NURS 663 Exam 4 V1 | NURS 663
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 4 2026)
1. A 9-year-old male is diagnosed with ADHD, combined type. Which of the following is
considered the first-line pharmacological treatment according to the American Academy of
Pediatrics?
A. Guanfacine
B. Atomoxetine
C. Bupropion
D. Methylphenidate
Answer: D
Rationale: Stimulants such as methylphenidate are considered first-line treatments for
children with ADHD due to their high efficacy rates. These medications work by increasing
the availability of dopamine and norepinephrine in the prefrontal cortex. Clinicians must
monitor growth and blood pressure regularly when prescribing these agents.
2. When screening a 24-month-old child for Autism Spectrum Disorder (ASD), which tool is
most appropriate for use in the clinical setting?
A. PHQ-9
,B. Vanderbilt Assessment Scale
C. M-CHAT-R/F
D. GDS-15
Answer: C
Rationale: The Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-
CHAT-R/F) is a validated screening tool for children aged 16 to 30 months. It consists of a
series of questions that parents answer regarding their child’s social and communication
behaviors. A high score on this tool necessitates a referral for a comprehensive
developmental evaluation.
3. An 82-year-old female presents with sudden onset confusion that fluctuates throughout
the day. She has difficulty maintaining attention and is experiencing visual hallucinations.
What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Delirium
D. Major Depressive Disorder
Answer: C
Rationale: Delirium is characterized by an acute onset of cognitive impairment and a
fluctuating course of consciousness. Unlike dementia, which is progressive and stable,
, delirium is often secondary to an underlying medical condition such as a urinary tract
infection. Prompt identification and treatment of the underlying cause are essential for
resolving the symptoms.
4. Which of the following is a primary side effect of Donepezil (Aricept) that a PMHNP should
monitor in an elderly patient with Alzheimer’s disease?
A. Hypertension
B. Urinary retention
C. Bradycardia
D. Constipation
Answer: C
Rationale: Donepezil is a cholinesterase inhibitor that can cause vagotonic effects on the
heart, leading to bradycardia or heart block. Patients with pre-existing cardiac conduction
issues are at a higher risk for these adverse events. It is important to perform an EKG if the
patient reports dizziness or syncopal episodes while on this medication.
5. A 10-year-old child presents with persistent irritability and frequent temper outbursts that
are out of proportion to the situation. These symptoms have been present for over a year.
Which diagnosis is most likely?
A. Bipolar I Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Oppositional Defiant Disorder
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 4 2026)
1. A 9-year-old male is diagnosed with ADHD, combined type. Which of the following is
considered the first-line pharmacological treatment according to the American Academy of
Pediatrics?
A. Guanfacine
B. Atomoxetine
C. Bupropion
D. Methylphenidate
Answer: D
Rationale: Stimulants such as methylphenidate are considered first-line treatments for
children with ADHD due to their high efficacy rates. These medications work by increasing
the availability of dopamine and norepinephrine in the prefrontal cortex. Clinicians must
monitor growth and blood pressure regularly when prescribing these agents.
2. When screening a 24-month-old child for Autism Spectrum Disorder (ASD), which tool is
most appropriate for use in the clinical setting?
A. PHQ-9
,B. Vanderbilt Assessment Scale
C. M-CHAT-R/F
D. GDS-15
Answer: C
Rationale: The Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-
CHAT-R/F) is a validated screening tool for children aged 16 to 30 months. It consists of a
series of questions that parents answer regarding their child’s social and communication
behaviors. A high score on this tool necessitates a referral for a comprehensive
developmental evaluation.
3. An 82-year-old female presents with sudden onset confusion that fluctuates throughout
the day. She has difficulty maintaining attention and is experiencing visual hallucinations.
What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Vascular Dementia
C. Delirium
D. Major Depressive Disorder
Answer: C
Rationale: Delirium is characterized by an acute onset of cognitive impairment and a
fluctuating course of consciousness. Unlike dementia, which is progressive and stable,
, delirium is often secondary to an underlying medical condition such as a urinary tract
infection. Prompt identification and treatment of the underlying cause are essential for
resolving the symptoms.
4. Which of the following is a primary side effect of Donepezil (Aricept) that a PMHNP should
monitor in an elderly patient with Alzheimer’s disease?
A. Hypertension
B. Urinary retention
C. Bradycardia
D. Constipation
Answer: C
Rationale: Donepezil is a cholinesterase inhibitor that can cause vagotonic effects on the
heart, leading to bradycardia or heart block. Patients with pre-existing cardiac conduction
issues are at a higher risk for these adverse events. It is important to perform an EKG if the
patient reports dizziness or syncopal episodes while on this medication.
5. A 10-year-old child presents with persistent irritability and frequent temper outbursts that
are out of proportion to the situation. These symptoms have been present for over a year.
Which diagnosis is most likely?
A. Bipolar I Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Oppositional Defiant Disorder
