CHAMBERLAIN UNIVERSITY | NR606 PRACTICUM
Diagnosis & Management in
Psychiatric-Mental Health II
Practicum Examination
Comprehensive 75-question examination covering child and adolescent psychiatric disorders,
geriatric psychiatry, women's mental health, forensic psychiatry, psychopharmacology in
special populations, integrated care, telepsychiatry, and professional development. Aligned
with 2026-2027 curriculum standards.
Week 4 | Complete Guide 75 Questions | Verified Answers Latest Update | 2026/2027
P M H N P A DVA N C E D P R A C T I C E N U RS I N G E D UCAT I O N
, NR606 Week 4: Diagnosis and Management in
Psychiatric-Mental Health II Practicum Examination
Complete Guide with Questions and Verified Answers | 75 Questions
Aligned with 2026-2027 Chamberlain University NR606 Curriculum Standards
Section 1: Child and Adolescent Psychiatric Disorders (Q1-Q15)
Q1. A 9-year-old boy is brought to the PMHNP due to academic difficulties and inability to sit still in class. The teacher
reports he frequently leaves his seat, blurts out answers before questions are completed, and has difficulty waiting his turn.
Symptoms have been present for over 8 months and are observed both at home and at school. Which DSM-5-TR criterion is
most critical for confirming the diagnosis of ADHD?
A. Symptoms must cause clinically significant impairment in social, academic, or occupational functioning
B. Symptoms must be present exclusively in the school setting for at least 12 months
C. Symptoms must be present in two or more settings with onset before age 12 and persist for at least 6 months
[CORRECT]
D. The child must demonstrate both inattention and hyperactivity-impulsivity symptoms equally
Correct Answer: C
Rationale: DSM-5-TR criteria for ADHD require clinically significant impairment in functioning, presence in two or more settings, onset
before age 12, and persistence for at least 6 months. Option C captures all critical elements. Option B is incorrect because symptoms must
appear in at least two settings, not exclusively school. Option D is wrong because ADHD has three presentations (combined, predominantly
inattentive, predominantly hyperactive/impulsive) and equal symptom distribution is not required.
Q2. The PMHNP is initiating pharmacotherapy for a 7-year-old girl with ADHD, combined presentation. She has no cardiac
history, tics, or substance use. Which medication is the most appropriate first-line treatment?
A. Atomoxetine (Strattera) 10 mg daily
B. Methylphenidate (Ritalin) 5 mg twice daily [CORRECT]
C. Guanfacine (Intuniv) 1 mg daily
D. Clonidine (Kapvay) 0.1 mg twice daily
Correct Answer: B
Rationale: Stimulant medications (methylphenidate and amphetamines) are the established first-line pharmacotherapy for ADHD in children
based on extensive evidence. Methylphenidate at 5 mg twice daily is an appropriate starting dose for a 7-year-old. Atomoxetine, guanfacine,
and clonidine are non-stimulant alternatives reserved for when stimulants are contraindicated, ineffective, or poorly tolerated.
Q3. A 10-year-old boy with ADHD on methylphenidate for 6 months has lost 2 kg, has abdominal pain before bedtime, and
difficulty falling asleep. The PMHNP should prioritize which intervention?
A. Immediately discontinue methylphenidate and switch to an antipsychotic
B. Monitor growth parameters, adjust dosing schedule, and provide sleep hygiene education [CORRECT]
C. Add a second stimulant to address appetite and sleep concerns
D. Reassure the mother that these side effects are expected and need no intervention
Correct Answer: B
Rationale: Monitoring growth, appetite, and sleep is essential with pediatric stimulant use. Weight loss, abdominal discomfort, and insomnia
are known side effects. Best practice includes tracking height/weight at each visit, adjusting the dosing schedule to minimize sleep disruption,
and providing nutritional counseling and sleep hygiene education. Abrupt discontinuation, stimulant polypharmacy, or dismissing concerns are
inappropriate.
, Q4. A 4-year-old girl presents with lack of speech, poor eye contact, repetitive hand-flapping, not responding to her name, no
interest in peers, and extreme distress with routine changes. Which DSM-5-TR criteria cluster best describes this
presentation?
A. Persistent pattern of inattention and hyperactivity-impulsivity interfering with functioning
B. Persistent deficits in social communication/interaction plus restricted, repetitive patterns of behavior [CORRECT]
C. Pattern of angry/irritable mood and argumentative/defiant behavior lasting at least 6 months
D. Persistent pattern of violating the rights of others with onset before age 10
Correct Answer: B
Rationale: This child shows the two core DSM-5-TR criteria for Autism Spectrum Disorder: (1) persistent deficits in social communication and
interaction across contexts (speech delay, poor eye contact, no peer interest, name non-response) and (2) restricted, repetitive patterns of
behavior (hand-flapping, routine-change distress). Option A describes ADHD, C describes ODD, and D describes Conduct Disorder.
Q5. An 8-year-old boy with ASD has significant irritability, aggression toward peers, hitting, and severe tantrums despite
behavioral interventions. Which pharmacologic intervention has the strongest evidence for irritability in ASD?
A. Methylphenidate for core autism symptoms
B. Risperidone or aripiprazole for irritability associated with ASD [CORRECT]
C. Fluoxetine for restricted and repetitive behaviors
D. Lithium for mood stabilization in autism
Correct Answer: B
Rationale: Risperidone and aripiprazole are FDA-approved for treating irritability associated with ASD, including aggression, self-injurious
behavior, and severe tantrums. Methylphenidate targets comorbid ADHD symptoms, not core autism or irritability. SSRIs have limited evidence
for repetitive behaviors in ASD. Lithium is not indicated for ASD-related irritability without bipolar features.
Q6. A 14-year-old male has fire-setting, physical assault, stealing, and running away since age 8. He shows no remorse and
lacks empathy. Which specifier best applies to this Conduct Disorder?
A. Adolescent-onset type with limited prosocial emotions
B. Childhood-onset type with limited prosocial emotions [CORRECT]
C. Adolescent-onset type without limited prosocial emotions
D. Oppositional Defiant Disorder with aggressive features
Correct Answer: B
Rationale: This patient has Conduct Disorder with childhood-onset type (behaviors began at age 8, before age 10) and the specifier "with
limited prosocial emotions" due to lack of remorse and empathy. Adolescent-onset requires onset at age 10 or later. ODD involves
argumentative/defiant behavior without the serious aggression or violation of others rights seen in Conduct Disorder.
Q7. A 6-year-old girl frequently refuses to follow parental requests, argues with adults, is easily annoyed, and appears spiteful
toward her younger sibling. These behaviors have persisted for 7 months but she has not exhibited aggression toward animals,
destruction of property, or deceitfulness. What is the most likely diagnosis?
A. Conduct Disorder, childhood-onset type
B. Attention-Deficit/Hyperactivity Disorder, combined presentation
C. Oppositional Defiant Disorder [CORRECT]
D. Autism Spectrum Disorder
Correct Answer: C
Rationale: ODD is characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6
months. This child meets criteria with refusal to follow requests, arguing with adults, easy annoyance, and spitefulness. The absence of
aggression to animals, property destruction, or deceitfulness distinguishes ODD from Conduct Disorder. There is no evidence of
inattention/hyperactivity (ADHD) or social communication deficits (ASD).
NR606 Week 4 Practicum Examination | Page 2
Diagnosis & Management in
Psychiatric-Mental Health II
Practicum Examination
Comprehensive 75-question examination covering child and adolescent psychiatric disorders,
geriatric psychiatry, women's mental health, forensic psychiatry, psychopharmacology in
special populations, integrated care, telepsychiatry, and professional development. Aligned
with 2026-2027 curriculum standards.
Week 4 | Complete Guide 75 Questions | Verified Answers Latest Update | 2026/2027
P M H N P A DVA N C E D P R A C T I C E N U RS I N G E D UCAT I O N
, NR606 Week 4: Diagnosis and Management in
Psychiatric-Mental Health II Practicum Examination
Complete Guide with Questions and Verified Answers | 75 Questions
Aligned with 2026-2027 Chamberlain University NR606 Curriculum Standards
Section 1: Child and Adolescent Psychiatric Disorders (Q1-Q15)
Q1. A 9-year-old boy is brought to the PMHNP due to academic difficulties and inability to sit still in class. The teacher
reports he frequently leaves his seat, blurts out answers before questions are completed, and has difficulty waiting his turn.
Symptoms have been present for over 8 months and are observed both at home and at school. Which DSM-5-TR criterion is
most critical for confirming the diagnosis of ADHD?
A. Symptoms must cause clinically significant impairment in social, academic, or occupational functioning
B. Symptoms must be present exclusively in the school setting for at least 12 months
C. Symptoms must be present in two or more settings with onset before age 12 and persist for at least 6 months
[CORRECT]
D. The child must demonstrate both inattention and hyperactivity-impulsivity symptoms equally
Correct Answer: C
Rationale: DSM-5-TR criteria for ADHD require clinically significant impairment in functioning, presence in two or more settings, onset
before age 12, and persistence for at least 6 months. Option C captures all critical elements. Option B is incorrect because symptoms must
appear in at least two settings, not exclusively school. Option D is wrong because ADHD has three presentations (combined, predominantly
inattentive, predominantly hyperactive/impulsive) and equal symptom distribution is not required.
Q2. The PMHNP is initiating pharmacotherapy for a 7-year-old girl with ADHD, combined presentation. She has no cardiac
history, tics, or substance use. Which medication is the most appropriate first-line treatment?
A. Atomoxetine (Strattera) 10 mg daily
B. Methylphenidate (Ritalin) 5 mg twice daily [CORRECT]
C. Guanfacine (Intuniv) 1 mg daily
D. Clonidine (Kapvay) 0.1 mg twice daily
Correct Answer: B
Rationale: Stimulant medications (methylphenidate and amphetamines) are the established first-line pharmacotherapy for ADHD in children
based on extensive evidence. Methylphenidate at 5 mg twice daily is an appropriate starting dose for a 7-year-old. Atomoxetine, guanfacine,
and clonidine are non-stimulant alternatives reserved for when stimulants are contraindicated, ineffective, or poorly tolerated.
Q3. A 10-year-old boy with ADHD on methylphenidate for 6 months has lost 2 kg, has abdominal pain before bedtime, and
difficulty falling asleep. The PMHNP should prioritize which intervention?
A. Immediately discontinue methylphenidate and switch to an antipsychotic
B. Monitor growth parameters, adjust dosing schedule, and provide sleep hygiene education [CORRECT]
C. Add a second stimulant to address appetite and sleep concerns
D. Reassure the mother that these side effects are expected and need no intervention
Correct Answer: B
Rationale: Monitoring growth, appetite, and sleep is essential with pediatric stimulant use. Weight loss, abdominal discomfort, and insomnia
are known side effects. Best practice includes tracking height/weight at each visit, adjusting the dosing schedule to minimize sleep disruption,
and providing nutritional counseling and sleep hygiene education. Abrupt discontinuation, stimulant polypharmacy, or dismissing concerns are
inappropriate.
, Q4. A 4-year-old girl presents with lack of speech, poor eye contact, repetitive hand-flapping, not responding to her name, no
interest in peers, and extreme distress with routine changes. Which DSM-5-TR criteria cluster best describes this
presentation?
A. Persistent pattern of inattention and hyperactivity-impulsivity interfering with functioning
B. Persistent deficits in social communication/interaction plus restricted, repetitive patterns of behavior [CORRECT]
C. Pattern of angry/irritable mood and argumentative/defiant behavior lasting at least 6 months
D. Persistent pattern of violating the rights of others with onset before age 10
Correct Answer: B
Rationale: This child shows the two core DSM-5-TR criteria for Autism Spectrum Disorder: (1) persistent deficits in social communication and
interaction across contexts (speech delay, poor eye contact, no peer interest, name non-response) and (2) restricted, repetitive patterns of
behavior (hand-flapping, routine-change distress). Option A describes ADHD, C describes ODD, and D describes Conduct Disorder.
Q5. An 8-year-old boy with ASD has significant irritability, aggression toward peers, hitting, and severe tantrums despite
behavioral interventions. Which pharmacologic intervention has the strongest evidence for irritability in ASD?
A. Methylphenidate for core autism symptoms
B. Risperidone or aripiprazole for irritability associated with ASD [CORRECT]
C. Fluoxetine for restricted and repetitive behaviors
D. Lithium for mood stabilization in autism
Correct Answer: B
Rationale: Risperidone and aripiprazole are FDA-approved for treating irritability associated with ASD, including aggression, self-injurious
behavior, and severe tantrums. Methylphenidate targets comorbid ADHD symptoms, not core autism or irritability. SSRIs have limited evidence
for repetitive behaviors in ASD. Lithium is not indicated for ASD-related irritability without bipolar features.
Q6. A 14-year-old male has fire-setting, physical assault, stealing, and running away since age 8. He shows no remorse and
lacks empathy. Which specifier best applies to this Conduct Disorder?
A. Adolescent-onset type with limited prosocial emotions
B. Childhood-onset type with limited prosocial emotions [CORRECT]
C. Adolescent-onset type without limited prosocial emotions
D. Oppositional Defiant Disorder with aggressive features
Correct Answer: B
Rationale: This patient has Conduct Disorder with childhood-onset type (behaviors began at age 8, before age 10) and the specifier "with
limited prosocial emotions" due to lack of remorse and empathy. Adolescent-onset requires onset at age 10 or later. ODD involves
argumentative/defiant behavior without the serious aggression or violation of others rights seen in Conduct Disorder.
Q7. A 6-year-old girl frequently refuses to follow parental requests, argues with adults, is easily annoyed, and appears spiteful
toward her younger sibling. These behaviors have persisted for 7 months but she has not exhibited aggression toward animals,
destruction of property, or deceitfulness. What is the most likely diagnosis?
A. Conduct Disorder, childhood-onset type
B. Attention-Deficit/Hyperactivity Disorder, combined presentation
C. Oppositional Defiant Disorder [CORRECT]
D. Autism Spectrum Disorder
Correct Answer: C
Rationale: ODD is characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6
months. This child meets criteria with refusal to follow requests, arguing with adults, easy annoyance, and spitefulness. The absence of
aggression to animals, property destruction, or deceitfulness distinguishes ODD from Conduct Disorder. There is no evidence of
inattention/hyperactivity (ADHD) or social communication deficits (ASD).
NR606 Week 4 Practicum Examination | Page 2
