treatment for bulimia nervosa. It
helps patients recognize and change maladaptive eating behaviors and thoughts. SSRIs may be
used as adjuncts, especially if there is comorbid depression or anxiety, but CBT remains the most
effective intervention for the eating disorder itself.
6. Question:
A 30-year-old woman with a history of depression is prescribed sertraline (Zoloft). She returns to
the clinic after a few weeks and reports feeling more anxious, with increased agitation and
restlessness. What should the nurse practitioner do?
A. Reassure the patient that this is a normal side effect and that it will improve over time.
B. Discontinue the medication and switch to a different class of antidepressants.
C. Increase the dose of sertraline to relieve the anxiety symptoms.
D. Consider adding a benzodiazepine for short-term use.
Correct Answer: D. Consider adding a benzodiazepine for short-term use.
Rationale: Increased anxiety and agitation can sometimes occur when starting SSRIs,
particularly during the first few weeks. A short-term benzodiazepine, such as lorazepam, may be
added to help manage these symptoms while waiting for the antidepressant’s effects to take hold.
The SSRI dose should not be increased immediately due to the potential for worsening anxiety.
7. Question:
A patient with schizophrenia is being discharged from the hospital after an acute episode. The
nurse practitioner plans to initiate an injectable antipsychotic medication for long-term
management. Which of the following is the most appropriate choice?
A. Olanzapine (Zyprexa)
B. Clozapine (Clozaril)
C. Paliperidone (Invega Sustenna)
D. Haloperidol (Haldol)
Correct Answer: C. Paliperidone (Invega Sustenna)
Rationale: Paliperidone is an atypical antipsychotic that is available in a long-acting injectable
form. It is commonly used for patients with schizophrenia who are at risk of noncompliance with
oral medication. Olanzapine is also available in an injectable form, but paliperidone is more
commonly used for long-term management.
, 8. Question:
A 50-year-old male patient with a history of alcohol use disorder presents for an initial visit. He
has recently stopped drinking, but he is experiencing tremors, sweating, and anxiety. Which of
the following is the most appropriate intervention?
A. Start the patient on lorazepam for alcohol withdrawal.
B. Initiate disulfiram (Antabuse) to prevent further alcohol use.
C. Refer the patient for inpatient detoxification.
D. Recommend a 12-step program immediately.
Correct Answer: A. Start the patient on lorazepam for alcohol withdrawal.
Rationale: Lorazepam, a benzodiazepine, is commonly used to manage alcohol withdrawal
symptoms. It helps reduce the risk of complications such as seizures. If the withdrawal
symptoms are severe, inpatient detoxification may be necessary, but lorazepam is typically the
first-line intervention for alcohol withdrawal.
9. Question:
A 45-year-old male with a history of generalized anxiety disorder (GAD) is prescribed
fluoxetine. After a few weeks, he reports feeling more anxious and having difficulty sleeping.
Which of the following is the most appropriate next step?
A. Discontinue the medication and start a different antidepressant.
B. Increase the dose of fluoxetine.
C. Add a short-term sedative to help with sleep.
D. Educate the patient that these side effects will resolve within a few weeks.
Correct Answer: D. Educate the patient that these side effects will resolve within a few weeks.
Rationale: It is common for patients to experience increased anxiety and sleep disturbances
when first starting an SSRI. These symptoms often resolve as the body adjusts to the medication,
typically within a few weeks. Increasing the dose too early or adding a sedative may not be
necessary at this point.
10. Question:
A 25-year-old female presents with feelings of sadness, loss of interest in activities, and
disrupted sleep patterns. She has a history of recurrent depressive episodes. Which of the
following is the most appropriate long-term management strategy for this patient?
A. Start an SSRI and monitor for relapse.
B. Initiate cognitive-behavioral therapy (CBT) only.
Course
PMHNP
1. Question:
A 55-year-old female with a history of depression presents with significant fatigue, sleep
disturbances, and a lack of interest in activities she once enjoyed. She states, “I feel hopeless and
don’t know how to keep going.” The nurse practitioner suspects major depressive disorder
(MDD). Which of the following is the most appropriate initial treatment?
A. Cognitive-behavioral therapy (CBT) alone
B. A selective serotonin reuptake inhibitor (SSRI)
C. A tricyclic antidepressant (TCA)
D. Electroconvulsive therapy (ECT)
Correct Answer: B. A selective serotonin reuptake inhibitor (SSRI)
Rationale: SSRIs are considered the first-line pharmacologic treatment for major depressive
disorder due to their efficacy and favorable side effect profile compared to older antidepressants
like TCAs. CBT can be an effective adjunct, but pharmacological treatment is typically initiated
first for moderate-to-severe cases.
2. Question:
A 42-year-old male diagnosed with generalized anxiety disorder (GAD) presents to the clinic. He
reports persistent, excessive worry and anxiety that affects his ability to focus at work. He also
experiences physical symptoms such as muscle tension and restlessness. Which of the following
medications is most appropriate to initiate for this patient?
A. Fluoxetine (Prozac)
B. Clonazepam (Klonopin)
C. Buspirone (Buspar)
D. Mirtazapine (Remeron)
Correct Answer: C. Buspirone (Buspar)
Rationale: Buspirone is a non-benzodiazepine anxiolytic medication that is often used for the
treatment of generalized anxiety disorder (GAD). It does not carry the risk of dependence that
benzodiazepines such as clonazepam do, and it is preferred for long-term management of GAD.
3. Question:
,A patient diagnosed with bipolar disorder is prescribed lithium. Which of the following is the
most important lab value for the nurse practitioner to monitor during treatment?
A. Blood glucose levels
B. Serum sodium levels
C. Liver function tests
D. Serum lithium levels
Correct Answer: D. Serum lithium levels
Rationale: Lithium has a narrow therapeutic index, meaning there is a fine line between
therapeutic and toxic levels. Monitoring serum lithium levels is critical to ensure they are within
the therapeutic range (0.6–1.2 mEq/L) to avoid toxicity, which can lead to life-threatening
conditions.
4. Question:
A 30-year-old male with schizophrenia is prescribed an atypical antipsychotic medication.
Which of the following side effects is most commonly associated with atypical antipsychotics?
A. Extrapyramidal symptoms (EPS)
B. Weight gain and metabolic syndrome
C. Tardive dyskinesia
D. Hypertension
Correct Answer: B. Weight gain and metabolic syndrome
Rationale: Atypical antipsychotics, such as risperidone and olanzapine, are associated with a
higher risk of weight gain, hyperlipidemia, and insulin resistance, which can lead to metabolic
syndrome. While EPS and tardive dyskinesia are more commonly seen with typical
antipsychotics, atypical antipsychotics have a different side effect profile.
5. Question:
A 17-year-old female presents with symptoms of bulimia nervosa, including binge eating
followed by purging behaviors. Which of the following is the first-line treatment for bulimia
nervosa?
A. Cognitive-behavioral therapy (CBT)
B. Selective serotonin reuptake inhibitors (SSRIs)
C. Family therapy
D. Antipsychotic medications
,Correct Answer: A. Cognitive-behavioral therapy (CBT)
Rationale: Cognitive-behavioral therapy (CBT) is the first-line treatment for bulimia nervosa. It
helps patients recognize and change maladaptive eating behaviors and thoughts. SSRIs may be
used as adjuncts, especially if there is comorbid depression or anxiety, but CBT remains the most
effective intervention for the eating disorder itself.
6. Question:
A 30-year-old woman with a history of depression is prescribed sertraline (Zoloft). She returns to
the clinic after a few weeks and reports feeling more anxious, with increased agitation and
restlessness. What should the nurse practitioner do?
A. Reassure the patient that this is a normal side effect and that it will improve over time.
B. Discontinue the medication and switch to a different class of antidepressants.
C. Increase the dose of sertraline to relieve the anxiety symptoms.
D. Consider adding a benzodiazepine for short-term use.
Correct Answer: D. Consider adding a benzodiazepine for short-term use.
Rationale: Increased anxiety and agitation can sometimes occur when starting SSRIs,
particularly during the first few weeks. A short-term benzodiazepine, such as lorazepam, may be
added to help manage these symptoms while waiting for the antidepressant’s effects to take hold.
The SSRI dose should not be increased immediately due to the potential for worsening anxiety.
7. Question:
A patient with schizophrenia is being discharged from the hospital after an acute episode. The
nurse practitioner plans to initiate an injectable antipsychotic medication for long-term
management. Which of the following is the most appropriate choice?
A. Olanzapine (Zyprexa)
B. Clozapine (Clozaril)
C. Paliperidone (Invega Sustenna)
D. Haloperidol (Haldol)
Correct Answer: C. Paliperidone (Invega Sustenna)
Rationale: Paliperidone is an atypical antipsychotic that is available in a long-acting injectable
form. It is commonly used for patients with schizophrenia who are at risk of noncompliance with
oral medication. Olanzapine is also available in an injectable form, but paliperidone is more
commonly used for long-term management.
, 8. Question:
A 50-year-old male patient with a history of alcohol use disorder presents for an initial visit. He
has recently stopped drinking, but he is experiencing tremors, sweating, and anxiety. Which of
the following is the most appropriate intervention?
A. Start the patient on lorazepam for alcohol withdrawal.
B. Initiate disulfiram (Antabuse) to prevent further alcohol use.
C. Refer the patient for inpatient detoxification.
D. Recommend a 12-step program immediately.
Correct Answer: A. Start the patient on lorazepam for alcohol withdrawal.
Rationale: Lorazepam, a benzodiazepine, is commonly used to manage alcohol withdrawal
symptoms. It helps reduce the risk of complications such as seizures. If the withdrawal
symptoms are severe, inpatient detoxification may be necessary, but lorazepam is typically the
first-line intervention for alcohol withdrawal.
9. Question:
A 45-year-old male with a history of generalized anxiety disorder (GAD) is prescribed
fluoxetine. After a few weeks, he reports feeling more anxious and having difficulty sleeping.
Which of the following is the most appropriate next step?
A. Discontinue the medication and start a different antidepressant.
B. Increase the dose of fluoxetine.
C. Add a short-term sedative to help with sleep.
D. Educate the patient that these side effects will resolve within a few weeks.
Correct Answer: D. Educate the patient that these side effects will resolve within a few weeks.
Rationale: It is common for patients to experience increased anxiety and sleep disturbances
when first starting an SSRI. These symptoms often resolve as the body adjusts to the medication,
typically within a few weeks. Increasing the dose too early or adding a sedative may not be
necessary at this point.
10. Question:
A 25-year-old female presents with feelings of sadness, loss of interest in activities, and
disrupted sleep patterns. She has a history of recurrent depressive episodes. Which of the
following is the most appropriate long-term management strategy for this patient?
A. Start an SSRI and monitor for relapse.
B. Initiate cognitive-behavioral therapy (CBT) only.
