NR605 PMHNP DIAGNOSIS &
MANAGEMENT PRACTICUM REVIEW
(WEEKS 5-8) QUESTIONS AND
ANSWERS
1. A 28-year-old female presents with a 2-week history of elevated mood, decreased need for
sleep (3 hours per night), pressured speech, and grandiose ideas about a new business
venture. She has no history of hospitalization or psychosis. Which diagnosis is most
appropriate?
A. Bipolar I Disorder
B. Major Depressive Disorder with Hypomanic features
C. Cyclothymic Disorder
D. Bipolar II Disorder
Answer: D
Conceptual Explanation: Bipolar II requires at least one hypomanic episode (lasting at
least 4 days) and one major depressive episode. Since there is no mentioned impairment
requiring hospitalization or psychosis, it fits hypomania rather than mania.
,2. A patient taking Lithium for Bipolar Disorder reports coarse tremors, ataxia, and blurred
vision. The serum lithium level is 2.1 mEq/L. What is the priority intervention?
A. Continue current dose and recheck in 24 hours
B. Increase fluid intake and decrease the next dose
C. Switch the patient to Valproic acid immediately
D. Hold the dose and prepare for possible hemodialysis
Answer: D
Conceptual Explanation: Lithium levels above 1.5 mEq/L indicate toxicity. Levels above
2.0 mEq/L with severe symptoms like ataxia and coarse tremors are medical emergencies
requiring immediate cessation and potential hemodialysis.
3. Which of the following is a key differentiating factor between Neuroleptic Malignant
Syndrome (NMS) and Serotonin Syndrome?
A. NMS involves dopamine antagonism, while Serotonin Syndrome involves serotonergic
excess
B. NMS presents with hyperreflexia, while Serotonin Syndrome presents with lead-pipe
rigidity
C. Serotonin Syndrome is always associated with fever, whereas NMS is not
D. NMS occurs within 24 hours of medication start, while Serotonin Syndrome takes weeks
to develop
, Answer: A
Conceptual Explanation: NMS is caused by dopamine blockade (typically from
antipsychotics) and features lead-pipe rigidity. Serotonin Syndrome is caused by excess
serotonin and features hyperreflexia and myoclonus.
4. An 8-year-old child presents with symptoms of Major Depressive Disorder. Which
medication is FDA-approved for the treatment of depression in this age group?
A. Sertraline
B. Paroxetine
C. Fluoxetine
D. Venlafaxine
Answer: C
Conceptual Explanation: Fluoxetine is FDA-approved for the treatment of MDD in
children aged 8 and older. Escitalopram is approved for ages 12 and older.
5. A 75-year-old patient with multiple comorbidities is prescribed a new antidepressant.
According to the Beers Criteria, which class should be avoided due to the risk of orthostatic
hypotension and anticholinergic effects?
A. SSRIs
B. SNRIs
C. MAOIs
MANAGEMENT PRACTICUM REVIEW
(WEEKS 5-8) QUESTIONS AND
ANSWERS
1. A 28-year-old female presents with a 2-week history of elevated mood, decreased need for
sleep (3 hours per night), pressured speech, and grandiose ideas about a new business
venture. She has no history of hospitalization or psychosis. Which diagnosis is most
appropriate?
A. Bipolar I Disorder
B. Major Depressive Disorder with Hypomanic features
C. Cyclothymic Disorder
D. Bipolar II Disorder
Answer: D
Conceptual Explanation: Bipolar II requires at least one hypomanic episode (lasting at
least 4 days) and one major depressive episode. Since there is no mentioned impairment
requiring hospitalization or psychosis, it fits hypomania rather than mania.
,2. A patient taking Lithium for Bipolar Disorder reports coarse tremors, ataxia, and blurred
vision. The serum lithium level is 2.1 mEq/L. What is the priority intervention?
A. Continue current dose and recheck in 24 hours
B. Increase fluid intake and decrease the next dose
C. Switch the patient to Valproic acid immediately
D. Hold the dose and prepare for possible hemodialysis
Answer: D
Conceptual Explanation: Lithium levels above 1.5 mEq/L indicate toxicity. Levels above
2.0 mEq/L with severe symptoms like ataxia and coarse tremors are medical emergencies
requiring immediate cessation and potential hemodialysis.
3. Which of the following is a key differentiating factor between Neuroleptic Malignant
Syndrome (NMS) and Serotonin Syndrome?
A. NMS involves dopamine antagonism, while Serotonin Syndrome involves serotonergic
excess
B. NMS presents with hyperreflexia, while Serotonin Syndrome presents with lead-pipe
rigidity
C. Serotonin Syndrome is always associated with fever, whereas NMS is not
D. NMS occurs within 24 hours of medication start, while Serotonin Syndrome takes weeks
to develop
, Answer: A
Conceptual Explanation: NMS is caused by dopamine blockade (typically from
antipsychotics) and features lead-pipe rigidity. Serotonin Syndrome is caused by excess
serotonin and features hyperreflexia and myoclonus.
4. An 8-year-old child presents with symptoms of Major Depressive Disorder. Which
medication is FDA-approved for the treatment of depression in this age group?
A. Sertraline
B. Paroxetine
C. Fluoxetine
D. Venlafaxine
Answer: C
Conceptual Explanation: Fluoxetine is FDA-approved for the treatment of MDD in
children aged 8 and older. Escitalopram is approved for ages 12 and older.
5. A 75-year-old patient with multiple comorbidities is prescribed a new antidepressant.
According to the Beers Criteria, which class should be avoided due to the risk of orthostatic
hypotension and anticholinergic effects?
A. SSRIs
B. SNRIs
C. MAOIs
