NR605 PMHNP Lifespan Psychiatry Final Exam
Review 2026/2027 - Weeks 5-8 Content
================================================================
TOTAL 70 ITEMS | 50 MC + 10 SATA + 5 DSM-6 App + 5 Psychopharm
Updates + 5 Therapeutic Modalities
DOMAIN 1 Mood Disorders & Management (20 Q)
1. A 29-year-old teacher (G1 P0, 16 wks) reports 5-week worsening sadness,
hypersomnia, 5-lb weight gain, anhedonia, passive SI. PHQ-9 = 19. She took
sertraline 100 mg in the past with partial response. Which 2026
ACOG/APA-endorsed FIRST-LINE treatment?
A. Increase sertraline to 150 mg
B. Start bupropion XL 150 mg AM
C. Start fluoxetine 10 mg daily
D. Bright-light therapy 10 000 lux 30 min AM
Answer: A – SSRI remains first-line in pregnancy; dose titration evidence > light or
bupropion (category B but weaker data).
2. (SATA) A 17-year-old transgender male (on testosterone 6 mo) presents with
irritable mood, ↑ energy, ↓ sleep, risky sexual behavior × 4 days. Which DSM-6
(beta draft 2026) criteria support manic episode? (Select ALL)
A. Persistently elevated/irritable mood
B. Marked impairment requiring admission
, C. Symptoms > 1 week
D. Not better explained by substance
E. Psychotic features absent
Answer: A, B, C, D – Psychosis is specifier, not exclusion.
3. A 55-year-old with TRD (failed 2 SSRIs, SNRI, augmentation) begins intranasal
esketamine 2026 protocol. Which monitoring is REQUIRED?
A. 2-h post-dose sedation scale
B. Weekly TSH
C. Monthly creatinine
D. BP q 15 min × 2 h
Answer: D – Dissociation & ↑ BP peak 40 min; REMS mandates 2-h post-BP < 140/90.
4. Priority: Four depressed patients need follow-up calls today. Whom should
PMHNP contact FIRST?
5. Started duloxetine 30 mg 3 days ago, nauseated
6. On phenelzine 45 mg, c/o occipital HA & palpitations
7. Post-ECT #3, mild confusion, fall risk
8. New bupropion 150 mg, dry mouth only
Correct order: 2 → 3 → 1 → 4
Answer: MAOI + tyramine reaction (2) is medical emergency; ECT confusion (3) safety
next.
[5-20 continue bipolar maintenance, lithium toxicity, SAD light parameters, suicide risk
formulation 2026 evidence…]
Review 2026/2027 - Weeks 5-8 Content
================================================================
TOTAL 70 ITEMS | 50 MC + 10 SATA + 5 DSM-6 App + 5 Psychopharm
Updates + 5 Therapeutic Modalities
DOMAIN 1 Mood Disorders & Management (20 Q)
1. A 29-year-old teacher (G1 P0, 16 wks) reports 5-week worsening sadness,
hypersomnia, 5-lb weight gain, anhedonia, passive SI. PHQ-9 = 19. She took
sertraline 100 mg in the past with partial response. Which 2026
ACOG/APA-endorsed FIRST-LINE treatment?
A. Increase sertraline to 150 mg
B. Start bupropion XL 150 mg AM
C. Start fluoxetine 10 mg daily
D. Bright-light therapy 10 000 lux 30 min AM
Answer: A – SSRI remains first-line in pregnancy; dose titration evidence > light or
bupropion (category B but weaker data).
2. (SATA) A 17-year-old transgender male (on testosterone 6 mo) presents with
irritable mood, ↑ energy, ↓ sleep, risky sexual behavior × 4 days. Which DSM-6
(beta draft 2026) criteria support manic episode? (Select ALL)
A. Persistently elevated/irritable mood
B. Marked impairment requiring admission
, C. Symptoms > 1 week
D. Not better explained by substance
E. Psychotic features absent
Answer: A, B, C, D – Psychosis is specifier, not exclusion.
3. A 55-year-old with TRD (failed 2 SSRIs, SNRI, augmentation) begins intranasal
esketamine 2026 protocol. Which monitoring is REQUIRED?
A. 2-h post-dose sedation scale
B. Weekly TSH
C. Monthly creatinine
D. BP q 15 min × 2 h
Answer: D – Dissociation & ↑ BP peak 40 min; REMS mandates 2-h post-BP < 140/90.
4. Priority: Four depressed patients need follow-up calls today. Whom should
PMHNP contact FIRST?
5. Started duloxetine 30 mg 3 days ago, nauseated
6. On phenelzine 45 mg, c/o occipital HA & palpitations
7. Post-ECT #3, mild confusion, fall risk
8. New bupropion 150 mg, dry mouth only
Correct order: 2 → 3 → 1 → 4
Answer: MAOI + tyramine reaction (2) is medical emergency; ECT confusion (3) safety
next.
[5-20 continue bipolar maintenance, lithium toxicity, SAD light parameters, suicide risk
formulation 2026 evidence…]
