NR606 Week 8 Exam V2 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 8 Exam) | Chamberlain University
1. A 9-year-old child is brought to the clinic for an evaluation due to persistent patterns of
inattention and hyperactivity that interfere with school performance. According to the DSM-
5-TR, how many symptoms of inattention must be present for a diagnosis in a child?
A. At least 5 symptoms for at least 12 months
B. At least 6 symptoms for at least 6 months
C. At least 4 symptoms for at least 3 months
D. At least 7 symptoms for at least 6 months
Answer: B
Explanation: The DSM-5-TR requires at least 6 symptoms of inattention or hyperactivity-
impulsivity for children up to age 16. These symptoms must have persisted for at least 6
months to a degree that is inconsistent with developmental level. For individuals 17 and
older, only 5 symptoms are required for the diagnosis.
2. When prescribing Atomoxetine (Strattera) for a pediatric patient with ADHD, which of the
following mechanisms of action is correct?
A. Selective inhibition of the presynaptic norepinephrine transporter
B. Dopamine reuptake inhibition in the prefrontal cortex
C. Alpha-2 adrenergic receptor agonism
D. Serotonin and Norepinephrine reuptake inhibition
Answer: A
Explanation: Atomoxetine is a non-stimulant medication used for ADHD that works as a
selective norepinephrine reuptake inhibitor. It specifically targets the presynaptic
norepinephrine transporter to increase synaptic levels of norepinephrine. Unlike
stimulants, it does not have a high potential for abuse or controlled substance status.
3. The FDA has issued a ‘black box warning’ for all selective serotonin reuptake inhibitors
(SSRIs) when prescribed to children and adolescents. What is the primary concern addressed
in this warning?
A. Increased risk of cardiac arrhythmias
B. Potential for permanent growth suppression
C. Increased risk of suicidal ideation and behavior
,D. Higher incidence of hepatotoxicity
Answer: C
Explanation: The FDA black box warning highlights an increased risk of suicidal thinking
and behavior in children, adolescents, and young adults (under 25) taking antidepressants.
Providers must monitor patients closely for clinical worsening or unusual changes in
behavior when starting these medications. This warning was implemented after pooled
analyses showed a statistically significant increase in risk compared to placebo.
4. A 10-year-old patient exhibits a pattern of angry/irritable mood, argumentative/defiant
behavior, and vindictiveness lasting at least 6 months. This presentation is most consistent
with which diagnosis?
A. Conduct Disorder (CD)
B. Oppositional Defiant Disorder (ODD)
C. Intermittent Explosive Disorder (IED)
D. Disruptive Mood Dysregulation Disorder (DMDD)
Answer: B
Explanation: Oppositional Defiant Disorder (ODD) is characterized by a frequent and
persistent pattern of anger, irritability, arguing, defiance, or vindictiveness toward parents
and other authority figures. The criteria require at least four symptoms from these
categories occurring with at least one individual who is not a sibling. If the behaviors
escalate to physical aggression toward people or animals or destruction of property,
Conduct Disorder would be a more likely diagnosis.
5. Which clinical feature distinguishes Conduct Disorder from Oppositional Defiant Disorder?
A. Argumentative behavior with authority figures
B. Violation of the basic rights of others or major societal norms
C. Refusal to comply with rules set by parents
D. Persistent irritability and low frustration tolerance
Answer: B
Explanation: Conduct Disorder involves more severe behaviors that violate the rights of
others, such as aggression, destruction of property, deceitfulness, or theft. ODD typically
involves defiance and verbal hostility rather than physical aggression or illegal acts.
Understanding this distinction is crucial for proper management and legal considerations
in psychiatric practice.
6. When initiating Fluoxetine for a 14-year-old with Major Depressive Disorder, what is the
recommended starting dose according to clinical guidelines?
A. 5 mg daily
, B. 20 mg daily
C. 10 mg daily
D. 40 mg daily
Answer: C
Explanation: Fluoxetine is often started at 10 mg daily in adolescents to assess tolerance
and minimize side effects before titrating to 20 mg. While 20 mg is the standard
therapeutic dose, a lower start is prudent given the metabolic differences in younger
patients. Monitoring for activation or suicidal ideation is mandatory during the titration
phase.
7. The SCARED (Screen for Child Anxiety Related Emotional Disorders) tool is used to assess
for various anxiety disorders. A total score of what suggests the presence of an anxiety
disorder?
A. 25 or higher
B. 20 or higher
C. 15 or higher
D. 30 or higher
Answer: A
Explanation: A total score of 25 or higher on the SCARED tool indicates the presence of an
anxiety disorder in children and adolescents. It is a 41-item self-report or parent-report
instrument that screens for GAD, separation anxiety, and social phobia. Using standardized
screening tools helps the PMHNP objectively measure symptom severity over time.
8. Which of the following is considered a core deficit in Autism Spectrum Disorder (ASD)
according to the DSM-5-TR?
A. Persistent deficits in social communication and social interaction
B. Persistent pattern of inattention and impulsivity
C. Recurrent episodes of verbal or physical aggression
D. Deficits in intellectual functioning and adaptive behavior
Answer: A
Explanation: The core diagnostic criteria for ASD include persistent deficits in social
communication and social interaction across multiple contexts. Additionally, patients must
demonstrate restricted, repetitive patterns of behavior, interests, or activities. These
symptoms must be present in the early developmental period, even if they become more
apparent later in life.
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 8 Exam) | Chamberlain University
1. A 9-year-old child is brought to the clinic for an evaluation due to persistent patterns of
inattention and hyperactivity that interfere with school performance. According to the DSM-
5-TR, how many symptoms of inattention must be present for a diagnosis in a child?
A. At least 5 symptoms for at least 12 months
B. At least 6 symptoms for at least 6 months
C. At least 4 symptoms for at least 3 months
D. At least 7 symptoms for at least 6 months
Answer: B
Explanation: The DSM-5-TR requires at least 6 symptoms of inattention or hyperactivity-
impulsivity for children up to age 16. These symptoms must have persisted for at least 6
months to a degree that is inconsistent with developmental level. For individuals 17 and
older, only 5 symptoms are required for the diagnosis.
2. When prescribing Atomoxetine (Strattera) for a pediatric patient with ADHD, which of the
following mechanisms of action is correct?
A. Selective inhibition of the presynaptic norepinephrine transporter
B. Dopamine reuptake inhibition in the prefrontal cortex
C. Alpha-2 adrenergic receptor agonism
D. Serotonin and Norepinephrine reuptake inhibition
Answer: A
Explanation: Atomoxetine is a non-stimulant medication used for ADHD that works as a
selective norepinephrine reuptake inhibitor. It specifically targets the presynaptic
norepinephrine transporter to increase synaptic levels of norepinephrine. Unlike
stimulants, it does not have a high potential for abuse or controlled substance status.
3. The FDA has issued a ‘black box warning’ for all selective serotonin reuptake inhibitors
(SSRIs) when prescribed to children and adolescents. What is the primary concern addressed
in this warning?
A. Increased risk of cardiac arrhythmias
B. Potential for permanent growth suppression
C. Increased risk of suicidal ideation and behavior
,D. Higher incidence of hepatotoxicity
Answer: C
Explanation: The FDA black box warning highlights an increased risk of suicidal thinking
and behavior in children, adolescents, and young adults (under 25) taking antidepressants.
Providers must monitor patients closely for clinical worsening or unusual changes in
behavior when starting these medications. This warning was implemented after pooled
analyses showed a statistically significant increase in risk compared to placebo.
4. A 10-year-old patient exhibits a pattern of angry/irritable mood, argumentative/defiant
behavior, and vindictiveness lasting at least 6 months. This presentation is most consistent
with which diagnosis?
A. Conduct Disorder (CD)
B. Oppositional Defiant Disorder (ODD)
C. Intermittent Explosive Disorder (IED)
D. Disruptive Mood Dysregulation Disorder (DMDD)
Answer: B
Explanation: Oppositional Defiant Disorder (ODD) is characterized by a frequent and
persistent pattern of anger, irritability, arguing, defiance, or vindictiveness toward parents
and other authority figures. The criteria require at least four symptoms from these
categories occurring with at least one individual who is not a sibling. If the behaviors
escalate to physical aggression toward people or animals or destruction of property,
Conduct Disorder would be a more likely diagnosis.
5. Which clinical feature distinguishes Conduct Disorder from Oppositional Defiant Disorder?
A. Argumentative behavior with authority figures
B. Violation of the basic rights of others or major societal norms
C. Refusal to comply with rules set by parents
D. Persistent irritability and low frustration tolerance
Answer: B
Explanation: Conduct Disorder involves more severe behaviors that violate the rights of
others, such as aggression, destruction of property, deceitfulness, or theft. ODD typically
involves defiance and verbal hostility rather than physical aggression or illegal acts.
Understanding this distinction is crucial for proper management and legal considerations
in psychiatric practice.
6. When initiating Fluoxetine for a 14-year-old with Major Depressive Disorder, what is the
recommended starting dose according to clinical guidelines?
A. 5 mg daily
, B. 20 mg daily
C. 10 mg daily
D. 40 mg daily
Answer: C
Explanation: Fluoxetine is often started at 10 mg daily in adolescents to assess tolerance
and minimize side effects before titrating to 20 mg. While 20 mg is the standard
therapeutic dose, a lower start is prudent given the metabolic differences in younger
patients. Monitoring for activation or suicidal ideation is mandatory during the titration
phase.
7. The SCARED (Screen for Child Anxiety Related Emotional Disorders) tool is used to assess
for various anxiety disorders. A total score of what suggests the presence of an anxiety
disorder?
A. 25 or higher
B. 20 or higher
C. 15 or higher
D. 30 or higher
Answer: A
Explanation: A total score of 25 or higher on the SCARED tool indicates the presence of an
anxiety disorder in children and adolescents. It is a 41-item self-report or parent-report
instrument that screens for GAD, separation anxiety, and social phobia. Using standardized
screening tools helps the PMHNP objectively measure symptom severity over time.
8. Which of the following is considered a core deficit in Autism Spectrum Disorder (ASD)
according to the DSM-5-TR?
A. Persistent deficits in social communication and social interaction
B. Persistent pattern of inattention and impulsivity
C. Recurrent episodes of verbal or physical aggression
D. Deficits in intellectual functioning and adaptive behavior
Answer: A
Explanation: The core diagnostic criteria for ASD include persistent deficits in social
communication and social interaction across multiple contexts. Additionally, patients must
demonstrate restricted, repetitive patterns of behavior, interests, or activities. These
symptoms must be present in the early developmental period, even if they become more
apparent later in life.
