NR606 Week 9 Exam V1 | NR606 Diagnosis
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 9 Exam) | Chamberlain
University
1. A 32-year-old female patient diagnosed with schizophrenia has failed two trials of second-
generation antipsychotics. The PMHNP is considering Clozapine. Which laboratory value must
be documented before starting therapy and monitored weekly for the first six months?
A. Absolute Neutrophil Count (ANC)
B. Platelet count
C. Liver function tests
D. Serum creatinine
Answer: A
Rationale: Clozapine carries a significant risk for agranulocytosis, which requires strict
monitoring of the Absolute Neutrophil Count (ANC) through the REMS program. According
to the protocol, therapy must be stopped if the ANC falls below 1,000/mm³ to prevent life-
threatening infections. The initial monitoring frequency is weekly for the first six months to
ensure patient safety during the highest-risk period.
,2. A 28-year-old patient with Bipolar I Disorder presents with a Lithium level of 1.8 mEq/L.
Which clinical manifestation is most consistent with this level of toxicity?
A. Severe diarrhea and ataxia
B. Fine resting hand tremor
C. Increased appetite
D. Hyporeflexia
Answer: A
Rationale: Lithium toxicity typically occurs at levels above 1.5 mEq/L, with levels between
1.5 and 2.0 manifesting as severe gastrointestinal distress and neurological impairments
like ataxia. A fine hand tremor is common even at therapeutic levels, whereas gross
tremors and incoordination indicate toxicity. The PMHNP must immediately discontinue
the medication and assess the patient’s hydration and renal function.
3. The PMHNP is treating a patient for Major Depressive Disorder (MDD). The patient reports
that they are currently taking Phenelzine (Nardil) and has accidentally ingested a significant
amount of aged cheese and wine. What is the patient at risk for developing?
A. Serotonin Syndrome
B. Hypertensive Crisis
C. Neuroleptic Malignant Syndrome
D. Hypotensive Episode
,Answer: B
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that inhibits the
breakdown of tyramine in the gut. When high-tyramine foods like aged cheese and wine
are consumed, tyramine enters the bloodstream and causes a massive release of
norepinephrine. This physiological response results in a rapid and dangerous increase in
blood pressure known as a hypertensive crisis.
4. During a family therapy session, the PMHNP observes a child being forced to choose sides
between two arguing parents. Which family systems concept does this describe?
A. Enmeshment
B. Differentiation of self
C. Double bind
D. Triangulation
Answer: D
Rationale: Triangulation occurs when a third party, often a child, is brought into a conflict
between two others to reduce anxiety within the dyad. This process stabilizes the
relationship between the two primary actors but puts undue psychological stress on the
third person. According to Bowenian family systems theory, identifying and resolving these
triangles is essential for healthy family functioning.
, 5. A 45-year-old male with a history of alcohol use disorder is admitted for detox. He exhibits
tremors, tachycardia, and diaphoresis. Which assessment tool is most appropriate for
monitoring withdrawal severity?
A. PHQ-9
B. COWS
C. GAD-7
D. CIWA-Ar
Answer: D
Rationale: The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is the gold
standard for measuring the severity of alcohol withdrawal symptoms. It tracks ten different
clinical signs, such as nausea, tremors, and anxiety, to guide benzodiazepine dosing.
Consistent use of this tool helps prevent the progression to delirium tremens or seizures.
6. A PMHNP is evaluating a 72-year-old patient for depression. The patient complains of
memory loss and poor concentration. Which finding would most likely suggest
‘pseudodementia’ (depression) rather than a primary neurocognitive disorder?
A. Patient emphasizes cognitive failures
B. Patient minimizes cognitive deficits
C. Sun-downing behavior
D. Slow, insidious onset of symptoms
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 9 Exam) | Chamberlain
University
1. A 32-year-old female patient diagnosed with schizophrenia has failed two trials of second-
generation antipsychotics. The PMHNP is considering Clozapine. Which laboratory value must
be documented before starting therapy and monitored weekly for the first six months?
A. Absolute Neutrophil Count (ANC)
B. Platelet count
C. Liver function tests
D. Serum creatinine
Answer: A
Rationale: Clozapine carries a significant risk for agranulocytosis, which requires strict
monitoring of the Absolute Neutrophil Count (ANC) through the REMS program. According
to the protocol, therapy must be stopped if the ANC falls below 1,000/mm³ to prevent life-
threatening infections. The initial monitoring frequency is weekly for the first six months to
ensure patient safety during the highest-risk period.
,2. A 28-year-old patient with Bipolar I Disorder presents with a Lithium level of 1.8 mEq/L.
Which clinical manifestation is most consistent with this level of toxicity?
A. Severe diarrhea and ataxia
B. Fine resting hand tremor
C. Increased appetite
D. Hyporeflexia
Answer: A
Rationale: Lithium toxicity typically occurs at levels above 1.5 mEq/L, with levels between
1.5 and 2.0 manifesting as severe gastrointestinal distress and neurological impairments
like ataxia. A fine hand tremor is common even at therapeutic levels, whereas gross
tremors and incoordination indicate toxicity. The PMHNP must immediately discontinue
the medication and assess the patient’s hydration and renal function.
3. The PMHNP is treating a patient for Major Depressive Disorder (MDD). The patient reports
that they are currently taking Phenelzine (Nardil) and has accidentally ingested a significant
amount of aged cheese and wine. What is the patient at risk for developing?
A. Serotonin Syndrome
B. Hypertensive Crisis
C. Neuroleptic Malignant Syndrome
D. Hypotensive Episode
,Answer: B
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that inhibits the
breakdown of tyramine in the gut. When high-tyramine foods like aged cheese and wine
are consumed, tyramine enters the bloodstream and causes a massive release of
norepinephrine. This physiological response results in a rapid and dangerous increase in
blood pressure known as a hypertensive crisis.
4. During a family therapy session, the PMHNP observes a child being forced to choose sides
between two arguing parents. Which family systems concept does this describe?
A. Enmeshment
B. Differentiation of self
C. Double bind
D. Triangulation
Answer: D
Rationale: Triangulation occurs when a third party, often a child, is brought into a conflict
between two others to reduce anxiety within the dyad. This process stabilizes the
relationship between the two primary actors but puts undue psychological stress on the
third person. According to Bowenian family systems theory, identifying and resolving these
triangles is essential for healthy family functioning.
, 5. A 45-year-old male with a history of alcohol use disorder is admitted for detox. He exhibits
tremors, tachycardia, and diaphoresis. Which assessment tool is most appropriate for
monitoring withdrawal severity?
A. PHQ-9
B. COWS
C. GAD-7
D. CIWA-Ar
Answer: D
Rationale: The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is the gold
standard for measuring the severity of alcohol withdrawal symptoms. It tracks ten different
clinical signs, such as nausea, tremors, and anxiety, to guide benzodiazepine dosing.
Consistent use of this tool helps prevent the progression to delirium tremens or seizures.
6. A PMHNP is evaluating a 72-year-old patient for depression. The patient complains of
memory loss and poor concentration. Which finding would most likely suggest
‘pseudodementia’ (depression) rather than a primary neurocognitive disorder?
A. Patient emphasizes cognitive failures
B. Patient minimizes cognitive deficits
C. Sun-downing behavior
D. Slow, insidious onset of symptoms
