NR606 Week 9 Exam V3 | NR606 Diagnosis
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 9 Exam) | Chamberlain
University
1. A 32-year-old patient with Schizophrenia has been on Clozapine for 6 months. The most
recent Absolute Neutrophil Count (ANC) is 1,200/mm3. According to the Clozapine REMS
program, what is the appropriate action?
A. Continue treatment and monitor blood work monthly.
B. Stop treatment immediately and repeat ANC within 24 hours.
C. Continue treatment but increase frequency of ANC monitoring to three times weekly.
D. Increase the dosage of Clozapine to improve therapeutic response.
Answer: C
Rationale: For a general population patient, an ANC between 1,000 and 1,499/mm3 is
classified as mild neutropenia. The provider should continue treatment but must monitor
the ANC three times weekly until it returns to 1,500/mm3 or higher. This ensures patient
safety while minimizing the risk of agranulocytosis during the stabilization phase.
,2. A patient taking Lithium for Bipolar I Disorder presents with coarse hand tremors, diarrhea,
and confusion. Which of the following serum lithium levels is most likely associated with
these symptoms?
A. 0.8 mEq/L
B. 1.1 mEq/L
C. 2.2 mEq/L
D. 0.4 mEq/L
Answer: C
Rationale: The symptoms described are consistent with moderate to severe lithium
toxicity. Serum levels above 1.5 mEq/L are generally considered toxic, with levels over 2.0
mEq/L leading to significant neurological and gastrointestinal distress. Immediate medical
intervention and potential hemodialysis are required at these elevated concentrations.
3. A 28-year-old female reports excessive worry about her job, health, and finances for the
past 7 months. She describes muscle tension, irritability, and difficulty concentrating. What is
the most likely diagnosis?
A. Panic Disorder
B. Social Anxiety Disorder
C. Generalized Anxiety Disorder (GAD)
D. Adjustment Disorder with Anxiety
,Answer: C
Rationale: Generalized Anxiety Disorder requires the presence of excessive worry
occurring more days than not for at least 6 months. The patient’s symptoms of muscle
tension and irritability meet the diagnostic criteria outlined in the DSM-5-TR. It is
important to rule out other medical conditions or substance use before finalizing this
diagnosis.
4. When treating a patient with Borderline Personality Disorder who demonstrates frequent
self-harm behaviors, which psychotherapy is considered the gold standard?
A. Cognitive Behavioral Therapy (CBT)
B. Interpersonal Therapy (IPT)
C. Dialectical Behavior Therapy (DBT)
D. Exposure and Response Prevention (ERP)
Answer: C
Rationale: Dialectical Behavior Therapy was specifically designed to treat the emotional
dysregulation and self-harm associated with Borderline Personality Disorder. It combines
individual therapy with skills training groups to teach mindfulness and distress tolerance.
Research consistently shows DBT reduces hospitalization rates and improves interpersonal
functioning in this population.
, 5. A PMHNP is evaluating a 70-year-old male with new-onset depressive symptoms and
cognitive decline. Which lab test is most essential to rule out a reversible cause of these
symptoms?
A. Serum Lead Level
B. C-Reactive Protein
C. Urine Drug Screen
D. Vitamin B12 Level
Answer: D
Rationale: Vitamin B12 deficiency is a common reversible cause of cognitive impairment
and mood changes in the elderly. Low levels can mimic symptoms of dementia or major
depression, necessitating a thorough nutritional assessment. Checking B12 and folate
levels is a standard part of the diagnostic workup for late-life depression.
6. Which of the following symptoms is a hallmark sign of Neuroleptic Malignant Syndrome
(NMS) distinguishing it from Serotonin Syndrome?
A. Hyperreflexia
B. Dilated pupils
C. Lead-pipe muscle rigidity
D. Hyperactive bowel sounds
Answer: C
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 9 Exam) | Chamberlain
University
1. A 32-year-old patient with Schizophrenia has been on Clozapine for 6 months. The most
recent Absolute Neutrophil Count (ANC) is 1,200/mm3. According to the Clozapine REMS
program, what is the appropriate action?
A. Continue treatment and monitor blood work monthly.
B. Stop treatment immediately and repeat ANC within 24 hours.
C. Continue treatment but increase frequency of ANC monitoring to three times weekly.
D. Increase the dosage of Clozapine to improve therapeutic response.
Answer: C
Rationale: For a general population patient, an ANC between 1,000 and 1,499/mm3 is
classified as mild neutropenia. The provider should continue treatment but must monitor
the ANC three times weekly until it returns to 1,500/mm3 or higher. This ensures patient
safety while minimizing the risk of agranulocytosis during the stabilization phase.
,2. A patient taking Lithium for Bipolar I Disorder presents with coarse hand tremors, diarrhea,
and confusion. Which of the following serum lithium levels is most likely associated with
these symptoms?
A. 0.8 mEq/L
B. 1.1 mEq/L
C. 2.2 mEq/L
D. 0.4 mEq/L
Answer: C
Rationale: The symptoms described are consistent with moderate to severe lithium
toxicity. Serum levels above 1.5 mEq/L are generally considered toxic, with levels over 2.0
mEq/L leading to significant neurological and gastrointestinal distress. Immediate medical
intervention and potential hemodialysis are required at these elevated concentrations.
3. A 28-year-old female reports excessive worry about her job, health, and finances for the
past 7 months. She describes muscle tension, irritability, and difficulty concentrating. What is
the most likely diagnosis?
A. Panic Disorder
B. Social Anxiety Disorder
C. Generalized Anxiety Disorder (GAD)
D. Adjustment Disorder with Anxiety
,Answer: C
Rationale: Generalized Anxiety Disorder requires the presence of excessive worry
occurring more days than not for at least 6 months. The patient’s symptoms of muscle
tension and irritability meet the diagnostic criteria outlined in the DSM-5-TR. It is
important to rule out other medical conditions or substance use before finalizing this
diagnosis.
4. When treating a patient with Borderline Personality Disorder who demonstrates frequent
self-harm behaviors, which psychotherapy is considered the gold standard?
A. Cognitive Behavioral Therapy (CBT)
B. Interpersonal Therapy (IPT)
C. Dialectical Behavior Therapy (DBT)
D. Exposure and Response Prevention (ERP)
Answer: C
Rationale: Dialectical Behavior Therapy was specifically designed to treat the emotional
dysregulation and self-harm associated with Borderline Personality Disorder. It combines
individual therapy with skills training groups to teach mindfulness and distress tolerance.
Research consistently shows DBT reduces hospitalization rates and improves interpersonal
functioning in this population.
, 5. A PMHNP is evaluating a 70-year-old male with new-onset depressive symptoms and
cognitive decline. Which lab test is most essential to rule out a reversible cause of these
symptoms?
A. Serum Lead Level
B. C-Reactive Protein
C. Urine Drug Screen
D. Vitamin B12 Level
Answer: D
Rationale: Vitamin B12 deficiency is a common reversible cause of cognitive impairment
and mood changes in the elderly. Low levels can mimic symptoms of dementia or major
depression, necessitating a thorough nutritional assessment. Checking B12 and folate
levels is a standard part of the diagnostic workup for late-life depression.
6. Which of the following symptoms is a hallmark sign of Neuroleptic Malignant Syndrome
(NMS) distinguishing it from Serotonin Syndrome?
A. Hyperreflexia
B. Dilated pupils
C. Lead-pipe muscle rigidity
D. Hyperactive bowel sounds
Answer: C
