NURS 663 Exam 2 V2 | NURS 663
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 2 2026)
1. A 34-year-old male is being treated for Major Depressive Disorder with Phenelzine. Which
of the following snack choices indicates the patient understands the necessary dietary
restrictions?
A. A sandwich with aged cheddar cheese and salami
B. A glass of red wine and a plate of fava beans
C. A bowl of fresh grapes and a yogurt cup
D. A bowl of miso soup and crackers
Answer: C
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that requires a low-
tyramine diet to prevent hypertensive crisis. Fresh fruits and most yogurt are generally
safe, whereas aged cheeses, cured meats, and fermented products like miso are high in
tyramine. Education for patients on MAOIs must emphasize the avoidance of high-tyramine
foods to ensure safety and compliance.
,2. During a follow-up visit, a patient taking Lithium for Bipolar I Disorder reports coarse hand
tremors, persistent diarrhea, and blurred vision. What is the most appropriate initial action
by the PMHNP?
A. Instruct the patient to increase water intake and re-evaluate in one week.
B. Order an immediate serum lithium level and advise the patient to hold the medication.
C. Decrease the lithium dosage by half and add Propropanol for the tremors.
D. Refer the patient to a neurologist for a possible movement disorder.
Answer: B
Rationale: Coarse tremors, diarrhea, and blurred vision are hallmark signs of moderate to
severe lithium toxicity. The PMHNP must prioritize patient safety by stopping the
medication immediately and obtaining a serum level to determine the severity of toxicity.
Lithium has a narrow therapeutic index, and toxicity can be life-threatening if not
addressed promptly.
3. A 24-year-old female patient diagnosed with Bipolar II Disorder is interested in starting a
family. When discussing the use of Valproate, which information is most critical for the
PMHNP to share?
A. Valproate is the safest mood stabilizer to use during the first trimester.
B. There are no known contraindications for Valproate in pregnancy.
C. Valproate carries a high risk of neural tube defects like spina bifida.
D. The patient must increase her caffeine intake while taking Valproate.
,Answer: C
Rationale: Valproate is associated with significant teratogenic risks, specifically neural
tube defects and lower IQ in children exposed in utero. It is generally avoided in women of
childbearing age unless other treatments have failed and strict contraception is used. The
PMHNP must discuss these risks thoroughly as part of preconception counseling and
shared decision-making.
4. A patient with Treatment-Resistant Depression is being considered for Esketamine nasal
spray. Which of the following is a mandatory requirement for the administration of this
medication?
A. The patient must administer the dose at home before bed.
B. The patient may drive home immediately after the observation period.
C. No blood pressure monitoring is required after administration.
D. The medication must be administered under the supervision of a healthcare provider in
a certified setting.
Answer: D
Rationale: Esketamine is regulated under a Risk Evaluation and Mitigation Strategy
(REMS) program due to risks of sedation and dissociation. Patients must be monitored by a
healthcare provider for at least two hours post-administration to ensure safety.
Additionally, patients are instructed not to drive or operate heavy machinery until the
following day after a restful sleep.
, 5. What is the minimum duration of symptoms required for a diagnosis of Cyclothymic
Disorder in an adult patient?
A. 6 months
B. 1 year
C. 5 years
D. 2 years
Answer: D
Rationale: According to the DSM-5, Cyclothymic Disorder in adults requires at least 2
years of numerous periods with hypomanic symptoms and depressive symptoms that do
not meet the full criteria for a major episode. During this period, symptoms must be
present at least half the time and the individual must not be without symptoms for more
than 2 months. This chronic, fluctuating mood disturbance is less severe but more
persistent than Bipolar I or II.
6. A PMHNP is treating a patient with Social Anxiety Disorder. The patient experiences
debilitating performance anxiety before work presentations. Which medication is most
appropriate for ‘as-needed’ (PRN) use for this specific symptom?
A. Sertraline
B. Buspirone
C. Quetiapine
D. Propranolol
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 2 2026)
1. A 34-year-old male is being treated for Major Depressive Disorder with Phenelzine. Which
of the following snack choices indicates the patient understands the necessary dietary
restrictions?
A. A sandwich with aged cheddar cheese and salami
B. A glass of red wine and a plate of fava beans
C. A bowl of fresh grapes and a yogurt cup
D. A bowl of miso soup and crackers
Answer: C
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that requires a low-
tyramine diet to prevent hypertensive crisis. Fresh fruits and most yogurt are generally
safe, whereas aged cheeses, cured meats, and fermented products like miso are high in
tyramine. Education for patients on MAOIs must emphasize the avoidance of high-tyramine
foods to ensure safety and compliance.
,2. During a follow-up visit, a patient taking Lithium for Bipolar I Disorder reports coarse hand
tremors, persistent diarrhea, and blurred vision. What is the most appropriate initial action
by the PMHNP?
A. Instruct the patient to increase water intake and re-evaluate in one week.
B. Order an immediate serum lithium level and advise the patient to hold the medication.
C. Decrease the lithium dosage by half and add Propropanol for the tremors.
D. Refer the patient to a neurologist for a possible movement disorder.
Answer: B
Rationale: Coarse tremors, diarrhea, and blurred vision are hallmark signs of moderate to
severe lithium toxicity. The PMHNP must prioritize patient safety by stopping the
medication immediately and obtaining a serum level to determine the severity of toxicity.
Lithium has a narrow therapeutic index, and toxicity can be life-threatening if not
addressed promptly.
3. A 24-year-old female patient diagnosed with Bipolar II Disorder is interested in starting a
family. When discussing the use of Valproate, which information is most critical for the
PMHNP to share?
A. Valproate is the safest mood stabilizer to use during the first trimester.
B. There are no known contraindications for Valproate in pregnancy.
C. Valproate carries a high risk of neural tube defects like spina bifida.
D. The patient must increase her caffeine intake while taking Valproate.
,Answer: C
Rationale: Valproate is associated with significant teratogenic risks, specifically neural
tube defects and lower IQ in children exposed in utero. It is generally avoided in women of
childbearing age unless other treatments have failed and strict contraception is used. The
PMHNP must discuss these risks thoroughly as part of preconception counseling and
shared decision-making.
4. A patient with Treatment-Resistant Depression is being considered for Esketamine nasal
spray. Which of the following is a mandatory requirement for the administration of this
medication?
A. The patient must administer the dose at home before bed.
B. The patient may drive home immediately after the observation period.
C. No blood pressure monitoring is required after administration.
D. The medication must be administered under the supervision of a healthcare provider in
a certified setting.
Answer: D
Rationale: Esketamine is regulated under a Risk Evaluation and Mitigation Strategy
(REMS) program due to risks of sedation and dissociation. Patients must be monitored by a
healthcare provider for at least two hours post-administration to ensure safety.
Additionally, patients are instructed not to drive or operate heavy machinery until the
following day after a restful sleep.
, 5. What is the minimum duration of symptoms required for a diagnosis of Cyclothymic
Disorder in an adult patient?
A. 6 months
B. 1 year
C. 5 years
D. 2 years
Answer: D
Rationale: According to the DSM-5, Cyclothymic Disorder in adults requires at least 2
years of numerous periods with hypomanic symptoms and depressive symptoms that do
not meet the full criteria for a major episode. During this period, symptoms must be
present at least half the time and the individual must not be without symptoms for more
than 2 months. This chronic, fluctuating mood disturbance is less severe but more
persistent than Bipolar I or II.
6. A PMHNP is treating a patient with Social Anxiety Disorder. The patient experiences
debilitating performance anxiety before work presentations. Which medication is most
appropriate for ‘as-needed’ (PRN) use for this specific symptom?
A. Sertraline
B. Buspirone
C. Quetiapine
D. Propranolol
