NR606 Week 10 Exam V3 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 10 Exam) | Chamberlain University
1. A 10-year-old male is diagnosed with ADHD, combined type. Which of the following first-
line pharmacological treatments should the PMHNP consider, assuming no contraindications?
A. Atomoxetine
B. Clonidine
C. Methylphenidate
D. Bupropion
Answer: C
Explanation: Methylphenidate is considered a first-line stimulant for the treatment of
ADHD in pediatric patients. Stimulants work by increasing the availability of dopamine and
norepinephrine in the prefrontal cortex. Atomoxetine is generally considered a second-line
option for patients who do not tolerate or respond to stimulants.
2. When evaluating a 75-year-old patient for depression, the PMHNP notes significant
cognitive impairment. Which tool is most appropriate to differentiate between depression-
related cognitive impairment (pseudodementia) and true dementia?
A. PHQ-9
B. Geriatric Depression Scale (GDS)
C. Mini-Mental State Examination (MMSE)
D. Beck Anxiety Inventory
Answer: B
Explanation: The Geriatric Depression Scale is specifically designed to screen for
depression in older adults and helps distinguish mood issues from primary cognitive
decline. Pseudodementia typically presents with a sudden onset and the patient often
complains of memory loss, whereas true dementia has an insidious onset. Utilizing the GDS
alongside cognitive testing allows for a more comprehensive diagnostic picture.
3. An adolescent patient is prescribed Fluoxetine for Major Depressive Disorder. What is the
Black Box Warning associated with this medication in this population?
A. Increased risk of hepatotoxicity
B. Risk of cardiac arrhythmias
C. Risk of Stevens-Johnson Syndrome
,D. Increased risk of suicidal ideation and behavior
Answer: D
Explanation: The FDA requires a Black Box Warning on all antidepressants regarding the
increased risk of suicidal thoughts and behaviors in children, adolescents, and young
adults. Clinicians must closely monitor these patients for any signs of worsening
depression or emerging suicidality, especially during the first few months of treatment.
Families should be educated on specific warning signs and the importance of regular
follow-up appointments.
4. A 14-year-old female presents with a pattern of angry/irritable mood,
argumentative/defiant behavior, and vindictiveness for at least 6 months. She does not
violate the basic rights of others or major age-appropriate societal norms. What is the most
likely diagnosis?
A. Conduct Disorder
B. Antisocial Personality Disorder
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 mood and defiance without the severe aggression or property destruction seen in
Conduct Disorder. The criteria require symptoms to be present for at least six months and
observed during interactions with at least one individual who is not a sibling. DMDD is
differentiated by the presence of severe, recurrent temper outbursts that are out of
proportion to the situation.
5. A PMHNP is treating a child with Autism Spectrum Disorder (ASD) who exhibits severe
irritability and temper tantrums. Which medication is FDA-approved for this specific
indication in ASD?
A. Risperidone
B. Lithium
C. Sertraline
D. Methylphenidate
Answer: A
Explanation: Risperidone is one of the few medications FDA-approved for the treatment of
irritability associated with Autism Spectrum Disorder in children and adolescents. It helps
manage symptoms such as aggression, deliberate self-injury, and temper tantrums.
Monitoring for metabolic side effects and extrapyramidal symptoms is essential when
using second-generation antipsychotics in this population.
, 6. An 82-year-old female patient is experiencing insomnia. Which medication should be
avoided according to the Beers Criteria?
A. Melatonin
B. Diphenhydramine
C. Trazodone
D. Ramelteon
Answer: B
Explanation: Diphenhydramine is an anticholinergic medication that is listed on the Beers
Criteria as potentially inappropriate for older adults. It increases the risk of confusion, falls,
and urinary retention in the geriatric population. Safer alternatives for insomnia in the
elderly include non-pharmacological sleep hygiene or low-dose melatonin.
7. A 16-year-old male is brought to the clinic for ‘getting into trouble.’ He has a history of
stealing, lying, and initiating physical fights with others. He shows no remorse for his actions.
Which diagnosis is most consistent with this behavior?
A. Oppositional Defiant Disorder
B. Attention-Deficit/Hyperactivity Disorder
C. Intermittent Explosive Disorder
D. Conduct Disorder
Answer: D
Explanation: Conduct Disorder involves a repetitive and persistent pattern of behavior in
which the basic rights of others or major societal norms are violated. This includes
aggression toward people and animals, destruction of property, and theft. The lack of
remorse is a common specifier that indicates a more severe clinical course.
8. A PMHNP is considering Clozapine for a patient with treatment-resistant schizophrenia.
Which laboratory value must be monitored weekly during the first 6 months of treatment?
A. Liver function tests
B.
C. Serum Creatinine
D. Thyroid Stimulating Hormone (TSH)
D. Absolute Neutrophil Count (ANC)
Answer: D
Explanation: Clozapine carries a significant risk of agranulocytosis, requiring strict
monitoring of the Absolute Neutrophil Count (ANC). Treatment can only be initiated if the
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 10 Exam) | Chamberlain University
1. A 10-year-old male is diagnosed with ADHD, combined type. Which of the following first-
line pharmacological treatments should the PMHNP consider, assuming no contraindications?
A. Atomoxetine
B. Clonidine
C. Methylphenidate
D. Bupropion
Answer: C
Explanation: Methylphenidate is considered a first-line stimulant for the treatment of
ADHD in pediatric patients. Stimulants work by increasing the availability of dopamine and
norepinephrine in the prefrontal cortex. Atomoxetine is generally considered a second-line
option for patients who do not tolerate or respond to stimulants.
2. When evaluating a 75-year-old patient for depression, the PMHNP notes significant
cognitive impairment. Which tool is most appropriate to differentiate between depression-
related cognitive impairment (pseudodementia) and true dementia?
A. PHQ-9
B. Geriatric Depression Scale (GDS)
C. Mini-Mental State Examination (MMSE)
D. Beck Anxiety Inventory
Answer: B
Explanation: The Geriatric Depression Scale is specifically designed to screen for
depression in older adults and helps distinguish mood issues from primary cognitive
decline. Pseudodementia typically presents with a sudden onset and the patient often
complains of memory loss, whereas true dementia has an insidious onset. Utilizing the GDS
alongside cognitive testing allows for a more comprehensive diagnostic picture.
3. An adolescent patient is prescribed Fluoxetine for Major Depressive Disorder. What is the
Black Box Warning associated with this medication in this population?
A. Increased risk of hepatotoxicity
B. Risk of cardiac arrhythmias
C. Risk of Stevens-Johnson Syndrome
,D. Increased risk of suicidal ideation and behavior
Answer: D
Explanation: The FDA requires a Black Box Warning on all antidepressants regarding the
increased risk of suicidal thoughts and behaviors in children, adolescents, and young
adults. Clinicians must closely monitor these patients for any signs of worsening
depression or emerging suicidality, especially during the first few months of treatment.
Families should be educated on specific warning signs and the importance of regular
follow-up appointments.
4. A 14-year-old female presents with a pattern of angry/irritable mood,
argumentative/defiant behavior, and vindictiveness for at least 6 months. She does not
violate the basic rights of others or major age-appropriate societal norms. What is the most
likely diagnosis?
A. Conduct Disorder
B. Antisocial Personality Disorder
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 mood and defiance without the severe aggression or property destruction seen in
Conduct Disorder. The criteria require symptoms to be present for at least six months and
observed during interactions with at least one individual who is not a sibling. DMDD is
differentiated by the presence of severe, recurrent temper outbursts that are out of
proportion to the situation.
5. A PMHNP is treating a child with Autism Spectrum Disorder (ASD) who exhibits severe
irritability and temper tantrums. Which medication is FDA-approved for this specific
indication in ASD?
A. Risperidone
B. Lithium
C. Sertraline
D. Methylphenidate
Answer: A
Explanation: Risperidone is one of the few medications FDA-approved for the treatment of
irritability associated with Autism Spectrum Disorder in children and adolescents. It helps
manage symptoms such as aggression, deliberate self-injury, and temper tantrums.
Monitoring for metabolic side effects and extrapyramidal symptoms is essential when
using second-generation antipsychotics in this population.
, 6. An 82-year-old female patient is experiencing insomnia. Which medication should be
avoided according to the Beers Criteria?
A. Melatonin
B. Diphenhydramine
C. Trazodone
D. Ramelteon
Answer: B
Explanation: Diphenhydramine is an anticholinergic medication that is listed on the Beers
Criteria as potentially inappropriate for older adults. It increases the risk of confusion, falls,
and urinary retention in the geriatric population. Safer alternatives for insomnia in the
elderly include non-pharmacological sleep hygiene or low-dose melatonin.
7. A 16-year-old male is brought to the clinic for ‘getting into trouble.’ He has a history of
stealing, lying, and initiating physical fights with others. He shows no remorse for his actions.
Which diagnosis is most consistent with this behavior?
A. Oppositional Defiant Disorder
B. Attention-Deficit/Hyperactivity Disorder
C. Intermittent Explosive Disorder
D. Conduct Disorder
Answer: D
Explanation: Conduct Disorder involves a repetitive and persistent pattern of behavior in
which the basic rights of others or major societal norms are violated. This includes
aggression toward people and animals, destruction of property, and theft. The lack of
remorse is a common specifier that indicates a more severe clinical course.
8. A PMHNP is considering Clozapine for a patient with treatment-resistant schizophrenia.
Which laboratory value must be monitored weekly during the first 6 months of treatment?
A. Liver function tests
B.
C. Serum Creatinine
D. Thyroid Stimulating Hormone (TSH)
D. Absolute Neutrophil Count (ANC)
Answer: D
Explanation: Clozapine carries a significant risk of agranulocytosis, requiring strict
monitoring of the Absolute Neutrophil Count (ANC). Treatment can only be initiated if the
