NR 605 PSYCHIATRIC-MENTAL HEALTH FINAL
EXAM 2026/2027 Diagnosis & Management Across
Lifespan I Questions with Verified Answers and
Rationales
Q1: A 28-year-old patient is brought to the emergency department by family who
report he has been sleeping only 2 hours per night for the past week, spending
$8,000 on electronics he cannot afford, and stating he has "special powers to heal
the world." He was hospitalized 6 months ago for similar behavior. Which
diagnosis is most appropriate?
A. Bipolar II disorder with hypomanic episode
B. Bipolar I disorder with current manic episode
C. Cyclothymic disorder with mood instability
D. Major depressive disorder with psychotic features
Correct Answer: B
Rationale: The patient meets criteria for Bipolar I disorder: manic episode (≥1
week, causing marked impairment, hospitalization required, psychotic features
present) and history of at least one manic episode. Bipolar II requires hypomania
(not full mania) and major depression. The severity, duration, and functional
impairment rule out hypomania.
Q2: A 34-year-old patient reports periods of elevated mood lasting 4-5 days with
increased energy, racing thoughts, and decreased need for sleep, but she continues
working and social functioning without major impairment. She also experiences
major depressive episodes. Which diagnosis fits this presentation?
A. Bipolar I disorder with previous mania
B. Bipolar II disorder
C. Cyclothymic disorder with rapid cycling
D. Borderline personality disorder with mood lability
Correct Answer: B
,Rationale: Bipolar II disorder is characterized by at least one hypomanic episode
(≥4 days, no marked impairment, no psychosis, no hospitalization) and at least one
major depressive episode. This patient’s elevated periods don’t cause significant
functional impairment, distinguishing hypomania from mania.
Q3: A PMHNP is initiating lithium therapy for a patient with Bipolar I disorder.
Which baseline monitoring is required before starting treatment?
A. Pulmonary function tests and chest X-ray
B. Renal function, thyroid function, and ECG
C. Liver function tests and abdominal ultrasound
D. Bone density scan and vitamin D levels
Correct Answer: B
Rationale: Lithium requires baseline and ongoing monitoring of renal function
(creatinine, eGFR), thyroid function (TSH), and ECG (especially if >50 years or
cardiac history) because lithium affects renal concentrating ability, can cause
hypothyroidism, and has cardiac effects. Therapeutic drug monitoring is also
essential.
Q4: A patient with Bipolar I disorder is in a depressive episode. The PMHNP is
considering antidepressant therapy. Which statement reflects best practice
regarding antidepressant use in bipolar depression?
A. Antidepressants are first-line monotherapy for bipolar depression
B. Antidepressants should be avoided due to risk of mania/hypomania/mixed
states
C. Antidepressants are safe when combined with any mood stabilizer
D. Antidepressants are preferred over atypical antipsychotics
Correct Answer: B
Rationale: Antidepressants in bipolar disorder carry significant risk of inducing
mania, hypomania, mixed states, or rapid cycling. First-line treatments for bipolar
depression include mood stabilizers (lithium, lamotrigine) and atypical
antipsychotics (quetiapine, lurasidone, cariprazine). If antidepressants are used,
they should be with caution and mood stabilizer coverage.
,Q5: A patient on valproic acid for bipolar disorder presents with lethargy,
confusion, and easy bruising. Laboratory studies show platelet count of 85,000 and
elevated ammonia. Which adverse effect is occurring?
A. Therapeutic response requiring dose increase
B. Hepatotoxicity and thrombocytopenia requiring immediate evaluation
C. Expected side effects that will resolve spontaneously
D. Drug interaction requiring only monitoring
Correct Answer: B
Rationale: Valproate can cause hepatotoxicity (elevated ammonia, liver enzymes),
thrombocytopenia, and pancreatitis. These are serious adverse effects requiring
immediate evaluation, potential discontinuation, and medical management.
Regular monitoring of LFTs, CBC, and valproate levels is essential.
Q6: A 42-year-old patient reports feeling depressed most of the day, nearly every
day, for the past 3 weeks. She has lost 10 pounds without dieting, has difficulty
sleeping, feels worthless, and has difficulty concentrating. She denies suicidal
ideation. Which diagnosis is most appropriate?
A. Persistent depressive disorder (dysthymia)
B. Major depressive disorder, single episode
C. Adjustment disorder with depressed mood
D. Bipolar II disorder with current depression
Correct Answer: B
Rationale: The patient meets DSM-5 criteria for major depressive episode: ≥5
symptoms (depressed mood, weight loss, insomnia, worthlessness, poor
concentration) present for at least 2 weeks. Persistent depressive disorder requires
symptoms for ≥2 years. Adjustment disorder occurs within 3 months of a stressor.
Q7: A 60-year-old patient with major depressive disorder has failed trials of
sertraline and venlafaxine. The PMHNP is considering switching to an MAOI.
Which dietary restriction is most important to discuss?
, A. Avoid grapefruit juice
B. Avoid tyramine-rich foods (aged cheese, cured meats, fermented products)
C. Avoid high-fat meals
D. Avoid caffeine
Correct Answer: B
Rationale: MAOIs (phenelzine, tranylcypromine) inhibit monoamine oxidase,
leading to tyramine accumulation and hypertensive crisis. Tyramine-rich foods
include aged cheese, cured meats, fermented products, and certain beers.
Grapefruit affects CYP3A4 (not MAOIs).
Q8: A 22-year-old patient with bipolar I disorder presents with rapid cycling (4
episodes in the past year). Which medication is most likely to worsen rapid
cycling?
A. Lithium
B. Lamotrigine
C. Antidepressants
D. Valproate
Correct Answer: C
Rationale: Antidepressants can precipitate rapid cycling (≥4 mood episodes per
year) in bipolar disorder. Mood stabilizers (lithium, valproate, lamotrigine) are
preferred; lamotrigine is particularly effective for bipolar depression but does not
prevent mania.
Q9: A 30-year-old woman with major depressive disorder has been on fluoxetine
40 mg daily for 6 weeks with minimal response. She reports no side effects. What
is the next best step?
A. Discontinue fluoxetine and switch to bupropion
B. Increase fluoxetine to 60 mg daily
C. Add a second antidepressant (augmentation)
D. Obtain genetic testing before any change
Correct Answer: B
EXAM 2026/2027 Diagnosis & Management Across
Lifespan I Questions with Verified Answers and
Rationales
Q1: A 28-year-old patient is brought to the emergency department by family who
report he has been sleeping only 2 hours per night for the past week, spending
$8,000 on electronics he cannot afford, and stating he has "special powers to heal
the world." He was hospitalized 6 months ago for similar behavior. Which
diagnosis is most appropriate?
A. Bipolar II disorder with hypomanic episode
B. Bipolar I disorder with current manic episode
C. Cyclothymic disorder with mood instability
D. Major depressive disorder with psychotic features
Correct Answer: B
Rationale: The patient meets criteria for Bipolar I disorder: manic episode (≥1
week, causing marked impairment, hospitalization required, psychotic features
present) and history of at least one manic episode. Bipolar II requires hypomania
(not full mania) and major depression. The severity, duration, and functional
impairment rule out hypomania.
Q2: A 34-year-old patient reports periods of elevated mood lasting 4-5 days with
increased energy, racing thoughts, and decreased need for sleep, but she continues
working and social functioning without major impairment. She also experiences
major depressive episodes. Which diagnosis fits this presentation?
A. Bipolar I disorder with previous mania
B. Bipolar II disorder
C. Cyclothymic disorder with rapid cycling
D. Borderline personality disorder with mood lability
Correct Answer: B
,Rationale: Bipolar II disorder is characterized by at least one hypomanic episode
(≥4 days, no marked impairment, no psychosis, no hospitalization) and at least one
major depressive episode. This patient’s elevated periods don’t cause significant
functional impairment, distinguishing hypomania from mania.
Q3: A PMHNP is initiating lithium therapy for a patient with Bipolar I disorder.
Which baseline monitoring is required before starting treatment?
A. Pulmonary function tests and chest X-ray
B. Renal function, thyroid function, and ECG
C. Liver function tests and abdominal ultrasound
D. Bone density scan and vitamin D levels
Correct Answer: B
Rationale: Lithium requires baseline and ongoing monitoring of renal function
(creatinine, eGFR), thyroid function (TSH), and ECG (especially if >50 years or
cardiac history) because lithium affects renal concentrating ability, can cause
hypothyroidism, and has cardiac effects. Therapeutic drug monitoring is also
essential.
Q4: A patient with Bipolar I disorder is in a depressive episode. The PMHNP is
considering antidepressant therapy. Which statement reflects best practice
regarding antidepressant use in bipolar depression?
A. Antidepressants are first-line monotherapy for bipolar depression
B. Antidepressants should be avoided due to risk of mania/hypomania/mixed
states
C. Antidepressants are safe when combined with any mood stabilizer
D. Antidepressants are preferred over atypical antipsychotics
Correct Answer: B
Rationale: Antidepressants in bipolar disorder carry significant risk of inducing
mania, hypomania, mixed states, or rapid cycling. First-line treatments for bipolar
depression include mood stabilizers (lithium, lamotrigine) and atypical
antipsychotics (quetiapine, lurasidone, cariprazine). If antidepressants are used,
they should be with caution and mood stabilizer coverage.
,Q5: A patient on valproic acid for bipolar disorder presents with lethargy,
confusion, and easy bruising. Laboratory studies show platelet count of 85,000 and
elevated ammonia. Which adverse effect is occurring?
A. Therapeutic response requiring dose increase
B. Hepatotoxicity and thrombocytopenia requiring immediate evaluation
C. Expected side effects that will resolve spontaneously
D. Drug interaction requiring only monitoring
Correct Answer: B
Rationale: Valproate can cause hepatotoxicity (elevated ammonia, liver enzymes),
thrombocytopenia, and pancreatitis. These are serious adverse effects requiring
immediate evaluation, potential discontinuation, and medical management.
Regular monitoring of LFTs, CBC, and valproate levels is essential.
Q6: A 42-year-old patient reports feeling depressed most of the day, nearly every
day, for the past 3 weeks. She has lost 10 pounds without dieting, has difficulty
sleeping, feels worthless, and has difficulty concentrating. She denies suicidal
ideation. Which diagnosis is most appropriate?
A. Persistent depressive disorder (dysthymia)
B. Major depressive disorder, single episode
C. Adjustment disorder with depressed mood
D. Bipolar II disorder with current depression
Correct Answer: B
Rationale: The patient meets DSM-5 criteria for major depressive episode: ≥5
symptoms (depressed mood, weight loss, insomnia, worthlessness, poor
concentration) present for at least 2 weeks. Persistent depressive disorder requires
symptoms for ≥2 years. Adjustment disorder occurs within 3 months of a stressor.
Q7: A 60-year-old patient with major depressive disorder has failed trials of
sertraline and venlafaxine. The PMHNP is considering switching to an MAOI.
Which dietary restriction is most important to discuss?
, A. Avoid grapefruit juice
B. Avoid tyramine-rich foods (aged cheese, cured meats, fermented products)
C. Avoid high-fat meals
D. Avoid caffeine
Correct Answer: B
Rationale: MAOIs (phenelzine, tranylcypromine) inhibit monoamine oxidase,
leading to tyramine accumulation and hypertensive crisis. Tyramine-rich foods
include aged cheese, cured meats, fermented products, and certain beers.
Grapefruit affects CYP3A4 (not MAOIs).
Q8: A 22-year-old patient with bipolar I disorder presents with rapid cycling (4
episodes in the past year). Which medication is most likely to worsen rapid
cycling?
A. Lithium
B. Lamotrigine
C. Antidepressants
D. Valproate
Correct Answer: C
Rationale: Antidepressants can precipitate rapid cycling (≥4 mood episodes per
year) in bipolar disorder. Mood stabilizers (lithium, valproate, lamotrigine) are
preferred; lamotrigine is particularly effective for bipolar depression but does not
prevent mania.
Q9: A 30-year-old woman with major depressive disorder has been on fluoxetine
40 mg daily for 6 weeks with minimal response. She reports no side effects. What
is the next best step?
A. Discontinue fluoxetine and switch to bupropion
B. Increase fluoxetine to 60 mg daily
C. Add a second antidepressant (augmentation)
D. Obtain genetic testing before any change
Correct Answer: B
