NR606 Week 3 Exam V3 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 3 Exam) | Chamberlain University
1. When evaluating a 7-year-old male for Attention-Deficit/Hyperactivity Disorder (ADHD),
which of the following criteria is mandatory for a DSM-5-TR diagnosis?
A. Symptoms must have been present before the age of 7.
B. Symptoms must be present in at least two different settings (e.g., home and school).
C. The child must exhibit at least 9 symptoms of inattention.
D. The child must show a significant decrease in intellectual functioning.
Answer: B
Explanation: According to the DSM-5-TR, ADHD symptoms must manifest in two or more
settings to ensure the behavior is not context-dependent. The age of onset criterion was
shifted from 7 to 12 years in recent updates. For children, at least six symptoms are
required, rather than nine, and intellectual decline is not a core diagnostic feature.
2. A 14-year-old female is prescribed Fluoxetine for Major Depressive Disorder. What is the
most critical FDA black box warning the PMHNP must discuss with the patient and her
parents?
A. Risk of hepatotoxicity and liver failure.
B. Potential for developing Stevens-Johnson Syndrome.
C. Increased risk of suicidal ideation and behavior in children and adolescents.
D. Irreversible extrapyramidal side effects.
Answer: C
Explanation: The FDA mandates a black box warning on all antidepressants regarding the
increased risk of suicidal thoughts and behaviors in young patients. This requires close
monitoring, especially during the first few weeks of treatment or dose adjustments. The
PMHNP must educate the family on reporting any changes in mood or behavior
immediately.
3. Which neurodevelopmental disorder is characterized by persistent deficits in social
communication and social interaction across multiple contexts, alongside restricted,
repetitive patterns of behavior?
A. Autism Spectrum Disorder
B. Attention-Deficit/Hyperactivity Disorder
,C. Social Communication Disorder
D. Intellectual Disability
Answer: A
Explanation: Autism Spectrum Disorder (ASD) involves the dyad of social communication
deficits and repetitive behaviors. Unlike Social Communication Disorder, ASD must include
the restricted/repetitive interest component. Early identification and referral for
behavioral therapies are essential for optimizing developmental outcomes.
4. A 9-year-old child presents with severe, recurrent temper outbursts that are grossly out of
proportion to the situation. These occur at least three times a week, and the mood between
outbursts is persistently irritable. What is the most likely diagnosis?
A. Bipolar I Disorder
B. Oppositional Defiant Disorder
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Conduct Disorder
Answer: C
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was introduced to address
the over-diagnosis of Bipolar Disorder in children. The core features are chronic irritability
and frequent temper tantrums in children over age 6 but under age 18. This diagnosis
cannot coexist with Bipolar Disorder or Oppositional Defiant Disorder.
5. When prescribing Methylphenidate to a pediatric patient, which physical parameters must
be monitored at every follow-up visit?
A. Serum electrolytes and renal function
B. Liver enzymes and CBC
C. Visual acuity and intraocular pressure
D. Height, weight, blood pressure, and heart rate
Answer: D
Explanation: Stimulants like Methylphenidate carry risks of growth suppression and
cardiovascular effects. It is standard practice to track height and weight on growth charts
to monitor for significant deviations. Additionally, stimulants can increase heart rate and
blood pressure, necessitating regular cardiovascular screenings.
6. Which of the following is considered a first-line non-stimulant medication for the
treatment of ADHD in children who cannot tolerate stimulants?
A. Risperidone (Risperdal)
, B. Atomoxetine (Strattera)
C. Alprazolam (Xanax)
D. Modafinil (Provigil)
Answer: B
Explanation: Atomoxetine is a Selective Norepinephrine Reuptake Inhibitor (SNRI) and is
FDA-approved as a non-stimulant option for ADHD. It is particularly useful when there is a
risk of stimulant diversion or when the patient has co-occurring anxiety or tics. Its onset of
action is slower than stimulants, often taking several weeks to show full effect.
7. A 16-year-old male is brought to the clinic for ‘getting into fights,’ stealing, and destroying
property. He shows a lack of remorse for his actions. These behaviors indicate which
diagnosis?
A. Conduct Disorder
B. Oppositional Defiant Disorder
C. Antisocial Personality Disorder
D. Intermittent Explosive Disorder
Answer: A
Explanation: Conduct Disorder involves a repetitive and persistent pattern of behavior in
which the basic rights of others or major age-appropriate societal norms are violated.
Antisocial Personality Disorder cannot be diagnosed until the age of 18. Conduct Disorder
is often a precursor to adult personality disorders and requires intensive multi-modal
intervention.
8. Which screening tool is most appropriate for a PMHNP to use when assessing for ADHD in a
school-aged child?
A. PHQ-9
B. GAD-7
C. Vanderbilt Assessment Scales
D. CAGE Questionnaire
Answer: C
Explanation: The Vanderbilt Assessment Scales are specifically designed to collect
information from both parents and teachers to screen for ADHD. They also include screens
for common comorbidities like ODD and Anxiety. The PHQ-9 is for depression, the GAD-7 is
for anxiety, and the CAGE is for alcohol use.
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 3 Exam) | Chamberlain University
1. When evaluating a 7-year-old male for Attention-Deficit/Hyperactivity Disorder (ADHD),
which of the following criteria is mandatory for a DSM-5-TR diagnosis?
A. Symptoms must have been present before the age of 7.
B. Symptoms must be present in at least two different settings (e.g., home and school).
C. The child must exhibit at least 9 symptoms of inattention.
D. The child must show a significant decrease in intellectual functioning.
Answer: B
Explanation: According to the DSM-5-TR, ADHD symptoms must manifest in two or more
settings to ensure the behavior is not context-dependent. The age of onset criterion was
shifted from 7 to 12 years in recent updates. For children, at least six symptoms are
required, rather than nine, and intellectual decline is not a core diagnostic feature.
2. A 14-year-old female is prescribed Fluoxetine for Major Depressive Disorder. What is the
most critical FDA black box warning the PMHNP must discuss with the patient and her
parents?
A. Risk of hepatotoxicity and liver failure.
B. Potential for developing Stevens-Johnson Syndrome.
C. Increased risk of suicidal ideation and behavior in children and adolescents.
D. Irreversible extrapyramidal side effects.
Answer: C
Explanation: The FDA mandates a black box warning on all antidepressants regarding the
increased risk of suicidal thoughts and behaviors in young patients. This requires close
monitoring, especially during the first few weeks of treatment or dose adjustments. The
PMHNP must educate the family on reporting any changes in mood or behavior
immediately.
3. Which neurodevelopmental disorder is characterized by persistent deficits in social
communication and social interaction across multiple contexts, alongside restricted,
repetitive patterns of behavior?
A. Autism Spectrum Disorder
B. Attention-Deficit/Hyperactivity Disorder
,C. Social Communication Disorder
D. Intellectual Disability
Answer: A
Explanation: Autism Spectrum Disorder (ASD) involves the dyad of social communication
deficits and repetitive behaviors. Unlike Social Communication Disorder, ASD must include
the restricted/repetitive interest component. Early identification and referral for
behavioral therapies are essential for optimizing developmental outcomes.
4. A 9-year-old child presents with severe, recurrent temper outbursts that are grossly out of
proportion to the situation. These occur at least three times a week, and the mood between
outbursts is persistently irritable. What is the most likely diagnosis?
A. Bipolar I Disorder
B. Oppositional Defiant Disorder
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Conduct Disorder
Answer: C
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was introduced to address
the over-diagnosis of Bipolar Disorder in children. The core features are chronic irritability
and frequent temper tantrums in children over age 6 but under age 18. This diagnosis
cannot coexist with Bipolar Disorder or Oppositional Defiant Disorder.
5. When prescribing Methylphenidate to a pediatric patient, which physical parameters must
be monitored at every follow-up visit?
A. Serum electrolytes and renal function
B. Liver enzymes and CBC
C. Visual acuity and intraocular pressure
D. Height, weight, blood pressure, and heart rate
Answer: D
Explanation: Stimulants like Methylphenidate carry risks of growth suppression and
cardiovascular effects. It is standard practice to track height and weight on growth charts
to monitor for significant deviations. Additionally, stimulants can increase heart rate and
blood pressure, necessitating regular cardiovascular screenings.
6. Which of the following is considered a first-line non-stimulant medication for the
treatment of ADHD in children who cannot tolerate stimulants?
A. Risperidone (Risperdal)
, B. Atomoxetine (Strattera)
C. Alprazolam (Xanax)
D. Modafinil (Provigil)
Answer: B
Explanation: Atomoxetine is a Selective Norepinephrine Reuptake Inhibitor (SNRI) and is
FDA-approved as a non-stimulant option for ADHD. It is particularly useful when there is a
risk of stimulant diversion or when the patient has co-occurring anxiety or tics. Its onset of
action is slower than stimulants, often taking several weeks to show full effect.
7. A 16-year-old male is brought to the clinic for ‘getting into fights,’ stealing, and destroying
property. He shows a lack of remorse for his actions. These behaviors indicate which
diagnosis?
A. Conduct Disorder
B. Oppositional Defiant Disorder
C. Antisocial Personality Disorder
D. Intermittent Explosive Disorder
Answer: A
Explanation: Conduct Disorder involves a repetitive and persistent pattern of behavior in
which the basic rights of others or major age-appropriate societal norms are violated.
Antisocial Personality Disorder cannot be diagnosed until the age of 18. Conduct Disorder
is often a precursor to adult personality disorders and requires intensive multi-modal
intervention.
8. Which screening tool is most appropriate for a PMHNP to use when assessing for ADHD in a
school-aged child?
A. PHQ-9
B. GAD-7
C. Vanderbilt Assessment Scales
D. CAGE Questionnaire
Answer: C
Explanation: The Vanderbilt Assessment Scales are specifically designed to collect
information from both parents and teachers to screen for ADHD. They also include screens
for common comorbidities like ODD and Anxiety. The PHQ-9 is for depression, the GAD-7 is
for anxiety, and the CAGE is for alcohol use.
