NR606 Week 7 Exam V3 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 7 Exam) | Chamberlain University
1. A 45-year-old patient with treatment-resistant schizophrenia is being started on Clozapine.
Which of the following lab values must be monitored most stringently during the first 6
months of treatment?
A. Serum Creatinine
B. Liver Function Tests (LFTs)
C. Absolute Neutrophil Count (ANC)
D. Thyroid Stimulating Hormone (TSH)
Answer: C
Explanation: Clozapine carries a black box warning for agranulocytosis, requiring strict
monitoring of the Absolute Neutrophil Count (ANC). During the first six months, these
levels must be checked weekly to ensure patient safety and prevent life-threatening
infections. The PMHNP must document these values in the Risk Evaluation and Mitigation
Strategy (REMS) registry before the pharmacy can dispense the medication.
2. Which standardized tool is most appropriate for a PMHNP to use when assessing a patient
for involuntary movements associated with long-term antipsychotic use?
A. PHQ-9
B. GADI-7
C. CAGE-AID
D. AIMS
Answer: D
Explanation: The Abnormal Involuntary Movement Scale (AIMS) is the gold standard for
detecting Tardive Dyskinesia in patients receiving dopamine receptor antagonists. Routine
screening with the AIMS allows for early detection of potentially irreversible
extrapyramidal symptoms. PMHNPs should perform this assessment at baseline and at
least every six months during ongoing treatment.
3. A 68-year-old male presents with sudden onset confusion, visual hallucinations, and
fluctuating levels of consciousness. Which diagnosis is most likely?
A. Delirium
B. Alzheimer’s Dementia
,C. Major Depressive Disorder
D. Schizotypal Personality Disorder
Answer: A
Explanation: Delirium is characterized by an acute change in mental status, fluctuating
course, and disturbances in attention and awareness. Unlike dementia, which is
progressive and chronic, delirium often has an underlying medical cause such as infection
or medication toxicity. The PMHNP must prioritize identifying and treating the reversible
physiological cause to prevent further cognitive decline.
4. A patient taking Lithium for Bipolar I Disorder presents with coarse tremors, ataxia, and
persistent nausea. The lithium level is 1.6 mEq/L. What is the priority intervention?
A. Continue current dose and recheck level in one month
B. Hold the dose and assess for signs of toxicity
C. Increase the dose to manage breakthrough mania
D. Add a benzodiazepine for the tremors
Answer: B
Explanation: A lithium level of 1.6 mEq/L is above the standard therapeutic range (0.6 to
1.2 mEq/L) and indicates mild to moderate toxicity. Symptoms such as coarse tremors and
ataxia are clinical markers that require immediate cessation of the drug to prevent renal
failure or seizures. The provider should also order metabolic panels and encourage
hydration to facilitate lithium clearance.
5. Which neurotransmitter is primarily targeted by Selective Serotonin Reuptake Inhibitors
(SSRIs) to alleviate symptoms of depression?
A. Serotonin
B. Dopamine
C. Norepinephrine
D. GABA
Answer: A
Explanation: SSRIs function by inhibiting the reuptake of 5-hydroxytryptamine
(serotonin) into the presynaptic neuron, thereby increasing its availability in the synaptic
cleft. This mechanism is thought to improve mood regulation and alleviate the vegetative
symptoms of depression over several weeks. PMHNPs must monitor for the ‘serotonergic
effect,’ noting that full therapeutic benefits often take 4 to 6 weeks to manifest.
, 6. A patient experiences muscle rigidity, high fever, and autonomic instability shortly after
starting Haloperidol. Which condition should the PMHNP suspect?
A. Neuroleptic Malignant Syndrome (NMS)
B. Serotonin Syndrome
C. Acute Dystonia
D. Anticholinergic Crisis
Answer: A
Explanation: Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening
reaction to antipsychotic medications, characterized by the ‘lead-pipe’ muscle rigidity and
hyperpyrexia. It differs from Serotonin Syndrome primarily by the presence of severe
rigidity rather than hyperreflexia. Immediate discontinuation of the offending agent and
supportive care in an intensive care setting are mandatory.
7. What is the legal term for the PMHNP’s obligation to protect a third party from a patient’s
threat of violence?
A. Habeas Corpus
B. Duty to Warn
C. Parens Patriae
D. Informed Consent
Answer: B
Explanation: The Duty to Warn, originating from the Tarasoff v. Regents of the University
of California case, requires clinicians to breach confidentiality if a patient poses a specific
threat to an identifiable victim. This legal mandate balances patient privacy with public
safety. Failure to act can result in professional liability and harm to the community.
8. A 22-year-old female presents with recurrent episodes of binge eating followed by self-
induced vomiting and excessive exercise. Which physical exam finding is most consistent with
this disorder?
A. Lanugo
B. Hypotension
C. Bradycardia
D. Russell’s Sign
Answer: D
Explanation: Russell’s sign refers to the calluses on the knuckles or back of the hand
caused by repeated self-induced vomiting in patients with Bulimia Nervosa. Other common
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 7 Exam) | Chamberlain University
1. A 45-year-old patient with treatment-resistant schizophrenia is being started on Clozapine.
Which of the following lab values must be monitored most stringently during the first 6
months of treatment?
A. Serum Creatinine
B. Liver Function Tests (LFTs)
C. Absolute Neutrophil Count (ANC)
D. Thyroid Stimulating Hormone (TSH)
Answer: C
Explanation: Clozapine carries a black box warning for agranulocytosis, requiring strict
monitoring of the Absolute Neutrophil Count (ANC). During the first six months, these
levels must be checked weekly to ensure patient safety and prevent life-threatening
infections. The PMHNP must document these values in the Risk Evaluation and Mitigation
Strategy (REMS) registry before the pharmacy can dispense the medication.
2. Which standardized tool is most appropriate for a PMHNP to use when assessing a patient
for involuntary movements associated with long-term antipsychotic use?
A. PHQ-9
B. GADI-7
C. CAGE-AID
D. AIMS
Answer: D
Explanation: The Abnormal Involuntary Movement Scale (AIMS) is the gold standard for
detecting Tardive Dyskinesia in patients receiving dopamine receptor antagonists. Routine
screening with the AIMS allows for early detection of potentially irreversible
extrapyramidal symptoms. PMHNPs should perform this assessment at baseline and at
least every six months during ongoing treatment.
3. A 68-year-old male presents with sudden onset confusion, visual hallucinations, and
fluctuating levels of consciousness. Which diagnosis is most likely?
A. Delirium
B. Alzheimer’s Dementia
,C. Major Depressive Disorder
D. Schizotypal Personality Disorder
Answer: A
Explanation: Delirium is characterized by an acute change in mental status, fluctuating
course, and disturbances in attention and awareness. Unlike dementia, which is
progressive and chronic, delirium often has an underlying medical cause such as infection
or medication toxicity. The PMHNP must prioritize identifying and treating the reversible
physiological cause to prevent further cognitive decline.
4. A patient taking Lithium for Bipolar I Disorder presents with coarse tremors, ataxia, and
persistent nausea. The lithium level is 1.6 mEq/L. What is the priority intervention?
A. Continue current dose and recheck level in one month
B. Hold the dose and assess for signs of toxicity
C. Increase the dose to manage breakthrough mania
D. Add a benzodiazepine for the tremors
Answer: B
Explanation: A lithium level of 1.6 mEq/L is above the standard therapeutic range (0.6 to
1.2 mEq/L) and indicates mild to moderate toxicity. Symptoms such as coarse tremors and
ataxia are clinical markers that require immediate cessation of the drug to prevent renal
failure or seizures. The provider should also order metabolic panels and encourage
hydration to facilitate lithium clearance.
5. Which neurotransmitter is primarily targeted by Selective Serotonin Reuptake Inhibitors
(SSRIs) to alleviate symptoms of depression?
A. Serotonin
B. Dopamine
C. Norepinephrine
D. GABA
Answer: A
Explanation: SSRIs function by inhibiting the reuptake of 5-hydroxytryptamine
(serotonin) into the presynaptic neuron, thereby increasing its availability in the synaptic
cleft. This mechanism is thought to improve mood regulation and alleviate the vegetative
symptoms of depression over several weeks. PMHNPs must monitor for the ‘serotonergic
effect,’ noting that full therapeutic benefits often take 4 to 6 weeks to manifest.
, 6. A patient experiences muscle rigidity, high fever, and autonomic instability shortly after
starting Haloperidol. Which condition should the PMHNP suspect?
A. Neuroleptic Malignant Syndrome (NMS)
B. Serotonin Syndrome
C. Acute Dystonia
D. Anticholinergic Crisis
Answer: A
Explanation: Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening
reaction to antipsychotic medications, characterized by the ‘lead-pipe’ muscle rigidity and
hyperpyrexia. It differs from Serotonin Syndrome primarily by the presence of severe
rigidity rather than hyperreflexia. Immediate discontinuation of the offending agent and
supportive care in an intensive care setting are mandatory.
7. What is the legal term for the PMHNP’s obligation to protect a third party from a patient’s
threat of violence?
A. Habeas Corpus
B. Duty to Warn
C. Parens Patriae
D. Informed Consent
Answer: B
Explanation: The Duty to Warn, originating from the Tarasoff v. Regents of the University
of California case, requires clinicians to breach confidentiality if a patient poses a specific
threat to an identifiable victim. This legal mandate balances patient privacy with public
safety. Failure to act can result in professional liability and harm to the community.
8. A 22-year-old female presents with recurrent episodes of binge eating followed by self-
induced vomiting and excessive exercise. Which physical exam finding is most consistent with
this disorder?
A. Lanugo
B. Hypotension
C. Bradycardia
D. Russell’s Sign
Answer: D
Explanation: Russell’s sign refers to the calluses on the knuckles or back of the hand
caused by repeated self-induced vomiting in patients with Bulimia Nervosa. Other common
