NR606 Week 10 Exam V2 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 10 Exam) | Chamberlain University
1. A 28-year-old patient diagnosed with Schizophrenia is prescribed Clozapine. Which
laboratory monitoring is strictly required before every refill during the initial phase of
treatment?
A. Absolute Neutrophil Count (ANC)
B. Liver function tests
C. Serum Potassium levels
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Explanation: Clozapine carries a significant risk for agranulocytosis, a life-threatening
drop in white blood cell count. The Clozapine REMS program mandates regular monitoring
of the Absolute Neutrophil Count (ANC) to ensure patient safety. For the first six months,
monitoring occurs weekly, and treatment must be interrupted if the ANC falls below
1,500/mm³.
2. When assessing a patient for Bipolar I Disorder, the PMHNP notes the presence of a ‘manic
episode.’ According to the DSM-5, which symptom is characteristic of mania rather than
hypomania?
A. Increased goal-directed activity
B. Marked impairment in social or occupational functioning
C. Symptoms lasting at least 4 consecutive days
D. Decreased need for sleep
Answer: B
Explanation: A manic episode requires symptoms to last at least one week and cause
marked impairment in functioning or necessitate hospitalization. In contrast, hypomania
only requires a four-day duration and does not cause severe social or occupational
impairment. Both conditions share symptoms like decreased need for sleep and increased
activity, but the severity of impairment is a key diagnostic differentiator.
3. A patient taking Lithium Carbonate for Bipolar Disorder presents with coarse hand tremors,
ataxia, and confusion. The serum lithium level is 2.1 mEq/L. What is the most appropriate
next step?
A. Discontinue Lithium and initiate emergency protocols for toxicity
,B. Increase fluid intake and decrease the dose
C. Continue the current dose and recheck in one week
D. Add a beta-blocker to manage the hand tremors
Answer: A
Explanation: A serum lithium level above 1.5 mEq/L is generally considered toxic, and
levels above 2.0 mEq/L are severe. Symptoms such as coarse tremors, ataxia, and confusion
indicate significant toxicity that requires immediate intervention. The PMHNP must stop
the medication and potentially order hemodialysis if levels reach critical thresholds or
symptoms worsen.
4. Which legal principle was established by the Tarasoff v. Regents of the University of
California case regarding psychiatric practice?
A. The duty to warn and protect potential victims
B. The right to refuse treatment
C. The standard for involuntary commitment
D. Confidentiality of HIV status
Answer: A
Explanation: The Tarasoff case established the ‘duty to warn’ when a patient poses a
serious threat of violence to a specific, identifiable victim. The PMHNP has a legal and
ethical obligation to breach confidentiality to protect third parties from harm. This
principle balances patient privacy with the safety of the public at large.
5. A 10-year-old child presents with a pattern of angry mood, argumentative behavior, and
vindictiveness toward authority figures for 7 months. Which diagnosis is most likely?
A. Conduct Disorder
B. Attention-Deficit/Hyperactivity Disorder (ADHD)
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Oppositional Defiant Disorder (ODD)
Answer: D
Explanation: Oppositional Defiant Disorder (ODD) is characterized by a persistent pattern
of angry/irritable mood and argumentative behavior toward non-siblings. Conduct
Disorder involves more severe violations of basic rights or societal norms, such as
aggression toward people or animals. Because the symptoms described focus on mood and
defiance rather than criminal acts, ODD is the correct diagnostic choice.
, 6. A patient with long-term Schizophrenia displays involuntary smacking of lips and tongue
protrusion. Which assessment tool should the PMHNP utilize to monitor these symptoms?
A. AIMS
B. PHQ-9
C. GAD-7
D. PANSS
Answer: A
Explanation: The Abnormal Involuntary Movement Scale (AIMS) is the standard tool for
assessing and monitoring symptoms of Tardive Dyskinesia (TD). Patients taking first-
generation or second-generation antipsychotics should be screened regularly for
involuntary movements. The AIMS tracks movements in the mouth, face, extremities, and
trunk to identify early signs of neurological side effects.
7. Which neurotransmitter is primarily targeted by Selective Serotonin Reuptake Inhibitors
(SSRIs) to treat Depressive Disorders?
A. Dopamine
B. GABA
C. Serotonin
D. Norepinephrine
Answer: C
Explanation: SSRIs work by inhibiting the reuptake of serotonin (5-HT) into the
presynaptic neuron, thereby increasing the amount of serotonin available in the synaptic
cleft. This increased availability is thought to improve mood and emotional regulation over
time. While other neurotransmitters may be indirectly affected, the primary mechanism of
action is specific to serotonin transporters.
8. A PMHNP is treating a patient for Major Depressive Disorder who reports symptoms of
‘heavy’ limbs and increased sensitivity to rejection. Which specifier best fits this
presentation?
A. With Melancholic Features
B. With Anxious Distress
C. With Mixed Features
D. With Atypical Features
Answer: D
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 10 Exam) | Chamberlain University
1. A 28-year-old patient diagnosed with Schizophrenia is prescribed Clozapine. Which
laboratory monitoring is strictly required before every refill during the initial phase of
treatment?
A. Absolute Neutrophil Count (ANC)
B. Liver function tests
C. Serum Potassium levels
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Explanation: Clozapine carries a significant risk for agranulocytosis, a life-threatening
drop in white blood cell count. The Clozapine REMS program mandates regular monitoring
of the Absolute Neutrophil Count (ANC) to ensure patient safety. For the first six months,
monitoring occurs weekly, and treatment must be interrupted if the ANC falls below
1,500/mm³.
2. When assessing a patient for Bipolar I Disorder, the PMHNP notes the presence of a ‘manic
episode.’ According to the DSM-5, which symptom is characteristic of mania rather than
hypomania?
A. Increased goal-directed activity
B. Marked impairment in social or occupational functioning
C. Symptoms lasting at least 4 consecutive days
D. Decreased need for sleep
Answer: B
Explanation: A manic episode requires symptoms to last at least one week and cause
marked impairment in functioning or necessitate hospitalization. In contrast, hypomania
only requires a four-day duration and does not cause severe social or occupational
impairment. Both conditions share symptoms like decreased need for sleep and increased
activity, but the severity of impairment is a key diagnostic differentiator.
3. A patient taking Lithium Carbonate for Bipolar Disorder presents with coarse hand tremors,
ataxia, and confusion. The serum lithium level is 2.1 mEq/L. What is the most appropriate
next step?
A. Discontinue Lithium and initiate emergency protocols for toxicity
,B. Increase fluid intake and decrease the dose
C. Continue the current dose and recheck in one week
D. Add a beta-blocker to manage the hand tremors
Answer: A
Explanation: A serum lithium level above 1.5 mEq/L is generally considered toxic, and
levels above 2.0 mEq/L are severe. Symptoms such as coarse tremors, ataxia, and confusion
indicate significant toxicity that requires immediate intervention. The PMHNP must stop
the medication and potentially order hemodialysis if levels reach critical thresholds or
symptoms worsen.
4. Which legal principle was established by the Tarasoff v. Regents of the University of
California case regarding psychiatric practice?
A. The duty to warn and protect potential victims
B. The right to refuse treatment
C. The standard for involuntary commitment
D. Confidentiality of HIV status
Answer: A
Explanation: The Tarasoff case established the ‘duty to warn’ when a patient poses a
serious threat of violence to a specific, identifiable victim. The PMHNP has a legal and
ethical obligation to breach confidentiality to protect third parties from harm. This
principle balances patient privacy with the safety of the public at large.
5. A 10-year-old child presents with a pattern of angry mood, argumentative behavior, and
vindictiveness toward authority figures for 7 months. Which diagnosis is most likely?
A. Conduct Disorder
B. Attention-Deficit/Hyperactivity Disorder (ADHD)
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Oppositional Defiant Disorder (ODD)
Answer: D
Explanation: Oppositional Defiant Disorder (ODD) is characterized by a persistent pattern
of angry/irritable mood and argumentative behavior toward non-siblings. Conduct
Disorder involves more severe violations of basic rights or societal norms, such as
aggression toward people or animals. Because the symptoms described focus on mood and
defiance rather than criminal acts, ODD is the correct diagnostic choice.
, 6. A patient with long-term Schizophrenia displays involuntary smacking of lips and tongue
protrusion. Which assessment tool should the PMHNP utilize to monitor these symptoms?
A. AIMS
B. PHQ-9
C. GAD-7
D. PANSS
Answer: A
Explanation: The Abnormal Involuntary Movement Scale (AIMS) is the standard tool for
assessing and monitoring symptoms of Tardive Dyskinesia (TD). Patients taking first-
generation or second-generation antipsychotics should be screened regularly for
involuntary movements. The AIMS tracks movements in the mouth, face, extremities, and
trunk to identify early signs of neurological side effects.
7. Which neurotransmitter is primarily targeted by Selective Serotonin Reuptake Inhibitors
(SSRIs) to treat Depressive Disorders?
A. Dopamine
B. GABA
C. Serotonin
D. Norepinephrine
Answer: C
Explanation: SSRIs work by inhibiting the reuptake of serotonin (5-HT) into the
presynaptic neuron, thereby increasing the amount of serotonin available in the synaptic
cleft. This increased availability is thought to improve mood and emotional regulation over
time. While other neurotransmitters may be indirectly affected, the primary mechanism of
action is specific to serotonin transporters.
8. A PMHNP is treating a patient for Major Depressive Disorder who reports symptoms of
‘heavy’ limbs and increased sensitivity to rejection. Which specifier best fits this
presentation?
A. With Melancholic Features
B. With Anxious Distress
C. With Mixed Features
D. With Atypical Features
Answer: D
