NU 673 Assessment Midterm Questions With Complete
Solutions
Course
NU 673
1. Question:
A 35-year-old patient with generalized anxiety disorder (GAD) has been prescribed an SSRI.
After two weeks, the patient reports increased anxiety and agitation. What is the most
appropriate response?
Solution:
SSRIs can initially worsen anxiety due to increased serotonin levels before receptor
downregulation occurs. The provider should reassure the patient that this is temporary and may
last 2-4 weeks. To manage this, a temporary low-dose benzodiazepine (e.g., lorazepam) or
hydroxyzine can be prescribed while continuing the SSRI.
2. Question:
Which neurotransmitter is primarily targeted by benzodiazepines in the treatment of anxiety
disorders?
Solution:
Benzodiazepines enhance the activity of gamma-aminobutyric acid (GABA), the brain’s primary
inhibitory neurotransmitter. They bind to the GABA-A receptor, increasing chloride ion influx
and leading to a calming effect.
3. Question:
A patient with bipolar disorder is prescribed lithium. What are the key laboratory tests that
should be monitored?
Solution:
Lithium has a narrow therapeutic index, requiring regular monitoring:
Serum lithium levels (0.6-1.2 mEq/L)
Renal function (BUN, creatinine)
Thyroid function tests (TSH, T3, T4)
Electrolytes (sodium, calcium)
, ECG (if patient is older or has cardiac risks)
4. Question:
What is the black box warning associated with atypical antipsychotics in elderly patients with
dementia-related psychosis?
Solution:
Atypical antipsychotics (e.g., risperidone, quetiapine) carry a black box warning for an increased
risk of mortality in elderly patients with dementia-related psychosis due to cardiovascular events
and infections.
5. Question:
Which antidepressant is preferred in patients with major depressive disorder (MDD) who also
experience chronic pain conditions like fibromyalgia?
Solution:
Duloxetine (Cymbalta) is a serotonin-norepinephrine reuptake inhibitor (SNRI) that is FDA-
approved for both MDD and chronic pain conditions like fibromyalgia.
6. Question:
A patient on clozapine presents with flu-like symptoms, sore throat, and fever. What is the most
appropriate next step?
Solution:
Clozapine can cause agranulocytosis, a life-threatening condition. The provider should:
Order an absolute neutrophil count (ANC) immediately.
Discontinue clozapine if ANC is below the safe threshold (<500/μL).
Monitor for signs of infection and consider hospitalization if neutropenia is severe.
7. Question:
A patient with attention-deficit/hyperactivity disorder (ADHD) is prescribed a stimulant. What
are common side effects and how can they be managed?
,Solution:
Common side effects include:
Insomnia → Take in the morning, or switch to an extended-release formulation.
Appetite suppression → Take after meals, or consider drug holidays.
Increased heart rate/BP → Monitor vitals regularly, consider non-stimulant options like
atomoxetine.
Irritability → Adjust dosage or consider alternative medications.
8. Question:
What is the primary mechanism of action of first-generation antipsychotics (FGAs)?
Solution:
FGAs (e.g., haloperidol, chlorpromazine) primarily work by blocking dopamine D2 receptors
in the mesolimbic pathway, reducing psychotic symptoms. However, this blockade can also
cause extrapyramidal symptoms (EPS).
9. Question:
A patient with major depressive disorder is unresponsive to SSRIs. What is the next best
treatment option?
Solution:
If SSRIs are ineffective after 6-8 weeks, options include:
Switch to an SNRI (e.g., venlafaxine, duloxetine)
Augment with an atypical antipsychotic (e.g., aripiprazole, quetiapine)
Use bupropion (if fatigue is a concern) or mirtazapine (if insomnia is present)
10. Question:
Which mood stabilizer is contraindicated in pregnancy due to its teratogenic effects?
Solution:
Valproate (Depakote) is contraindicated in pregnancy as it can cause neural tube defects (e.g.,
spina bifida). Lamotrigine or low-dose lithium may be safer alternatives.
, 11. Question:
A patient is started on fluoxetine for major depressive disorder. How long does it typically take
for the full therapeutic effects to occur?
Solution:
SSRIs, including fluoxetine, take 4-6 weeks for full therapeutic effects due to receptor
desensitization and neuroadaptive changes. Initial improvements in sleep and appetite may occur
within the first 1-2 weeks.
12. Question:
A patient taking risperidone develops rigidity, hyperthermia, autonomic instability, and altered
mental status. What is the most likely diagnosis and treatment?
Solution:
This presentation suggests Neuroleptic Malignant Syndrome (NMS), a life-threatening
reaction to antipsychotics. Treatment includes:
Discontinuing the antipsychotic immediately
Supportive care (IV fluids, cooling measures, ICU admission if severe)
Administering dantrolene (muscle relaxant) or bromocriptine (dopamine agonist)
13. Question:
Which antidepressant is associated with the highest risk of QT prolongation?
Solution:
Citalopram (Celexa) is known for causing dose-dependent QT prolongation, especially at
doses >40 mg/day. Monitoring ECG is necessary in patients with cardiac risk factors.
14. Question:
What is the preferred pharmacological treatment for PTSD-related nightmares?
Solution:
Prazosin, an alpha-1 blocker, is effective in reducing PTSD-related nightmares by decreasing
norepinephrine activity in the brain.
Solutions
Course
NU 673
1. Question:
A 35-year-old patient with generalized anxiety disorder (GAD) has been prescribed an SSRI.
After two weeks, the patient reports increased anxiety and agitation. What is the most
appropriate response?
Solution:
SSRIs can initially worsen anxiety due to increased serotonin levels before receptor
downregulation occurs. The provider should reassure the patient that this is temporary and may
last 2-4 weeks. To manage this, a temporary low-dose benzodiazepine (e.g., lorazepam) or
hydroxyzine can be prescribed while continuing the SSRI.
2. Question:
Which neurotransmitter is primarily targeted by benzodiazepines in the treatment of anxiety
disorders?
Solution:
Benzodiazepines enhance the activity of gamma-aminobutyric acid (GABA), the brain’s primary
inhibitory neurotransmitter. They bind to the GABA-A receptor, increasing chloride ion influx
and leading to a calming effect.
3. Question:
A patient with bipolar disorder is prescribed lithium. What are the key laboratory tests that
should be monitored?
Solution:
Lithium has a narrow therapeutic index, requiring regular monitoring:
Serum lithium levels (0.6-1.2 mEq/L)
Renal function (BUN, creatinine)
Thyroid function tests (TSH, T3, T4)
Electrolytes (sodium, calcium)
, ECG (if patient is older or has cardiac risks)
4. Question:
What is the black box warning associated with atypical antipsychotics in elderly patients with
dementia-related psychosis?
Solution:
Atypical antipsychotics (e.g., risperidone, quetiapine) carry a black box warning for an increased
risk of mortality in elderly patients with dementia-related psychosis due to cardiovascular events
and infections.
5. Question:
Which antidepressant is preferred in patients with major depressive disorder (MDD) who also
experience chronic pain conditions like fibromyalgia?
Solution:
Duloxetine (Cymbalta) is a serotonin-norepinephrine reuptake inhibitor (SNRI) that is FDA-
approved for both MDD and chronic pain conditions like fibromyalgia.
6. Question:
A patient on clozapine presents with flu-like symptoms, sore throat, and fever. What is the most
appropriate next step?
Solution:
Clozapine can cause agranulocytosis, a life-threatening condition. The provider should:
Order an absolute neutrophil count (ANC) immediately.
Discontinue clozapine if ANC is below the safe threshold (<500/μL).
Monitor for signs of infection and consider hospitalization if neutropenia is severe.
7. Question:
A patient with attention-deficit/hyperactivity disorder (ADHD) is prescribed a stimulant. What
are common side effects and how can they be managed?
,Solution:
Common side effects include:
Insomnia → Take in the morning, or switch to an extended-release formulation.
Appetite suppression → Take after meals, or consider drug holidays.
Increased heart rate/BP → Monitor vitals regularly, consider non-stimulant options like
atomoxetine.
Irritability → Adjust dosage or consider alternative medications.
8. Question:
What is the primary mechanism of action of first-generation antipsychotics (FGAs)?
Solution:
FGAs (e.g., haloperidol, chlorpromazine) primarily work by blocking dopamine D2 receptors
in the mesolimbic pathway, reducing psychotic symptoms. However, this blockade can also
cause extrapyramidal symptoms (EPS).
9. Question:
A patient with major depressive disorder is unresponsive to SSRIs. What is the next best
treatment option?
Solution:
If SSRIs are ineffective after 6-8 weeks, options include:
Switch to an SNRI (e.g., venlafaxine, duloxetine)
Augment with an atypical antipsychotic (e.g., aripiprazole, quetiapine)
Use bupropion (if fatigue is a concern) or mirtazapine (if insomnia is present)
10. Question:
Which mood stabilizer is contraindicated in pregnancy due to its teratogenic effects?
Solution:
Valproate (Depakote) is contraindicated in pregnancy as it can cause neural tube defects (e.g.,
spina bifida). Lamotrigine or low-dose lithium may be safer alternatives.
, 11. Question:
A patient is started on fluoxetine for major depressive disorder. How long does it typically take
for the full therapeutic effects to occur?
Solution:
SSRIs, including fluoxetine, take 4-6 weeks for full therapeutic effects due to receptor
desensitization and neuroadaptive changes. Initial improvements in sleep and appetite may occur
within the first 1-2 weeks.
12. Question:
A patient taking risperidone develops rigidity, hyperthermia, autonomic instability, and altered
mental status. What is the most likely diagnosis and treatment?
Solution:
This presentation suggests Neuroleptic Malignant Syndrome (NMS), a life-threatening
reaction to antipsychotics. Treatment includes:
Discontinuing the antipsychotic immediately
Supportive care (IV fluids, cooling measures, ICU admission if severe)
Administering dantrolene (muscle relaxant) or bromocriptine (dopamine agonist)
13. Question:
Which antidepressant is associated with the highest risk of QT prolongation?
Solution:
Citalopram (Celexa) is known for causing dose-dependent QT prolongation, especially at
doses >40 mg/day. Monitoring ECG is necessary in patients with cardiac risk factors.
14. Question:
What is the preferred pharmacological treatment for PTSD-related nightmares?
Solution:
Prazosin, an alpha-1 blocker, is effective in reducing PTSD-related nightmares by decreasing
norepinephrine activity in the brain.
