NR606 Week 4 Exam V3 | NR606 Diagnosis
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 4 Exam) | Chamberlain
University
1. A 28-year-old male presents with a 2-week history of increased energy, decreased need for
sleep, and grandiosity. He has no history of depressive episodes. Which diagnosis is most
appropriate based on DSM-5-TR criteria?
A. Bipolar I Disorder
B. Cyclothymic Disorder
C. Bipolar II Disorder
D. Major Depressive Disorder with Mixed Features
Answer: A
Rationale: According to the DSM-5-TR, a diagnosis of Bipolar I Disorder requires at least
one manic episode lasting at least one week. Unlike Bipolar II, Bipolar I does not require a
history of major depressive episodes for the diagnosis. The clinician must ensure that the
symptoms are not better explained by a substance use disorder or another medical
condition.
,2. Which lab value is most critical to monitor for a patient newly prescribed Clozapine
(Clozaril)?
A. Serum Potassium
B. Thyroid Stimulating Hormone (TSH)
C. Absolute Neutrophil Count (ANC)
D. Blood Urea Nitrogen (BUN)
Answer: C
Rationale: The risk of severe neutropenia and agranulocytosis necessitates strict
monitoring of the Absolute Neutrophil Count (ANC) in patients taking Clozapine. The FDA
mandates registration in the Clozapine REMS program to track these values and prevent
life-threatening infections. Practitioners must follow specific monitoring frequencies,
typically weekly for the first six months of treatment.
3. A patient taking Lithium Carbonate for Bipolar Disorder presents with coarse tremors,
ataxia, and blurred vision. What is the most likely serum lithium level for this patient?
A. 2.0 mEq/L
B. 0.9 mEq/L
C. 1.2 mEq/L
D. 0.6 mEq/L
Answer: A
,Rationale: Serum lithium levels above 1.5 mEq/L are generally considered toxic, with
levels reaching 2.0 mEq/L often presenting with severe symptoms like ataxia and coarse
tremors. Therapeutic levels typically range between 0.6 and 1.2 mEq/L for maintenance.
Immediate intervention is required to prevent seizures, coma, or permanent neurological
damage in such cases.
4. Which medication is considered first-line for the treatment of acute dystonia secondary to
antipsychotic use?
A. Lorazepam
B. Haloperidol
C. Propranolol
D. Benztropine
Answer: D
Rationale: Benztropine is an anticholinergic medication frequently used to rapidly reverse
acute dystonic reactions caused by dopamine blockade. This condition involves involuntary
muscle contractions and can be highly distressing for the patient. Alternative treatments
include diphenhydramine administered intravenously or intramuscularly for immediate
relief.
5. A patient with Schizophrenia reports hearing voices that command him to hurt others. This
is best described as:
A. Visual Hallucinations
, B. Somatic Delusions
C. Command Hallucinations
D. Ideas of Reference
Answer: C
Rationale: Command hallucinations are a specific type of auditory hallucination where the
patient is instructed to perform certain actions. These are considered high-risk symptoms
that require immediate safety assessment and potentially hospitalization to protect the
patient and others. The clinician must evaluate the patient’s intent and ability to resist
these commands during the diagnostic process.
6. Which of the following is a ‘negative symptom’ of Schizophrenia?
A. Disorganized Speech
B. Delusions of Grandeur
C. Auditory Hallucinations
D. Flat Affect
Answer: D
Rationale: Negative symptoms refer to the absence or reduction of normal functions, such
as flat affect, alogia, and avolition. Positive symptoms, conversely, involve the presence of
abnormal behaviors like hallucinations and delusions. Distinguishing between these two
categories is essential for determining the prognosis and selecting appropriate
pharmacological interventions.
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 4 Exam) | Chamberlain
University
1. A 28-year-old male presents with a 2-week history of increased energy, decreased need for
sleep, and grandiosity. He has no history of depressive episodes. Which diagnosis is most
appropriate based on DSM-5-TR criteria?
A. Bipolar I Disorder
B. Cyclothymic Disorder
C. Bipolar II Disorder
D. Major Depressive Disorder with Mixed Features
Answer: A
Rationale: According to the DSM-5-TR, a diagnosis of Bipolar I Disorder requires at least
one manic episode lasting at least one week. Unlike Bipolar II, Bipolar I does not require a
history of major depressive episodes for the diagnosis. The clinician must ensure that the
symptoms are not better explained by a substance use disorder or another medical
condition.
,2. Which lab value is most critical to monitor for a patient newly prescribed Clozapine
(Clozaril)?
A. Serum Potassium
B. Thyroid Stimulating Hormone (TSH)
C. Absolute Neutrophil Count (ANC)
D. Blood Urea Nitrogen (BUN)
Answer: C
Rationale: The risk of severe neutropenia and agranulocytosis necessitates strict
monitoring of the Absolute Neutrophil Count (ANC) in patients taking Clozapine. The FDA
mandates registration in the Clozapine REMS program to track these values and prevent
life-threatening infections. Practitioners must follow specific monitoring frequencies,
typically weekly for the first six months of treatment.
3. A patient taking Lithium Carbonate for Bipolar Disorder presents with coarse tremors,
ataxia, and blurred vision. What is the most likely serum lithium level for this patient?
A. 2.0 mEq/L
B. 0.9 mEq/L
C. 1.2 mEq/L
D. 0.6 mEq/L
Answer: A
,Rationale: Serum lithium levels above 1.5 mEq/L are generally considered toxic, with
levels reaching 2.0 mEq/L often presenting with severe symptoms like ataxia and coarse
tremors. Therapeutic levels typically range between 0.6 and 1.2 mEq/L for maintenance.
Immediate intervention is required to prevent seizures, coma, or permanent neurological
damage in such cases.
4. Which medication is considered first-line for the treatment of acute dystonia secondary to
antipsychotic use?
A. Lorazepam
B. Haloperidol
C. Propranolol
D. Benztropine
Answer: D
Rationale: Benztropine is an anticholinergic medication frequently used to rapidly reverse
acute dystonic reactions caused by dopamine blockade. This condition involves involuntary
muscle contractions and can be highly distressing for the patient. Alternative treatments
include diphenhydramine administered intravenously or intramuscularly for immediate
relief.
5. A patient with Schizophrenia reports hearing voices that command him to hurt others. This
is best described as:
A. Visual Hallucinations
, B. Somatic Delusions
C. Command Hallucinations
D. Ideas of Reference
Answer: C
Rationale: Command hallucinations are a specific type of auditory hallucination where the
patient is instructed to perform certain actions. These are considered high-risk symptoms
that require immediate safety assessment and potentially hospitalization to protect the
patient and others. The clinician must evaluate the patient’s intent and ability to resist
these commands during the diagnostic process.
6. Which of the following is a ‘negative symptom’ of Schizophrenia?
A. Disorganized Speech
B. Delusions of Grandeur
C. Auditory Hallucinations
D. Flat Affect
Answer: D
Rationale: Negative symptoms refer to the absence or reduction of normal functions, such
as flat affect, alogia, and avolition. Positive symptoms, conversely, involve the presence of
abnormal behaviors like hallucinations and delusions. Distinguishing between these two
categories is essential for determining the prognosis and selecting appropriate
pharmacological interventions.
