PMHNP 7348.01 FINAL EXAM 2026
COMPLETE STUDY GUIDE | PSYCHIATRIC
MENTAL HEALTH NURSE PRACTITIONER
EXAM ONE REVIEW & PRACTICE
QUESTIONS
| GRADED A+ |GUARANTEED SUCCESS
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales Included
,Mood spectrum continuum, or spectrum, of all possible moods that any person may experience
Typical Bipolar vs Rapid Cycling Typical: Depressive and manic episodes last for several months, often with
periods of normal mood between.
Rapid Cycling: When there are 2+ episodes of each mania/depression within a
year (D,M,D,M). Can dramatically switch moods from week to week or day to day.
Substance abuse/medications are often the provoking factor.
rapid cycling bipolar disorder characterized by at least 4 mood episodes
symptoms of mania -Restless activity (goal-directed or psychomotor agitation)
-Decreased need for sleep...enormous surge of energy
-Excitement (elevated, expansive or irritable mood)
-Laughter
-Self-confidence (inflated self-esteem or grandiosity)
-Rambling speech
-Flight of ideas or subjective experience that thoughts are racing
-Loss of inhibitions (excessive involvement in pleasurable activities that have high
potential for painful consequences)
-Distractibility
-Impairments in verbal memory
Symptoms of a mixed episode - Rapidly alternating symptoms of mania and major depression
- impair functioning, hospitalization, and/or psychotic symptoms
- marked irritability
- severe agitation/anxiety
- unrelenting worry or despair
- suicidal ideation
- Decreased need for sleep
- at least one week in duration
Symptoms of Hypomania - Increased levels of energy/mental productivity
- Impulsivity & risk taking
- Person talks excessively (uncharacteristically)
- elated/mildly grandiose
Presenting w/ manic episode (+agitation/psychosis) Treat w/ antimanic agent and antipsychotic (ie Olanzapine, improve behavior
rapidly).
Mood stabilizers typically take 10 days to manifest decreased symptoms.
Alternatively, high potency benzos may be used klonipin/ativan but xanax may
aggravate mania.
,Decision tree for bipolar Manic episode w/ agitation antipsychotic or benzo
Manic episode w/ euphoric mania lithium or divalproex
Manic episode w/ mixed mania divalproex
Manic episode w/ rapid cycling lamotrigine or divalproex
Manic episode w/ agitation antipsychotic or benzo
Manic episode w/ euphoric mania lithium or divalproex
Manic episode w/ mixed mania divalproex
Manic episode w/ rapid cycling lamotrigine or divalproex
Bipolar depressive episode Mood Stabilizer: lamotrigine, lithium, quetiapine or OFC (olanzapine-fluoxetine =
Symbyax)
Lithium: labs - UA
-BUN/Crt (renally eliminated)
-CBC with diff (leukocytosis)
-serum Na (hponatremia)
- Ca
- P Phosphorus
-TSH: (hypothyroidism)
- EKG
Lithium level 0.6-1.2 goal, however 1.2-1.5 often for symptom relief (over 1.5 is toxic)
lithium starting dose 600-900mg daily in divided doses
300mg BID-TID
, Lithium general daily dose 1200-3000mg daily
When stable, titrate to
0.8 mEq/l BPI
0.6 mEq/l BPII
Lithium side effects NVD, hand tremors, sedation, muscle wekaness, polyuria, polydypsia, edema,
weight gain, and include hypothyroidism and nephrogenic diabetes being most
common over the long-term. Serum TSH levels and renal function should be
monitored
lithum toxicity Ataxia, diarrhea, slurred speech, tinnitus, drowsiness, coarse tremor, confusion,
hypotension, seizure, shock, delirium, and coma
Combination with lithium: Mood stabilizing Mood stabilizing anticonvulsants: Divalproex/Valproic acid
anticonvulsants Carbamazepine/Tegretol
Oxcarbazepine/Trileptal
Combination with lithium: Antipsychotic Antipsychotic :
Olanzapine/Zyprexa
Ziprasidone/Geodon
Quetiapine/Seroquel
Aripiprazole/Abilify
COMPLETE STUDY GUIDE | PSYCHIATRIC
MENTAL HEALTH NURSE PRACTITIONER
EXAM ONE REVIEW & PRACTICE
QUESTIONS
| GRADED A+ |GUARANTEED SUCCESS
Updated 2026 Questions and Answers
100% Verified Exam Prep and Comprehensive
Rationales Included
,Mood spectrum continuum, or spectrum, of all possible moods that any person may experience
Typical Bipolar vs Rapid Cycling Typical: Depressive and manic episodes last for several months, often with
periods of normal mood between.
Rapid Cycling: When there are 2+ episodes of each mania/depression within a
year (D,M,D,M). Can dramatically switch moods from week to week or day to day.
Substance abuse/medications are often the provoking factor.
rapid cycling bipolar disorder characterized by at least 4 mood episodes
symptoms of mania -Restless activity (goal-directed or psychomotor agitation)
-Decreased need for sleep...enormous surge of energy
-Excitement (elevated, expansive or irritable mood)
-Laughter
-Self-confidence (inflated self-esteem or grandiosity)
-Rambling speech
-Flight of ideas or subjective experience that thoughts are racing
-Loss of inhibitions (excessive involvement in pleasurable activities that have high
potential for painful consequences)
-Distractibility
-Impairments in verbal memory
Symptoms of a mixed episode - Rapidly alternating symptoms of mania and major depression
- impair functioning, hospitalization, and/or psychotic symptoms
- marked irritability
- severe agitation/anxiety
- unrelenting worry or despair
- suicidal ideation
- Decreased need for sleep
- at least one week in duration
Symptoms of Hypomania - Increased levels of energy/mental productivity
- Impulsivity & risk taking
- Person talks excessively (uncharacteristically)
- elated/mildly grandiose
Presenting w/ manic episode (+agitation/psychosis) Treat w/ antimanic agent and antipsychotic (ie Olanzapine, improve behavior
rapidly).
Mood stabilizers typically take 10 days to manifest decreased symptoms.
Alternatively, high potency benzos may be used klonipin/ativan but xanax may
aggravate mania.
,Decision tree for bipolar Manic episode w/ agitation antipsychotic or benzo
Manic episode w/ euphoric mania lithium or divalproex
Manic episode w/ mixed mania divalproex
Manic episode w/ rapid cycling lamotrigine or divalproex
Manic episode w/ agitation antipsychotic or benzo
Manic episode w/ euphoric mania lithium or divalproex
Manic episode w/ mixed mania divalproex
Manic episode w/ rapid cycling lamotrigine or divalproex
Bipolar depressive episode Mood Stabilizer: lamotrigine, lithium, quetiapine or OFC (olanzapine-fluoxetine =
Symbyax)
Lithium: labs - UA
-BUN/Crt (renally eliminated)
-CBC with diff (leukocytosis)
-serum Na (hponatremia)
- Ca
- P Phosphorus
-TSH: (hypothyroidism)
- EKG
Lithium level 0.6-1.2 goal, however 1.2-1.5 often for symptom relief (over 1.5 is toxic)
lithium starting dose 600-900mg daily in divided doses
300mg BID-TID
, Lithium general daily dose 1200-3000mg daily
When stable, titrate to
0.8 mEq/l BPI
0.6 mEq/l BPII
Lithium side effects NVD, hand tremors, sedation, muscle wekaness, polyuria, polydypsia, edema,
weight gain, and include hypothyroidism and nephrogenic diabetes being most
common over the long-term. Serum TSH levels and renal function should be
monitored
lithum toxicity Ataxia, diarrhea, slurred speech, tinnitus, drowsiness, coarse tremor, confusion,
hypotension, seizure, shock, delirium, and coma
Combination with lithium: Mood stabilizing Mood stabilizing anticonvulsants: Divalproex/Valproic acid
anticonvulsants Carbamazepine/Tegretol
Oxcarbazepine/Trileptal
Combination with lithium: Antipsychotic Antipsychotic :
Olanzapine/Zyprexa
Ziprasidone/Geodon
Quetiapine/Seroquel
Aripiprazole/Abilify
