Psychiatric-Mental Health Nurse Practitioner Exam Medications 3 — Questions and Answers
Question 1: A patient on bupropion reports new-onset generalized tonic-clonic seizure. Which pre-existing condition most likely increased this risk?
- Hypertension
- Bulimia nervosa (Correct answer)
- Hypothyroidism
- Diabetes mellitus
Correct answer: Bulimia nervosa
Bupropion lowers seizure threshold and is contraindicated in patients with eating disorders such as bulimia nervosa due to electrolyte imbalances that further increase seizure risk.
Question 2: Which benzodiazepine is preferred in elderly patients due to its lack of active metabolites and shorter half-life?
- Diazepam
- Chlordiazepoxide
- Lorazepam (Correct answer)
- Clonazepam
Correct answer: Lorazepam
Lorazepam undergoes direct glucuronidation without active metabolites and has a shorter half-life, reducing cumulative CNS depression in elderly patients (LOT = Lorazepam, Oxazepam, Temazepam preferred).
Question 3: A patient with schizophrenia on risperidone develops gynecomastia and galactorrhea. What is the most likely cause?
- Risperidone-induced hypothyroidism raising TSH
- Tuberoinfundibular dopamine blockade causing hyperprolactinemia (Correct answer)
- Direct stimulation of prolactin receptors by risperidone
- Risperidone-induced estrogen excess
Correct answer: Tuberoinfundibular dopamine blockade causing hyperprolactinemia
Risperidone strongly blocks D2 receptors in the tuberoinfundibular pathway, removing dopamine's inhibitory tone on prolactin secretion, resulting in hyperprolactinemia.
Question 4: Which mood stabilizer has the most evidence for suicide prevention in patients with bipolar disorder?
- Valproate
- Carbamazepine
- Lithium (Correct answer)
- Lamotrigine
Correct answer: Lithium
Lithium has robust long-term evidence for reducing suicide and suicidal behavior in patients with mood disorders, likely through serotonergic and neuroprotective mechanisms.
Question 5: A patient being treated with an SSRI for 6 weeks reports worsening anxiety and insomnia in the first 2 weeks but has now improved. What was the most likely early mechanism causing the initial worsening?
- SSRI increasing cortisol levels transiently
- Initial excessive serotonergic stimulation of 5-HT2 receptors before autoreceptor desensitization (Correct answer)
- SSRI-induced dopamine depletion in the first weeks
- Anticholinergic effects peaking at week 2
Correct answer: Initial excessive serotonergic stimulation of 5-HT2 receptors before autoreceptor desensitization
SSRIs initially overstimulate postsynaptic 5-HT2 receptors before somatodendritic 5-HT1A autoreceptors desensitize, causing transient anxiety, agitation, and insomnia.
Question 6: Which of the following is a black box warning associated with atomoxetine (Strattera)?
- Sudden cardiac death in adults
- Increased suicidal ideation in children and adolescents (Correct answer)
- Risk of agranulocytosis
- Severe hepatotoxicity leading to liver failure
Correct answer: Increased suicidal ideation in children and adolescents
Atomoxetine carries a black box warning for increased suicidal ideation in pediatric patients, requiring close monitoring especially during dose initiation and adjustment.
Question 7: A patient with bipolar I disorder needs an antimanic agent but has liver disease precluding valproate use and renal disease precluding lithium. Which atypical antipsychotic is FDA-approved for acute mania with the least metabolic risk?
- Olanzapine
- Quetiapine
- Ziprasidone (Correct answer)
- Clozapine
Correct answer: Ziprasidone
Ziprasidone is FDA-approved for acute manic episodes and has the lowest weight-gain and metabolic risk profile among second-generation antipsychotics, though it requires QTc monitoring.
Psychiatric-Mental Health Nurse Practitioner Exam Medications 3
A patient on bupropion reports new-onset generalized tonic-clonic seizure.
Which pre-existing condition most likely increased this risk?