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NURS 663 — PSYCHIATRIC MENTAL HEALTH DIAGNOSIS
AND MANAGEMENT II — PRACTICE EXAM 2026/2027
COMPLETE (100) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
PSYCHIATRIC
Prepare for the NURS 663 Exam – Maryville University with a focused study resource
designed to reinforce advanced psychiatric mental health diagnosis and management
concepts. It supports review of mental health disorders across the lifespan,
psychiatric assessment, diagnostic criteria, psychopharmacology, psychotherapy,
treatment planning, and clinical management strategies. Use the practice material to
strengthen clinical reasoning, apply psychiatric concepts to patient scenarios, and
identify areas that may require additional review before the exam. This resource is
best suited for Maryville University NURS 663 students, PMHNP learners, and graduate
nursing students preparing for Psychiatric Mental Health Diagnosis and Management
II assessments.
MULTIPLE CHOICE.
SECTION 1: MOOD DISORDERS — BIPOLAR DISORDER (Questions 1–15)
Question 1:
A 16-year-old patient presents with a history of at least one manic episode
lasting at least 7 days. Which of the following is a required criterion for the
diagnosis of Bipolar I Disorder?
A) Depressed mood most of the day, nearly every day
B) At least one lifetime manic episode
C) Hypomanic episodes lasting at least 4 days
D) Psychotic features must be present
Answer: B) At least one lifetime manic episode
Rationale: The diagnostic criteria for Bipolar I Disorder require at least
one lifetime manic episode. A manic episode is defined as a distinct
period of abnormally and persistently elevated, expansive, or irritable
mood and abnormally and persistently increased goal-directed activity or
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energy, lasting at least 1 week and present most of the day, nearly every
day.
Question 2:
A 14-year-old patient with Bipolar I Disorder is experiencing acute mania.
Which of the following medications is FDA-approved for acute mania in
adolescents aged 13 and older?
A) Lamotrigine
B) Olanzapine
C) Lithium
D) Quetiapine
Answer: C) Lithium
Rationale: Lithium is FDA-approved for acute mania in adolescents aged
13 and older. Quetiapine is approved for acute mania but with age
restrictions; aripiprazole, risperidone, and olanzapine are approved for
ages 13 and older for acute mania. However, lithium is the classic mood
stabilizer with established efficacy.
Question 3:
Which of the following is a classic mood stabilizer with anti-manic,
antidepressant, and anti-suicidal properties?
A) Lamotrigine
B) Valproic acid (Depakote)
C) Lithium
D) Carbamazepine (Tegretol)
Answer: C) Lithium
Rationale: Lithium is a classic mood stabilizer that has anti-manic,
antidepressant, and anti-suicidal properties. It is the gold standard for
bipolar disorder and has been shown to reduce suicide risk in patients
with mood disorders.
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Question 4:
A 15-year-old female with Bipolar I Disorder is being started on valproic acid
(Depakote). Which of the following is a significant concern when prescribing
valproic acid to adolescent females?
A) Weight loss
B) Polycystic ovarian syndrome (PCOS) and pregnancy risks
C) Hypertension
D) Hyperthyroidism
Answer: B) Polycystic ovarian syndrome (PCOS) and pregnancy risks
Rationale: Valproic acid (Depakote) should be avoided in females of
childbearing age when possible due to the risk of PCOS and teratogenic
effects during pregnancy. It is associated with an increased risk of neural
tube defects and other congenital abnormalities.
Question 5:
A 17-year-old patient with Bipolar I Disorder presents with depressive
symptoms. Which of the following medications is FDA-approved for bipolar
depression in adolescents aged 13 and older?
A) Sertraline
B) Fluoxetine
C) Lurasidone
D) Bupropion
Answer: C) Lurasidone
Rationale: Lurasidone is FDA-approved for bipolar depression in patients
aged 13 and older. Olanzapine-fluoxetine combination (Symbyax) is also
approved for bipolar depression in patients aged 10 and older.
Antidepressants are generally not used as monotherapy in bipolar
disorder due to the risk of inducing mania.
Question 6:
A 16-year-old patient is started on lithium for Bipolar I Disorder. Which of the
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following laboratory tests should be monitored at baseline and periodically
during treatment?
A) Serum lithium level, sodium, calcium, phosphorus, EKG, creatinine,
urinalysis, CBC, and TSH
B) Serum lithium level and CBC only
C) Serum lithium level and liver function tests only
D) Serum lithium level and thyroid function tests only
Answer: A) Serum lithium level, sodium, calcium, phosphorus, EKG,
creatinine, urinalysis, CBC, and TSH
Rationale: Lithium monitoring requires a comprehensive set of baseline
and periodic laboratory tests: lithium level, sodium, calcium,
phosphorus, EKG, creatinine, urinalysis, CBC, and TSH. Lithium affects
renal function, thyroid function, and cardiac conduction, and can cause
electrolyte imbalances.
Question 7:
A 14-year-old patient on lithium therapy presents with sudden onset of
tremors, nausea, vomiting, diarrhea, muscle weakness, and slurred speech.
Which of the following is the most likely diagnosis?
A) Lithium toxicity
B) Serotonin syndrome
C) Neuroleptic malignant syndrome
D) Hypothyroidism
Answer: A) Lithium toxicity
Rationale: The symptoms described—sudden onset tremors, nausea,
vomiting, diarrhea, muscle weakness, slurred speech, confusion, and
seizures—are classic signs of lithium toxicity. Patients may feel "slowed
down" and "really out of it". Lithium toxicity is a medical emergency
requiring immediate intervention.
NURS 663 — PSYCHIATRIC MENTAL HEALTH DIAGNOSIS
AND MANAGEMENT II — PRACTICE EXAM 2026/2027
COMPLETE (100) CURRENT TESTING QUESTIONS AND
CORRECT ANSWERS WITH DETAILED RATIONALES.
PSYCHIATRIC
Prepare for the NURS 663 Exam – Maryville University with a focused study resource
designed to reinforce advanced psychiatric mental health diagnosis and management
concepts. It supports review of mental health disorders across the lifespan,
psychiatric assessment, diagnostic criteria, psychopharmacology, psychotherapy,
treatment planning, and clinical management strategies. Use the practice material to
strengthen clinical reasoning, apply psychiatric concepts to patient scenarios, and
identify areas that may require additional review before the exam. This resource is
best suited for Maryville University NURS 663 students, PMHNP learners, and graduate
nursing students preparing for Psychiatric Mental Health Diagnosis and Management
II assessments.
MULTIPLE CHOICE.
SECTION 1: MOOD DISORDERS — BIPOLAR DISORDER (Questions 1–15)
Question 1:
A 16-year-old patient presents with a history of at least one manic episode
lasting at least 7 days. Which of the following is a required criterion for the
diagnosis of Bipolar I Disorder?
A) Depressed mood most of the day, nearly every day
B) At least one lifetime manic episode
C) Hypomanic episodes lasting at least 4 days
D) Psychotic features must be present
Answer: B) At least one lifetime manic episode
Rationale: The diagnostic criteria for Bipolar I Disorder require at least
one lifetime manic episode. A manic episode is defined as a distinct
period of abnormally and persistently elevated, expansive, or irritable
mood and abnormally and persistently increased goal-directed activity or
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energy, lasting at least 1 week and present most of the day, nearly every
day.
Question 2:
A 14-year-old patient with Bipolar I Disorder is experiencing acute mania.
Which of the following medications is FDA-approved for acute mania in
adolescents aged 13 and older?
A) Lamotrigine
B) Olanzapine
C) Lithium
D) Quetiapine
Answer: C) Lithium
Rationale: Lithium is FDA-approved for acute mania in adolescents aged
13 and older. Quetiapine is approved for acute mania but with age
restrictions; aripiprazole, risperidone, and olanzapine are approved for
ages 13 and older for acute mania. However, lithium is the classic mood
stabilizer with established efficacy.
Question 3:
Which of the following is a classic mood stabilizer with anti-manic,
antidepressant, and anti-suicidal properties?
A) Lamotrigine
B) Valproic acid (Depakote)
C) Lithium
D) Carbamazepine (Tegretol)
Answer: C) Lithium
Rationale: Lithium is a classic mood stabilizer that has anti-manic,
antidepressant, and anti-suicidal properties. It is the gold standard for
bipolar disorder and has been shown to reduce suicide risk in patients
with mood disorders.
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Question 4:
A 15-year-old female with Bipolar I Disorder is being started on valproic acid
(Depakote). Which of the following is a significant concern when prescribing
valproic acid to adolescent females?
A) Weight loss
B) Polycystic ovarian syndrome (PCOS) and pregnancy risks
C) Hypertension
D) Hyperthyroidism
Answer: B) Polycystic ovarian syndrome (PCOS) and pregnancy risks
Rationale: Valproic acid (Depakote) should be avoided in females of
childbearing age when possible due to the risk of PCOS and teratogenic
effects during pregnancy. It is associated with an increased risk of neural
tube defects and other congenital abnormalities.
Question 5:
A 17-year-old patient with Bipolar I Disorder presents with depressive
symptoms. Which of the following medications is FDA-approved for bipolar
depression in adolescents aged 13 and older?
A) Sertraline
B) Fluoxetine
C) Lurasidone
D) Bupropion
Answer: C) Lurasidone
Rationale: Lurasidone is FDA-approved for bipolar depression in patients
aged 13 and older. Olanzapine-fluoxetine combination (Symbyax) is also
approved for bipolar depression in patients aged 10 and older.
Antidepressants are generally not used as monotherapy in bipolar
disorder due to the risk of inducing mania.
Question 6:
A 16-year-old patient is started on lithium for Bipolar I Disorder. Which of the
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following laboratory tests should be monitored at baseline and periodically
during treatment?
A) Serum lithium level, sodium, calcium, phosphorus, EKG, creatinine,
urinalysis, CBC, and TSH
B) Serum lithium level and CBC only
C) Serum lithium level and liver function tests only
D) Serum lithium level and thyroid function tests only
Answer: A) Serum lithium level, sodium, calcium, phosphorus, EKG,
creatinine, urinalysis, CBC, and TSH
Rationale: Lithium monitoring requires a comprehensive set of baseline
and periodic laboratory tests: lithium level, sodium, calcium,
phosphorus, EKG, creatinine, urinalysis, CBC, and TSH. Lithium affects
renal function, thyroid function, and cardiac conduction, and can cause
electrolyte imbalances.
Question 7:
A 14-year-old patient on lithium therapy presents with sudden onset of
tremors, nausea, vomiting, diarrhea, muscle weakness, and slurred speech.
Which of the following is the most likely diagnosis?
A) Lithium toxicity
B) Serotonin syndrome
C) Neuroleptic malignant syndrome
D) Hypothyroidism
Answer: A) Lithium toxicity
Rationale: The symptoms described—sudden onset tremors, nausea,
vomiting, diarrhea, muscle weakness, slurred speech, confusion, and
seizures—are classic signs of lithium toxicity. Patients may feel "slowed
down" and "really out of it". Lithium toxicity is a medical emergency
requiring immediate intervention.
