NR606 Week 7 Exam V1 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 7 Exam) | Chamberlain University
1. A 24-year-old female patient presents with a history of mood swings, impulsivity, and
intense, unstable relationships. She reports feeling ‘empty’ and has a history of self-injurious
behavior. Which personality disorder is the most likely diagnosis?
A. Narcissistic Personality Disorder
B. Antisocial Personality Disorder
C. Histrionic Personality Disorder
D. Borderline Personality Disorder
Answer: D
Explanation: Borderline Personality Disorder is characterized by a pervasive pattern of
instability in interpersonal relationships, self-image, and affects, along with marked
impulsivity. Patients often exhibit recurrent suicidal behavior or self-mutilation and
chronic feelings of emptiness. The diagnosis requires meeting at least five of the DSM-5-TR
criteria including frantic efforts to avoid abandonment and affective instability.
2. When initiating Lithium carbonate for a patient with Bipolar I Disorder, which of the
following baseline laboratory tests is most critical for monitoring potential adverse effects?
A. Liver Function Tests (LFTs)
B. Amylase and Lipase levels
C. Complete Blood Count (CBC) with differential
D. Serum Creatinine and Thyroid Stimulating Hormone (TSH)
Answer: D
Explanation: Lithium is primarily excreted by the kidneys and can significantly impact
renal function over time, necessitating baseline serum creatinine and BUN levels.
Additionally, lithium can induce hypothyroidism or goiter, making the assessment of TSH
essential prior to and during treatment. Regular monitoring ensures the safety of the
patient and prevents long-term complications such as chronic kidney disease or metabolic
disturbances.
3. A 45-year-old male with Schizophrenia is currently taking Haloperidol. He presents with
high fever, muscle rigidity, altered mental status, and autonomic instability. What is the most
likely complication?
A. Serotonin Syndrome
,B. Neuroleptic Malignant Syndrome (NMS)
C. Anticholinergic Toxicity
D. Acute Dystonic Reaction
Answer: B
Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening idiosyncratic
reaction to antipsychotic drugs, characterized by the clinical tetrad of mental status
changes, muscular rigidity, hyperthermia, and autonomic instability. The presence of ‘lead-
pipe’ rigidity and elevated creatine kinase is highly indicative of this condition. Immediate
discontinuation of the offending agent and supportive care in a medical setting are vital to
prevent mortality.
4. Which pharmacological agent is considered the first-line treatment for a patient diagnosed
with Obsessive-Compulsive Disorder (OCD)?
A. Buspirone
B. Selective Serotonin Reuptake Inhibitors (SSRIs)
C. Bupropion
D. Lorazepam
Answer: B
Explanation: SSRIs are recognized by clinical guidelines as the primary pharmacological
intervention for OCD due to their efficacy and safety profile. Higher doses of SSRIs are often
required for the treatment of OCD compared to Major Depressive Disorder to achieve
symptom relief. If a patient does not respond to SSRIs, Clomipramine, a tricyclic
antidepressant, may be considered as a second-line option.
5. A PMHNP is treating a 10-year-old child for ADHD. The parents are concerned about the
side effects of stimulant medications. Which non-stimulant medication is FDA-approved for
the treatment of ADHD in children?
A. Fluoxetine
B. Modafinil
C. Atomoxetine
D. Alprazolam
Answer: C
Explanation: Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) and was
the first non-stimulant medication approved by the FDA for ADHD treatment in both
children and adults. It is an effective alternative for patients who do not tolerate stimulants
or for families who have concerns about the abuse potential of controlled substances.
, Unlike stimulants, it may take several weeks to see the full therapeutic effect of
Atomoxetine.
6. A patient is being treated with Clozapine for treatment-resistant schizophrenia. Which of
the following Absolute Neutrophil Count (ANC) values requires immediate discontinuation of
the medication?
A. ANC < 2000/mm³
B. ANC < 1500/mm³
C. ANC < 1000/mm³
D. ANC < 500/mm³
Answer: C
Explanation: Clozapine carries a Black Box Warning for severe neutropenia, formerly
referred to as agranulocytosis. According to the Clozapine REMS program, a patient with a
general population ANC must have their treatment interrupted if the ANC drops below
1000/mm³. Close monitoring of the ANC is mandatory to prevent life-threatening
infections and to ensure patient safety throughout the course of treatment.
7. In the assessment of a patient with suspected Major Depressive Disorder, which symptom
is necessary for the diagnosis according to the DSM-5-TR?
A. Anhedonia or depressed mood
B. Psychomotor agitation
C. Excessive guilt
D. Sleep disturbance
Answer: A
Explanation: To meet the criteria for a Major Depressive Episode, a patient must
experience at least five symptoms during the same 2-week period, and at least one of the
symptoms must be either depressed mood or loss of interest/pleasure (anhedonia). These
core symptoms distinguish MDD from other psychiatric conditions that may involve
sadness or fatigue. Clinical documentation must clearly reflect the presence of these
primary criteria to support the diagnosis.
8. A 68-year-old patient presents with symptoms of cognitive decline, specifically memory
loss and disorientation. The PMHNP must differentiate between Delirium and Dementia.
Which feature is most characteristic of Delirium?
A. Gradual onset over years
B. Fluctuating level of consciousness
C. Intact attention and awareness
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 7 Exam) | Chamberlain University
1. A 24-year-old female patient presents with a history of mood swings, impulsivity, and
intense, unstable relationships. She reports feeling ‘empty’ and has a history of self-injurious
behavior. Which personality disorder is the most likely diagnosis?
A. Narcissistic Personality Disorder
B. Antisocial Personality Disorder
C. Histrionic Personality Disorder
D. Borderline Personality Disorder
Answer: D
Explanation: Borderline Personality Disorder is characterized by a pervasive pattern of
instability in interpersonal relationships, self-image, and affects, along with marked
impulsivity. Patients often exhibit recurrent suicidal behavior or self-mutilation and
chronic feelings of emptiness. The diagnosis requires meeting at least five of the DSM-5-TR
criteria including frantic efforts to avoid abandonment and affective instability.
2. When initiating Lithium carbonate for a patient with Bipolar I Disorder, which of the
following baseline laboratory tests is most critical for monitoring potential adverse effects?
A. Liver Function Tests (LFTs)
B. Amylase and Lipase levels
C. Complete Blood Count (CBC) with differential
D. Serum Creatinine and Thyroid Stimulating Hormone (TSH)
Answer: D
Explanation: Lithium is primarily excreted by the kidneys and can significantly impact
renal function over time, necessitating baseline serum creatinine and BUN levels.
Additionally, lithium can induce hypothyroidism or goiter, making the assessment of TSH
essential prior to and during treatment. Regular monitoring ensures the safety of the
patient and prevents long-term complications such as chronic kidney disease or metabolic
disturbances.
3. A 45-year-old male with Schizophrenia is currently taking Haloperidol. He presents with
high fever, muscle rigidity, altered mental status, and autonomic instability. What is the most
likely complication?
A. Serotonin Syndrome
,B. Neuroleptic Malignant Syndrome (NMS)
C. Anticholinergic Toxicity
D. Acute Dystonic Reaction
Answer: B
Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening idiosyncratic
reaction to antipsychotic drugs, characterized by the clinical tetrad of mental status
changes, muscular rigidity, hyperthermia, and autonomic instability. The presence of ‘lead-
pipe’ rigidity and elevated creatine kinase is highly indicative of this condition. Immediate
discontinuation of the offending agent and supportive care in a medical setting are vital to
prevent mortality.
4. Which pharmacological agent is considered the first-line treatment for a patient diagnosed
with Obsessive-Compulsive Disorder (OCD)?
A. Buspirone
B. Selective Serotonin Reuptake Inhibitors (SSRIs)
C. Bupropion
D. Lorazepam
Answer: B
Explanation: SSRIs are recognized by clinical guidelines as the primary pharmacological
intervention for OCD due to their efficacy and safety profile. Higher doses of SSRIs are often
required for the treatment of OCD compared to Major Depressive Disorder to achieve
symptom relief. If a patient does not respond to SSRIs, Clomipramine, a tricyclic
antidepressant, may be considered as a second-line option.
5. A PMHNP is treating a 10-year-old child for ADHD. The parents are concerned about the
side effects of stimulant medications. Which non-stimulant medication is FDA-approved for
the treatment of ADHD in children?
A. Fluoxetine
B. Modafinil
C. Atomoxetine
D. Alprazolam
Answer: C
Explanation: Atomoxetine is a selective norepinephrine reuptake inhibitor (SNRI) and was
the first non-stimulant medication approved by the FDA for ADHD treatment in both
children and adults. It is an effective alternative for patients who do not tolerate stimulants
or for families who have concerns about the abuse potential of controlled substances.
, Unlike stimulants, it may take several weeks to see the full therapeutic effect of
Atomoxetine.
6. A patient is being treated with Clozapine for treatment-resistant schizophrenia. Which of
the following Absolute Neutrophil Count (ANC) values requires immediate discontinuation of
the medication?
A. ANC < 2000/mm³
B. ANC < 1500/mm³
C. ANC < 1000/mm³
D. ANC < 500/mm³
Answer: C
Explanation: Clozapine carries a Black Box Warning for severe neutropenia, formerly
referred to as agranulocytosis. According to the Clozapine REMS program, a patient with a
general population ANC must have their treatment interrupted if the ANC drops below
1000/mm³. Close monitoring of the ANC is mandatory to prevent life-threatening
infections and to ensure patient safety throughout the course of treatment.
7. In the assessment of a patient with suspected Major Depressive Disorder, which symptom
is necessary for the diagnosis according to the DSM-5-TR?
A. Anhedonia or depressed mood
B. Psychomotor agitation
C. Excessive guilt
D. Sleep disturbance
Answer: A
Explanation: To meet the criteria for a Major Depressive Episode, a patient must
experience at least five symptoms during the same 2-week period, and at least one of the
symptoms must be either depressed mood or loss of interest/pleasure (anhedonia). These
core symptoms distinguish MDD from other psychiatric conditions that may involve
sadness or fatigue. Clinical documentation must clearly reflect the presence of these
primary criteria to support the diagnosis.
8. A 68-year-old patient presents with symptoms of cognitive decline, specifically memory
loss and disorientation. The PMHNP must differentiate between Delirium and Dementia.
Which feature is most characteristic of Delirium?
A. Gradual onset over years
B. Fluctuating level of consciousness
C. Intact attention and awareness
