**Psychiatric-Mental Health Nurse
Practitioner (PMHNP) Certification Intensive**
1. Pt w/ bipolar I disorder, currently manic, not sleeping, grandiose, irritable. Which medication first-line
for acute mania?
💫RATIONALE✔️✔️: Lithium or valproate for acute mania. Atypical antipsychotics (quetiapine,
risperidone) also first-line.
💫ANSWER✔️✔️: B. Valproate.
2. Pt w/ major depression, failed 2 SSRIs and 1 SNRI at adequate doses. Which next step?
💫RATIONALE✔️✔️: Treatment-resistant depression: augment with aripiprazole or switch to
MAOI/ketamine/ECT.
💫ANSWER✔️✔️: C. Add aripiprazole.
3. Pt w/ generalized anxiety disorder, GAD-7 score 15, on escitalopram 20 mg x 8 weeks, partial
response. Next?
💫RATIONALE✔️✔️: Augment with buspirone or gabapentin. Switch to duloxetine or venlafaxine also
option.
💫ANSWER✔️✔️: A. Add buspirone.
4. Pt w/ schizophrenia, stable on paliperidone palmitate 117 mg IM monthly. Reports amenorrhea and
galactorrhea. Likely cause?
💫RATIONALE✔️✔️: Hyperprolactinemia from D2 blockade. Switch to aripiprazole (partial agonist)
reduces prolactin.
💫ANSWER✔️✔️: C. Hyperprolactinemia.
5. Pt w/ PTSD, recurrent nightmares and hypervigilance. Which medication reduces nightmares?
, 💫RATIONALE✔️✔️: Prazosin (alpha-1 blocker) 1-15 mg at bedtime reduces trauma-related nightmares.
💫ANSWER✔️✔️: D. Prazosin.
6. Pt w/ OCD, Yale-Brown score 28, on fluvoxamine 300 mg daily x 12 weeks, minimal improvement.
Next?
💫RATIONALE✔️✔️: Augment with risperidone or aripiprazole. Switch to clomipramine or CBT with ERP.
💫ANSWER✔️✔️: B. Add risperidone.
7. Adolescent w/ major depression, PHQ-9 19, active suicidal ideation. Which first-line medication?
💫RATIONALE✔️✔️: Fluoxetine approved for pediatric depression. Start 10 mg daily, monitor for
suicidality.
💫ANSWER✔️✔️: A. Fluoxetine.
8. Pt w/ panic disorder, agoraphobia, unable to leave home. Which medication and therapy gold
standard?
💫RATIONALE✔️✔️: SSRI (sertraline) + CBT (exposure therapy). Benzodiazepines second-line.
💫ANSWER✔️✔️: C. Sertraline and CBT.
9. Pt w/ borderline personality disorder, recurrent self-harm, emotional dysregulation. Which therapy
first-line?
💫RATIONALE✔️✔️: Dialectical behavior therapy (DBT) specifically for BPD. Skills training + individual
therapy.
💫ANSWER✔️✔️: D. DBT.
10. Pt w/ alcohol use disorder, drinking 10 drinks/day, last drink 6 hr ago, CIWA-Ar 12. Which medication
for withdrawal?
💫RATIONALE✔️✔️: Symptom-triggered lorazepam or chlordiazepoxide. Also thiamine 100 mg IV/IM.
💫ANSWER✔️✔️: A. Lorazepam.
11. Pt w/ bipolar II depression, currently hypomanic? No, depressed. Which medication first-line?
Practitioner (PMHNP) Certification Intensive**
1. Pt w/ bipolar I disorder, currently manic, not sleeping, grandiose, irritable. Which medication first-line
for acute mania?
💫RATIONALE✔️✔️: Lithium or valproate for acute mania. Atypical antipsychotics (quetiapine,
risperidone) also first-line.
💫ANSWER✔️✔️: B. Valproate.
2. Pt w/ major depression, failed 2 SSRIs and 1 SNRI at adequate doses. Which next step?
💫RATIONALE✔️✔️: Treatment-resistant depression: augment with aripiprazole or switch to
MAOI/ketamine/ECT.
💫ANSWER✔️✔️: C. Add aripiprazole.
3. Pt w/ generalized anxiety disorder, GAD-7 score 15, on escitalopram 20 mg x 8 weeks, partial
response. Next?
💫RATIONALE✔️✔️: Augment with buspirone or gabapentin. Switch to duloxetine or venlafaxine also
option.
💫ANSWER✔️✔️: A. Add buspirone.
4. Pt w/ schizophrenia, stable on paliperidone palmitate 117 mg IM monthly. Reports amenorrhea and
galactorrhea. Likely cause?
💫RATIONALE✔️✔️: Hyperprolactinemia from D2 blockade. Switch to aripiprazole (partial agonist)
reduces prolactin.
💫ANSWER✔️✔️: C. Hyperprolactinemia.
5. Pt w/ PTSD, recurrent nightmares and hypervigilance. Which medication reduces nightmares?
, 💫RATIONALE✔️✔️: Prazosin (alpha-1 blocker) 1-15 mg at bedtime reduces trauma-related nightmares.
💫ANSWER✔️✔️: D. Prazosin.
6. Pt w/ OCD, Yale-Brown score 28, on fluvoxamine 300 mg daily x 12 weeks, minimal improvement.
Next?
💫RATIONALE✔️✔️: Augment with risperidone or aripiprazole. Switch to clomipramine or CBT with ERP.
💫ANSWER✔️✔️: B. Add risperidone.
7. Adolescent w/ major depression, PHQ-9 19, active suicidal ideation. Which first-line medication?
💫RATIONALE✔️✔️: Fluoxetine approved for pediatric depression. Start 10 mg daily, monitor for
suicidality.
💫ANSWER✔️✔️: A. Fluoxetine.
8. Pt w/ panic disorder, agoraphobia, unable to leave home. Which medication and therapy gold
standard?
💫RATIONALE✔️✔️: SSRI (sertraline) + CBT (exposure therapy). Benzodiazepines second-line.
💫ANSWER✔️✔️: C. Sertraline and CBT.
9. Pt w/ borderline personality disorder, recurrent self-harm, emotional dysregulation. Which therapy
first-line?
💫RATIONALE✔️✔️: Dialectical behavior therapy (DBT) specifically for BPD. Skills training + individual
therapy.
💫ANSWER✔️✔️: D. DBT.
10. Pt w/ alcohol use disorder, drinking 10 drinks/day, last drink 6 hr ago, CIWA-Ar 12. Which medication
for withdrawal?
💫RATIONALE✔️✔️: Symptom-triggered lorazepam or chlordiazepoxide. Also thiamine 100 mg IV/IM.
💫ANSWER✔️✔️: A. Lorazepam.
11. Pt w/ bipolar II depression, currently hypomanic? No, depressed. Which medication first-line?
