Psychiatric-Mental Health Nurse Practitioner Exam Medications 3

Question 1

A patient on bupropion reports new-onset generalized tonic-clonic seizure. Which pre-existing condition most likely increased this risk?

Accepted Answer

Bulimia nervosa

Answer

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?

Accepted Answer

Lorazepam

Answer

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?

Accepted Answer

Tuberoinfundibular dopamine blockade causing hyperprolactinemia

Answer

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?

Accepted Answer

Lithium

Answer

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?

Accepted Answer

Initial excessive serotonergic stimulation of 5-HT2 receptors before autoreceptor desensitization

Answer

SSRIs initially overstimulate postsynaptic 5-HT2 receptors before somatodendritic 5-HT1A autoreceptors desensitize, causing transient anxiety, agitation, and insomnia.

Psychiatric-Mental Health Nurse Practitioner Exam Practice Test

Psychiatric-Mental Health Nurse Practitioner Exam Practice Test

Psychiatric-Mental Health Nurse Practitioner Exam Medications 3