NR606 Final Exam V3 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Final Exam) | Chamberlain University
1. A 28-year-old female patient with a history of Schizophrenia has been stabilized on
Clozapine for six months. During a follow-up visit, she reports she has started smoking one
pack of cigarettes per day to cope with stress. How should the PMHNP respond regarding her
medication?
A. Decrease the Clozapine dose by 50% immediately.
B. Maintain the current dose and provide smoking cessation education.
C. Switch the patient to Olanzapine to avoid interactions.
D. Increase the Clozapine dose and monitor serum levels.
Answer: D
Explanation: Cigarette smoke contains polycyclic aromatic hydrocarbons which induce the
CYP1A2 enzyme. This induction leads to increased metabolism and decreased serum levels
of Clozapine, potentially causing a relapse of psychotic symptoms. The PMHNP must
monitor Clozapine levels and likely increase the dosage to maintain therapeutic efficacy.
2. When assessing a geriatric patient for depression, the PMHNP notes significant cognitive
impairment, slowed processing, and poor concentration. Which finding would most likely
distinguish ‘pseudodementia’ (depression) from true neurocognitive disorder (dementia)?
A. The patient is consistently disoriented to time and place.
B. The patient experiences a gradual, insidious onset of symptoms over years.
C. The patient attempts to hide cognitive deficits through confabulation.
D. The patient makes little effort to answer questions or says ‘I don’t know.’
Answer: D
Explanation: Patients with depression-related cognitive impairment (pseudodementia)
often highlight their failures and make little effort to complete tasks, frequently answering
‘I don’t know.’ In contrast, patients with true dementia often try to hide their deficits or
confabulate to fill memory gaps. Pseudodementia typically has a more acute onset
compared to the slow progression seen in Alzheimer’s disease.
3. A 10-year-old male is brought to the clinic for an initial evaluation. The parents report he is
frequently irritable, loses his temper daily, and has been ‘exploding’ at home and school for
the past 14 months. Which diagnosis is most appropriate according to DSM-5 criteria?
A. Oppositional Defiant Disorder (ODD)
,B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Bipolar I Disorder
D. Intermittent Explosive Disorder (IED)
Answer: B
Explanation: DMDD was added to the DSM-5 to address the over-diagnosis of bipolar
disorder in children. It requires chronic, severe irritability and frequent temper outbursts
(3 or more times per week) for at least 12 months in at least two settings. The diagnosis
cannot be made before age 6 or after age 18, and the onset must be before age 10.
4. A patient is prescribed Lamotrigine for Bipolar II disorder. Which instruction is most critical
for the PMHNP to provide to ensure patient safety?
A. ‘Take the medication with food to avoid gastrointestinal upset.’
B. ‘You will need weekly blood draws to check for toxicity.’}],
C. ‘Avoid all dairy products while taking this medication.’
D. ‘Report any new rash or skin peeling immediately.’
Answer: D
Explanation: Lamotrigine carries a black box warning for serious, life-threatening rashes,
including Stevens-Johnson Syndrome (SJS). The risk is minimized by a very slow upward
titration of the dosage. Patients must be educated to stop the medication and seek
immediate medical attention if any skin changes occur.
5. A 32-year-old patient presents with symptoms of Serotonin Syndrome after accidentally
doubling her dose of Sertraline. Which clinical finding is most characteristic of Serotonin
Syndrome compared to Neuroleptic Malignant Syndrome (NMS)?
A. ‘Lead-pipe’ muscle rigidity
B. Hypotension and bradycardia
C. Hyperreflexia and myoclonus
D. Elevated Creatine Kinase (CK) levels
Answer: C
Explanation: Serotonin Syndrome is characterized by neuromuscular excitability,
including hyperreflexia and myoclonus, particularly in the lower extremities. Neuroleptic
Malignant Syndrome (NMS) is typically associated with dopamine antagonists and presents
with ‘lead-pipe’ rigidity rather than hyperreflexia. Both conditions involve autonomic
instability and fever, but the neuromuscular exam is key for differentiation.
, 6. The PMHNP is evaluating a 45-year-old male with a history of Alcohol Use Disorder who is
experiencing tremors, sweating, and tachycardia 12 hours after his last drink. Which
assessment tool is the standard of care for monitoring withdrawal severity?
A. CAGE Questionnaire
B. PHQ-9
C. AUDIT-C
D. CIWA-Ar
Answer: D
Explanation: The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is the
validated tool used to monitor the severity of alcohol withdrawal symptoms. It assesses ten
categories, including nausea, tremors, and anxiety, to guide symptom-triggered
benzodiazepine dosing. Consistent use of this tool helps prevent progression to seizures or
delirium tremens.
7. A patient with Bipolar I Disorder expresses the desire to become pregnant. She is currently
stable on Lithium. What is the primary fetal risk associated with first-trimester Lithium
exposure?
A. Neural tube defects
B. Cleft palate
C. Fetal hydantoin syndrome
D. Ebstein’s anomaly
Answer: D
Explanation: Lithium exposure during the first trimester is associated with a specific
cardiac malformation known as Ebstein’s anomaly, which involves the displacement of the
tricuspid valve. While the absolute risk is lower than previously thought, it remains
significantly higher than the general population. The PMHNP must discuss the risks and
benefits of continuing versus switching medications during pregnancy.
8. Which of the following findings is required to differentiate Bipolar II Disorder from Bipolar I
Disorder?
A. A history of at least one major depressive episode and at least one hypomanic episode.
B. The presence of at least one manic episode.
C. The presence of psychotic features during a depressive episode.
D. A total duration of symptoms lasting at least two years.
Answer: A
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Final Exam) | Chamberlain University
1. A 28-year-old female patient with a history of Schizophrenia has been stabilized on
Clozapine for six months. During a follow-up visit, she reports she has started smoking one
pack of cigarettes per day to cope with stress. How should the PMHNP respond regarding her
medication?
A. Decrease the Clozapine dose by 50% immediately.
B. Maintain the current dose and provide smoking cessation education.
C. Switch the patient to Olanzapine to avoid interactions.
D. Increase the Clozapine dose and monitor serum levels.
Answer: D
Explanation: Cigarette smoke contains polycyclic aromatic hydrocarbons which induce the
CYP1A2 enzyme. This induction leads to increased metabolism and decreased serum levels
of Clozapine, potentially causing a relapse of psychotic symptoms. The PMHNP must
monitor Clozapine levels and likely increase the dosage to maintain therapeutic efficacy.
2. When assessing a geriatric patient for depression, the PMHNP notes significant cognitive
impairment, slowed processing, and poor concentration. Which finding would most likely
distinguish ‘pseudodementia’ (depression) from true neurocognitive disorder (dementia)?
A. The patient is consistently disoriented to time and place.
B. The patient experiences a gradual, insidious onset of symptoms over years.
C. The patient attempts to hide cognitive deficits through confabulation.
D. The patient makes little effort to answer questions or says ‘I don’t know.’
Answer: D
Explanation: Patients with depression-related cognitive impairment (pseudodementia)
often highlight their failures and make little effort to complete tasks, frequently answering
‘I don’t know.’ In contrast, patients with true dementia often try to hide their deficits or
confabulate to fill memory gaps. Pseudodementia typically has a more acute onset
compared to the slow progression seen in Alzheimer’s disease.
3. A 10-year-old male is brought to the clinic for an initial evaluation. The parents report he is
frequently irritable, loses his temper daily, and has been ‘exploding’ at home and school for
the past 14 months. Which diagnosis is most appropriate according to DSM-5 criteria?
A. Oppositional Defiant Disorder (ODD)
,B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Bipolar I Disorder
D. Intermittent Explosive Disorder (IED)
Answer: B
Explanation: DMDD was added to the DSM-5 to address the over-diagnosis of bipolar
disorder in children. It requires chronic, severe irritability and frequent temper outbursts
(3 or more times per week) for at least 12 months in at least two settings. The diagnosis
cannot be made before age 6 or after age 18, and the onset must be before age 10.
4. A patient is prescribed Lamotrigine for Bipolar II disorder. Which instruction is most critical
for the PMHNP to provide to ensure patient safety?
A. ‘Take the medication with food to avoid gastrointestinal upset.’
B. ‘You will need weekly blood draws to check for toxicity.’}],
C. ‘Avoid all dairy products while taking this medication.’
D. ‘Report any new rash or skin peeling immediately.’
Answer: D
Explanation: Lamotrigine carries a black box warning for serious, life-threatening rashes,
including Stevens-Johnson Syndrome (SJS). The risk is minimized by a very slow upward
titration of the dosage. Patients must be educated to stop the medication and seek
immediate medical attention if any skin changes occur.
5. A 32-year-old patient presents with symptoms of Serotonin Syndrome after accidentally
doubling her dose of Sertraline. Which clinical finding is most characteristic of Serotonin
Syndrome compared to Neuroleptic Malignant Syndrome (NMS)?
A. ‘Lead-pipe’ muscle rigidity
B. Hypotension and bradycardia
C. Hyperreflexia and myoclonus
D. Elevated Creatine Kinase (CK) levels
Answer: C
Explanation: Serotonin Syndrome is characterized by neuromuscular excitability,
including hyperreflexia and myoclonus, particularly in the lower extremities. Neuroleptic
Malignant Syndrome (NMS) is typically associated with dopamine antagonists and presents
with ‘lead-pipe’ rigidity rather than hyperreflexia. Both conditions involve autonomic
instability and fever, but the neuromuscular exam is key for differentiation.
, 6. The PMHNP is evaluating a 45-year-old male with a history of Alcohol Use Disorder who is
experiencing tremors, sweating, and tachycardia 12 hours after his last drink. Which
assessment tool is the standard of care for monitoring withdrawal severity?
A. CAGE Questionnaire
B. PHQ-9
C. AUDIT-C
D. CIWA-Ar
Answer: D
Explanation: The Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) is the
validated tool used to monitor the severity of alcohol withdrawal symptoms. It assesses ten
categories, including nausea, tremors, and anxiety, to guide symptom-triggered
benzodiazepine dosing. Consistent use of this tool helps prevent progression to seizures or
delirium tremens.
7. A patient with Bipolar I Disorder expresses the desire to become pregnant. She is currently
stable on Lithium. What is the primary fetal risk associated with first-trimester Lithium
exposure?
A. Neural tube defects
B. Cleft palate
C. Fetal hydantoin syndrome
D. Ebstein’s anomaly
Answer: D
Explanation: Lithium exposure during the first trimester is associated with a specific
cardiac malformation known as Ebstein’s anomaly, which involves the displacement of the
tricuspid valve. While the absolute risk is lower than previously thought, it remains
significantly higher than the general population. The PMHNP must discuss the risks and
benefits of continuing versus switching medications during pregnancy.
8. Which of the following findings is required to differentiate Bipolar II Disorder from Bipolar I
Disorder?
A. A history of at least one major depressive episode and at least one hypomanic episode.
B. The presence of at least one manic episode.
C. The presence of psychotic features during a depressive episode.
D. A total duration of symptoms lasting at least two years.
Answer: A
