NR606 Final Exam V3 | NR606 Diagnosis &
Management in Psychiatric-Mental Health
II Practicum | Q&A with Rationale (NR606
Final Exam) | Chamberlain University
1. A 28-year-old male with treatment-resistant schizophrenia is starting Clozapine. Which
laboratory value must be documented in the national registry before the medication can be
dispensed?
A. Absolute Neutrophil Count (ANC)
B. Serum creatinine
C. Liver function tests
D. Hemoglobin A1c
Answer: A
Rationale: The Absolute Neutrophil Count (ANC) must be monitored due to the risk of
agranulocytosis associated with Clozapine. For the general population, the ANC must be
1500/µL or higher to initiate treatment. This mandatory monitoring ensures patient safety
by identifying potential bone marrow suppression early in the course of treatment.
2. When assessing a 75-year-old patient for neurocognitive decline, which tool is most
appropriate for screening for delirium rather than chronic dementia?
A. Mini-Mental State Exam (MMSE)
,B. Montreal Cognitive Assessment (MoCA)
C. Confusion Assessment Method (CAM)
D. Geriatric Depression Scale (GDS)
Answer: C
Rationale: The Confusion Assessment Method (CAM) is specifically designed to identify the
presence of delirium by assessing acute onset and fluctuating course. Unlike the MMSE or
MoCA, which assess general cognitive status, the CAM focuses on features like inattention
and disorganized thinking. This distinction is critical for PMHNPs to ensure that underlying
medical causes for acute confusion are addressed promptly.
3. A PMHNP is treating a 9-year-old child diagnosed with ADHD who is starting
methylphenidate. What are the two most important physical parameters to monitor at every
visit?
A. Blood pressure and heart rate
B. Visual acuity and hearing
C. Abdominal girth and BMI
D. Height and weight
Answer: D
Rationale: Stimulants like methylphenidate are associated with potential growth
suppression in pediatric patients. Monitoring height and weight at every visit allows the
,provider to track the child’s growth trajectory against standardized charts. If significant
growth inhibition occurs, the PMHNP may consider a ‘drug holiday’ or adjusting the dosage
to mitigate these side effects.
4. Which of the following symptoms is a hallmark sign that distinguishes Neuroleptic
Malignant Syndrome (NMS) from Serotonin Syndrome?
A. Hyperthermia
B. Lead-pipe muscle rigidity
C. Autonomic instability
D. Altered mental status
Answer: B
Rationale: Lead-pipe muscle rigidity is a classic sign of NMS, whereas Serotonin Syndrome
typically presents with hyperreflexia and myoclonus. NMS is usually caused by dopamine
antagonists like first-generation antipsychotics, leading to severe extrapyramidal
symptoms. Recognizing this distinction is vital for immediate intervention and stopping the
causative agent in emergency psychiatric care.
5. A 32-year-old female patient presents with rapid speech, decreased need for sleep (3 hours
per night), and grandiosity. She has a history of major depressive episodes but no prior
mania. What is the most likely diagnosis?
A. Major Depressive Disorder with anxious distress
B. Bipolar I Disorder
, C. Cyclothymic Disorder
D. Bipolar II Disorder
Answer: B
Rationale: The presence of a manic episode, characterized by grandiosity and decreased
need for sleep, warrants a diagnosis of Bipolar I Disorder. While the patient has a history of
depression, a single manic episode is sufficient for the Bipolar I classification according to
the DSM-5-TR. Bipolar II would require a hypomanic episode and a major depressive
episode, rather than full-blown mania.
6. In the treatment of Bipolar Disorder, which medication requires regular monitoring of
serum levels, thyroid function, and renal function?
A. Lithium
B. Valproate
C. Quetiapine
D. Lamotrigine
Answer: A
Rationale: Lithium has a narrow therapeutic index and potential long-term effects on
organ systems, necessitating regular blood tests. Renal function must be monitored
because Lithium is excreted almost entirely by the kidneys, and thyroid function is checked
due to the risk of lithium-induced hypothyroidism. Maintaining levels between 0.6 and 1.2
mEq/L is essential for efficacy while avoiding toxicity.
Management in Psychiatric-Mental Health
II Practicum | Q&A with Rationale (NR606
Final Exam) | Chamberlain University
1. A 28-year-old male with treatment-resistant schizophrenia is starting Clozapine. Which
laboratory value must be documented in the national registry before the medication can be
dispensed?
A. Absolute Neutrophil Count (ANC)
B. Serum creatinine
C. Liver function tests
D. Hemoglobin A1c
Answer: A
Rationale: The Absolute Neutrophil Count (ANC) must be monitored due to the risk of
agranulocytosis associated with Clozapine. For the general population, the ANC must be
1500/µL or higher to initiate treatment. This mandatory monitoring ensures patient safety
by identifying potential bone marrow suppression early in the course of treatment.
2. When assessing a 75-year-old patient for neurocognitive decline, which tool is most
appropriate for screening for delirium rather than chronic dementia?
A. Mini-Mental State Exam (MMSE)
,B. Montreal Cognitive Assessment (MoCA)
C. Confusion Assessment Method (CAM)
D. Geriatric Depression Scale (GDS)
Answer: C
Rationale: The Confusion Assessment Method (CAM) is specifically designed to identify the
presence of delirium by assessing acute onset and fluctuating course. Unlike the MMSE or
MoCA, which assess general cognitive status, the CAM focuses on features like inattention
and disorganized thinking. This distinction is critical for PMHNPs to ensure that underlying
medical causes for acute confusion are addressed promptly.
3. A PMHNP is treating a 9-year-old child diagnosed with ADHD who is starting
methylphenidate. What are the two most important physical parameters to monitor at every
visit?
A. Blood pressure and heart rate
B. Visual acuity and hearing
C. Abdominal girth and BMI
D. Height and weight
Answer: D
Rationale: Stimulants like methylphenidate are associated with potential growth
suppression in pediatric patients. Monitoring height and weight at every visit allows the
,provider to track the child’s growth trajectory against standardized charts. If significant
growth inhibition occurs, the PMHNP may consider a ‘drug holiday’ or adjusting the dosage
to mitigate these side effects.
4. Which of the following symptoms is a hallmark sign that distinguishes Neuroleptic
Malignant Syndrome (NMS) from Serotonin Syndrome?
A. Hyperthermia
B. Lead-pipe muscle rigidity
C. Autonomic instability
D. Altered mental status
Answer: B
Rationale: Lead-pipe muscle rigidity is a classic sign of NMS, whereas Serotonin Syndrome
typically presents with hyperreflexia and myoclonus. NMS is usually caused by dopamine
antagonists like first-generation antipsychotics, leading to severe extrapyramidal
symptoms. Recognizing this distinction is vital for immediate intervention and stopping the
causative agent in emergency psychiatric care.
5. A 32-year-old female patient presents with rapid speech, decreased need for sleep (3 hours
per night), and grandiosity. She has a history of major depressive episodes but no prior
mania. What is the most likely diagnosis?
A. Major Depressive Disorder with anxious distress
B. Bipolar I Disorder
, C. Cyclothymic Disorder
D. Bipolar II Disorder
Answer: B
Rationale: The presence of a manic episode, characterized by grandiosity and decreased
need for sleep, warrants a diagnosis of Bipolar I Disorder. While the patient has a history of
depression, a single manic episode is sufficient for the Bipolar I classification according to
the DSM-5-TR. Bipolar II would require a hypomanic episode and a major depressive
episode, rather than full-blown mania.
6. In the treatment of Bipolar Disorder, which medication requires regular monitoring of
serum levels, thyroid function, and renal function?
A. Lithium
B. Valproate
C. Quetiapine
D. Lamotrigine
Answer: A
Rationale: Lithium has a narrow therapeutic index and potential long-term effects on
organ systems, necessitating regular blood tests. Renal function must be monitored
because Lithium is excreted almost entirely by the kidneys, and thyroid function is checked
due to the risk of lithium-induced hypothyroidism. Maintaining levels between 0.6 and 1.2
mEq/L is essential for efficacy while avoiding toxicity.
