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 9-year-old male is brought to the clinic by his parents who report he is easily distracted,
fails to finish schoolwork, and often loses his belongings. To meet DSM-5 criteria for
Attention-Deficit/Hyperactivity Disorder (ADHD), symptoms must be present in at least how
many settings?
A. Two or more settings
B. One setting
C. Three settings
D. Home setting only
Answer: A
Explanation: The DSM-5 diagnostic criteria for ADHD require that several inattentive or
hyperactive-impulsive symptoms be present in two or more settings, such as at home,
school, or work, and with friends or relatives. This ensures that the symptoms are not a
reaction to a specific environment or individual. Evidence of clinically significant
impairment in social, academic, or occupational functioning is also necessary for a formal
diagnosis.
2. When initiating stimulant medication for a child with ADHD, which of the following
baseline assessments is considered most essential by the PMHNP?
A. Electroencephalogram (EEG)
B. Liver function tests (LFTs)
C. Serum creatinine and BUN
D. Height, weight, blood pressure, and heart rate
Answer: D
Explanation: Baseline assessment of height, weight, blood pressure, and heart rate is
crucial before starting stimulants because these medications can cause appetite
suppression and cardiovascular changes. Monitoring growth trajectories and vital signs
throughout treatment helps in managing potential side effects like growth retardation or
hypertension. While a cardiac history is assessed, routine EEGs or LFTs are not standard
requirements for stimulant initiation unless specific comorbidities exist.
,3. A 14-year-old female presents with persistent irritability and frequent temper outbursts
that are out of proportion to the situation, occurring at least three times per week for the
past year. Which diagnosis is most consistent with this clinical picture?
A. Disruptive Mood Dysregulation Disorder (DMDD)
B. Oppositional Defiant Disorder
C. Bipolar I Disorder
D. Conduct Disorder
Answer: A
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was introduced in the
DSM-5 to address the over-diagnosis of bipolar disorder in children who exhibit chronic,
severe irritability rather than episodic mania. The criteria include severe recurrent temper
outbursts and a persistently irritable or angry mood between outbursts for at least 12
months. This diagnosis cannot be made before age 6 or after age 18, and symptoms must
begin before age 10.
4. Which medication is currently the only FDA-approved SSRI for the treatment of Major
Depressive Disorder in children aged 8 and older?
A. Sertraline (Zoloft)
B. Escitalopram (Lexapro)
C. Paroxetine (Paxil)
D. Fluoxetine (Prozac)
Answer: D
Explanation: Fluoxetine is the only SSRI with FDA approval for treating Major Depressive
Disorder in children 8 years of age and older. Escitalopram is approved for MDD in
adolescents aged 12 to 17. Providers must remain vigilant regarding the black box warning
for increased suicidal ideation in pediatric populations when prescribing any
antidepressant.
5. A PMHNP is evaluating a 6-year-old child for Autism Spectrum Disorder (ASD). The child
demonstrates repetitive movements and a fixation on spinning objects. Which of the
following is another core diagnostic feature of ASD?
A. High levels of physical aggression
B. Deficits in social-emotional reciprocity
C. Significant delays in gross motor skills
D. Persistent auditory hallucinations
Answer: B
, Explanation: The two core domains of Autism Spectrum Disorder according to the DSM-5
are persistent deficits in social communication and social interaction, and restricted,
repetitive patterns of behavior, interests, or activities. Deficits in social-emotional
reciprocity include an inability to engage in back-and-forth conversation or reduced
sharing of interests. These symptoms must be present in the early developmental period
for an accurate diagnosis.
6. In family systems theory, the process where a two-person relationship under stress draws
in a third person to stabilize the tension is known as:
A. Enmeshment
B. Triangulation
C. Differentiation
D. Homeostasis
Answer: B
Explanation: Triangulation occurs when a dyad in conflict involves a third person to
reduce anxiety and shift the focus away from the primary conflict. While this may provide
temporary stability, it prevents the original two people from resolving their issues. This
concept is a hallmark of Bowenian family systems theory and is often seen in high-conflict
parental relationships involving a child.
7. An adolescent patient taking Atomoxetine (Strattera) for ADHD should be monitored for
which rare but serious adverse effect?
A. Severe liver injury
B. Stevens-Johnson Syndrome
C. Agranulocytosis
D. Nephrogenic diabetes insipidus
Answer: A
Explanation: Atomoxetine carries a warning for potential severe liver injury, which can
progress to liver failure in rare cases. Patients and parents should be educated to report
symptoms such as jaundice, dark urine, or upper right quadrant pain immediately. Unlike
stimulants, Atomoxetine is a selective norepinephrine reuptake inhibitor and is not a
controlled substance.
8. A 16-year-old male is referred for evaluation after repeatedly getting into physical fights,
stealing from peers, and showing no remorse for hurting others. These behaviors are
characteristic of:
A. Oppositional Defiant Disorder
B. Intermittent Explosive Disorder
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 6 Exam) | Chamberlain University
1. A 9-year-old male is brought to the clinic by his parents who report he is easily distracted,
fails to finish schoolwork, and often loses his belongings. To meet DSM-5 criteria for
Attention-Deficit/Hyperactivity Disorder (ADHD), symptoms must be present in at least how
many settings?
A. Two or more settings
B. One setting
C. Three settings
D. Home setting only
Answer: A
Explanation: The DSM-5 diagnostic criteria for ADHD require that several inattentive or
hyperactive-impulsive symptoms be present in two or more settings, such as at home,
school, or work, and with friends or relatives. This ensures that the symptoms are not a
reaction to a specific environment or individual. Evidence of clinically significant
impairment in social, academic, or occupational functioning is also necessary for a formal
diagnosis.
2. When initiating stimulant medication for a child with ADHD, which of the following
baseline assessments is considered most essential by the PMHNP?
A. Electroencephalogram (EEG)
B. Liver function tests (LFTs)
C. Serum creatinine and BUN
D. Height, weight, blood pressure, and heart rate
Answer: D
Explanation: Baseline assessment of height, weight, blood pressure, and heart rate is
crucial before starting stimulants because these medications can cause appetite
suppression and cardiovascular changes. Monitoring growth trajectories and vital signs
throughout treatment helps in managing potential side effects like growth retardation or
hypertension. While a cardiac history is assessed, routine EEGs or LFTs are not standard
requirements for stimulant initiation unless specific comorbidities exist.
,3. A 14-year-old female presents with persistent irritability and frequent temper outbursts
that are out of proportion to the situation, occurring at least three times per week for the
past year. Which diagnosis is most consistent with this clinical picture?
A. Disruptive Mood Dysregulation Disorder (DMDD)
B. Oppositional Defiant Disorder
C. Bipolar I Disorder
D. Conduct Disorder
Answer: A
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was introduced in the
DSM-5 to address the over-diagnosis of bipolar disorder in children who exhibit chronic,
severe irritability rather than episodic mania. The criteria include severe recurrent temper
outbursts and a persistently irritable or angry mood between outbursts for at least 12
months. This diagnosis cannot be made before age 6 or after age 18, and symptoms must
begin before age 10.
4. Which medication is currently the only FDA-approved SSRI for the treatment of Major
Depressive Disorder in children aged 8 and older?
A. Sertraline (Zoloft)
B. Escitalopram (Lexapro)
C. Paroxetine (Paxil)
D. Fluoxetine (Prozac)
Answer: D
Explanation: Fluoxetine is the only SSRI with FDA approval for treating Major Depressive
Disorder in children 8 years of age and older. Escitalopram is approved for MDD in
adolescents aged 12 to 17. Providers must remain vigilant regarding the black box warning
for increased suicidal ideation in pediatric populations when prescribing any
antidepressant.
5. A PMHNP is evaluating a 6-year-old child for Autism Spectrum Disorder (ASD). The child
demonstrates repetitive movements and a fixation on spinning objects. Which of the
following is another core diagnostic feature of ASD?
A. High levels of physical aggression
B. Deficits in social-emotional reciprocity
C. Significant delays in gross motor skills
D. Persistent auditory hallucinations
Answer: B
, Explanation: The two core domains of Autism Spectrum Disorder according to the DSM-5
are persistent deficits in social communication and social interaction, and restricted,
repetitive patterns of behavior, interests, or activities. Deficits in social-emotional
reciprocity include an inability to engage in back-and-forth conversation or reduced
sharing of interests. These symptoms must be present in the early developmental period
for an accurate diagnosis.
6. In family systems theory, the process where a two-person relationship under stress draws
in a third person to stabilize the tension is known as:
A. Enmeshment
B. Triangulation
C. Differentiation
D. Homeostasis
Answer: B
Explanation: Triangulation occurs when a dyad in conflict involves a third person to
reduce anxiety and shift the focus away from the primary conflict. While this may provide
temporary stability, it prevents the original two people from resolving their issues. This
concept is a hallmark of Bowenian family systems theory and is often seen in high-conflict
parental relationships involving a child.
7. An adolescent patient taking Atomoxetine (Strattera) for ADHD should be monitored for
which rare but serious adverse effect?
A. Severe liver injury
B. Stevens-Johnson Syndrome
C. Agranulocytosis
D. Nephrogenic diabetes insipidus
Answer: A
Explanation: Atomoxetine carries a warning for potential severe liver injury, which can
progress to liver failure in rare cases. Patients and parents should be educated to report
symptoms such as jaundice, dark urine, or upper right quadrant pain immediately. Unlike
stimulants, Atomoxetine is a selective norepinephrine reuptake inhibitor and is not a
controlled substance.
8. A 16-year-old male is referred for evaluation after repeatedly getting into physical fights,
stealing from peers, and showing no remorse for hurting others. These behaviors are
characteristic of:
A. Oppositional Defiant Disorder
B. Intermittent Explosive Disorder
