NURS 6630 FINAL EXAM 5 LATEST VERSIONS (VERSION
V1,V2,V3,V4,&V5) 2024-2025 ACTUAL EXAM EACH EXAM CONTAINS
150 QUESTIONS AND CORRECT ANSWERS
Question 1
What is the most strongly established and significant risk factor for the development of bipolar
disorder?
A) History of substance abuse
B) Female gender
C) Low socioeconomic status
D) Family history
E) Previous diagnosis of major depression
Correct Answer: D) Family history
Rationale: While other factors can be associated with bipolar disorder, genetic
predisposition is the strongest and most well-established risk factor. Individuals with a
first-degree relative (parent, sibling, child) with bipolar disorder have a significantly higher
risk of developing the illness compared to the general population. This genetic link is more
powerful than any other environmental or individual risk factor.
Question 2
A patient is diagnosed with schizophrenia and has a history of poor medication adherence. The
PMHNP understands that non-adherence in this patient population significantly increases the risk
for which of the following?
A) Development of a personality disorder
B) Spontaneous remission of symptoms
C) Increased risk of substance use, violence, and victimization
D) Improved overall quality of life due to fewer side effects
E) Decreased need for future hospitalizations
Correct Answer: C) Increased risk of substance use, violence, and victimization
Rationale: Non-adherence to antipsychotic medication in patients with schizophrenia is a
major clinical challenge. It directly correlates with a higher rate of relapse, which in turn
increases the patient's vulnerability to substance use as a form of self-medication, episodes
of violence (often related to psychotic symptoms), and becoming a victim of crime. It also
leads to a worse overall quality of life and more frequent hospitalizations.
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Question 3
A 72-year-old male with a history of atrial fibrillation and COPD is newly diagnosed with major
depressive disorder. Given his comorbidities, which antidepressant class should the PMHNP
generally AVOID as a first-line treatment?
A) Selective Serotonin Reuptake Inhibitors (SSRIs)
B) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
C) Tricyclic Antidepressants (TCAs)
D) Atypical antidepressants like bupropion
E) Mirtazapine
Correct Answer: C) Tricyclic Antidepressants (TCAs)
Rationale: Tricyclic antidepressants (e.g., nortriptyline, amitriptyline) have significant
cardiotoxic potential. They can affect cardiac conduction, leading to arrhythmias, which is
particularly dangerous in a patient with a pre-existing condition like atrial fibrillation.
Their anticholinergic properties and risk of orthostatic hypotension also make them a poor
choice for older adults. SSRIs or SNRIs are generally safer first-line options in this
population.
Question 4
A PMHNP is managing a patient with treatment-resistant depression who has not responded to
an adequate trial of a first-line SSRI. Which of the following is an appropriate next-step strategy?
A) Discontinue the SSRI and begin a monoamine oxidase inhibitor (MAOI).
B) Augment the SSRI with a second-generation antipsychotic like aripiprazole.
C) Increase the SSRI dose to four times the maximum recommended level.
D) Switch to a benzodiazepine for long-term monotherapy.
E) Recommend discontinuing all medications and focusing only on therapy.
Correct Answer: B) Augment the SSRI with a second-generation antipsychotic like
aripiprazole.
Rationale: Augmentation with a second-generation (atypical) antipsychotic is a widely
accepted, evidence-based strategy for treatment-resistant depression. Agents like
aripiprazole, quetiapine, and olanzapine (in combination with fluoxetine) have FDA
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approval for this indication. They work through different mechanisms (e.g., dopamine and
serotonin modulation) to enhance the effect of the primary antidepressant.
Question 5
When considering long-term maintenance treatment for a patient with bipolar disorder, which
medication class is generally best to avoid as monotherapy due to the risk of inducing mood
switching or increasing mood episode frequency?
A) Mood stabilizers (e.g., lithium)
B) Anticonvulsants (e.g., lamotrigine)
C) Second-generation antipsychotics (e.g., quetiapine)
D) Antidepressants (e.g., fluoxetine)
E) Calcium channel blockers
Correct Answer: D) Antidepressants (e.g., fluoxetine)
Rationale: While sometimes used cautiously for bipolar depression, antidepressant
monotherapy is generally avoided in the maintenance phase of bipolar disorder. There is a
significant risk that these agents can precipitate a switch into mania or hypomania, or lead
to cycle acceleration (an increase in the frequency of mood episodes) over time.
Question 6
An 8-year-old child presents with symptoms of severe hyperactivity, inattention, and impulsivity
consistent with ADHD. After a thorough evaluation, the PMHNP decides to initiate a first-line
pharmacological treatment. Which medication is most likely to be prescribed?
A) Clonidine
B) Atomoxetine
C) Methylphenidate
D) Guanfacine
E) Trazodone
Correct Answer: C) Methylphenidate
Rationale: Stimulant medications, including methylphenidate (Ritalin, Concerta) and
amphetamines, are the first-line and most effective pharmacological treatments for ADHD
in children and adolescents. They have a rapid onset of action and high efficacy in reducing
core ADHD symptoms.
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Question 7
The parents of an adolescent diagnosed with kleptomania are seeking pharmacological options.
The PMHNP explains that while no medication is FDA-approved for this condition, some have
shown potential benefit in case studies. Which medication might be an appropriate option to
discuss?
A) Diazepam
B) Methylphenidate
C) Haloperidol
D) Naltrexone
E) Lithium
Correct Answer: D) Naltrexone
Rationale: Kleptomania is an impulse control disorder. The neurobiology is thought to
involve the brain's opioid system, which mediates reward and reinforcement. Naltrexone,
an opioid antagonist, may reduce the rewarding effects and urges associated with stealing,
making it a rational off-label treatment option to consider.
Question 8
Which of the following substances carries the highest probability of inducing physical and
psychological dependence after just a single use?
A) Alcohol
B) Cannabis
C) Caffeine
D) Heroin
E) Nicotine
Correct Answer: E) Nicotine
Rationale: Nicotine has one of the highest addiction potentials of all substances. It rapidly
enters the brain and stimulates the release of dopamine in the reward pathway, creating a
powerful reinforcing effect. Many individuals report cravings and difficulty quitting after
very limited initial use, highlighting its extremely high probability of causing dependence.
Question 9
The nursing staff on a dementia unit asks the PMHNP for education on managing agitation. What
V1,V2,V3,V4,&V5) 2024-2025 ACTUAL EXAM EACH EXAM CONTAINS
150 QUESTIONS AND CORRECT ANSWERS
Question 1
What is the most strongly established and significant risk factor for the development of bipolar
disorder?
A) History of substance abuse
B) Female gender
C) Low socioeconomic status
D) Family history
E) Previous diagnosis of major depression
Correct Answer: D) Family history
Rationale: While other factors can be associated with bipolar disorder, genetic
predisposition is the strongest and most well-established risk factor. Individuals with a
first-degree relative (parent, sibling, child) with bipolar disorder have a significantly higher
risk of developing the illness compared to the general population. This genetic link is more
powerful than any other environmental or individual risk factor.
Question 2
A patient is diagnosed with schizophrenia and has a history of poor medication adherence. The
PMHNP understands that non-adherence in this patient population significantly increases the risk
for which of the following?
A) Development of a personality disorder
B) Spontaneous remission of symptoms
C) Increased risk of substance use, violence, and victimization
D) Improved overall quality of life due to fewer side effects
E) Decreased need for future hospitalizations
Correct Answer: C) Increased risk of substance use, violence, and victimization
Rationale: Non-adherence to antipsychotic medication in patients with schizophrenia is a
major clinical challenge. It directly correlates with a higher rate of relapse, which in turn
increases the patient's vulnerability to substance use as a form of self-medication, episodes
of violence (often related to psychotic symptoms), and becoming a victim of crime. It also
leads to a worse overall quality of life and more frequent hospitalizations.
,[Type here]
Question 3
A 72-year-old male with a history of atrial fibrillation and COPD is newly diagnosed with major
depressive disorder. Given his comorbidities, which antidepressant class should the PMHNP
generally AVOID as a first-line treatment?
A) Selective Serotonin Reuptake Inhibitors (SSRIs)
B) Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
C) Tricyclic Antidepressants (TCAs)
D) Atypical antidepressants like bupropion
E) Mirtazapine
Correct Answer: C) Tricyclic Antidepressants (TCAs)
Rationale: Tricyclic antidepressants (e.g., nortriptyline, amitriptyline) have significant
cardiotoxic potential. They can affect cardiac conduction, leading to arrhythmias, which is
particularly dangerous in a patient with a pre-existing condition like atrial fibrillation.
Their anticholinergic properties and risk of orthostatic hypotension also make them a poor
choice for older adults. SSRIs or SNRIs are generally safer first-line options in this
population.
Question 4
A PMHNP is managing a patient with treatment-resistant depression who has not responded to
an adequate trial of a first-line SSRI. Which of the following is an appropriate next-step strategy?
A) Discontinue the SSRI and begin a monoamine oxidase inhibitor (MAOI).
B) Augment the SSRI with a second-generation antipsychotic like aripiprazole.
C) Increase the SSRI dose to four times the maximum recommended level.
D) Switch to a benzodiazepine for long-term monotherapy.
E) Recommend discontinuing all medications and focusing only on therapy.
Correct Answer: B) Augment the SSRI with a second-generation antipsychotic like
aripiprazole.
Rationale: Augmentation with a second-generation (atypical) antipsychotic is a widely
accepted, evidence-based strategy for treatment-resistant depression. Agents like
aripiprazole, quetiapine, and olanzapine (in combination with fluoxetine) have FDA
,[Type here]
approval for this indication. They work through different mechanisms (e.g., dopamine and
serotonin modulation) to enhance the effect of the primary antidepressant.
Question 5
When considering long-term maintenance treatment for a patient with bipolar disorder, which
medication class is generally best to avoid as monotherapy due to the risk of inducing mood
switching or increasing mood episode frequency?
A) Mood stabilizers (e.g., lithium)
B) Anticonvulsants (e.g., lamotrigine)
C) Second-generation antipsychotics (e.g., quetiapine)
D) Antidepressants (e.g., fluoxetine)
E) Calcium channel blockers
Correct Answer: D) Antidepressants (e.g., fluoxetine)
Rationale: While sometimes used cautiously for bipolar depression, antidepressant
monotherapy is generally avoided in the maintenance phase of bipolar disorder. There is a
significant risk that these agents can precipitate a switch into mania or hypomania, or lead
to cycle acceleration (an increase in the frequency of mood episodes) over time.
Question 6
An 8-year-old child presents with symptoms of severe hyperactivity, inattention, and impulsivity
consistent with ADHD. After a thorough evaluation, the PMHNP decides to initiate a first-line
pharmacological treatment. Which medication is most likely to be prescribed?
A) Clonidine
B) Atomoxetine
C) Methylphenidate
D) Guanfacine
E) Trazodone
Correct Answer: C) Methylphenidate
Rationale: Stimulant medications, including methylphenidate (Ritalin, Concerta) and
amphetamines, are the first-line and most effective pharmacological treatments for ADHD
in children and adolescents. They have a rapid onset of action and high efficacy in reducing
core ADHD symptoms.
, [Type here]
Question 7
The parents of an adolescent diagnosed with kleptomania are seeking pharmacological options.
The PMHNP explains that while no medication is FDA-approved for this condition, some have
shown potential benefit in case studies. Which medication might be an appropriate option to
discuss?
A) Diazepam
B) Methylphenidate
C) Haloperidol
D) Naltrexone
E) Lithium
Correct Answer: D) Naltrexone
Rationale: Kleptomania is an impulse control disorder. The neurobiology is thought to
involve the brain's opioid system, which mediates reward and reinforcement. Naltrexone,
an opioid antagonist, may reduce the rewarding effects and urges associated with stealing,
making it a rational off-label treatment option to consider.
Question 8
Which of the following substances carries the highest probability of inducing physical and
psychological dependence after just a single use?
A) Alcohol
B) Cannabis
C) Caffeine
D) Heroin
E) Nicotine
Correct Answer: E) Nicotine
Rationale: Nicotine has one of the highest addiction potentials of all substances. It rapidly
enters the brain and stimulates the release of dopamine in the reward pathway, creating a
powerful reinforcing effect. Many individuals report cravings and difficulty quitting after
very limited initial use, highlighting its extremely high probability of causing dependence.
Question 9
The nursing staff on a dementia unit asks the PMHNP for education on managing agitation. What
