NR606 Week 6 Exam V3 | NR606 Diagnosis
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 6 Exam) | Chamberlain
University
1. A 45-year-old female presents with a six-month history of excessive worry about various
aspects of her life, including her health, finances, and children’s safety. She reports feeling
restless and having difficulty concentrating. Which of the following is the most likely
diagnosis according to DSM-5 criteria?
A. Panic Disorder
B. Generalized Anxiety Disorder
C. Social Anxiety Disorder
D. Obsessive-Compulsive Disorder
Answer: B
Rationale: Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and
worry occurring more days than not for at least six months about a number of events or
activities. The patient also exhibits associated symptoms such as restlessness and difficulty
concentrating. The PMHNP must differentiate this from specific phobias or panic disorder
which have more acute presentations.
,2. When prescribing Lithium for a patient with Bipolar I Disorder, which of the following
laboratory tests is most critical to monitor periodically to prevent toxicity and ensure safety?
A. Serum Glucose
B. Complete Blood Count (CBC) with differential
C. Liver Function Tests (LFTs)
D. Serum Creatinine and Thyroid Stimulating Hormone (TSH)
Answer: D
Rationale: Lithium is primarily excreted by the kidneys and can significantly impact renal
function over time, necessitating regular serum creatinine monitoring. It also has a well-
documented effect on the thyroid gland, often leading to hypothyroidism, which requires
TSH monitoring. The PMHNP must establish baseline levels and monitor these values
throughout the course of treatment to prevent long-term complications.
3. A PMHNP is treating a 10-year-old child who exhibits a pattern of angry/irritable mood,
argumentative/defiant behavior, and vindictiveness lasting at least six months. This clinical
presentation most closely aligns with which diagnosis?
A. Conduct Disorder
B. Attention-Deficit/Hyperactivity Disorder (ADHD)
C. Oppositional Defiant Disorder (ODD)
D. Disruptive Mood Dysregulation Disorder (DMDD)
,Answer: C
Rationale: Oppositional Defiant Disorder (ODD) is defined by a pattern of angry/irritable
mood and defiant behavior toward authority figures. Unlike Conduct Disorder, ODD does
not typically involve physical aggression toward people or animals or serious violations of
societal norms. It is crucial for the PMHNP to distinguish ODD from ADHD, although they
often co-occur in pediatric populations.
4. Which psychotherapeutic approach focuses on changing maladaptive thought patterns and
behaviors by identifying cognitive distortions?
A. Cognitive Behavioral Therapy (CBT)
B. Dialectical Behavior Therapy (DBT)
C. Interpersonal Therapy (IPT)
D. Psychodynamic Psychotherapy
Answer: A
Rationale: Cognitive Behavioral Therapy (CBT) is an evidence-based treatment that
addresses the relationship between thoughts, feelings, and behaviors. The primary goal is
to identify and challenge cognitive distortions that contribute to emotional distress. This
modality is highly effective for a wide range of psychiatric conditions, including depression
and anxiety disorders.
, 5. A patient on Clozapine therapy presents for a follow-up. The PMHNP notes the Absolute
Neutrophil Count (ANC) is 1,200/mm3. According to the Clozapine REMS program, what is the
most appropriate action?
A. Continue current dose and recheck in one month.
B. Increase the dose to manage symptoms.
C. Interrupt treatment and monitor ANC daily.
D. Continue treatment but monitor ANC three times weekly.
Answer: D
Rationale: According to Clozapine Risk Evaluation and Mitigation Strategy (REMS)
guidelines, an ANC between 1,000 and 1,499/mm3 is classified as mild neutropenia. For
the general population, the provider should continue treatment but increase monitoring
frequency to three times weekly until the ANC returns to 1,500/mm3 or higher. If the ANC
falls below 1,000, treatment must be interrupted to avoid life-threatening infections.
6. A 72-year-old male with a history of dementia presents with increased agitation and
physical aggression. Which of the following is a critical consideration before initiating an
atypical antipsychotic?
A. Antipsychotics are FDA-approved for dementia-related psychosis.
B. Antipsychotics will improve cognitive functioning in dementia.
C. There is a black box warning for increased risk of death in elderly patients with
dementia.
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 6 Exam) | Chamberlain
University
1. A 45-year-old female presents with a six-month history of excessive worry about various
aspects of her life, including her health, finances, and children’s safety. She reports feeling
restless and having difficulty concentrating. Which of the following is the most likely
diagnosis according to DSM-5 criteria?
A. Panic Disorder
B. Generalized Anxiety Disorder
C. Social Anxiety Disorder
D. Obsessive-Compulsive Disorder
Answer: B
Rationale: Generalized Anxiety Disorder (GAD) is characterized by excessive anxiety and
worry occurring more days than not for at least six months about a number of events or
activities. The patient also exhibits associated symptoms such as restlessness and difficulty
concentrating. The PMHNP must differentiate this from specific phobias or panic disorder
which have more acute presentations.
,2. When prescribing Lithium for a patient with Bipolar I Disorder, which of the following
laboratory tests is most critical to monitor periodically to prevent toxicity and ensure safety?
A. Serum Glucose
B. Complete Blood Count (CBC) with differential
C. Liver Function Tests (LFTs)
D. Serum Creatinine and Thyroid Stimulating Hormone (TSH)
Answer: D
Rationale: Lithium is primarily excreted by the kidneys and can significantly impact renal
function over time, necessitating regular serum creatinine monitoring. It also has a well-
documented effect on the thyroid gland, often leading to hypothyroidism, which requires
TSH monitoring. The PMHNP must establish baseline levels and monitor these values
throughout the course of treatment to prevent long-term complications.
3. A PMHNP is treating a 10-year-old child who exhibits a pattern of angry/irritable mood,
argumentative/defiant behavior, and vindictiveness lasting at least six months. This clinical
presentation most closely aligns with which diagnosis?
A. Conduct Disorder
B. Attention-Deficit/Hyperactivity Disorder (ADHD)
C. Oppositional Defiant Disorder (ODD)
D. Disruptive Mood Dysregulation Disorder (DMDD)
,Answer: C
Rationale: Oppositional Defiant Disorder (ODD) is defined by a pattern of angry/irritable
mood and defiant behavior toward authority figures. Unlike Conduct Disorder, ODD does
not typically involve physical aggression toward people or animals or serious violations of
societal norms. It is crucial for the PMHNP to distinguish ODD from ADHD, although they
often co-occur in pediatric populations.
4. Which psychotherapeutic approach focuses on changing maladaptive thought patterns and
behaviors by identifying cognitive distortions?
A. Cognitive Behavioral Therapy (CBT)
B. Dialectical Behavior Therapy (DBT)
C. Interpersonal Therapy (IPT)
D. Psychodynamic Psychotherapy
Answer: A
Rationale: Cognitive Behavioral Therapy (CBT) is an evidence-based treatment that
addresses the relationship between thoughts, feelings, and behaviors. The primary goal is
to identify and challenge cognitive distortions that contribute to emotional distress. This
modality is highly effective for a wide range of psychiatric conditions, including depression
and anxiety disorders.
, 5. A patient on Clozapine therapy presents for a follow-up. The PMHNP notes the Absolute
Neutrophil Count (ANC) is 1,200/mm3. According to the Clozapine REMS program, what is the
most appropriate action?
A. Continue current dose and recheck in one month.
B. Increase the dose to manage symptoms.
C. Interrupt treatment and monitor ANC daily.
D. Continue treatment but monitor ANC three times weekly.
Answer: D
Rationale: According to Clozapine Risk Evaluation and Mitigation Strategy (REMS)
guidelines, an ANC between 1,000 and 1,499/mm3 is classified as mild neutropenia. For
the general population, the provider should continue treatment but increase monitoring
frequency to three times weekly until the ANC returns to 1,500/mm3 or higher. If the ANC
falls below 1,000, treatment must be interrupted to avoid life-threatening infections.
6. A 72-year-old male with a history of dementia presents with increased agitation and
physical aggression. Which of the following is a critical consideration before initiating an
atypical antipsychotic?
A. Antipsychotics are FDA-approved for dementia-related psychosis.
B. Antipsychotics will improve cognitive functioning in dementia.
C. There is a black box warning for increased risk of death in elderly patients with
dementia.
