NR606 FINAL CERTIFICATION EVALUATION
TEST 2026 QUESTIONS AND SOLUTIONS
GUARANTEED TO PASS
◉ Teddy is a 7-year-old who was diagnosed with ADHD with
hyperactive-impulsive presentation. The PMHNP prescribed
dexmethylphenidate extended-release 10 mg once daily. His mother
has been giving him the medication before school. Teddy's teachers
report that his symptoms are much improved, but his parents note
that he has a significant rebound of symptoms in the late afternoon,
and he struggles on days he has homework and after-school
activities.
Which of the following medication adjustments are appropriate for
Teddy?
prescribe a daily afternoon dose of dexmethylphenidate immediate
release 2.5 mg in addition to the morning dose
increase the daily dose of dexmethylphenidate extended-release to
20 mg
recommend a PRN afternoon dose of dexmethylphenidate 5mg IR
when Teddy has after school commitments
,switch to lisdexamfetamine dimesylate 10 mg daily
add atomoxetine 0.5mg/kg/day. Answer: prescribe a daily afternoon
dose of dexmethylphenidate immediate release 2.5 mg in addition to
the morning dose
Rationale: Although long-acting medications typically act for 8-12
hours, some clients experience a shorter window of symptom
control. A "booster" dose of short-acting stimulant medication can
reduce problems of rebound when the earlier dose wears off.
◉ Josue is an 11-year-old who was diagnosed with ADHD combined
presentation. He was prescribed amphetamine/dextroamphetamine
immediate release 10mg twice daily. He takes the medication in the
morning and after school. His symptoms have improved; however,
he now complains of difficulty falling and staying asleep. Which of
the following medication adjustments is appropriate for Josue?
Select all that apply.
switch to amphetamine/dextroamphetamine extended-release 20
mg daily
decrease the dose of amphetamine/dextroamphetamine immediate
release to 5 mg twice daily
,decrease the frequency of amphetamine/dextroamphetamine
immediate release to once daily
recommend sleep hygiene techniques
prescribe zolpidem as needed. Answer: switch to
amphetamine/dextroamphetamine extended-release 20 mg daily
recommend sleep hygiene techniques
Rationale: Stimulant medications may cause sleep disturbances,
especially if the doses are taken later in the day.
Amphetamine/dextroamphetamine immediate release has a
duration of 4-8 hours, while extended-release has a duration of 8-12
hours. Switching to extended-release dosing and improving sleep
hygiene may help improve sleep. Alternatively, the second dose of
amphetamine/dextroamphetamine immediate release can be taken
earlier in the day.
◉ Addison is a 9-year-old who was diagnosed with ADHD
predominantly combined presentation and was prescribed
methylphenidate extended-release chewable tablets 20 mg once
daily. Since she has started taking the medication, her appetite has
decreased. She is 51 inches tall, and her initial weight was 58 lbs.
She has lost 8 lbs. since beginning treatment.
, Which of the following medication adjustments is appropriate for
Addison?
implement stimulant holidays on weekends and non-school days
decrease the dosage of methylphenidate extended-release to 10 mg
daily
switch to methylphenidate immediate-release 20 mg once daily
switch to atomoxetine 25 mg once daily. Answer: implement
stimulant holidays on weekends and non-school days
Rationale: Stimulant holidays combined with caloric
supplementation and monitoring can help offset stimulant-related
weight loss. Switching to a non-stimulant medication may be
warranted if drug holidays do not provide the desired result of
weight stabilization.
◉ ADHD nonpharmacologic tx. Answer: -Schools
• educational support, behavioral interventions in the classroom,
and accommodations
-Psychotherapy
• CBT
TEST 2026 QUESTIONS AND SOLUTIONS
GUARANTEED TO PASS
◉ Teddy is a 7-year-old who was diagnosed with ADHD with
hyperactive-impulsive presentation. The PMHNP prescribed
dexmethylphenidate extended-release 10 mg once daily. His mother
has been giving him the medication before school. Teddy's teachers
report that his symptoms are much improved, but his parents note
that he has a significant rebound of symptoms in the late afternoon,
and he struggles on days he has homework and after-school
activities.
Which of the following medication adjustments are appropriate for
Teddy?
prescribe a daily afternoon dose of dexmethylphenidate immediate
release 2.5 mg in addition to the morning dose
increase the daily dose of dexmethylphenidate extended-release to
20 mg
recommend a PRN afternoon dose of dexmethylphenidate 5mg IR
when Teddy has after school commitments
,switch to lisdexamfetamine dimesylate 10 mg daily
add atomoxetine 0.5mg/kg/day. Answer: prescribe a daily afternoon
dose of dexmethylphenidate immediate release 2.5 mg in addition to
the morning dose
Rationale: Although long-acting medications typically act for 8-12
hours, some clients experience a shorter window of symptom
control. A "booster" dose of short-acting stimulant medication can
reduce problems of rebound when the earlier dose wears off.
◉ Josue is an 11-year-old who was diagnosed with ADHD combined
presentation. He was prescribed amphetamine/dextroamphetamine
immediate release 10mg twice daily. He takes the medication in the
morning and after school. His symptoms have improved; however,
he now complains of difficulty falling and staying asleep. Which of
the following medication adjustments is appropriate for Josue?
Select all that apply.
switch to amphetamine/dextroamphetamine extended-release 20
mg daily
decrease the dose of amphetamine/dextroamphetamine immediate
release to 5 mg twice daily
,decrease the frequency of amphetamine/dextroamphetamine
immediate release to once daily
recommend sleep hygiene techniques
prescribe zolpidem as needed. Answer: switch to
amphetamine/dextroamphetamine extended-release 20 mg daily
recommend sleep hygiene techniques
Rationale: Stimulant medications may cause sleep disturbances,
especially if the doses are taken later in the day.
Amphetamine/dextroamphetamine immediate release has a
duration of 4-8 hours, while extended-release has a duration of 8-12
hours. Switching to extended-release dosing and improving sleep
hygiene may help improve sleep. Alternatively, the second dose of
amphetamine/dextroamphetamine immediate release can be taken
earlier in the day.
◉ Addison is a 9-year-old who was diagnosed with ADHD
predominantly combined presentation and was prescribed
methylphenidate extended-release chewable tablets 20 mg once
daily. Since she has started taking the medication, her appetite has
decreased. She is 51 inches tall, and her initial weight was 58 lbs.
She has lost 8 lbs. since beginning treatment.
, Which of the following medication adjustments is appropriate for
Addison?
implement stimulant holidays on weekends and non-school days
decrease the dosage of methylphenidate extended-release to 10 mg
daily
switch to methylphenidate immediate-release 20 mg once daily
switch to atomoxetine 25 mg once daily. Answer: implement
stimulant holidays on weekends and non-school days
Rationale: Stimulant holidays combined with caloric
supplementation and monitoring can help offset stimulant-related
weight loss. Switching to a non-stimulant medication may be
warranted if drug holidays do not provide the desired result of
weight stabilization.
◉ ADHD nonpharmacologic tx. Answer: -Schools
• educational support, behavioral interventions in the classroom,
and accommodations
-Psychotherapy
• CBT
