NR606 Week 4 Exam V2 | NR606 Diagnosis
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 4 Exam) | Chamberlain
University
1. A 9-year-old child presents with symptoms of persistent irritability and frequent episodes
of extreme behavioral dyscontrol occurring at least three times a week. The provider
considers a diagnosis of Disruptive Mood Dysregulation Disorder (DMDD). Which of the
following is a requirement for this diagnosis?
A. The symptoms must be present for at least 6 months.
B. The diagnosis should be made for the first time before age 6.
C. The child must demonstrate symptoms of mania for at least two days.
D. The symptoms must be present in at least two of three settings.
Answer: D
Rationale: According to the DSM-5, the core feature of DMDD is chronic, severe persistent
irritability with temper outbursts. These symptoms must be present in at least two of three
settings (home, school, with peers) and be severe in at least one. The onset of symptoms
must be before age 10, and the diagnosis should not be made for the first time before age 6
or after age 18.
,2. When prescribing stimulant medication for a child with ADHD, which physical monitoring
parameter is considered the most critical at each follow-up visit?
A. Serum creatinine and BUN levels.
B. Height, weight, blood pressure, and heart rate.
C. Liver function tests and platelet count.
D. Vision screening and auditory processing tests.
Answer: B
Rationale: Stimulants are known to cause potential side effects such as appetite
suppression and cardiovascular changes. Consequently, tracking height and weight is
essential to monitor for growth suppression over time. Additionally, checking blood
pressure and heart rate ensures that the sympathetic nervous system activation remains
within safe limits for the pediatric patient.
3. An adolescent patient is diagnosed with Conduct Disorder after showing a pattern of
violating the basic rights of others. Which of the following behaviors is most characteristic of
this diagnosis rather than Oppositional Defiant Disorder (ODD)?
A. Physical cruelty to animals or people.
B. Deliberately annoying others.
C. Arguing with authority figures.
D. Losing one’s temper frequently.
,Answer: A
Rationale: Conduct Disorder involves more severe infractions compared to ODD, including
aggression toward people and animals, destruction of property, and theft. ODD is primarily
characterized by a pattern of angry/irritable mood and argumentative/defiant behavior.
The presence of physical cruelty is a significant red flag that distinguishes CD from the less
aggressive ODD.
4. A 7-year-old is brought in for an evaluation due to difficulty sitting still, interrupting others,
and failing to finish schoolwork. Which assessment tool is standard for gathering information
from both parents and teachers to support an ADHD diagnosis?
A. The PHQ-9 Modified for Adolescents.
B. The GAD-7 Anxiety Scale.
C. The Vanderbilt Assessment Scales.
D. The CAGE Questionnaire.
Answer: C
Rationale: The Vanderbilt Assessment Scales are widely used in clinical practice to collect
standardized data from multiple observers regarding ADHD symptoms. These scales assess
both the core symptoms of inattention and hyperactivity/impulsivity and screen for
common comorbidities like ODD and anxiety. Utilizing feedback from both home and
school environments is a requirement for a comprehensive DSM-5 evaluation.
, 5. The PMHNP is considering starting an Alpha-2 Adrenergic Agonist for a child who has failed
stimulant trials for ADHD. Which medication fits this classification?
A. Lisdexamfetamine (Vyvanse)
B. Atomoxetine (Strattera)
C. Guanfacine ER (Intuniv)
D. Methylphenidate (Concecta)
Answer: C
Rationale: Guanfacine ER and Clonidine ER are alpha-2 adrenergic agonists used to treat
ADHD, especially when stimulants are contraindicated or poorly tolerated. These
medications work by stimulating alpha-2A receptors in the prefrontal cortex to improve
executive function. Unlike stimulants, they are non-controlled substances and can also help
with co-occurring tics or aggression.
6. A 14-year-old female presents with signs of major depressive disorder. When initiating an
SSRI, the PMHNP must provide education regarding the FDA Black Box Warning. What is the
focus of this warning in children and adolescents?
A. Increased risk of suicidal ideation and behavior.
B. Increased risk of hepatotoxicity.
C. Risk of Stevens-Johnson Syndrome.
D. Permanent growth suppression.
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 4 Exam) | Chamberlain
University
1. A 9-year-old child presents with symptoms of persistent irritability and frequent episodes
of extreme behavioral dyscontrol occurring at least three times a week. The provider
considers a diagnosis of Disruptive Mood Dysregulation Disorder (DMDD). Which of the
following is a requirement for this diagnosis?
A. The symptoms must be present for at least 6 months.
B. The diagnosis should be made for the first time before age 6.
C. The child must demonstrate symptoms of mania for at least two days.
D. The symptoms must be present in at least two of three settings.
Answer: D
Rationale: According to the DSM-5, the core feature of DMDD is chronic, severe persistent
irritability with temper outbursts. These symptoms must be present in at least two of three
settings (home, school, with peers) and be severe in at least one. The onset of symptoms
must be before age 10, and the diagnosis should not be made for the first time before age 6
or after age 18.
,2. When prescribing stimulant medication for a child with ADHD, which physical monitoring
parameter is considered the most critical at each follow-up visit?
A. Serum creatinine and BUN levels.
B. Height, weight, blood pressure, and heart rate.
C. Liver function tests and platelet count.
D. Vision screening and auditory processing tests.
Answer: B
Rationale: Stimulants are known to cause potential side effects such as appetite
suppression and cardiovascular changes. Consequently, tracking height and weight is
essential to monitor for growth suppression over time. Additionally, checking blood
pressure and heart rate ensures that the sympathetic nervous system activation remains
within safe limits for the pediatric patient.
3. An adolescent patient is diagnosed with Conduct Disorder after showing a pattern of
violating the basic rights of others. Which of the following behaviors is most characteristic of
this diagnosis rather than Oppositional Defiant Disorder (ODD)?
A. Physical cruelty to animals or people.
B. Deliberately annoying others.
C. Arguing with authority figures.
D. Losing one’s temper frequently.
,Answer: A
Rationale: Conduct Disorder involves more severe infractions compared to ODD, including
aggression toward people and animals, destruction of property, and theft. ODD is primarily
characterized by a pattern of angry/irritable mood and argumentative/defiant behavior.
The presence of physical cruelty is a significant red flag that distinguishes CD from the less
aggressive ODD.
4. A 7-year-old is brought in for an evaluation due to difficulty sitting still, interrupting others,
and failing to finish schoolwork. Which assessment tool is standard for gathering information
from both parents and teachers to support an ADHD diagnosis?
A. The PHQ-9 Modified for Adolescents.
B. The GAD-7 Anxiety Scale.
C. The Vanderbilt Assessment Scales.
D. The CAGE Questionnaire.
Answer: C
Rationale: The Vanderbilt Assessment Scales are widely used in clinical practice to collect
standardized data from multiple observers regarding ADHD symptoms. These scales assess
both the core symptoms of inattention and hyperactivity/impulsivity and screen for
common comorbidities like ODD and anxiety. Utilizing feedback from both home and
school environments is a requirement for a comprehensive DSM-5 evaluation.
, 5. The PMHNP is considering starting an Alpha-2 Adrenergic Agonist for a child who has failed
stimulant trials for ADHD. Which medication fits this classification?
A. Lisdexamfetamine (Vyvanse)
B. Atomoxetine (Strattera)
C. Guanfacine ER (Intuniv)
D. Methylphenidate (Concecta)
Answer: C
Rationale: Guanfacine ER and Clonidine ER are alpha-2 adrenergic agonists used to treat
ADHD, especially when stimulants are contraindicated or poorly tolerated. These
medications work by stimulating alpha-2A receptors in the prefrontal cortex to improve
executive function. Unlike stimulants, they are non-controlled substances and can also help
with co-occurring tics or aggression.
6. A 14-year-old female presents with signs of major depressive disorder. When initiating an
SSRI, the PMHNP must provide education regarding the FDA Black Box Warning. What is the
focus of this warning in children and adolescents?
A. Increased risk of suicidal ideation and behavior.
B. Increased risk of hepatotoxicity.
C. Risk of Stevens-Johnson Syndrome.
D. Permanent growth suppression.
