CMN 548 Introduction to PMHNP: Comprehensive Final Exam
Review & Clinical Practice Questions University of Alabama
is an advanced foundational course designed to prepare Psychiatric-Mental Health
Nurse Practitioner students to evaluate and manage psychiatric needs across the
lifespan. The curriculum introduces vital competencies in psychiatric clinical
assessments, evidence-based psychopharmacology, differential diagnosis
development, and therapeutic communication strategies. Mastering these core
principles prepares advanced practice nursing candidates to deliver
comprehensive clinical interventions and safely guide mental health care delivery.
3 — Antidepressant selection
Which agent is generally considered first-line for moderate to severe major
depressive disorder due to favorable tolerability and evidence base?
A. Imipramine (TCA)
B. Fluoxetine (SSRI)
C. Phenelzine (MAOI)
D. Lithium
Answer: B — Fluoxetine (SSRI).
Big rationale: SSRIs are commonly first-line for MDD given favorable sideeffect
profile and robust evidence. Older agents (TCAs, MAOIs) are effective but have
more adverse effects and greater safety concerns (overdose, interactions) and
,are generally reserved for treatmentresistant or specific indications. Lithium is a
mood stabilizer used in bipolar disorder and as augmentation in depression
sometimes, but not primary first-line monotherapy for unipolar MDD in general
practice. Consult APA guideline for treatment choices. (American Psychological
Association)
4 — Bipolar diagnosis
A patient has a 10-day period of persistently elevated mood and increased goal-
directed activity with significantly decreased need for sleep, grandiosity, and
pressured speech, requiring hospitalization for risky behavior. This episode best
meets criteria for:
A. Hypomanic episode
B. Manic episode (Bipolar I)
C. Cyclothymic disorder
D. Unipolar depression
Answer: B — Manic episode (Bipolar I).
Big rationale: Mania is characterized by ≥1 week of abnormally elevated/irritable
mood and increased energy plus marked impairment in functioning or
hospitalization or psychotic features. Hypomania is similar but not severe enough
to cause marked impairment or require
,5 — Lithium monitoring
Which monitoring is most important when a patient starts lithium?
A. Serum lithium level, renal function (creatinine), and thyroid function tests.
B. Only CBC every month.
C. No monitoring required for lithium.
D. Immediate MRI brain.
Answer: A — Lithium level, renal function, thyroid tests.
Big rationale: Lithium has a narrow therapeutic index and can cause
nephrotoxicity and hypothyroidism. Monitor serum lithium levels periodically,
baseline and periodic renal function and TSH. Frequency of monitoring follows
local guidelines and clinical status. (NICE and other guidelines provide monitoring
recommendations.) (NICE)
1 — Diagnostic criteria (MDD)
A 45-year-old reports 3 weeks of depressed mood, anhedonia, insomnia, fatigue,
feelings of worthlessness, and difficulty concentrating. She denies suicidal
ideation. According to DSM-5, which is TRUE?
Answer: A — She meets criteria for MDD.
Big rationale: 5 requires ≥5 symptoms during the same 2-week
, over 3 weeks → meets MDD criteria. Suicidality is not required. (See DSM
summaries). (MDCalc)
2 — Suicide risk management
A patient tells you “I’ve been thinking about ending my life lately” and describes a
plan but no access to a firearm. What is the next best action?
A. Say you’re sorry and book follow-up in 2 weeks.
B. Ask about intent, plan, means, timeframe, and past attempts; do safety planning
and consider urgent referral/hospitalization if high risk. C. Offer an
antidepressant and discharge with family support.
D. Assure them it will pass and no further action is needed.
Answer: B — Ask detailed risk questions and act accordingly.
Big rationale: Disclosure of suicidal thoughts requires direct assessment for
intent, specificity of plan, available means, timeframe, prior attempts, and
protective factors. High acute risk → immediate safety measures (removing
means, close supervision, emergency referral/hospitalization). Safety planning
and documentation are essential; passive reassurance or delayed follow-up is
unsafe. (American Psychiatric Association)
6 — Antipsychotic metabolic monitoring
A patient starts an atypical antipsychotic. Which baseline and follow-up monitoring
is recommended?
Review & Clinical Practice Questions University of Alabama
is an advanced foundational course designed to prepare Psychiatric-Mental Health
Nurse Practitioner students to evaluate and manage psychiatric needs across the
lifespan. The curriculum introduces vital competencies in psychiatric clinical
assessments, evidence-based psychopharmacology, differential diagnosis
development, and therapeutic communication strategies. Mastering these core
principles prepares advanced practice nursing candidates to deliver
comprehensive clinical interventions and safely guide mental health care delivery.
3 — Antidepressant selection
Which agent is generally considered first-line for moderate to severe major
depressive disorder due to favorable tolerability and evidence base?
A. Imipramine (TCA)
B. Fluoxetine (SSRI)
C. Phenelzine (MAOI)
D. Lithium
Answer: B — Fluoxetine (SSRI).
Big rationale: SSRIs are commonly first-line for MDD given favorable sideeffect
profile and robust evidence. Older agents (TCAs, MAOIs) are effective but have
more adverse effects and greater safety concerns (overdose, interactions) and
,are generally reserved for treatmentresistant or specific indications. Lithium is a
mood stabilizer used in bipolar disorder and as augmentation in depression
sometimes, but not primary first-line monotherapy for unipolar MDD in general
practice. Consult APA guideline for treatment choices. (American Psychological
Association)
4 — Bipolar diagnosis
A patient has a 10-day period of persistently elevated mood and increased goal-
directed activity with significantly decreased need for sleep, grandiosity, and
pressured speech, requiring hospitalization for risky behavior. This episode best
meets criteria for:
A. Hypomanic episode
B. Manic episode (Bipolar I)
C. Cyclothymic disorder
D. Unipolar depression
Answer: B — Manic episode (Bipolar I).
Big rationale: Mania is characterized by ≥1 week of abnormally elevated/irritable
mood and increased energy plus marked impairment in functioning or
hospitalization or psychotic features. Hypomania is similar but not severe enough
to cause marked impairment or require
,5 — Lithium monitoring
Which monitoring is most important when a patient starts lithium?
A. Serum lithium level, renal function (creatinine), and thyroid function tests.
B. Only CBC every month.
C. No monitoring required for lithium.
D. Immediate MRI brain.
Answer: A — Lithium level, renal function, thyroid tests.
Big rationale: Lithium has a narrow therapeutic index and can cause
nephrotoxicity and hypothyroidism. Monitor serum lithium levels periodically,
baseline and periodic renal function and TSH. Frequency of monitoring follows
local guidelines and clinical status. (NICE and other guidelines provide monitoring
recommendations.) (NICE)
1 — Diagnostic criteria (MDD)
A 45-year-old reports 3 weeks of depressed mood, anhedonia, insomnia, fatigue,
feelings of worthlessness, and difficulty concentrating. She denies suicidal
ideation. According to DSM-5, which is TRUE?
Answer: A — She meets criteria for MDD.
Big rationale: 5 requires ≥5 symptoms during the same 2-week
, over 3 weeks → meets MDD criteria. Suicidality is not required. (See DSM
summaries). (MDCalc)
2 — Suicide risk management
A patient tells you “I’ve been thinking about ending my life lately” and describes a
plan but no access to a firearm. What is the next best action?
A. Say you’re sorry and book follow-up in 2 weeks.
B. Ask about intent, plan, means, timeframe, and past attempts; do safety planning
and consider urgent referral/hospitalization if high risk. C. Offer an
antidepressant and discharge with family support.
D. Assure them it will pass and no further action is needed.
Answer: B — Ask detailed risk questions and act accordingly.
Big rationale: Disclosure of suicidal thoughts requires direct assessment for
intent, specificity of plan, available means, timeframe, prior attempts, and
protective factors. High acute risk → immediate safety measures (removing
means, close supervision, emergency referral/hospitalization). Safety planning
and documentation are essential; passive reassurance or delayed follow-up is
unsafe. (American Psychiatric Association)
6 — Antipsychotic metabolic monitoring
A patient starts an atypical antipsychotic. Which baseline and follow-up monitoring
is recommended?
