NR606 Final Exam V1 | NR606 Diagnosis &
Management in Psychiatric-Mental Health
II Practicum | Q&A with Rationale (NR606
Final Exam) | Chamberlain University
1. A 9-year-old male is diagnosed with ADHD, predominantly hyperactive-impulsive type.
Which of the following is the first-line pharmacological treatment according to current clinical
guidelines?
A. Atomoxetine (Strattera)
B. Fluoxetine (Prozac)
C. Guanfacine (Intuniv)
D. Methylphenidate (Ritalin)
Answer: D
Rationale: Stimulants like Methylphenidate are considered first-line treatments for
pediatric ADHD due to their high efficacy rates in reducing core symptoms. Non-stimulants
like Atomoxetine are typically reserved for patients who do not tolerate stimulants or have
a history of substance abuse. It is essential for the PMHNP to monitor growth and
cardiovascular health throughout the duration of stimulant therapy.
,2. A patient taking Clozapine for treatment-resistant schizophrenia presents for their weekly
lab work. Which Absolute Neutrophil Count (ANC) result would require the immediate
discontinuation of the medication?
A. 950/mm3
B. 1600/mm3
C. 1800/mm3
D. 2000/mm3
Answer: A
Rationale: An ANC below 1000/mm3 is classified as severe neutropenia and requires
immediate cessation of Clozapine therapy to prevent life-threatening infections. The
Clozapine REMS program mandates frequent monitoring to catch agranulocytosis in its
early stages. The PMHNP must report these values and follow the specific protocol for re-
challenging or permanent discontinuation based on the patient’s hematologic history.
3. A 28-year-old female with Bipolar I Disorder is prescribed Lithium Carbonate. Which
laboratory test should be performed at baseline and monitored regularly to assess for
potential long-term toxicity?
A. Serum Creatinine and BUN
B. Liver Function Tests (LFTs)
C. Hemoglobin A1c
D. Prothrombin Time (PT)
,Answer: A
Rationale: Lithium is primarily excreted by the kidneys, so monitoring renal function via
Serum Creatinine and BUN is vital to avoid toxicity. Long-term use of Lithium can lead to a
decrease in glomerular filtration rate or nephrogenic diabetes insipidus. Practitioners must
also monitor thyroid function, as Lithium can cause hypothyroidism over time.
4. A patient on a high-dose SSRI for Major Depressive Disorder presents with hyperreflexia,
agitation, and diaphoresis. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome
B. Extrapyramidal Side Effects
C. Anticholinergic Toxicity
D. Serotonin Syndrome
Answer: D
Rationale: Serotonin Syndrome is characterized by neuromuscular excitability such as
hyperreflexia and myoclonus, often resulting from excess serotonergic activity. This
condition differs from Neuroleptic Malignant Syndrome, which is more commonly
associated with lead-pipe rigidity and dopamine antagonists. Immediate intervention
involves discontinuing the offending agent and providing supportive care such as
benzodiazepines.
, 5. Which of the following physical findings is most characteristic of Neuroleptic Malignant
Syndrome (NMS) in a patient taking Haloperidol?
A. Miosis
B. Hyperactive bowel sounds
C. Lead-pipe muscle rigidity
D. Hypothermia
Answer: C
Rationale: Lead-pipe rigidity is a hallmark sign of NMS and helps distinguish it from other
hypertensive or hypermetabolic crises. Patients with NMS also typically present with high
fever, autonomic instability, and elevated creatine kinase levels. This condition is a medical
emergency that requires immediate hospitalization and the cessation of all antipsychotic
medications.
6. A 15-year-old girl is brought to the clinic for an evaluation of a possible eating disorder. She
is significantly underweight and has a fear of gaining weight, despite being cachectic. Which
of the following is the most appropriate first-line psychotherapy?
A. Family-Based Treatment (FBT)
B. Dialectical Behavior Therapy (DBT)
C. Interpersonal Therapy (IPT)
D. Eye Movement Desensitization and Reprocessing (EMDR)
Management in Psychiatric-Mental Health
II Practicum | Q&A with Rationale (NR606
Final Exam) | Chamberlain University
1. A 9-year-old male is diagnosed with ADHD, predominantly hyperactive-impulsive type.
Which of the following is the first-line pharmacological treatment according to current clinical
guidelines?
A. Atomoxetine (Strattera)
B. Fluoxetine (Prozac)
C. Guanfacine (Intuniv)
D. Methylphenidate (Ritalin)
Answer: D
Rationale: Stimulants like Methylphenidate are considered first-line treatments for
pediatric ADHD due to their high efficacy rates in reducing core symptoms. Non-stimulants
like Atomoxetine are typically reserved for patients who do not tolerate stimulants or have
a history of substance abuse. It is essential for the PMHNP to monitor growth and
cardiovascular health throughout the duration of stimulant therapy.
,2. A patient taking Clozapine for treatment-resistant schizophrenia presents for their weekly
lab work. Which Absolute Neutrophil Count (ANC) result would require the immediate
discontinuation of the medication?
A. 950/mm3
B. 1600/mm3
C. 1800/mm3
D. 2000/mm3
Answer: A
Rationale: An ANC below 1000/mm3 is classified as severe neutropenia and requires
immediate cessation of Clozapine therapy to prevent life-threatening infections. The
Clozapine REMS program mandates frequent monitoring to catch agranulocytosis in its
early stages. The PMHNP must report these values and follow the specific protocol for re-
challenging or permanent discontinuation based on the patient’s hematologic history.
3. A 28-year-old female with Bipolar I Disorder is prescribed Lithium Carbonate. Which
laboratory test should be performed at baseline and monitored regularly to assess for
potential long-term toxicity?
A. Serum Creatinine and BUN
B. Liver Function Tests (LFTs)
C. Hemoglobin A1c
D. Prothrombin Time (PT)
,Answer: A
Rationale: Lithium is primarily excreted by the kidneys, so monitoring renal function via
Serum Creatinine and BUN is vital to avoid toxicity. Long-term use of Lithium can lead to a
decrease in glomerular filtration rate or nephrogenic diabetes insipidus. Practitioners must
also monitor thyroid function, as Lithium can cause hypothyroidism over time.
4. A patient on a high-dose SSRI for Major Depressive Disorder presents with hyperreflexia,
agitation, and diaphoresis. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome
B. Extrapyramidal Side Effects
C. Anticholinergic Toxicity
D. Serotonin Syndrome
Answer: D
Rationale: Serotonin Syndrome is characterized by neuromuscular excitability such as
hyperreflexia and myoclonus, often resulting from excess serotonergic activity. This
condition differs from Neuroleptic Malignant Syndrome, which is more commonly
associated with lead-pipe rigidity and dopamine antagonists. Immediate intervention
involves discontinuing the offending agent and providing supportive care such as
benzodiazepines.
, 5. Which of the following physical findings is most characteristic of Neuroleptic Malignant
Syndrome (NMS) in a patient taking Haloperidol?
A. Miosis
B. Hyperactive bowel sounds
C. Lead-pipe muscle rigidity
D. Hypothermia
Answer: C
Rationale: Lead-pipe rigidity is a hallmark sign of NMS and helps distinguish it from other
hypertensive or hypermetabolic crises. Patients with NMS also typically present with high
fever, autonomic instability, and elevated creatine kinase levels. This condition is a medical
emergency that requires immediate hospitalization and the cessation of all antipsychotic
medications.
6. A 15-year-old girl is brought to the clinic for an evaluation of a possible eating disorder. She
is significantly underweight and has a fear of gaining weight, despite being cachectic. Which
of the following is the most appropriate first-line psychotherapy?
A. Family-Based Treatment (FBT)
B. Dialectical Behavior Therapy (DBT)
C. Interpersonal Therapy (IPT)
D. Eye Movement Desensitization and Reprocessing (EMDR)
