NURS 663 Exam 3 V3 | NURS 663
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 3 2026)
1. A 9-year-old child presents with symptoms of ADHD. After a failed trial of
methylphenidate, which of the following is the most appropriate next step in
pharmacological management according to clinical guidelines?
A. Start Atomoxetine as the first alternative
B. Initiate Bupropion immediately
C. Switch to an amphetamine-based stimulant
D. Prescribe Alprazolam for hyperactivity
Answer: C
Rationale: Clinical guidelines suggest that if a patient does not respond to one class of
stimulants, they may respond to another class. Methylphenidate and amphetamines are the
primary stimulant categories used for ADHD. Switching to an amphetamine-based product
is often the next logical step before moving to non-stimulants.
,2. Which cognitive screening tool is specifically designed to detect mild cognitive impairment
and covers domains like executive function and visuospatial ability more comprehensively
than the MMSE?
A. PHQ-9
B. CAGE Questionnaire
C. GDS (Geriatric Depression Scale)
D. MoCA (Montreal Cognitive Assessment)
Answer: D
Rationale: The MoCA is preferred over the MMSE for identifying early cognitive decline
because it includes more sensitive measures of executive function. It assesses several
cognitive domains including attention, memory, and language. This tool is widely used in
geriatric psychiatry for initial screenings.
3. An 82-year-old patient with no prior psychiatric history presents with acute onset
confusion, visual hallucinations, and a fluctuating level of consciousness. What is the most
likely diagnosis?
A. Schizophrenia
B. Delirium
C. Major Depressive Disorder
D. Vascular Dementia
, Answer: B
Rationale: Delirium is characterized by an acute onset and fluctuating course of impaired
consciousness and cognition. It is frequently caused by underlying medical conditions, such
as infections or metabolic imbalances, in the elderly population. Visual hallucinations are
common in delirium but less so in primary psychotic disorders appearing later in life.
4. Which medication is FDA-approved for the treatment of irritability associated with Autistic
Disorder in children and adolescents?
A. Fluoxetine
B. Buspirone
C. Lithium
D. Risperidone
Answer: D
Rationale: Risperidone was the first medication FDA-approved specifically for the
treatment of irritability in children with autism. It helps manage behaviors such as
aggression, deliberate self-injury, and temper tantrums. Clinical monitoring for metabolic
side effects and prolactin elevation is required during its use.
5. A patient with Alcohol Use Disorder is prescribed Disulfiram (Antabuse). What is the
primary mechanism by which this medication discourages alcohol consumption?
A. It blocks opioid receptors to reduce cravings
B. It inhibits aldehyde dehydrogenase, causing toxic accumulation of acetaldehyde
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 3 2026)
1. A 9-year-old child presents with symptoms of ADHD. After a failed trial of
methylphenidate, which of the following is the most appropriate next step in
pharmacological management according to clinical guidelines?
A. Start Atomoxetine as the first alternative
B. Initiate Bupropion immediately
C. Switch to an amphetamine-based stimulant
D. Prescribe Alprazolam for hyperactivity
Answer: C
Rationale: Clinical guidelines suggest that if a patient does not respond to one class of
stimulants, they may respond to another class. Methylphenidate and amphetamines are the
primary stimulant categories used for ADHD. Switching to an amphetamine-based product
is often the next logical step before moving to non-stimulants.
,2. Which cognitive screening tool is specifically designed to detect mild cognitive impairment
and covers domains like executive function and visuospatial ability more comprehensively
than the MMSE?
A. PHQ-9
B. CAGE Questionnaire
C. GDS (Geriatric Depression Scale)
D. MoCA (Montreal Cognitive Assessment)
Answer: D
Rationale: The MoCA is preferred over the MMSE for identifying early cognitive decline
because it includes more sensitive measures of executive function. It assesses several
cognitive domains including attention, memory, and language. This tool is widely used in
geriatric psychiatry for initial screenings.
3. An 82-year-old patient with no prior psychiatric history presents with acute onset
confusion, visual hallucinations, and a fluctuating level of consciousness. What is the most
likely diagnosis?
A. Schizophrenia
B. Delirium
C. Major Depressive Disorder
D. Vascular Dementia
, Answer: B
Rationale: Delirium is characterized by an acute onset and fluctuating course of impaired
consciousness and cognition. It is frequently caused by underlying medical conditions, such
as infections or metabolic imbalances, in the elderly population. Visual hallucinations are
common in delirium but less so in primary psychotic disorders appearing later in life.
4. Which medication is FDA-approved for the treatment of irritability associated with Autistic
Disorder in children and adolescents?
A. Fluoxetine
B. Buspirone
C. Lithium
D. Risperidone
Answer: D
Rationale: Risperidone was the first medication FDA-approved specifically for the
treatment of irritability in children with autism. It helps manage behaviors such as
aggression, deliberate self-injury, and temper tantrums. Clinical monitoring for metabolic
side effects and prolactin elevation is required during its use.
5. A patient with Alcohol Use Disorder is prescribed Disulfiram (Antabuse). What is the
primary mechanism by which this medication discourages alcohol consumption?
A. It blocks opioid receptors to reduce cravings
B. It inhibits aldehyde dehydrogenase, causing toxic accumulation of acetaldehyde
