NR 547 PMHNP 2025 LATEST TEST BANK FOR
MIDTERM AND FINAL EXAM REVIEW questions and
answers(latest update ,graded A+
Ameeta, a 42-year-old female, presents to the primary care clinic with a three-month history of
"feeling low and sad" with poor energy, inability to concentrate, and irritability. She indicates
that the symptoms were initially present once per week but have increased to 4-5 times per
week. She reports making an error last week at the grocery store where she works as a cashier
and snapping at the customer when the error was brought to her attention. She is concerned
about her loss of interest in her usual social activities and a 20-pound weight gain. She also
reports frequent headaches, difficulty getting out of bed in the morning, feeling worthless, and
low libido. She acknowledges that she feels guilty daily as she has not visited her son in 6
months and believes that she has "let him down". Thinking about it keeps her "up at night". She
has difficulty falling and staying asleep every night. She denies suicidal idea - answer citalopram
20 mg po daily
Rationale: Although all three drugs are appropriate to use when treating unipolar depression,
Citalopram is an SSRI and is considered a first-line choice.
Seth is a 22-year-old with a court-ordered referral for assessment. He was arrested on charges
of stealing from an aunt while he was house-sitting. This is the third time he has been caught
stealing from the family in the past two years, but the first time that the victim pressed charges.
Seth states that he isn't too worried about his stealing behaviors, because his family "has a lot
of money, and they are not going to miss a little here and there." Seth has held several entry-
level jobs over the past three years, but he has left each position after only a few months
because he felt he was "above that kind of work". He endorses having multiple unprotected
sexual experiences, but he denies ever being in a relationship.
Seth meets several criteria for antisocial personality disorder. Which of the following statements
will help support this diagnosis? Select all that apply.
,Seth states that he has been stealing from - answer -Dependent personal disorder
Rationale: Nora meets diagnostic criteria for dependent personality disorder. She has difficulty
making decisions without input from others, has difficulty expressing disagreement, and has
feelings of discomfort about being alone and caring for herself.
SDRIs - answer -inhibit DA reuptake (↑alertness, motivation)
-inhibit NE reuptake (↑energy)
-Adverse effects:
• agitation
• headache
• dry mouth
• constipation
• weight loss
TCAs - answer -Action: inhibits the reuptake of serotonin and norepinephrine; blocks
norepinephrine, histamine, and acetylcholine receptors
-Examples: amitriptyline, clomipramine, desipramine, doxepin
-Common Side Effects:
• dry mouth
• constipation
• blurred vision
• urinary retention
• sedation
• weight gain
• hypotension
,• tachycardia
• sexual dysfunction
MAOIs - answer -Action: increases norepinephrine and serotonin by inhibiting the enzyme that
inactivates it
-Examples: isocarboxazid, phenelzine, tranylcypromine
-Common Side Effects:
• sedation
• dizziness
• sexual dysfunction
• hypertensive crisis
Prescribing pearls: citalopram (Celexa) - answer mild antihistamine effects
Prescribing pearls: escitalopram (Lexapro) - answer no known drug interactions
Prescribing pearls: fluoxetine (Prozac) - answer longest half-life
Prescribing pearls: paroxetine (Paxil) - answer also treats social anxiety and insomnia
Prescribing pearls: fluvoxamine (Luvox) - answer treats anxious depression smokers require
increased dose
Prescribing pearls: sertraline (Zoloft) - answer also treats social anxiety and hypersomnolence
, Prescribing pearls: bupropion (Wellbutrin) - answer NDRI may improve energy, alertness, and
motivation; not first line treatment for anxiety; contraindicated in clients with a history of
seizures
Prescribing pearls: duloxetine (Cymbalta) - answer effective for atypical pain at higher doses;
appropriate for clients who present with somatic symptoms of depression; effective for atypical
pain, such as fibromyalgia and diabetic neuropathy
Prescribing pearls: venlafaxine (Effexor) - answer treats both depression and anxiety disorders,
ensure trial of higher dose before switching to a different medication
Prescribing pearls: desvenlafaxine (Pristiq) - answer effective for perimenopausal vasomotor
symptoms
considered when selecting a medication: - answer -Client preference
-Prior treatment response
-Anticipated adverse effects
-Comorbidities
-Half-life and interactions
-Cost
if a medication is not achieving efficacy: - answer -Increase dose gradually
-Switch to a different drug within the same class
-Switch to drug in a different class
-Add a second medication
Use to protect against suicide - answer lithium
MIDTERM AND FINAL EXAM REVIEW questions and
answers(latest update ,graded A+
Ameeta, a 42-year-old female, presents to the primary care clinic with a three-month history of
"feeling low and sad" with poor energy, inability to concentrate, and irritability. She indicates
that the symptoms were initially present once per week but have increased to 4-5 times per
week. She reports making an error last week at the grocery store where she works as a cashier
and snapping at the customer when the error was brought to her attention. She is concerned
about her loss of interest in her usual social activities and a 20-pound weight gain. She also
reports frequent headaches, difficulty getting out of bed in the morning, feeling worthless, and
low libido. She acknowledges that she feels guilty daily as she has not visited her son in 6
months and believes that she has "let him down". Thinking about it keeps her "up at night". She
has difficulty falling and staying asleep every night. She denies suicidal idea - answer citalopram
20 mg po daily
Rationale: Although all three drugs are appropriate to use when treating unipolar depression,
Citalopram is an SSRI and is considered a first-line choice.
Seth is a 22-year-old with a court-ordered referral for assessment. He was arrested on charges
of stealing from an aunt while he was house-sitting. This is the third time he has been caught
stealing from the family in the past two years, but the first time that the victim pressed charges.
Seth states that he isn't too worried about his stealing behaviors, because his family "has a lot
of money, and they are not going to miss a little here and there." Seth has held several entry-
level jobs over the past three years, but he has left each position after only a few months
because he felt he was "above that kind of work". He endorses having multiple unprotected
sexual experiences, but he denies ever being in a relationship.
Seth meets several criteria for antisocial personality disorder. Which of the following statements
will help support this diagnosis? Select all that apply.
,Seth states that he has been stealing from - answer -Dependent personal disorder
Rationale: Nora meets diagnostic criteria for dependent personality disorder. She has difficulty
making decisions without input from others, has difficulty expressing disagreement, and has
feelings of discomfort about being alone and caring for herself.
SDRIs - answer -inhibit DA reuptake (↑alertness, motivation)
-inhibit NE reuptake (↑energy)
-Adverse effects:
• agitation
• headache
• dry mouth
• constipation
• weight loss
TCAs - answer -Action: inhibits the reuptake of serotonin and norepinephrine; blocks
norepinephrine, histamine, and acetylcholine receptors
-Examples: amitriptyline, clomipramine, desipramine, doxepin
-Common Side Effects:
• dry mouth
• constipation
• blurred vision
• urinary retention
• sedation
• weight gain
• hypotension
,• tachycardia
• sexual dysfunction
MAOIs - answer -Action: increases norepinephrine and serotonin by inhibiting the enzyme that
inactivates it
-Examples: isocarboxazid, phenelzine, tranylcypromine
-Common Side Effects:
• sedation
• dizziness
• sexual dysfunction
• hypertensive crisis
Prescribing pearls: citalopram (Celexa) - answer mild antihistamine effects
Prescribing pearls: escitalopram (Lexapro) - answer no known drug interactions
Prescribing pearls: fluoxetine (Prozac) - answer longest half-life
Prescribing pearls: paroxetine (Paxil) - answer also treats social anxiety and insomnia
Prescribing pearls: fluvoxamine (Luvox) - answer treats anxious depression smokers require
increased dose
Prescribing pearls: sertraline (Zoloft) - answer also treats social anxiety and hypersomnolence
, Prescribing pearls: bupropion (Wellbutrin) - answer NDRI may improve energy, alertness, and
motivation; not first line treatment for anxiety; contraindicated in clients with a history of
seizures
Prescribing pearls: duloxetine (Cymbalta) - answer effective for atypical pain at higher doses;
appropriate for clients who present with somatic symptoms of depression; effective for atypical
pain, such as fibromyalgia and diabetic neuropathy
Prescribing pearls: venlafaxine (Effexor) - answer treats both depression and anxiety disorders,
ensure trial of higher dose before switching to a different medication
Prescribing pearls: desvenlafaxine (Pristiq) - answer effective for perimenopausal vasomotor
symptoms
considered when selecting a medication: - answer -Client preference
-Prior treatment response
-Anticipated adverse effects
-Comorbidities
-Half-life and interactions
-Cost
if a medication is not achieving efficacy: - answer -Increase dose gradually
-Switch to a different drug within the same class
-Switch to drug in a different class
-Add a second medication
Use to protect against suicide - answer lithium
