Barkley PMHNP CHaPter 9 Quiz:
CoMPreHeNsive review of PsyCHiatriC-
MeNtal HealtH assessMeNt, DiagNosis,
aND treatMeNt PlaNNiNg aCross tHe
lifesPaN a well DetaileD oNe 2025 /
2026 writteN aND graDeD a+ uPgraDeD
Question 1
A 45-year-old male with major depressive disorder has failed trials of fluoxetine, sertraline, and
venlafaxine. He reports increased appetite, hypersomnia, and extreme fatigue. Which
medication would be most appropriate as an adjunctive treatment?
A) Bupropion
B) Mirtazapine
C) Aripiprazole
D) Lithium
Correct Answer: C) Aripiprazole
Rationale: This patient exhibits atypical features of depression (increased appetite,
hypersomnia, fatigue). Aripiprazole is FDA-approved as an adjunctive treatment for major
depressive disorder and is particularly useful in treatment-resistant cases. Bupropion is more
activating and may worsen anxiety; mirtazapine is associated with weight gain and sedation;
lithium is not typically used as a first-line adjunctive for depression without bipolar features.
Question 2
,Which neurotransmitter is most closely associated with the regulation of mood, appetite, and
sleep, and is often targeted in the treatment of depression?
A) Dopamine
B) GABA
C) Serotonin
D) Acetylcholine
Correct Answer: C) Serotonin
Rationale: Serotonin plays a key role in mood regulation, appetite, and sleep. SSRIs increase
serotonin availability, alleviating depressive symptoms. Dopamine relates more to reward and
motivation, GABA to inhibition, and acetylcholine to cognition.
Question 3
A patient with major depressive disorder is started on an SSRI. Which early side effect should
the PMHNP educate the patient about?
A) Weight gain
B) Sexual dysfunction
C) Hypertension
D) Urinary retention
Correct Answer: B) Sexual dysfunction
Rationale: Sexual dysfunction is a common SSRI side effect, often emerging early in therapy.
Weight gain typically develops later, hypertension is unusual, and urinary retention is more
typical of anticholinergic drugs.
Question 4
Which finding is most consistent with bipolar I disorder?
A) Hypomanic episodes without psychosis
B) Major depressive episodes only
C) Mania with functional impairment
D) Cyclothymic mood variation
Correct Answer: C) Mania with functional impairment
Rationale: Bipolar I disorder requires at least one manic episode causing marked impairment.
,Hypomania defines bipolar II, pure depression is MDD, and chronic mood fluctuation signifies
cyclothymia.
Question 5
When prescribing lithium for a new patient, what baseline lab tests should be obtained?
A) CBC, liver panel, and lipid profile
B) TSH, renal function, and electrolyte panel
C) Blood glucose, ECG, and vitamin D
D) Urinalysis and C-reactive protein
Correct Answer: B) TSH, renal function, and electrolyte panel
Rationale: Lithium affects renal and thyroid function. Baseline kidney and thyroid studies ensure
safe initiation. CBC or liver tests are important for other medications like valproate.
Question 6
A 45-year-old patient on lithium develops tremors and nausea. The serum level is 1.8 mEq/L.
What is the appropriate next step?
A) Continue lithium at the same dose
B) Add propranolol to control tremors
C) Hold lithium and monitor hydration status
D) Decrease lithium by 50%
Correct Answer: C) Hold lithium and monitor hydration status
Rationale: A level of 1.8 mEq/L is in the toxic range. The drug should be held, and hydration
maintained to promote excretion. Once the patient stabilizes, a lower dose may be restarted.
Question 7
Which antipsychotic has the greatest risk of metabolic side effects, including significant weight
gain?
A) Aripiprazole
B) Olanzapine
C) Ziprasidone
D) Lurasidone
, Correct Answer: B) Olanzapine
Rationale: Olanzapine is associated with the highest risk of metabolic side effects, including
significant weight gain, dyslipidemia, and hyperglycemia. Aripiprazole, ziprasidone, and
lurasidone have lower metabolic risk profiles.
Question 8
A patient with schizophrenia reports hearing voices commanding them to harm themselves.
What is the highest-priority intervention?
A) Increase antipsychotic dose
B) Initiate safety assessment and protective measures
C) Encourage journaling of thoughts
D) Schedule group therapy
Correct Answer: B) Initiate safety assessment and protective measures
Rationale: Safety always comes first. Command hallucinations to self-harm indicate imminent
risk requiring immediate assessment and protective interventions.
Question 9
Which neurotransmitter is primarily associated with positive symptoms of schizophrenia?
A) Serotonin
B) Dopamine
C) GABA
D) Acetylcholine
Correct Answer: B) Dopamine
Rationale: Hyperactivity of dopaminergic pathways, particularly the mesolimbic pathway, is
associated with positive psychotic symptoms like hallucinations and delusions.
Question 10
Which of the following are key symptoms of mania? (Select all that apply)
A) Elevated mood
B) Decreased need for sleep
C) Psychomotor retardation
CoMPreHeNsive review of PsyCHiatriC-
MeNtal HealtH assessMeNt, DiagNosis,
aND treatMeNt PlaNNiNg aCross tHe
lifesPaN a well DetaileD oNe 2025 /
2026 writteN aND graDeD a+ uPgraDeD
Question 1
A 45-year-old male with major depressive disorder has failed trials of fluoxetine, sertraline, and
venlafaxine. He reports increased appetite, hypersomnia, and extreme fatigue. Which
medication would be most appropriate as an adjunctive treatment?
A) Bupropion
B) Mirtazapine
C) Aripiprazole
D) Lithium
Correct Answer: C) Aripiprazole
Rationale: This patient exhibits atypical features of depression (increased appetite,
hypersomnia, fatigue). Aripiprazole is FDA-approved as an adjunctive treatment for major
depressive disorder and is particularly useful in treatment-resistant cases. Bupropion is more
activating and may worsen anxiety; mirtazapine is associated with weight gain and sedation;
lithium is not typically used as a first-line adjunctive for depression without bipolar features.
Question 2
,Which neurotransmitter is most closely associated with the regulation of mood, appetite, and
sleep, and is often targeted in the treatment of depression?
A) Dopamine
B) GABA
C) Serotonin
D) Acetylcholine
Correct Answer: C) Serotonin
Rationale: Serotonin plays a key role in mood regulation, appetite, and sleep. SSRIs increase
serotonin availability, alleviating depressive symptoms. Dopamine relates more to reward and
motivation, GABA to inhibition, and acetylcholine to cognition.
Question 3
A patient with major depressive disorder is started on an SSRI. Which early side effect should
the PMHNP educate the patient about?
A) Weight gain
B) Sexual dysfunction
C) Hypertension
D) Urinary retention
Correct Answer: B) Sexual dysfunction
Rationale: Sexual dysfunction is a common SSRI side effect, often emerging early in therapy.
Weight gain typically develops later, hypertension is unusual, and urinary retention is more
typical of anticholinergic drugs.
Question 4
Which finding is most consistent with bipolar I disorder?
A) Hypomanic episodes without psychosis
B) Major depressive episodes only
C) Mania with functional impairment
D) Cyclothymic mood variation
Correct Answer: C) Mania with functional impairment
Rationale: Bipolar I disorder requires at least one manic episode causing marked impairment.
,Hypomania defines bipolar II, pure depression is MDD, and chronic mood fluctuation signifies
cyclothymia.
Question 5
When prescribing lithium for a new patient, what baseline lab tests should be obtained?
A) CBC, liver panel, and lipid profile
B) TSH, renal function, and electrolyte panel
C) Blood glucose, ECG, and vitamin D
D) Urinalysis and C-reactive protein
Correct Answer: B) TSH, renal function, and electrolyte panel
Rationale: Lithium affects renal and thyroid function. Baseline kidney and thyroid studies ensure
safe initiation. CBC or liver tests are important for other medications like valproate.
Question 6
A 45-year-old patient on lithium develops tremors and nausea. The serum level is 1.8 mEq/L.
What is the appropriate next step?
A) Continue lithium at the same dose
B) Add propranolol to control tremors
C) Hold lithium and monitor hydration status
D) Decrease lithium by 50%
Correct Answer: C) Hold lithium and monitor hydration status
Rationale: A level of 1.8 mEq/L is in the toxic range. The drug should be held, and hydration
maintained to promote excretion. Once the patient stabilizes, a lower dose may be restarted.
Question 7
Which antipsychotic has the greatest risk of metabolic side effects, including significant weight
gain?
A) Aripiprazole
B) Olanzapine
C) Ziprasidone
D) Lurasidone
, Correct Answer: B) Olanzapine
Rationale: Olanzapine is associated with the highest risk of metabolic side effects, including
significant weight gain, dyslipidemia, and hyperglycemia. Aripiprazole, ziprasidone, and
lurasidone have lower metabolic risk profiles.
Question 8
A patient with schizophrenia reports hearing voices commanding them to harm themselves.
What is the highest-priority intervention?
A) Increase antipsychotic dose
B) Initiate safety assessment and protective measures
C) Encourage journaling of thoughts
D) Schedule group therapy
Correct Answer: B) Initiate safety assessment and protective measures
Rationale: Safety always comes first. Command hallucinations to self-harm indicate imminent
risk requiring immediate assessment and protective interventions.
Question 9
Which neurotransmitter is primarily associated with positive symptoms of schizophrenia?
A) Serotonin
B) Dopamine
C) GABA
D) Acetylcholine
Correct Answer: B) Dopamine
Rationale: Hyperactivity of dopaminergic pathways, particularly the mesolimbic pathway, is
associated with positive psychotic symptoms like hallucinations and delusions.
Question 10
Which of the following are key symptoms of mania? (Select all that apply)
A) Elevated mood
B) Decreased need for sleep
C) Psychomotor retardation
