NR606 Week 8 Final Exam Due 26 April 2026
Diagnosis and Management in Psychiatric-
Mental Health II Practicum PMHNP- 1-75
ACTUAL EXAM QUESTIONS AT Chamberlain
University..pdf
SECTION 1: MOOD DISORDERS
Question 1
A 35-year-old patient presents with a persistent depressed mood, anhedonia,
significant weight loss, insomnia, psychomotor retardation, and feelings of
worthlessness for the past 5 weeks. The patient has no history of manic or
hypomanic episodes. What is the most likely diagnosis according to DSM-5-TR
criteria?
A) Persistent depressive disorder (dysthymia)
B) Major depressive disorder, single episode
C) Bipolar II disorder, current episode depressed
D) Adjustment disorder with depressed mood
Answer: B
Rationale: Major depressive disorder requires ≥5 symptoms (depressed mood or
anhedonia plus others) for at least 2 weeks, causing significant impairment. This
patient meets criteria for a single episode with melancholic features (weight loss,
psychomotor retardation). Dysthymia requires symptoms for ≥2 years, making A
incorrect. Bipolar II requires a history of hypomania, which this patient lacks.
Adjustment disorder would be related to an identifiable stressor and is less severe .
,Question 2
A patient with major depressive disorder has failed two adequate trials of SSRIs.
The PMHNP decides to augment with an atypical antipsychotic. Which agent is
FDA-approved for this indication?
A) Olanzapine
B) Risperidone
C) Aripiprazole
D) Haloperidol
Answer: C
Rationale: Aripiprazole, brexpiprazole, and quetiapine XR are FDA-approved as
adjunctive therapy for MDD. Olanzapine is approved only in combination with
fluoxetine (Symbyax). Risperidone and haloperidol are not FDA-approved for MDD
augmentation .
Question 3
A patient with bipolar I disorder is in an acute manic episode. The patient has not
slept for 3 days, is hyperverbal, and displays grandiosity. Which medication should
be initiated first?
A) Lithium
B) Lamotrigine
C) Olanzapine or another second-generation antipsychotic
D) Fluoxetine
Answer: C
Rationale: Second-generation antipsychotics (olanzapine, risperidone, quetiapine,
aripiprazole) have a rapid onset and are first-line for acute mania. Lithium has a
slower onset. Lamotrigine is for bipolar depression/maintenance, not acute mania.
Fluoxetine would worsen mania .
, Question 4
A patient on lithium therapy presents with nausea, vomiting, coarse tremor,
ataxia, and confusion. Lithium level is 2.0 mEq/L. What is the priority action?
A) Administer the next dose with food
B) Hold lithium and arrange immediate medical evaluation; consider
hemodialysis
C) Give propranolol for the tremor
D) Reassure the patient that these are normal side effects
Answer: B
Rationale: Lithium level >1.5 mEq/L indicates toxicity. Symptoms include nausea,
vomiting, coarse tremor, ataxia, and confusion. Lithium must be held and urgent
evaluation including possible hemodialysis is required. Propranolol treats benign
tremor but not toxicity .
Question 5
A 28-year-old female with bipolar II disorder is currently experiencing a depressive
episode. She is not taking any medications. Which agent is most appropriate?
A) Fluoxetine
B) Lamotrigine
C) Olanzapine
D) Venlafaxine
Answer: B
Rationale: Lamotrigine is FDA-approved for maintenance treatment of bipolar I
and has strong evidence for bipolar depression. Antidepressant monotherapy
(fluoxetine, venlafaxine) can precipitate mania in bipolar patients and is not
recommended without a mood stabilizer .
Diagnosis and Management in Psychiatric-
Mental Health II Practicum PMHNP- 1-75
ACTUAL EXAM QUESTIONS AT Chamberlain
University..pdf
SECTION 1: MOOD DISORDERS
Question 1
A 35-year-old patient presents with a persistent depressed mood, anhedonia,
significant weight loss, insomnia, psychomotor retardation, and feelings of
worthlessness for the past 5 weeks. The patient has no history of manic or
hypomanic episodes. What is the most likely diagnosis according to DSM-5-TR
criteria?
A) Persistent depressive disorder (dysthymia)
B) Major depressive disorder, single episode
C) Bipolar II disorder, current episode depressed
D) Adjustment disorder with depressed mood
Answer: B
Rationale: Major depressive disorder requires ≥5 symptoms (depressed mood or
anhedonia plus others) for at least 2 weeks, causing significant impairment. This
patient meets criteria for a single episode with melancholic features (weight loss,
psychomotor retardation). Dysthymia requires symptoms for ≥2 years, making A
incorrect. Bipolar II requires a history of hypomania, which this patient lacks.
Adjustment disorder would be related to an identifiable stressor and is less severe .
,Question 2
A patient with major depressive disorder has failed two adequate trials of SSRIs.
The PMHNP decides to augment with an atypical antipsychotic. Which agent is
FDA-approved for this indication?
A) Olanzapine
B) Risperidone
C) Aripiprazole
D) Haloperidol
Answer: C
Rationale: Aripiprazole, brexpiprazole, and quetiapine XR are FDA-approved as
adjunctive therapy for MDD. Olanzapine is approved only in combination with
fluoxetine (Symbyax). Risperidone and haloperidol are not FDA-approved for MDD
augmentation .
Question 3
A patient with bipolar I disorder is in an acute manic episode. The patient has not
slept for 3 days, is hyperverbal, and displays grandiosity. Which medication should
be initiated first?
A) Lithium
B) Lamotrigine
C) Olanzapine or another second-generation antipsychotic
D) Fluoxetine
Answer: C
Rationale: Second-generation antipsychotics (olanzapine, risperidone, quetiapine,
aripiprazole) have a rapid onset and are first-line for acute mania. Lithium has a
slower onset. Lamotrigine is for bipolar depression/maintenance, not acute mania.
Fluoxetine would worsen mania .
, Question 4
A patient on lithium therapy presents with nausea, vomiting, coarse tremor,
ataxia, and confusion. Lithium level is 2.0 mEq/L. What is the priority action?
A) Administer the next dose with food
B) Hold lithium and arrange immediate medical evaluation; consider
hemodialysis
C) Give propranolol for the tremor
D) Reassure the patient that these are normal side effects
Answer: B
Rationale: Lithium level >1.5 mEq/L indicates toxicity. Symptoms include nausea,
vomiting, coarse tremor, ataxia, and confusion. Lithium must be held and urgent
evaluation including possible hemodialysis is required. Propranolol treats benign
tremor but not toxicity .
Question 5
A 28-year-old female with bipolar II disorder is currently experiencing a depressive
episode. She is not taking any medications. Which agent is most appropriate?
A) Fluoxetine
B) Lamotrigine
C) Olanzapine
D) Venlafaxine
Answer: B
Rationale: Lamotrigine is FDA-approved for maintenance treatment of bipolar I
and has strong evidence for bipolar depression. Antidepressant monotherapy
(fluoxetine, venlafaxine) can precipitate mania in bipolar patients and is not
recommended without a mood stabilizer .
