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PMHNP PSYCHOPATHOLOGICAL DISORDERS AND
PSYCHOTHERAPY Professional Practice Exam – Questions with
Detailed Rationales
Format: Multiple Choice
Content Areas: Mood Disorders, Anxiety Disorders, Psychotic
Disorders, Substance Use, Neurodevelopmental/Cognitive
Disorders, Personality Disorders, Psychotherapy Modalities,
Psychopharmacology, Ethics/Legal, Special Populations
SECTION 1: MOOD DISORDERS
Question 1
A 35-year-old woman presents with a 2-week history of
depressed mood, anhedonia, fatigue, insomnia, and poor
concentration. She reports feeling worthless and has passive
suicidal ideation. Which of the following is the most appropriate
first-line pharmacologic treatment?
A. Bupropion
B. Sertraline
C. Amitriptyline
D. Phenelzine
E. Lithium
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Answer: B
Rationale: SSRIs such as sertraline are first-line for major
depressive disorder due to efficacy, safety, and tolerability.
Bupropion is also first-line but may worsen insomnia in some;
amitriptyline is a TCA with more side effects; phenelzine is an
MAOI reserved for refractory cases; lithium is for bipolar
disorder.
Question 2
A patient with major depressive disorder has not responded to
two different SSRIs at adequate doses and duration. Which of
the following is the most appropriate next step?
A. Add a benzodiazepine
B. Switch to an SNRI or augment with an atypical antipsychotic
C. Discontinue all medications
D. Start lithium
E. Refer for ECT immediately
Answer: B
Rationale: For treatment-resistant depression, switching to an
SNRI or augmenting with an atypical antipsychotic (e.g.,
aripiprazole, quetiapine) is evidence-based. Benzodiazepines
are not first-line for depression; lithium augmentation can be
used but atypical antipsychotic augmentation is more common;
ECT is reserved for severe/refractory cases.
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Question 3
Which of the following is a common side effect of SSRIs that
often leads to sexual dysfunction?
A. Priapism
B. Delayed ejaculation and decreased libido
C. Premature ejaculation
D. Increased libido
E. Vaginal dryness only
Answer: B
Rationale: SSRIs commonly cause sexual dysfunction including
delayed ejaculation, decreased libido, and anorgasmia.
Bupropion is often added or substituted to mitigate this.
Question 4
A 28-year-old man presents with episodes of elevated mood,
decreased need for sleep, grandiosity, and increased goal-
directed activity lasting 5 days. He does not have psychotic
features and is not hospitalized. What is the most likely
diagnosis?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
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D. Major depressive disorder
E. Hypomanic episode
Answer: E
Rationale: A hypomanic episode lasts at least 4 days, causes a
noticeable change in functioning, but does not cause severe
impairment or require hospitalization, and no psychotic
features. If it meets criteria for mania (≥7 days, severe), it would
be Bipolar I.
Question 5
Which medication is FDA-approved for maintenance treatment
of bipolar disorder and has strong evidence for reducing suicide
risk?
A. Valproate
B. Lamotrigine
C. Lithium
D. Quetiapine
E. Olanzapine
Answer: C
Rationale: Lithium is the gold standard for maintenance in
bipolar disorder and has unique anti-suicide properties.
Valproate and lamotrigine are also used but lithium is preferred
for suicide prevention.
PMHNP PSYCHOPATHOLOGICAL DISORDERS AND
PSYCHOTHERAPY Professional Practice Exam – Questions with
Detailed Rationales
Format: Multiple Choice
Content Areas: Mood Disorders, Anxiety Disorders, Psychotic
Disorders, Substance Use, Neurodevelopmental/Cognitive
Disorders, Personality Disorders, Psychotherapy Modalities,
Psychopharmacology, Ethics/Legal, Special Populations
SECTION 1: MOOD DISORDERS
Question 1
A 35-year-old woman presents with a 2-week history of
depressed mood, anhedonia, fatigue, insomnia, and poor
concentration. She reports feeling worthless and has passive
suicidal ideation. Which of the following is the most appropriate
first-line pharmacologic treatment?
A. Bupropion
B. Sertraline
C. Amitriptyline
D. Phenelzine
E. Lithium
, Page |2
Answer: B
Rationale: SSRIs such as sertraline are first-line for major
depressive disorder due to efficacy, safety, and tolerability.
Bupropion is also first-line but may worsen insomnia in some;
amitriptyline is a TCA with more side effects; phenelzine is an
MAOI reserved for refractory cases; lithium is for bipolar
disorder.
Question 2
A patient with major depressive disorder has not responded to
two different SSRIs at adequate doses and duration. Which of
the following is the most appropriate next step?
A. Add a benzodiazepine
B. Switch to an SNRI or augment with an atypical antipsychotic
C. Discontinue all medications
D. Start lithium
E. Refer for ECT immediately
Answer: B
Rationale: For treatment-resistant depression, switching to an
SNRI or augmenting with an atypical antipsychotic (e.g.,
aripiprazole, quetiapine) is evidence-based. Benzodiazepines
are not first-line for depression; lithium augmentation can be
used but atypical antipsychotic augmentation is more common;
ECT is reserved for severe/refractory cases.
, Page |3
Question 3
Which of the following is a common side effect of SSRIs that
often leads to sexual dysfunction?
A. Priapism
B. Delayed ejaculation and decreased libido
C. Premature ejaculation
D. Increased libido
E. Vaginal dryness only
Answer: B
Rationale: SSRIs commonly cause sexual dysfunction including
delayed ejaculation, decreased libido, and anorgasmia.
Bupropion is often added or substituted to mitigate this.
Question 4
A 28-year-old man presents with episodes of elevated mood,
decreased need for sleep, grandiosity, and increased goal-
directed activity lasting 5 days. He does not have psychotic
features and is not hospitalized. What is the most likely
diagnosis?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymic disorder
, Page |4
D. Major depressive disorder
E. Hypomanic episode
Answer: E
Rationale: A hypomanic episode lasts at least 4 days, causes a
noticeable change in functioning, but does not cause severe
impairment or require hospitalization, and no psychotic
features. If it meets criteria for mania (≥7 days, severe), it would
be Bipolar I.
Question 5
Which medication is FDA-approved for maintenance treatment
of bipolar disorder and has strong evidence for reducing suicide
risk?
A. Valproate
B. Lamotrigine
C. Lithium
D. Quetiapine
E. Olanzapine
Answer: C
Rationale: Lithium is the gold standard for maintenance in
bipolar disorder and has unique anti-suicide properties.
Valproate and lamotrigine are also used but lithium is preferred
for suicide prevention.
