• Table of Contents
I. Advanced Psychiatric Assessment and Diagnostic Reasoning
II. Psychopharmacology and Medication Management
III. Psychotherapy and Therapeutic Communication
IV. Depressive, Bipolar, and Anxiety Disorders
V. Psychotic, Personality, and Substance Use Disorders
VI. Child, Adolescent, and Geriatric Psychiatry
VII. Crisis Intervention, Trauma, and Suicide Prevention
VIII. Legal, Ethical, and Professional Practice
1. A 32-year-old female presents with a 2-week history of depressed
mood, anhedonia, fatigue, and feelings of worthlessness. She
reports sleeping 12 hours per day and gaining 8 pounds. Which
specifier should the PMH nurse consider?
A) Melancholic features
B) Atypical features
C) Catatonic features
D) Postpartum onset
Correct Answer: B
Atypical depression includes mood reactivity, hypersomnia,
hyperphagia, leaden paralysis, and rejection sensitivity. Melancholic
,features would show insomnia and weight loss. Catatonia involves
motor abnormalities. Postpartum onset is a specifier if symptoms begin
within 4 weeks postpartum.
2. A 45-year-old male with bipolar I disorder is stable on lithium. He
reports increased thirst and urination. Which laboratory test is
most important?
A) Serum lithium level
B) Fasting blood glucose
C) Urine osmolality and specific gravity
D) Liver function tests
Correct Answer: C
Polyuria and polydipsia may indicate lithium-induced nephrogenic
diabetes insipidus. Urine osmolality and specific gravity help assess
concentrating ability. Serum lithium level monitors toxicity but not the
renal concentration defect. Blood glucose rules out diabetes mellitus.
Liver function is unrelated.
3. A 25-year-old patient with schizophrenia is started on clozapine.
Which monitoring is essential before each dispensing?
A) Serum lithium level
B) Absolute neutrophil count (ANC)
C) Thyroid-stimulating hormone
D) Prolactin level
Correct Answer: B
Clozapine can cause agranulocytosis; absolute neutrophil count must be
monitored per REMS schedule before each dispensing. Lithium, TSH, and
prolactin are not specific to clozapine safety.
, 4. A patient with major depressive disorder has not responded to
two SSRIs. Which augmentation strategy is best supported by
evidence?
A) Adding a benzodiazepine
B) Adding bupropion or an atypical antipsychotic
C) Switching to a stimulant
D) Adding a beta-blocker
Correct Answer: B
For treatment-resistant depression, augmentation with bupropion,
mirtazapine, or atypical antipsychotics (e.g., aripiprazole, quetiapine) is
evidence-based. Benzodiazepines do not treat core depression.
Stimulants are not first-line augmentation. Beta-blockers are not
indicated.
5. A patient presents with recurrent, unexpected panic attacks and
persistent worry about future attacks. What is the first-line
medication?
A) Propranolol
B) Sertraline
C) Alprazolam
D) Quetiapine
Correct Answer: B
SSRIs such as sertraline are first-line for panic disorder. Propranolol is for
performance anxiety. Alprazolam is effective but second-line due to
dependence risk. Quetiapine is not first-line.
6. A 16-year-old presents with a 6-month history of excessive worry
about school and social situations, restlessness, and difficulty
concentrating. The most likely diagnosis is:
, A) Panic disorder
B) Generalized anxiety disorder
C) Social anxiety disorder
D) Separation anxiety disorder
Correct Answer: B
Generalized anxiety disorder involves excessive, difficult-to-control worry
across multiple domains with associated symptoms. Panic disorder has
discrete attacks. Social anxiety is specific to social situations. Separation
anxiety focuses on separation from attachment figures.
7. A patient with bipolar II disorder is started on lamotrigine. Which
adverse effect requires immediate reporting?
A) Nausea
B) Headache
C) Rash
D) Dizziness
Correct Answer: C
Lamotrigine can cause serious rash, including Stevens-Johnson
syndrome, especially with rapid titration. Any new rash requires
immediate evaluation and likely discontinuation. Nausea, headache,
and dizziness are less concerning.
8. A 55-year-old male with major depressive disorder is started on
venlafaxine. He has hypertension and coronary artery disease.
What is the most important nursing consideration?
A) Monitor blood pressure and heart rate
B) Check liver enzymes weekly
C) Avoid all foods with tyramine
D) Administer only at bedtime
I. Advanced Psychiatric Assessment and Diagnostic Reasoning
II. Psychopharmacology and Medication Management
III. Psychotherapy and Therapeutic Communication
IV. Depressive, Bipolar, and Anxiety Disorders
V. Psychotic, Personality, and Substance Use Disorders
VI. Child, Adolescent, and Geriatric Psychiatry
VII. Crisis Intervention, Trauma, and Suicide Prevention
VIII. Legal, Ethical, and Professional Practice
1. A 32-year-old female presents with a 2-week history of depressed
mood, anhedonia, fatigue, and feelings of worthlessness. She
reports sleeping 12 hours per day and gaining 8 pounds. Which
specifier should the PMH nurse consider?
A) Melancholic features
B) Atypical features
C) Catatonic features
D) Postpartum onset
Correct Answer: B
Atypical depression includes mood reactivity, hypersomnia,
hyperphagia, leaden paralysis, and rejection sensitivity. Melancholic
,features would show insomnia and weight loss. Catatonia involves
motor abnormalities. Postpartum onset is a specifier if symptoms begin
within 4 weeks postpartum.
2. A 45-year-old male with bipolar I disorder is stable on lithium. He
reports increased thirst and urination. Which laboratory test is
most important?
A) Serum lithium level
B) Fasting blood glucose
C) Urine osmolality and specific gravity
D) Liver function tests
Correct Answer: C
Polyuria and polydipsia may indicate lithium-induced nephrogenic
diabetes insipidus. Urine osmolality and specific gravity help assess
concentrating ability. Serum lithium level monitors toxicity but not the
renal concentration defect. Blood glucose rules out diabetes mellitus.
Liver function is unrelated.
3. A 25-year-old patient with schizophrenia is started on clozapine.
Which monitoring is essential before each dispensing?
A) Serum lithium level
B) Absolute neutrophil count (ANC)
C) Thyroid-stimulating hormone
D) Prolactin level
Correct Answer: B
Clozapine can cause agranulocytosis; absolute neutrophil count must be
monitored per REMS schedule before each dispensing. Lithium, TSH, and
prolactin are not specific to clozapine safety.
, 4. A patient with major depressive disorder has not responded to
two SSRIs. Which augmentation strategy is best supported by
evidence?
A) Adding a benzodiazepine
B) Adding bupropion or an atypical antipsychotic
C) Switching to a stimulant
D) Adding a beta-blocker
Correct Answer: B
For treatment-resistant depression, augmentation with bupropion,
mirtazapine, or atypical antipsychotics (e.g., aripiprazole, quetiapine) is
evidence-based. Benzodiazepines do not treat core depression.
Stimulants are not first-line augmentation. Beta-blockers are not
indicated.
5. A patient presents with recurrent, unexpected panic attacks and
persistent worry about future attacks. What is the first-line
medication?
A) Propranolol
B) Sertraline
C) Alprazolam
D) Quetiapine
Correct Answer: B
SSRIs such as sertraline are first-line for panic disorder. Propranolol is for
performance anxiety. Alprazolam is effective but second-line due to
dependence risk. Quetiapine is not first-line.
6. A 16-year-old presents with a 6-month history of excessive worry
about school and social situations, restlessness, and difficulty
concentrating. The most likely diagnosis is:
, A) Panic disorder
B) Generalized anxiety disorder
C) Social anxiety disorder
D) Separation anxiety disorder
Correct Answer: B
Generalized anxiety disorder involves excessive, difficult-to-control worry
across multiple domains with associated symptoms. Panic disorder has
discrete attacks. Social anxiety is specific to social situations. Separation
anxiety focuses on separation from attachment figures.
7. A patient with bipolar II disorder is started on lamotrigine. Which
adverse effect requires immediate reporting?
A) Nausea
B) Headache
C) Rash
D) Dizziness
Correct Answer: C
Lamotrigine can cause serious rash, including Stevens-Johnson
syndrome, especially with rapid titration. Any new rash requires
immediate evaluation and likely discontinuation. Nausea, headache,
and dizziness are less concerning.
8. A 55-year-old male with major depressive disorder is started on
venlafaxine. He has hypertension and coronary artery disease.
What is the most important nursing consideration?
A) Monitor blood pressure and heart rate
B) Check liver enzymes weekly
C) Avoid all foods with tyramine
D) Administer only at bedtime
