NR606 Week 8 Exam V1 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 8 Exam) | Chamberlain University
1. A 9-year-old male presents with persistent irritability and frequent temper outbursts that
are out of proportion to the situation, occurring at least three times a week. Which diagnosis
should the PMHNP prioritize based on these symptoms occurring for over a year?
A. Oppositional Defiant Disorder (ODD)
B. Pediatric Bipolar Disorder
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Conduct Disorder
Answer: C
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) is characterized by
chronic, severe persistent irritability and frequent temper outbursts in children. The DSM-
5 criteria require symptoms to be present for 12 or more months in at least two settings.
This diagnosis was created to address the over-diagnosis of Bipolar Disorder in children
who do not exhibit episodic mania.
2. When prescribing stimulants for a child with ADHD, which cardiovascular assessment is
essential according to current clinical guidelines?
A. Routine baseline Echocardiogram for all patients
B. Chest X-ray to rule out cardiomegaly
C. Baseline EKG only if the patient has a family history of sudden cardiac death
D. Daily blood pressure monitoring by the school nurse
Answer: C
Explanation: While routine EKGs are not required for all healthy children starting
stimulants, a thorough history and physical exam are mandatory. A baseline EKG is
indicated if there is a personal or family history of structural heart disease, syncope, or
sudden cardiac death. The PMHNP must document the absence of these risk factors before
initiating therapy.
3. A 15-year-old female presents with recurrent episodes of binge eating followed by self-
induced vomiting. Physical exam reveals Russell’s sign. Which physiological finding is most
likely?
A. Hyperkalemia
B. Metabolic Acidosis
,C. Hyponatremic acidosis
D. Hypokalemic hypochloremic alkalosis
Answer: D
Explanation: Frequent purging via vomiting leads to the loss of hydrochloric acid and
potassium from the stomach. This results in hypokalemic hypochloremic metabolic
alkalosis, a common laboratory finding in Bulimia Nervosa. Monitoring electrolytes is
critical in these patients to prevent cardiac arrhythmias.
4. Which therapeutic approach is considered the first-line psychosocial intervention for an
adolescent diagnosed with Mild Depressive Disorder?
A. Interpersonal Psychotherapy for Adolescents (IPT-A)
B. Dialectical Behavior Therapy (DBT)
C. Psychoanalysis
D. Brief Strategic Family Therapy
Answer: A
Explanation: Interpersonal Psychotherapy for Adolescents (IPT-A) focuses on improving
interpersonal relationships and social functioning to reduce depressive symptoms. It is
evidence-based and highly effective for the adolescent population. Other first-line
treatments include Cognitive Behavioral Therapy (CBT).
5. An 8-year-old child demonstrates significant deficits in social communication, repetitive
motor mannerisms, and a preoccupation with train schedules. What is the primary diagnostic
consideration?
A. Autism Spectrum Disorder (ASD)
B. Obsessive-Compulsive Disorder (OCD)
C. Social Communication Disorder
D. Stereotypic Movement Disorder
Answer: A
Explanation: Autism Spectrum Disorder (ASD) involves persistent deficits in social
communication and social interaction across multiple contexts. Additionally, it requires
restricted, repetitive patterns of behavior, interests, or activities. The preoccupation with
specific topics like train schedules is a hallmark restricted interest.
6. A PMHNP is evaluating a 6-year-old for ADHD. The parents report symptoms only at home,
while the teacher reports no issues at school. Can a diagnosis of ADHD be made?
A. No, symptoms must be present in two or more settings
, B. Yes, if the home symptoms are severe
C. Yes, but only the Inattentive subtype
D. No, diagnosis cannot be made before age 7
Answer: A
Explanation: Per the DSM-5, symptoms of ADHD must be present in two or more settings,
such as home, school, or social environments. If symptoms are only present in one setting,
the clinician should investigate environmental stressors or other localized causes.
Consistent cross-situational impairment is a core requirement for diagnosis.
7. Which medication is the only FDA-approved SSRI for the treatment of depression in
children aged 8 and older?
A. Sertraline
B. Paroxetine
C. Escitalopram
D. Fluoxetine
Answer: D
Explanation: Fluoxetine is currently the only SSRI with FDA approval for treating Major
Depressive Disorder in children as young as 8 years old. Escitalopram is approved for
adolescents aged 12 to 17. Use of other SSRIs in this population is considered off-label,
though common in clinical practice.
8. What is the primary Black Box Warning associated with the use of SSRIs in children,
adolescents, and young adults?
A. Risk of Stevens-Johnson Syndrome
B. Risk of hepatotoxicity
C. Increased risk of suicidal ideation and behavior
D. Potential for growth suppression
Answer: C
Explanation: The FDA issued a Black Box Warning for all antidepressants regarding the
increased risk of suicidal thinking and behavior in children, adolescents, and young adults.
Clinicians must closely monitor patients for worsening of symptoms or emergence of
suicidality. Frequent follow-up is especially critical during the first few months of
treatment.
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 8 Exam) | Chamberlain University
1. A 9-year-old male presents with persistent irritability and frequent temper outbursts that
are out of proportion to the situation, occurring at least three times a week. Which diagnosis
should the PMHNP prioritize based on these symptoms occurring for over a year?
A. Oppositional Defiant Disorder (ODD)
B. Pediatric Bipolar Disorder
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Conduct Disorder
Answer: C
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) is characterized by
chronic, severe persistent irritability and frequent temper outbursts in children. The DSM-
5 criteria require symptoms to be present for 12 or more months in at least two settings.
This diagnosis was created to address the over-diagnosis of Bipolar Disorder in children
who do not exhibit episodic mania.
2. When prescribing stimulants for a child with ADHD, which cardiovascular assessment is
essential according to current clinical guidelines?
A. Routine baseline Echocardiogram for all patients
B. Chest X-ray to rule out cardiomegaly
C. Baseline EKG only if the patient has a family history of sudden cardiac death
D. Daily blood pressure monitoring by the school nurse
Answer: C
Explanation: While routine EKGs are not required for all healthy children starting
stimulants, a thorough history and physical exam are mandatory. A baseline EKG is
indicated if there is a personal or family history of structural heart disease, syncope, or
sudden cardiac death. The PMHNP must document the absence of these risk factors before
initiating therapy.
3. A 15-year-old female presents with recurrent episodes of binge eating followed by self-
induced vomiting. Physical exam reveals Russell’s sign. Which physiological finding is most
likely?
A. Hyperkalemia
B. Metabolic Acidosis
,C. Hyponatremic acidosis
D. Hypokalemic hypochloremic alkalosis
Answer: D
Explanation: Frequent purging via vomiting leads to the loss of hydrochloric acid and
potassium from the stomach. This results in hypokalemic hypochloremic metabolic
alkalosis, a common laboratory finding in Bulimia Nervosa. Monitoring electrolytes is
critical in these patients to prevent cardiac arrhythmias.
4. Which therapeutic approach is considered the first-line psychosocial intervention for an
adolescent diagnosed with Mild Depressive Disorder?
A. Interpersonal Psychotherapy for Adolescents (IPT-A)
B. Dialectical Behavior Therapy (DBT)
C. Psychoanalysis
D. Brief Strategic Family Therapy
Answer: A
Explanation: Interpersonal Psychotherapy for Adolescents (IPT-A) focuses on improving
interpersonal relationships and social functioning to reduce depressive symptoms. It is
evidence-based and highly effective for the adolescent population. Other first-line
treatments include Cognitive Behavioral Therapy (CBT).
5. An 8-year-old child demonstrates significant deficits in social communication, repetitive
motor mannerisms, and a preoccupation with train schedules. What is the primary diagnostic
consideration?
A. Autism Spectrum Disorder (ASD)
B. Obsessive-Compulsive Disorder (OCD)
C. Social Communication Disorder
D. Stereotypic Movement Disorder
Answer: A
Explanation: Autism Spectrum Disorder (ASD) involves persistent deficits in social
communication and social interaction across multiple contexts. Additionally, it requires
restricted, repetitive patterns of behavior, interests, or activities. The preoccupation with
specific topics like train schedules is a hallmark restricted interest.
6. A PMHNP is evaluating a 6-year-old for ADHD. The parents report symptoms only at home,
while the teacher reports no issues at school. Can a diagnosis of ADHD be made?
A. No, symptoms must be present in two or more settings
, B. Yes, if the home symptoms are severe
C. Yes, but only the Inattentive subtype
D. No, diagnosis cannot be made before age 7
Answer: A
Explanation: Per the DSM-5, symptoms of ADHD must be present in two or more settings,
such as home, school, or social environments. If symptoms are only present in one setting,
the clinician should investigate environmental stressors or other localized causes.
Consistent cross-situational impairment is a core requirement for diagnosis.
7. Which medication is the only FDA-approved SSRI for the treatment of depression in
children aged 8 and older?
A. Sertraline
B. Paroxetine
C. Escitalopram
D. Fluoxetine
Answer: D
Explanation: Fluoxetine is currently the only SSRI with FDA approval for treating Major
Depressive Disorder in children as young as 8 years old. Escitalopram is approved for
adolescents aged 12 to 17. Use of other SSRIs in this population is considered off-label,
though common in clinical practice.
8. What is the primary Black Box Warning associated with the use of SSRIs in children,
adolescents, and young adults?
A. Risk of Stevens-Johnson Syndrome
B. Risk of hepatotoxicity
C. Increased risk of suicidal ideation and behavior
D. Potential for growth suppression
Answer: C
Explanation: The FDA issued a Black Box Warning for all antidepressants regarding the
increased risk of suicidal thinking and behavior in children, adolescents, and young adults.
Clinicians must closely monitor patients for worsening of symptoms or emergence of
suicidality. Frequent follow-up is especially critical during the first few months of
treatment.
