,NR 546 Advanced Psychopharmacology PMHNP Week 5 | Actual study
Questions and Answers + Rationales | 2026/27 Updates | 100% correct
1. Which of the following best differentiates Bipolar I Disorder from Bipolar II Disorder?
A) Bipolar I Disorder requires at least one hypomanic episode, while Bipolar II Disorder
requires a manic episode
B) Bipolar I Disorder requires at least one manic episode, while Bipolar II Disorder requires at
least one hypomanic episode and a major depressive episode
C) Bipolar I Disorder is characterized only by depressive episodes
D) Bipolar II Disorder is characterized by psychotic features exclusively
Correct Answer: Bipolar I Disorder requires at least one manic episode, while Bipolar II
Disorder requires at least one hypomanic episode and a major depressive episode
Rationale: The key diagnostic distinction is that Bipolar I Disorder requires a full manic
episode lasting at least one week, while Bipolar II Disorder requires a major depressive episode
and a hypomanic episode lasting at least four days but without the severity or impairment of a
full manic episode . Mania, which can involve psychotic features or necessitate hospitalization,
is not present in Bipolar II Disorder.
2. According to DSM-5 criteria, how long must manic symptoms persist for a diagnosis of a
manic episode?
A) At least 4 days
B) At least 1 week
C) At least 2 weeks
D) There is no minimum duration requirement
Correct Answer: At least 1 week
, Rationale: A manic episode in Bipolar I Disorder requires a distinct period of abnormally
elevated, expansive, or irritable mood and increased goal-directed activity lasting at least one
week (or any duration if hospitalization is necessary) . Hypomanic episodes require a shorter
duration of at least four consecutive days.
3. A patient presents with persistently elevated mood, grandiosity, decreased need for sleep,
racing thoughts, and excessive involvement in high-risk activities. These symptoms have been
present for 10 days and are causing significant functional impairment. What is the most likely
diagnosis?
A) Major Depressive Disorder
B) Bipolar II Disorder, hypomanic episode
C) Bipolar I Disorder, manic episode
D) Cyclothymia
Correct Answer: Bipolar I Disorder, manic episode
Rationale: This presentation meets DSM-5 criteria for a manic episode: abnormally
elevated/irritable mood and increased activity lasting at least one week, with at least three
symptoms such as grandiosity, decreased need for sleep, racing thoughts, and risky behavior,
causing significant impairment . The duration (10 days) and severity (functional impairment)
indicate mania, not hypomania.
4. A patient with Bipolar I Disorder is currently in a depressive episode. According to evidence-
based guidelines, what is the most critical prescribing principle regarding antidepressant use?
A) Antidepressants should be the first-line monotherapy
B) Antidepressants should be combined with a mood stabilizer
C) Antidepressants are contraindicated in all cases
D) Antidepressants are only effective for mania
, Correct Answer: Antidepressants should be combined with a mood stabilizer
Rationale: In bipolar depression, antidepressants should be used cautiously and never as
monotherapy, as they can precipitate a manic or hypomanic episode or induce rapid cycling .
Guidelines recommend combining antidepressants with a mood stabilizer or atypical
antipsychotic to prevent mood destabilization .
5. A PMHNP is treating a patient with acute mania. The patient is agitated, has psychotic
features, and is non-adherent to oral medications. Which class of medication is most
appropriate to rapidly control symptoms?
A) Oral selective serotonin reuptake inhibitor (SSRI)
B) Parenteral (IM) antipsychotic
C) Oral benzodiazepine monotherapy
D) Oral lamotrigine
Correct Answer: Parenteral (IM) antipsychotic
Rationale: For acute mania with severe agitation or non-adherence, intramuscular (IM)
antipsychotics such as haloperidol, chlorpromazine, or zuclopenthixol are recommended . They
provide rapid symptom control and are preferred when oral administration is not feasible or
safe.
6. Which of the following is considered the gold-standard mood stabilizer for the treatment and
maintenance of bipolar disorder?
A) Valproic acid
B) Lamotrigine
C) Lithium
D) Carbamazepine
Questions and Answers + Rationales | 2026/27 Updates | 100% correct
1. Which of the following best differentiates Bipolar I Disorder from Bipolar II Disorder?
A) Bipolar I Disorder requires at least one hypomanic episode, while Bipolar II Disorder
requires a manic episode
B) Bipolar I Disorder requires at least one manic episode, while Bipolar II Disorder requires at
least one hypomanic episode and a major depressive episode
C) Bipolar I Disorder is characterized only by depressive episodes
D) Bipolar II Disorder is characterized by psychotic features exclusively
Correct Answer: Bipolar I Disorder requires at least one manic episode, while Bipolar II
Disorder requires at least one hypomanic episode and a major depressive episode
Rationale: The key diagnostic distinction is that Bipolar I Disorder requires a full manic
episode lasting at least one week, while Bipolar II Disorder requires a major depressive episode
and a hypomanic episode lasting at least four days but without the severity or impairment of a
full manic episode . Mania, which can involve psychotic features or necessitate hospitalization,
is not present in Bipolar II Disorder.
2. According to DSM-5 criteria, how long must manic symptoms persist for a diagnosis of a
manic episode?
A) At least 4 days
B) At least 1 week
C) At least 2 weeks
D) There is no minimum duration requirement
Correct Answer: At least 1 week
, Rationale: A manic episode in Bipolar I Disorder requires a distinct period of abnormally
elevated, expansive, or irritable mood and increased goal-directed activity lasting at least one
week (or any duration if hospitalization is necessary) . Hypomanic episodes require a shorter
duration of at least four consecutive days.
3. A patient presents with persistently elevated mood, grandiosity, decreased need for sleep,
racing thoughts, and excessive involvement in high-risk activities. These symptoms have been
present for 10 days and are causing significant functional impairment. What is the most likely
diagnosis?
A) Major Depressive Disorder
B) Bipolar II Disorder, hypomanic episode
C) Bipolar I Disorder, manic episode
D) Cyclothymia
Correct Answer: Bipolar I Disorder, manic episode
Rationale: This presentation meets DSM-5 criteria for a manic episode: abnormally
elevated/irritable mood and increased activity lasting at least one week, with at least three
symptoms such as grandiosity, decreased need for sleep, racing thoughts, and risky behavior,
causing significant impairment . The duration (10 days) and severity (functional impairment)
indicate mania, not hypomania.
4. A patient with Bipolar I Disorder is currently in a depressive episode. According to evidence-
based guidelines, what is the most critical prescribing principle regarding antidepressant use?
A) Antidepressants should be the first-line monotherapy
B) Antidepressants should be combined with a mood stabilizer
C) Antidepressants are contraindicated in all cases
D) Antidepressants are only effective for mania
, Correct Answer: Antidepressants should be combined with a mood stabilizer
Rationale: In bipolar depression, antidepressants should be used cautiously and never as
monotherapy, as they can precipitate a manic or hypomanic episode or induce rapid cycling .
Guidelines recommend combining antidepressants with a mood stabilizer or atypical
antipsychotic to prevent mood destabilization .
5. A PMHNP is treating a patient with acute mania. The patient is agitated, has psychotic
features, and is non-adherent to oral medications. Which class of medication is most
appropriate to rapidly control symptoms?
A) Oral selective serotonin reuptake inhibitor (SSRI)
B) Parenteral (IM) antipsychotic
C) Oral benzodiazepine monotherapy
D) Oral lamotrigine
Correct Answer: Parenteral (IM) antipsychotic
Rationale: For acute mania with severe agitation or non-adherence, intramuscular (IM)
antipsychotics such as haloperidol, chlorpromazine, or zuclopenthixol are recommended . They
provide rapid symptom control and are preferred when oral administration is not feasible or
safe.
6. Which of the following is considered the gold-standard mood stabilizer for the treatment and
maintenance of bipolar disorder?
A) Valproic acid
B) Lamotrigine
C) Lithium
D) Carbamazepine
