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NR 606 FINAL ACTUAL EXAM 2025 COMPLETE ACCURATE QUESTIONS
WITH WELL ELABORATED ANSWERS WITH RATIONALES (100%
VERIFIED ANSWERS) A NEW UPDATED VERSION |GUARANTEED PASS
A+ (FULL REVISED EXAM) 2025/2026.
A 22-year-old female with a diagnosis of Bipolar I Disorder presents for a follow-up. She is stable on her
current medication regimen and reports being sexually active with her male partner but is not using any
form of contraception. Which of her following current medications warrants the MOST urgent and
comprehensive counseling regarding its significant teratogenic risks and the critical need for effective
contraception?
a) Lamotrigine (Lamictal)
b) Quetiapine (Seroquel)
c) Valproic Acid (Depakote)
d) Lithium
c) Valproic Acid (Depakote
Valproic Acid (Depakote) as the medication requiring the most urgent intervention. Valproic acid is highly
teratogenic and is associated with a significant risk of major congenital malformations, particularly neural tube
defects like spina bifida.
-Lamotrigine (Lamictal) is generally considered one of the safer mood stabilizers during pregnancy.
-Quetiapine (Seroquel), an atypical antipsychotic, primarily poses metabolic risks, such as gestational diabetes.
-Lithium is associated with a small risk of Ebstein's anomaly, a cardiac defect, but the benefits of preventing a
manic relapse often outweigh this risk.
A 12-year-old boy is brought in by his parents due to a gradual 1-year decline in his academic
performance and increasing social isolation. His parents note he has become emotionally distant with a
blunted affect. They occasionally overhear him mumbling to himself in his room, though he denies
hearing voices when asked directly. He had previously been a social and high-achieving student with no
developmental concerns. Which clinical feature is MOST indicative of Childhood-Onset Schizophrenia
(COS) rather than Autism Spectrum Disorder (ASD) in this case?
a) The presence of persistent deficits in social reciprocity and communication.
b) An inflexible adherence to routines and ritualized patterns of behavior.
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c) A marked deterioration in functioning from a previously higher baseline.
d) The presence of stereotyped or repetitive use of language.
marked deterioration in functioning from a previously higher baseline.
-social deficits, insistence on sameness, and stereotyped language are all core diagnostic criteria for ASD, which
must be present in the early developmental period.
A 24-year-old client with a new diagnosis of schizophreniform disorder reports smoking one pack of
cigarettes per day. When considering initial treatment, which of the following second-generation
antipsychotics is LEAST ideal as a first-choice monotherapy due to a significant pharmacokinetic
interaction with smoking?
a) Risperidone (Risperdal)
b) Olanzapine (Zyprexa)
c) Aripiprazole (Abilify)
d) Lurasidone (Latuda)
Olanzapine (Zyprexa)
- significant CYP1A2 interaction (same as cigarette carbons)
-requires a 30% higher dose
A 9-year-old is diagnosed with Tourette's Syndrome after a 14-month history of eye blinking, shoulder
shrugging, and intermittent throat-clearing tics. The tics are distressing to the parents, but they cause the
child only mild social embarrassment and no physical pain or injury. The parents want to "start a
treatment that will stop the tics." What is the most appropriate first-line intervention?
a) Refer the child for Comprehensive Behavioral Intervention for Tics (CBIT).
b) Initiate a low dose of aripiprazole to suppress the tic severity.
c) Provide psychoeducation to the child and parents about the nature of tics.
d) Start clonidine to manage the tics and any underlying hyperactivity.
Psychoeducation is the correct first-line intervention for Tourette's Syndrome (TS), especially when tics are not
causing severe impairment. This initial step involves educating the child and family about the nature of TS,
including the typical waxing and waning course of tics.
,3|Page
-Comprehensive Behavioral Intervention for Tics (CBIT) is a highly effective therapy, but it is considered
a second-line intervention
-aripiprazole or clonidine, are reserved for cases where tics cause significant social, academic, or physical
impairment and have not responded to non-pharmacological approaches.
A 28-year-old first-time mother calls your clinic 10 days after a normal vaginal delivery. She sounds
distressed and reports frequent crying spells, feeling overwhelmed, and experiencing anxiety that "comes
and goes." She is sleeping when the baby sleeps and is managing all infant care appropriately. She asks if
she has postpartum depression. Based on this specific timeline and symptom presentation, what is the
most likely diagnosis?
a) Baby Blues
b) Peripartum Major Depressive Disorder
c) Peripartum Generalized Anxiety Disorder
d) Adjustment Disorder with Depressed Mood
Baby Blues based on the critical factor of timing.
-sx's appear in the first few days after childbirth and resolve on their own
-sx's do not cause functional impairment
- MDD requires sx's more than two weeks
A 16-year-old male is brought to the clinic for a 3-month history of low mood, anhedonia, and fatigue. His
PHQ-9 score is 18 (moderately severe depression). During the interview, his mother mentions that four
months ago, there was a one-week period where he was "the life of the party," slept only 3-4 hours per
night without feeling tired, talked constantly, and started an elaborate project to build a robot that he
quickly abandoned. What is the most significant and immediate risk of initiating fluoxetine monotherapy
for this adolescent?
a) An increased risk of extrapyramidal symptoms (EPS).
b) The precipitation of a manic or hypomanic episode.
c) A gradual and complete lack of therapeutic response.
d) The development of serotonin syndrome.
the precipitation of a manic or hypomanic episode. The mother's description of a distinct period of elevated
energy, decreased need for sleep, and goal-directed but unfinished projects is a classic presentation of a
, 4|Page
hypomanic episode.
A 4-year-old girl is referred for evaluation due to developmental regression. Her parents report that after
a period of normal development, she began to lose her ability to speak and, most notably, lost the
purposeful use of her hands, now engaging in constant, stereotyped hand-wringing motions. Which of the
following is the most likely underlying cause of her condition?
a) An autoimmune response triggered by a streptococcal infection.
b) Severe, early-life trauma leading to functional neurological deficits.
c) A spontaneous mutation in the MECP2 gene on the X chromosome.
d) Perinatal exposure to a teratogenic substance like alcohol.
developmental regression, loss of speech, and, most critically, the
loss of purposeful hand use replaced by stereotyped hand-wringing is the classic presentation of Rett
Syndrome.
-developmental regression, loss of speech, and, most critically, the
loss of purposeful hand use replaced by stereotyped hand-wringing is the classic presentation of Rett
Syndrome.
A 28-year-old with treatment-resistant schizophrenia has failed adequate trials of olanzapine and
risperidone. The provider is now considering clozapine. Which of the following potential adverse effects is
associated with clozapine and requires frequent monitoring of the absolute neutrophil count (ANC)?
Agranulocytosis
-clozapine carries a low risk of TD
- metabolic syndrome can be significant
-QTc prolongation
An 8-year-old boy is brought in for evaluation. His parents state he is "angry and irritable almost every
day." For the past two years, he has had severe temper outbursts with yelling and throwing objects 4-5
times per week, which are grossly out of proportion to the situation. Between these outbursts, his mood is
consistently and noticeably irritable. His parents deny he has ever had a distinct, sustained period of
elevated mood, grandiosity, or a decreased need for sleep. Which diagnosis best fits this clinical
presentation?
a) Bipolar I Disorder
NR 606 FINAL ACTUAL EXAM 2025 COMPLETE ACCURATE QUESTIONS
WITH WELL ELABORATED ANSWERS WITH RATIONALES (100%
VERIFIED ANSWERS) A NEW UPDATED VERSION |GUARANTEED PASS
A+ (FULL REVISED EXAM) 2025/2026.
A 22-year-old female with a diagnosis of Bipolar I Disorder presents for a follow-up. She is stable on her
current medication regimen and reports being sexually active with her male partner but is not using any
form of contraception. Which of her following current medications warrants the MOST urgent and
comprehensive counseling regarding its significant teratogenic risks and the critical need for effective
contraception?
a) Lamotrigine (Lamictal)
b) Quetiapine (Seroquel)
c) Valproic Acid (Depakote)
d) Lithium
c) Valproic Acid (Depakote
Valproic Acid (Depakote) as the medication requiring the most urgent intervention. Valproic acid is highly
teratogenic and is associated with a significant risk of major congenital malformations, particularly neural tube
defects like spina bifida.
-Lamotrigine (Lamictal) is generally considered one of the safer mood stabilizers during pregnancy.
-Quetiapine (Seroquel), an atypical antipsychotic, primarily poses metabolic risks, such as gestational diabetes.
-Lithium is associated with a small risk of Ebstein's anomaly, a cardiac defect, but the benefits of preventing a
manic relapse often outweigh this risk.
A 12-year-old boy is brought in by his parents due to a gradual 1-year decline in his academic
performance and increasing social isolation. His parents note he has become emotionally distant with a
blunted affect. They occasionally overhear him mumbling to himself in his room, though he denies
hearing voices when asked directly. He had previously been a social and high-achieving student with no
developmental concerns. Which clinical feature is MOST indicative of Childhood-Onset Schizophrenia
(COS) rather than Autism Spectrum Disorder (ASD) in this case?
a) The presence of persistent deficits in social reciprocity and communication.
b) An inflexible adherence to routines and ritualized patterns of behavior.
,2|Page
c) A marked deterioration in functioning from a previously higher baseline.
d) The presence of stereotyped or repetitive use of language.
marked deterioration in functioning from a previously higher baseline.
-social deficits, insistence on sameness, and stereotyped language are all core diagnostic criteria for ASD, which
must be present in the early developmental period.
A 24-year-old client with a new diagnosis of schizophreniform disorder reports smoking one pack of
cigarettes per day. When considering initial treatment, which of the following second-generation
antipsychotics is LEAST ideal as a first-choice monotherapy due to a significant pharmacokinetic
interaction with smoking?
a) Risperidone (Risperdal)
b) Olanzapine (Zyprexa)
c) Aripiprazole (Abilify)
d) Lurasidone (Latuda)
Olanzapine (Zyprexa)
- significant CYP1A2 interaction (same as cigarette carbons)
-requires a 30% higher dose
A 9-year-old is diagnosed with Tourette's Syndrome after a 14-month history of eye blinking, shoulder
shrugging, and intermittent throat-clearing tics. The tics are distressing to the parents, but they cause the
child only mild social embarrassment and no physical pain or injury. The parents want to "start a
treatment that will stop the tics." What is the most appropriate first-line intervention?
a) Refer the child for Comprehensive Behavioral Intervention for Tics (CBIT).
b) Initiate a low dose of aripiprazole to suppress the tic severity.
c) Provide psychoeducation to the child and parents about the nature of tics.
d) Start clonidine to manage the tics and any underlying hyperactivity.
Psychoeducation is the correct first-line intervention for Tourette's Syndrome (TS), especially when tics are not
causing severe impairment. This initial step involves educating the child and family about the nature of TS,
including the typical waxing and waning course of tics.
,3|Page
-Comprehensive Behavioral Intervention for Tics (CBIT) is a highly effective therapy, but it is considered
a second-line intervention
-aripiprazole or clonidine, are reserved for cases where tics cause significant social, academic, or physical
impairment and have not responded to non-pharmacological approaches.
A 28-year-old first-time mother calls your clinic 10 days after a normal vaginal delivery. She sounds
distressed and reports frequent crying spells, feeling overwhelmed, and experiencing anxiety that "comes
and goes." She is sleeping when the baby sleeps and is managing all infant care appropriately. She asks if
she has postpartum depression. Based on this specific timeline and symptom presentation, what is the
most likely diagnosis?
a) Baby Blues
b) Peripartum Major Depressive Disorder
c) Peripartum Generalized Anxiety Disorder
d) Adjustment Disorder with Depressed Mood
Baby Blues based on the critical factor of timing.
-sx's appear in the first few days after childbirth and resolve on their own
-sx's do not cause functional impairment
- MDD requires sx's more than two weeks
A 16-year-old male is brought to the clinic for a 3-month history of low mood, anhedonia, and fatigue. His
PHQ-9 score is 18 (moderately severe depression). During the interview, his mother mentions that four
months ago, there was a one-week period where he was "the life of the party," slept only 3-4 hours per
night without feeling tired, talked constantly, and started an elaborate project to build a robot that he
quickly abandoned. What is the most significant and immediate risk of initiating fluoxetine monotherapy
for this adolescent?
a) An increased risk of extrapyramidal symptoms (EPS).
b) The precipitation of a manic or hypomanic episode.
c) A gradual and complete lack of therapeutic response.
d) The development of serotonin syndrome.
the precipitation of a manic or hypomanic episode. The mother's description of a distinct period of elevated
energy, decreased need for sleep, and goal-directed but unfinished projects is a classic presentation of a
, 4|Page
hypomanic episode.
A 4-year-old girl is referred for evaluation due to developmental regression. Her parents report that after
a period of normal development, she began to lose her ability to speak and, most notably, lost the
purposeful use of her hands, now engaging in constant, stereotyped hand-wringing motions. Which of the
following is the most likely underlying cause of her condition?
a) An autoimmune response triggered by a streptococcal infection.
b) Severe, early-life trauma leading to functional neurological deficits.
c) A spontaneous mutation in the MECP2 gene on the X chromosome.
d) Perinatal exposure to a teratogenic substance like alcohol.
developmental regression, loss of speech, and, most critically, the
loss of purposeful hand use replaced by stereotyped hand-wringing is the classic presentation of Rett
Syndrome.
-developmental regression, loss of speech, and, most critically, the
loss of purposeful hand use replaced by stereotyped hand-wringing is the classic presentation of Rett
Syndrome.
A 28-year-old with treatment-resistant schizophrenia has failed adequate trials of olanzapine and
risperidone. The provider is now considering clozapine. Which of the following potential adverse effects is
associated with clozapine and requires frequent monitoring of the absolute neutrophil count (ANC)?
Agranulocytosis
-clozapine carries a low risk of TD
- metabolic syndrome can be significant
-QTc prolongation
An 8-year-old boy is brought in for evaluation. His parents state he is "angry and irritable almost every
day." For the past two years, he has had severe temper outbursts with yelling and throwing objects 4-5
times per week, which are grossly out of proportion to the situation. Between these outbursts, his mood is
consistently and noticeably irritable. His parents deny he has ever had a distinct, sustained period of
elevated mood, grandiosity, or a decreased need for sleep. Which diagnosis best fits this clinical
presentation?
a) Bipolar I Disorder
