NR 606 Midterm Exam Questions with Verified Answers (Correct
Update)
Question 1: A 22-year-old female with a diagnosis of Bipolar I Disorder presents for a follow-up. She
is stable on her current medication regimen and reports being sexually active with her male partner
but is not using any form of contraception. Which her following current medications warrants the
MOST urgent and comprehensive counseling regarding its significant teratogenic risks and the
critical need for effective contraception?
A. Lamotrigine (Lamictal)
B. Quetiapine (Seroquel)
C. Valproic Acid (Depakote)
D. Lithium
Answer: C. Valproic Acid (Depakote Valproic Acid (Depakote) as the medication requiring the
most urgent intervention. Valproic acid is of highly teratogenic and is associated with a
significant risk of major congenital malformations, particularly neural tube defects like spina
bifida. -Lamotrigine (Lamictal) is generally considered one of the safer mood stabilizers during
pregnancy. -Quetiapine (Seroquel), an atypical antipsychotic, primarily poses metabolic risks,
such as gestational diabetes. -Lithium is associated with a small risk of Ebstein's anomaly, a
cardiac defect, but the benefits of preventing a manic relapse often outweigh this risk.
Question 2: A 12-year-old boy is brought in by his parents due to a gradual 1-year decline in his
academic performance and increasing social isolation. His parents note he has become emotionally
distant with a blunted affect. They occasionally overhear him mumbling to himself in his room,
though he denies hearing voices when asked directly. He had previously been a social and
high-achieving student with no developmental concerns. Which clinical feature is MOST indicative
of Childhood-Onset Schizophrenia (COS) rather than Autism Spectrum Disorder (ASD) in this case?
A. The presence of persistent deficits in social reciprocity and communication.
B. An inflexible adherence to routines and ritualized patterns of behavior.
C. A marked deterioration in functioning from a previously higher baseline.
D. The presence of stereotyped or repetitive use of language.
Answer: marked deterioration in functioning from a previously higher baseline. -social deficits,
insistence on sameness, and stereotyped language are all core diagnostic criteria for ASD, which
must be present in the early developmental period.
Page 1
,Question 3: A 24-year-old client with a new diagnosis of schizophreniform disorder reports smoking
- one pack of cigarettes per day. When considering initial treatment, which of the following
second-generation antipsychotics is LEAST ideal as a first-choice monotherapy due to a significant
pharmacokinetic interaction with smoking?
A. Risperidone (Risperdal)
B. Olanzapine (Zyprexa)
C. Aripiprazole (Abilify)
D. Lurasidone (Latuda)
Answer: Olanzapine (Zyprexa) significant CYP1A2 interaction (same as cigarette carbons)
-requires a 30% higher dose
Question 4: A 9-year-old is diagnosed with Tourette's Syndrome after a 14-month history of eye
blinking, shoulder shrugging, and intermittent throat-clearing tics. The tics are distressing to the
parents, but they cause the child only mild social embarrassment and no physical pain or injury. The
parents want to "start a treatment that will stop the tics." What is the most appropriate first-line
intervention?
A. Refer the child for Comprehensive Behavioral vention Intervention for Tics (CBIT).
B. Initiate a low dose of aripiprazole to suppress the tic severity.
C. Provide psychoeducation to the child and parents about the nature of tics.
D. Start clonidine to manage the tics and any underlying hyperactivity.
Answer: Psychoeducation is the correct first-line intervention for Tourette's Syndrome (TS),
especially when tics are not causing severe impairment. This initial step involves educating the
child and family about the nature of TS, including the typical waxing and waning course of tics.
-Comprehensive Behavioral Interfor Tics (CBIT) is a highly effective therapy, but it is
considered a second-line intervention -aripiprazole or clonidine, are reserved for cases where tics
cause significant social, academic, or physical impairment and have not responded to
non-pharmacological approaches.
Question 5: A 28-year-old first-time mother calls your clinic 10 days after a normal vaginal delivery.
She sounds distressed and reports frequent crying spells, feeling overwhelmed, and experiencing
anxiety that "comes and goes." She is sleeping when the baby sleeps and is managing all infant care
appropriately. She asks if she has postpartum depression. Based on this specific timeline and
symptom presentation, what is the most likely diagnosis?
A. Baby Blues
B. Peripartum Major Depressive Disorder
C. Peripartum Generalized Anxiety Disorder
D. Adjustment Disorder with Depressed Mood
Answer: Baby Blues based on the critical factor of timing. -sx's appear in the first few days after
childbirth and resolve on their own -sx's do not cause functional impairment - MDD requires sx's
more than two weeks
Page 2
, Question 6: A 16-year-old male is brought to the clinic for a 3-month history of low mood,
anhedonia, and fatigue. His PHQ-9 score is 18 (moderately severe depression). During the interview,
his mother mentions that four months ago, there was a one-week period where he was "the life of the
party," slept only 3-4 hours per night without feeling tired, talked constantly, and started an
elaborate project to build a robot that he quickly abandoned. What is the most significant and
immediate risk of initiating fluoxetine monotherapy for this adolescent?
A. An increased risk of extrapyramidal symptoms (EPS).
B. The precipitation of a manic or hypomanic episode.
C. A gradual and complete lack of therapeutic response.
D. The development of serotonin syndrome.
Answer: the precipitation of a manic or hypomanic episode. The mother's description of a distinct
period of elevated energy, decreased need for sleep, and goal-directed but unfinished projects is a
classic presentation of a hypomanic episode.
Question 7: A 4-year-old girl is referred for evaluation due to developmental regression. Her parents
report that after a period of normal development, she began to lose her ability to speak and, most
notably, lost the purposeful use of her hands, now engaging in constant, stereotyped hand-wringing
motions. Which of the following is the most likely underlying cause of her condition?
A. An autoimmune response triggered by a streptococcal infection.
B. Severe, early-life trauma leading to functional neurological deficits.
C. A spontaneous mutation in the MECP2 gene on the X chromosome.
D. Perinatal exposure to a teratogenic substance like alcohol.
Answer: developmental regression, loss of speech, and, most critically, the loss of purposeful
hand use replaced by stereotyped hand-wringing is the classic presentation of Rett Syndrome.
-developmental regression, loss of speech, and, most critically, the loss of purposeful hand use
replaced by stereotyped hand-wringing is the classic presentation of Rett Syndrome.
Question 8: An 8-year-old boy is brought in for evaluation. His parents state he is "angry and
irritable almost every day." For the past two years, he has had severe temper outbursts with yelling
and throwing objects 4-5 times per week, which are grossly out of proportion to the situation.
Between these outbursts, his mood is consistently and noticeably irritable. His parents deny he has
ever had a distinct, sustained period of elevated mood, grandiosity, or a decreased need for sleep.
Which diagnosis best fits this clinical presentation?
A. Bipolar I Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Oppositional Defiant Disorder (ODD)
D. Major Depressive Disorder, with irritable mood
Answer: B. Disruptive Mood Dysregulation Disorder (DMDD). -Severe, recurrent temper
outbursts that are out of proportion (the yelling and throwing) -three or more times per week
chronically angry or irritable mood between the outbursts
Page 3
Update)
Question 1: A 22-year-old female with a diagnosis of Bipolar I Disorder presents for a follow-up. She
is stable on her current medication regimen and reports being sexually active with her male partner
but is not using any form of contraception. Which her following current medications warrants the
MOST urgent and comprehensive counseling regarding its significant teratogenic risks and the
critical need for effective contraception?
A. Lamotrigine (Lamictal)
B. Quetiapine (Seroquel)
C. Valproic Acid (Depakote)
D. Lithium
Answer: C. Valproic Acid (Depakote Valproic Acid (Depakote) as the medication requiring the
most urgent intervention. Valproic acid is of highly teratogenic and is associated with a
significant risk of major congenital malformations, particularly neural tube defects like spina
bifida. -Lamotrigine (Lamictal) is generally considered one of the safer mood stabilizers during
pregnancy. -Quetiapine (Seroquel), an atypical antipsychotic, primarily poses metabolic risks,
such as gestational diabetes. -Lithium is associated with a small risk of Ebstein's anomaly, a
cardiac defect, but the benefits of preventing a manic relapse often outweigh this risk.
Question 2: A 12-year-old boy is brought in by his parents due to a gradual 1-year decline in his
academic performance and increasing social isolation. His parents note he has become emotionally
distant with a blunted affect. They occasionally overhear him mumbling to himself in his room,
though he denies hearing voices when asked directly. He had previously been a social and
high-achieving student with no developmental concerns. Which clinical feature is MOST indicative
of Childhood-Onset Schizophrenia (COS) rather than Autism Spectrum Disorder (ASD) in this case?
A. The presence of persistent deficits in social reciprocity and communication.
B. An inflexible adherence to routines and ritualized patterns of behavior.
C. A marked deterioration in functioning from a previously higher baseline.
D. The presence of stereotyped or repetitive use of language.
Answer: marked deterioration in functioning from a previously higher baseline. -social deficits,
insistence on sameness, and stereotyped language are all core diagnostic criteria for ASD, which
must be present in the early developmental period.
Page 1
,Question 3: A 24-year-old client with a new diagnosis of schizophreniform disorder reports smoking
- one pack of cigarettes per day. When considering initial treatment, which of the following
second-generation antipsychotics is LEAST ideal as a first-choice monotherapy due to a significant
pharmacokinetic interaction with smoking?
A. Risperidone (Risperdal)
B. Olanzapine (Zyprexa)
C. Aripiprazole (Abilify)
D. Lurasidone (Latuda)
Answer: Olanzapine (Zyprexa) significant CYP1A2 interaction (same as cigarette carbons)
-requires a 30% higher dose
Question 4: A 9-year-old is diagnosed with Tourette's Syndrome after a 14-month history of eye
blinking, shoulder shrugging, and intermittent throat-clearing tics. The tics are distressing to the
parents, but they cause the child only mild social embarrassment and no physical pain or injury. The
parents want to "start a treatment that will stop the tics." What is the most appropriate first-line
intervention?
A. Refer the child for Comprehensive Behavioral vention Intervention for Tics (CBIT).
B. Initiate a low dose of aripiprazole to suppress the tic severity.
C. Provide psychoeducation to the child and parents about the nature of tics.
D. Start clonidine to manage the tics and any underlying hyperactivity.
Answer: Psychoeducation is the correct first-line intervention for Tourette's Syndrome (TS),
especially when tics are not causing severe impairment. This initial step involves educating the
child and family about the nature of TS, including the typical waxing and waning course of tics.
-Comprehensive Behavioral Interfor Tics (CBIT) is a highly effective therapy, but it is
considered a second-line intervention -aripiprazole or clonidine, are reserved for cases where tics
cause significant social, academic, or physical impairment and have not responded to
non-pharmacological approaches.
Question 5: A 28-year-old first-time mother calls your clinic 10 days after a normal vaginal delivery.
She sounds distressed and reports frequent crying spells, feeling overwhelmed, and experiencing
anxiety that "comes and goes." She is sleeping when the baby sleeps and is managing all infant care
appropriately. She asks if she has postpartum depression. Based on this specific timeline and
symptom presentation, what is the most likely diagnosis?
A. Baby Blues
B. Peripartum Major Depressive Disorder
C. Peripartum Generalized Anxiety Disorder
D. Adjustment Disorder with Depressed Mood
Answer: Baby Blues based on the critical factor of timing. -sx's appear in the first few days after
childbirth and resolve on their own -sx's do not cause functional impairment - MDD requires sx's
more than two weeks
Page 2
, Question 6: A 16-year-old male is brought to the clinic for a 3-month history of low mood,
anhedonia, and fatigue. His PHQ-9 score is 18 (moderately severe depression). During the interview,
his mother mentions that four months ago, there was a one-week period where he was "the life of the
party," slept only 3-4 hours per night without feeling tired, talked constantly, and started an
elaborate project to build a robot that he quickly abandoned. What is the most significant and
immediate risk of initiating fluoxetine monotherapy for this adolescent?
A. An increased risk of extrapyramidal symptoms (EPS).
B. The precipitation of a manic or hypomanic episode.
C. A gradual and complete lack of therapeutic response.
D. The development of serotonin syndrome.
Answer: the precipitation of a manic or hypomanic episode. The mother's description of a distinct
period of elevated energy, decreased need for sleep, and goal-directed but unfinished projects is a
classic presentation of a hypomanic episode.
Question 7: A 4-year-old girl is referred for evaluation due to developmental regression. Her parents
report that after a period of normal development, she began to lose her ability to speak and, most
notably, lost the purposeful use of her hands, now engaging in constant, stereotyped hand-wringing
motions. Which of the following is the most likely underlying cause of her condition?
A. An autoimmune response triggered by a streptococcal infection.
B. Severe, early-life trauma leading to functional neurological deficits.
C. A spontaneous mutation in the MECP2 gene on the X chromosome.
D. Perinatal exposure to a teratogenic substance like alcohol.
Answer: developmental regression, loss of speech, and, most critically, the loss of purposeful
hand use replaced by stereotyped hand-wringing is the classic presentation of Rett Syndrome.
-developmental regression, loss of speech, and, most critically, the loss of purposeful hand use
replaced by stereotyped hand-wringing is the classic presentation of Rett Syndrome.
Question 8: An 8-year-old boy is brought in for evaluation. His parents state he is "angry and
irritable almost every day." For the past two years, he has had severe temper outbursts with yelling
and throwing objects 4-5 times per week, which are grossly out of proportion to the situation.
Between these outbursts, his mood is consistently and noticeably irritable. His parents deny he has
ever had a distinct, sustained period of elevated mood, grandiosity, or a decreased need for sleep.
Which diagnosis best fits this clinical presentation?
A. Bipolar I Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Oppositional Defiant Disorder (ODD)
D. Major Depressive Disorder, with irritable mood
Answer: B. Disruptive Mood Dysregulation Disorder (DMDD). -Severe, recurrent temper
outbursts that are out of proportion (the yelling and throwing) -three or more times per week
chronically angry or irritable mood between the outbursts
Page 3
