NR606 Final Exam V2 | NR606 Diagnosis &
Management in Psychiatric-Mental Health
II Practicum | Q&A with Rationale (NR606
Final Exam) | Chamberlain University
1. A 45-year-old patient presents with symptoms of depression and reports a history of one
episode of elevated mood, decreased need for sleep, and excessive spending that lasted for 5
days but did not require hospitalization. Which diagnosis is most likely?
A. Bipolar I Disorder
B. Major Depressive Disorder
C. Cyclothymic Disorder
D. Bipolar II Disorder
Answer: D
Rationale: Bipolar II Disorder is characterized by at least one major depressive episode
and at least one hypomanic episode. The patient’s description of symptoms lasting 5 days
without functional impairment requiring hospitalization fits the criteria for hypomania.
Bipolar I requires at least one full manic episode, which typically lasts at least a week or
requires hospitalization.
2. When initiating Clozapine (Clozaril) therapy, which laboratory value is the primary safety
concern for the PMHNP?
A. Absolute Neutrophil Count (ANC)
,B. Liver Function Tests (LFTs)
C. Serum Creatinine
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Rationale: Clozapine carries a black box warning for agranulocytosis, a potentially life-
threatening drop in white blood cell counts. The Absolute Neutrophil Count (ANC) must be
monitored weekly for the first six months of treatment according to the Risk Evaluation
and Mitigation Strategy (REMS). Failure to monitor ANC can lead to severe infections or
death in susceptible patients.
3. A PMHNP is treating a patient with Chronic Obstructive Pulmonary Disease (COPD) and
Generalized Anxiety Disorder. Which medication class should be used with extreme caution
due to the risk of respiratory depression?
A. SSRIs
B. Buspirone
C. Benzodiazepines
D. Beta-blockers
Answer: C
Rationale: Benzodiazepines can depress the central nervous system and exacerbate
respiratory insufficiency in patients with underlying pulmonary disease. While they are
,effective for acute anxiety, they may lead to hypercapnia or respiratory failure in severe
COPD cases. Alternatives like Buspirone or SSRIs are generally preferred for long-term
anxiety management in this population.
4. Which of the following symptoms is considered a ‘negative symptom’ of Schizophrenia?
A. Auditory Hallucinations
B. Avolition
C. Delusions of grandeur
D. Disorganized speech
Answer: B
Rationale: Negative symptoms represent a loss or diminution of normal functions, such as
avolition, alogia, and flat affect. Positive symptoms, conversely, involve the presence of
abnormal behaviors like hallucinations and delusions. Avolition specifically refers to a lack
of motivation to initiate or sustain self-directed purposeful activities.
5. A patient taking Lithium for Bipolar Disorder presents with coarse tremors, ataxia, and
persistent nausea. The PMHNP should first suspect:
A. Lithium toxicity
B. Normal therapeutic side effects
C. Serotonin syndrome
D. Wernicke-Korsakoff syndrome
, Answer: A
Rationale: Coarse tremors, ataxia, and gastrointestinal distress are classic signs of Lithium
toxicity, which can occur when levels exceed 1.5 mEq/L. The PMHNP must immediately
order a serum lithium level and advise the patient to hold the medication. Severe toxicity
can lead to seizures, coma, or permanent neurological damage if not addressed.
6. According to the DSM-5-TR, how long must symptoms persist for a diagnosis of Post-
Traumatic Stress Disorder (PTSD)?
A. More than 1 month
B. More than 2 weeks
C. More than 3 months
D. More than 6 months
Answer: A
Rationale: PTSD diagnosis requires that symptoms from the four clusters (intrusion,
avoidance, negative alterations in cognition/mood, and hyperarousal) persist for more
than one month. If symptoms last less than one month but at least three days following a
trauma, the diagnosis is Acute Stress Disorder. This duration criteria helps clinicians
differentiate between transient stress responses and chronic psychiatric conditions.
7. Which therapeutic modality is most evidence-based for the treatment of Borderline
Personality Disorder (BPD)?
A. Interpersonal Therapy (IPT)
Management in Psychiatric-Mental Health
II Practicum | Q&A with Rationale (NR606
Final Exam) | Chamberlain University
1. A 45-year-old patient presents with symptoms of depression and reports a history of one
episode of elevated mood, decreased need for sleep, and excessive spending that lasted for 5
days but did not require hospitalization. Which diagnosis is most likely?
A. Bipolar I Disorder
B. Major Depressive Disorder
C. Cyclothymic Disorder
D. Bipolar II Disorder
Answer: D
Rationale: Bipolar II Disorder is characterized by at least one major depressive episode
and at least one hypomanic episode. The patient’s description of symptoms lasting 5 days
without functional impairment requiring hospitalization fits the criteria for hypomania.
Bipolar I requires at least one full manic episode, which typically lasts at least a week or
requires hospitalization.
2. When initiating Clozapine (Clozaril) therapy, which laboratory value is the primary safety
concern for the PMHNP?
A. Absolute Neutrophil Count (ANC)
,B. Liver Function Tests (LFTs)
C. Serum Creatinine
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Rationale: Clozapine carries a black box warning for agranulocytosis, a potentially life-
threatening drop in white blood cell counts. The Absolute Neutrophil Count (ANC) must be
monitored weekly for the first six months of treatment according to the Risk Evaluation
and Mitigation Strategy (REMS). Failure to monitor ANC can lead to severe infections or
death in susceptible patients.
3. A PMHNP is treating a patient with Chronic Obstructive Pulmonary Disease (COPD) and
Generalized Anxiety Disorder. Which medication class should be used with extreme caution
due to the risk of respiratory depression?
A. SSRIs
B. Buspirone
C. Benzodiazepines
D. Beta-blockers
Answer: C
Rationale: Benzodiazepines can depress the central nervous system and exacerbate
respiratory insufficiency in patients with underlying pulmonary disease. While they are
,effective for acute anxiety, they may lead to hypercapnia or respiratory failure in severe
COPD cases. Alternatives like Buspirone or SSRIs are generally preferred for long-term
anxiety management in this population.
4. Which of the following symptoms is considered a ‘negative symptom’ of Schizophrenia?
A. Auditory Hallucinations
B. Avolition
C. Delusions of grandeur
D. Disorganized speech
Answer: B
Rationale: Negative symptoms represent a loss or diminution of normal functions, such as
avolition, alogia, and flat affect. Positive symptoms, conversely, involve the presence of
abnormal behaviors like hallucinations and delusions. Avolition specifically refers to a lack
of motivation to initiate or sustain self-directed purposeful activities.
5. A patient taking Lithium for Bipolar Disorder presents with coarse tremors, ataxia, and
persistent nausea. The PMHNP should first suspect:
A. Lithium toxicity
B. Normal therapeutic side effects
C. Serotonin syndrome
D. Wernicke-Korsakoff syndrome
, Answer: A
Rationale: Coarse tremors, ataxia, and gastrointestinal distress are classic signs of Lithium
toxicity, which can occur when levels exceed 1.5 mEq/L. The PMHNP must immediately
order a serum lithium level and advise the patient to hold the medication. Severe toxicity
can lead to seizures, coma, or permanent neurological damage if not addressed.
6. According to the DSM-5-TR, how long must symptoms persist for a diagnosis of Post-
Traumatic Stress Disorder (PTSD)?
A. More than 1 month
B. More than 2 weeks
C. More than 3 months
D. More than 6 months
Answer: A
Rationale: PTSD diagnosis requires that symptoms from the four clusters (intrusion,
avoidance, negative alterations in cognition/mood, and hyperarousal) persist for more
than one month. If symptoms last less than one month but at least three days following a
trauma, the diagnosis is Acute Stress Disorder. This duration criteria helps clinicians
differentiate between transient stress responses and chronic psychiatric conditions.
7. Which therapeutic modality is most evidence-based for the treatment of Borderline
Personality Disorder (BPD)?
A. Interpersonal Therapy (IPT)
