NURS 663 Exam 4 V2 | 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 neurobiological
mechanism is most implicated in the pathophysiology of this disorder?
A. Excessive serotonin in the raphe nuclei
B. Degeneration of acetylcholine neurons in the hippocampus
C. Overactivity of the GABAergic system in the basal ganglia
D. Dysregulation of dopamine and norepinephrine in the prefrontal cortex
Answer: D
Rationale: ADHD is primarily associated with dysregulation in the prefrontal cortex and its
connections to the striatum. Research suggests that inadequate levels of dopamine and
norepinephrine result in decreased signal-to-noise ratios in executive functioning centers.
Stimulant medications target these specific pathways to improve attention and behavioral
control.
2. When initiating Atomoxetine for a child with ADHD, which black box warning must the
PMHNP discuss with the family?
A. Risk of Stevens-Johnson syndrome
,B. Risk of severe hepatotoxicity
C. Potential for sudden cardiac death
D. Increased risk of suicidal ideation
Answer: D
Rationale: Atomoxetine, a selective norepinephrine reuptake inhibitor, carries a black box
warning regarding the increased risk of suicidal ideation in children and adolescents.
Clinical monitoring for changes in behavior or mood is essential during the first few
months of treatment. Parents should be educated to report any signs of agitation or
unusual thoughts immediately.
3. A 75-year-old patient presents with acute onset of confusion, fluctuating consciousness,
and visual hallucinations following a hip surgery. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Delirium
C. Vascular Dementia
D. Late-onset Schizophrenia
Answer: B
Rationale: Delirium is characterized by an acute, fluctuating change in mental status and
attention, often triggered by a medical condition or surgery. Unlike dementia, which is
progressive and chronic, delirium represents a medical emergency that requires
, identification of the underlying cause. Post-operative states and infections are common
triggers for delirium in the geriatric population.
4. Which FDA-approved medication for Autism Spectrum Disorder specifically targets
irritability and aggression in children aged 5-16?
A. Methylphenidate
B. Risperidone
C. Fluoxetine
D. Guanfacine
Answer: B
Rationale: Risperidone and Aripiprazole are the only two FDA-approved atypical
antipsychotics for the treatment of irritability associated with Autism Spectrum Disorder.
These medications help manage symptoms such as aggression, self-injury, and severe
temper tantrums. However, clinicians must monitor for metabolic side effects and
extrapyramidal symptoms during treatment.
5. A patient demonstrates a pervasive pattern of grandiosity, a constant need for admiration,
and a lack of empathy. Which Personality Disorder does this represent?
A. Borderline Personality Disorder
B. Histrionic Personality Disorder
C. Narcissistic Personality 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 neurobiological
mechanism is most implicated in the pathophysiology of this disorder?
A. Excessive serotonin in the raphe nuclei
B. Degeneration of acetylcholine neurons in the hippocampus
C. Overactivity of the GABAergic system in the basal ganglia
D. Dysregulation of dopamine and norepinephrine in the prefrontal cortex
Answer: D
Rationale: ADHD is primarily associated with dysregulation in the prefrontal cortex and its
connections to the striatum. Research suggests that inadequate levels of dopamine and
norepinephrine result in decreased signal-to-noise ratios in executive functioning centers.
Stimulant medications target these specific pathways to improve attention and behavioral
control.
2. When initiating Atomoxetine for a child with ADHD, which black box warning must the
PMHNP discuss with the family?
A. Risk of Stevens-Johnson syndrome
,B. Risk of severe hepatotoxicity
C. Potential for sudden cardiac death
D. Increased risk of suicidal ideation
Answer: D
Rationale: Atomoxetine, a selective norepinephrine reuptake inhibitor, carries a black box
warning regarding the increased risk of suicidal ideation in children and adolescents.
Clinical monitoring for changes in behavior or mood is essential during the first few
months of treatment. Parents should be educated to report any signs of agitation or
unusual thoughts immediately.
3. A 75-year-old patient presents with acute onset of confusion, fluctuating consciousness,
and visual hallucinations following a hip surgery. What is the most likely diagnosis?
A. Alzheimer’s Disease
B. Delirium
C. Vascular Dementia
D. Late-onset Schizophrenia
Answer: B
Rationale: Delirium is characterized by an acute, fluctuating change in mental status and
attention, often triggered by a medical condition or surgery. Unlike dementia, which is
progressive and chronic, delirium represents a medical emergency that requires
, identification of the underlying cause. Post-operative states and infections are common
triggers for delirium in the geriatric population.
4. Which FDA-approved medication for Autism Spectrum Disorder specifically targets
irritability and aggression in children aged 5-16?
A. Methylphenidate
B. Risperidone
C. Fluoxetine
D. Guanfacine
Answer: B
Rationale: Risperidone and Aripiprazole are the only two FDA-approved atypical
antipsychotics for the treatment of irritability associated with Autism Spectrum Disorder.
These medications help manage symptoms such as aggression, self-injury, and severe
temper tantrums. However, clinicians must monitor for metabolic side effects and
extrapyramidal symptoms during treatment.
5. A patient demonstrates a pervasive pattern of grandiosity, a constant need for admiration,
and a lack of empathy. Which Personality Disorder does this represent?
A. Borderline Personality Disorder
B. Histrionic Personality Disorder
C. Narcissistic Personality Disorder
