NR606 Week 5 Exam V2 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 5 Exam) | Chamberlain University
1. A 10-year-old male is brought to the clinic for an evaluation due to persistent patterns of
irritability and frequent temper outbursts that are out of proportion to the situation. The
child’s parents report these outbursts occur at least three times a week across multiple
settings. Which diagnosis is most likely according to the DSM-5-TR?
A. Bipolar I Disorder
B. Oppositional Defiant Disorder
C. Intermittent Explosive Disorder
D. Disruptive Mood Dysregulation Disorder
Answer: D
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was introduced into the
DSM-5 to address concerns about the potential overdiagnosis of bipolar disorder in
children. The criteria specify that temper outbursts must occur at least three times a week
and the mood between outbursts is persistently irritable or angry. This diagnosis should
not be made for the first time before age 6 or after age 18, and the onset must be before age
10.
2. Which of the following SSRIs is currently the only medication FDA-approved for the
treatment of Major Depressive Disorder in children aged 8 years and older?
A. Fluoxetine
B. Sertraline
C. Paroxetine
D. Escitalopram
Answer: A
Explanation: Fluoxetine is the only SSRI approved by the FDA for the treatment of
depression in children down to the age of 8. While Escitalopram is approved for
adolescents (ages 12-17), it is not approved for younger children. The provider must
closely monitor all pediatric patients on SSRIs for the Black Box Warning regarding
increased suicidal ideation and behavior.
3. In the diagnosis of ADHD, the DSM-5-TR requires that several symptoms of inattention or
hyperactivity-impulsivity must have been present prior to what age?
A. 7 years
,B. 10 years
C. 15 years
D. 12 years
Answer: D
Explanation: The age of onset criterion for ADHD was shifted from age 7 in the DSM-IV to
age 12 in the DSM-5-TR. This change acknowledges that many symptoms may not be
recognized until the academic demands of middle school increase. However, the clinician
must still establish that the symptoms were evident during childhood even if the diagnosis
is made later.
4. A 14-year-old female patient presents with significant weight loss, an intense fear of
gaining weight, and a distorted body image. The PMHNP notes fine hair growth on the
patient’s arms (lanugo) and bradycardia. What is the priority intervention for this patient?
A. Initiating family-based therapy
B. Starting a low-dose SSRI
C. Medical stabilization and nutritional rehabilitation
D. Inpatient psychiatric admission for body Dysmorphia
Answer: C
Explanation: For patients with Anorexia Nervosa showing signs of physiological instability
such as bradycardia and lanugo, medical stabilization is the immediate priority. Nutritional
rehabilitation must be handled carefully to avoid refeeding syndrome, a potentially fatal
electrolyte shift. Psychiatric interventions are typically secondary until the patient reaches
a safer metabolic and hemodynamic status.
5. In Bowenian Family Systems Theory, the process described as a two-person relationship
drawing in a third person to reduce anxiety is known as:
A. Emotional cut-off
B. Enmeshment
C. Differentiation
D. Triangulation
Answer: D
Explanation: Triangulation is a core concept in Bowen’s theory where a stable dyad
becomes unstable under stress and seeks a third party to diffuse tension. This process
prevents the original pair from resolving their conflict directly. Effective family therapy
often involves helping family members ‘detriangulate’ to improve direct communication.
, 6. A 7-year-old child demonstrates significant difficulty with social communication, repetitive
motor movements, and an insistence on sameness. The PMHNP is considering Autism
Spectrum Disorder (ASD). Which assessment tool is considered the ‘gold standard’ for
diagnosing ASD?
A. M-CHAT-R
B. Vanderbilt Assessment Scales
C. PHQ-9A
D. ADOS-2
Answer: D
Explanation: The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is the
standardized assessment considered the gold standard for clinical diagnosis. It involves a
semi-structured observation of social interaction and communication. While the M-CHAT is
a useful screening tool for toddlers, the ADOS-2 provides the comprehensive data required
for a definitive diagnosis.
7. The PMHNP is treating an adolescent for ADHD with a stimulant medication. Which of the
following physical parameters must be monitored at every visit?
A. Serum electrolytes and renal function
B. Liver function tests and CBC
C. Height, weight, blood pressure, and heart rate
D. Visual acuity and hearing screening
Answer: C
Explanation: Stimulants are known to cause potential suppression of growth and
cardiovascular effects such as increased heart rate and blood pressure. Therefore, tracking
height and weight on a growth chart and monitoring vitals is mandatory for pediatric
patients. This allow the clinician to identify any significant deviations from normal
development early in treatment.
8. Atomoxetine (Strattera) is often prescribed for ADHD when stimulants are contraindicated.
What is the mechanism of action for this medication?
A. Dopamine and Norepinephrine Reuptake Inhibitor
B. Alpha-2 Adrenergic Agonist
C. Selective Norepinephrine Reuptake Inhibitor
D. N-Methyl-D-Aspartate (NMDA) Antagonist
Answer: C
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 5 Exam) | Chamberlain University
1. A 10-year-old male is brought to the clinic for an evaluation due to persistent patterns of
irritability and frequent temper outbursts that are out of proportion to the situation. The
child’s parents report these outbursts occur at least three times a week across multiple
settings. Which diagnosis is most likely according to the DSM-5-TR?
A. Bipolar I Disorder
B. Oppositional Defiant Disorder
C. Intermittent Explosive Disorder
D. Disruptive Mood Dysregulation Disorder
Answer: D
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was introduced into the
DSM-5 to address concerns about the potential overdiagnosis of bipolar disorder in
children. The criteria specify that temper outbursts must occur at least three times a week
and the mood between outbursts is persistently irritable or angry. This diagnosis should
not be made for the first time before age 6 or after age 18, and the onset must be before age
10.
2. Which of the following SSRIs is currently the only medication FDA-approved for the
treatment of Major Depressive Disorder in children aged 8 years and older?
A. Fluoxetine
B. Sertraline
C. Paroxetine
D. Escitalopram
Answer: A
Explanation: Fluoxetine is the only SSRI approved by the FDA for the treatment of
depression in children down to the age of 8. While Escitalopram is approved for
adolescents (ages 12-17), it is not approved for younger children. The provider must
closely monitor all pediatric patients on SSRIs for the Black Box Warning regarding
increased suicidal ideation and behavior.
3. In the diagnosis of ADHD, the DSM-5-TR requires that several symptoms of inattention or
hyperactivity-impulsivity must have been present prior to what age?
A. 7 years
,B. 10 years
C. 15 years
D. 12 years
Answer: D
Explanation: The age of onset criterion for ADHD was shifted from age 7 in the DSM-IV to
age 12 in the DSM-5-TR. This change acknowledges that many symptoms may not be
recognized until the academic demands of middle school increase. However, the clinician
must still establish that the symptoms were evident during childhood even if the diagnosis
is made later.
4. A 14-year-old female patient presents with significant weight loss, an intense fear of
gaining weight, and a distorted body image. The PMHNP notes fine hair growth on the
patient’s arms (lanugo) and bradycardia. What is the priority intervention for this patient?
A. Initiating family-based therapy
B. Starting a low-dose SSRI
C. Medical stabilization and nutritional rehabilitation
D. Inpatient psychiatric admission for body Dysmorphia
Answer: C
Explanation: For patients with Anorexia Nervosa showing signs of physiological instability
such as bradycardia and lanugo, medical stabilization is the immediate priority. Nutritional
rehabilitation must be handled carefully to avoid refeeding syndrome, a potentially fatal
electrolyte shift. Psychiatric interventions are typically secondary until the patient reaches
a safer metabolic and hemodynamic status.
5. In Bowenian Family Systems Theory, the process described as a two-person relationship
drawing in a third person to reduce anxiety is known as:
A. Emotional cut-off
B. Enmeshment
C. Differentiation
D. Triangulation
Answer: D
Explanation: Triangulation is a core concept in Bowen’s theory where a stable dyad
becomes unstable under stress and seeks a third party to diffuse tension. This process
prevents the original pair from resolving their conflict directly. Effective family therapy
often involves helping family members ‘detriangulate’ to improve direct communication.
, 6. A 7-year-old child demonstrates significant difficulty with social communication, repetitive
motor movements, and an insistence on sameness. The PMHNP is considering Autism
Spectrum Disorder (ASD). Which assessment tool is considered the ‘gold standard’ for
diagnosing ASD?
A. M-CHAT-R
B. Vanderbilt Assessment Scales
C. PHQ-9A
D. ADOS-2
Answer: D
Explanation: The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is the
standardized assessment considered the gold standard for clinical diagnosis. It involves a
semi-structured observation of social interaction and communication. While the M-CHAT is
a useful screening tool for toddlers, the ADOS-2 provides the comprehensive data required
for a definitive diagnosis.
7. The PMHNP is treating an adolescent for ADHD with a stimulant medication. Which of the
following physical parameters must be monitored at every visit?
A. Serum electrolytes and renal function
B. Liver function tests and CBC
C. Height, weight, blood pressure, and heart rate
D. Visual acuity and hearing screening
Answer: C
Explanation: Stimulants are known to cause potential suppression of growth and
cardiovascular effects such as increased heart rate and blood pressure. Therefore, tracking
height and weight on a growth chart and monitoring vitals is mandatory for pediatric
patients. This allow the clinician to identify any significant deviations from normal
development early in treatment.
8. Atomoxetine (Strattera) is often prescribed for ADHD when stimulants are contraindicated.
What is the mechanism of action for this medication?
A. Dopamine and Norepinephrine Reuptake Inhibitor
B. Alpha-2 Adrenergic Agonist
C. Selective Norepinephrine Reuptake Inhibitor
D. N-Methyl-D-Aspartate (NMDA) Antagonist
Answer: C
