Barkley PMHNP Chapter 6 Quiz: Comprehensive
Psychiatric-Mental Health Assessment, Diagnostic
Reasoning, Neurological Evaluation, and Clinical
Decision-Making for Advanced Practice a well
detailed one written and graded A+
upgraded
QUESTION 1
A 45-year-old male with major depressive disorder has failed trials of fluoxetine, sertraline, and
venlafaxine. He reports increased appetite, hypersomnia, and extreme fatigue. Which
medication would be most appropriate as an adjunctive treatment?
A. Bupropion
B. Mirtazapine
C. Aripiprazole
D. Lithium
Correct Answer: C
Rationale: This patient has atypical features of depression (increased appetite, hypersomnia,
fatigue). Aripiprazole is FDA-approved as an adjunctive treatment for major depressive disorder
and is particularly useful in patients who have failed multiple antidepressant trials. Bupropion
would be more appropriate for patients with decreased energy but may exacerbate anxiety.
,Mirtazapine would worsen hypersomnia and increased appetite. Lithium is primarily used for
bipolar disorder.
QUESTION 2
Which neurotransmitter is most closely associated with the regulation of mood, appetite, and
sleep, and is often targeted in the treatment of depression?
A. Dopamine
B. GABA
C. Serotonin
D. Acetylcholine
Correct Answer: C
Rationale: Serotonin plays a key role in mood regulation, appetite, and sleep. SSRIs increase
serotonin availability, alleviating depressive symptoms. Dopamine relates more to reward and
motivation, GABA to inhibition, and acetylcholine to cognition.
QUESTION 3
A patient with major depressive disorder is started on an SSRI. Which early side effect should
the PMHNP educate the patient about?
A. Weight gain
B. Sexual dysfunction
C. Hypertension
D. Urinary retention
Correct Answer: B
Rationale: Sexual dysfunction is a common SSRI side effect, often emerging early in therapy.
Weight gain typically develops later, hypertension is unusual, and urinary retention is more
typical of anticholinergic drugs.
QUESTION 4
Which of the following findings is most consistent with bipolar I disorder?
,A. Hypomanic episodes without psychosis
B. Major depressive episodes only
C. Mania with functional impairment
D. Cyclothymic mood variation
Correct Answer: C
Rationale: Bipolar I disorder requires at least one manic episode causing marked impairment.
Hypomania defines bipolar II, pure depression is MDD, and chronic mood fluctuation signifies
cyclothymia.
QUESTION 5
When prescribing lithium for a new patient, what baseline lab tests should be obtained?
A. CBC, liver panel, and lipid profile
B. TSH, renal function, and electrolyte panel
C. Blood glucose, ECG, and vitamin D
D. Urinalysis and C-reactive protein
Correct Answer: B
Rationale: Lithium affects renal and thyroid function. Baseline kidney and thyroid studies ensure
safe initiation. CBC or liver tests are important for other medications like valproate.
QUESTION 6
A 45-year-old patient on lithium develops tremors and nausea. The serum level is 1.8 mEq/L.
What is the appropriate next step?
A. Continue lithium at the same dose
B. Add propranolol to control tremors
C. Hold lithium and monitor hydration status
D. Decrease lithium by 50%
Correct Answer: C
Rationale: A level of 1.8 is toxic. The drug should be held, and hydration maintained to promote
excretion. Once the patient stabilizes, a lower dose may be restarted.
, QUESTION 7
Which antipsychotic has the greatest risk of metabolic side effects, including significant weight
gain?
A. Ziprasidone
B. Aripiprazole
C. Clozapine
D. Lurasidone
Correct Answer: C
Rationale: Clozapine has the greatest risk of metabolic side effects, including significant weight
gain, diabetes, and dyslipidemia. Ziprasidone, aripiprazole, and lurasidone have relatively lower
metabolic risk profiles.
QUESTION 8
What is a systematic inquiry that elaborates on the chief complaint while eliciting pertinent
positive and negative factors from the history?
A. Mental status exam
B. Review of systems
C. Physical examination
D. Functional assessment
Correct Answer: B
Rationale: A systematic inquiry that elaborates on the chief complaint while eliciting pertinent
positive and negative factors from the history is known as the review of systems.
QUESTION 9
Which of the following is NOT typically included in a mental status exam?
A. Appearance and behavior
B. Mood and affect
C. Cranial nerves and reflexes
D. Thought process and content
Correct Answer: C
Psychiatric-Mental Health Assessment, Diagnostic
Reasoning, Neurological Evaluation, and Clinical
Decision-Making for Advanced Practice a well
detailed one written and graded A+
upgraded
QUESTION 1
A 45-year-old male with major depressive disorder has failed trials of fluoxetine, sertraline, and
venlafaxine. He reports increased appetite, hypersomnia, and extreme fatigue. Which
medication would be most appropriate as an adjunctive treatment?
A. Bupropion
B. Mirtazapine
C. Aripiprazole
D. Lithium
Correct Answer: C
Rationale: This patient has atypical features of depression (increased appetite, hypersomnia,
fatigue). Aripiprazole is FDA-approved as an adjunctive treatment for major depressive disorder
and is particularly useful in patients who have failed multiple antidepressant trials. Bupropion
would be more appropriate for patients with decreased energy but may exacerbate anxiety.
,Mirtazapine would worsen hypersomnia and increased appetite. Lithium is primarily used for
bipolar disorder.
QUESTION 2
Which neurotransmitter is most closely associated with the regulation of mood, appetite, and
sleep, and is often targeted in the treatment of depression?
A. Dopamine
B. GABA
C. Serotonin
D. Acetylcholine
Correct Answer: C
Rationale: Serotonin plays a key role in mood regulation, appetite, and sleep. SSRIs increase
serotonin availability, alleviating depressive symptoms. Dopamine relates more to reward and
motivation, GABA to inhibition, and acetylcholine to cognition.
QUESTION 3
A patient with major depressive disorder is started on an SSRI. Which early side effect should
the PMHNP educate the patient about?
A. Weight gain
B. Sexual dysfunction
C. Hypertension
D. Urinary retention
Correct Answer: B
Rationale: Sexual dysfunction is a common SSRI side effect, often emerging early in therapy.
Weight gain typically develops later, hypertension is unusual, and urinary retention is more
typical of anticholinergic drugs.
QUESTION 4
Which of the following findings is most consistent with bipolar I disorder?
,A. Hypomanic episodes without psychosis
B. Major depressive episodes only
C. Mania with functional impairment
D. Cyclothymic mood variation
Correct Answer: C
Rationale: Bipolar I disorder requires at least one manic episode causing marked impairment.
Hypomania defines bipolar II, pure depression is MDD, and chronic mood fluctuation signifies
cyclothymia.
QUESTION 5
When prescribing lithium for a new patient, what baseline lab tests should be obtained?
A. CBC, liver panel, and lipid profile
B. TSH, renal function, and electrolyte panel
C. Blood glucose, ECG, and vitamin D
D. Urinalysis and C-reactive protein
Correct Answer: B
Rationale: Lithium affects renal and thyroid function. Baseline kidney and thyroid studies ensure
safe initiation. CBC or liver tests are important for other medications like valproate.
QUESTION 6
A 45-year-old patient on lithium develops tremors and nausea. The serum level is 1.8 mEq/L.
What is the appropriate next step?
A. Continue lithium at the same dose
B. Add propranolol to control tremors
C. Hold lithium and monitor hydration status
D. Decrease lithium by 50%
Correct Answer: C
Rationale: A level of 1.8 is toxic. The drug should be held, and hydration maintained to promote
excretion. Once the patient stabilizes, a lower dose may be restarted.
, QUESTION 7
Which antipsychotic has the greatest risk of metabolic side effects, including significant weight
gain?
A. Ziprasidone
B. Aripiprazole
C. Clozapine
D. Lurasidone
Correct Answer: C
Rationale: Clozapine has the greatest risk of metabolic side effects, including significant weight
gain, diabetes, and dyslipidemia. Ziprasidone, aripiprazole, and lurasidone have relatively lower
metabolic risk profiles.
QUESTION 8
What is a systematic inquiry that elaborates on the chief complaint while eliciting pertinent
positive and negative factors from the history?
A. Mental status exam
B. Review of systems
C. Physical examination
D. Functional assessment
Correct Answer: B
Rationale: A systematic inquiry that elaborates on the chief complaint while eliciting pertinent
positive and negative factors from the history is known as the review of systems.
QUESTION 9
Which of the following is NOT typically included in a mental status exam?
A. Appearance and behavior
B. Mood and affect
C. Cranial nerves and reflexes
D. Thought process and content
Correct Answer: C
