NR606 Week 7 Exam V1 | NR606 Diagnosis
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 7 Exam) | Chamberlain
University
1. A 24-year-old female presents with symptoms of Major Depressive Disorder (MDD).
According to the DSM-5, which symptom must be present for a diagnosis to be made?
A. Depressed mood or loss of interest/pleasure
B. Psychomotor agitation or retardation
C. Feelings of worthlessness or guilt
D. Recurrent thoughts of death or suicidal ideation
Answer: A
Rationale: The DSM-5 criteria for Major Depressive Disorder require at least five
symptoms to be present during the same 2-week period. At least one of the symptoms must
be either depressed mood or loss of interest or pleasure (anhedonia). The other symptoms
listed are part of the criteria but are not mandatory for the primary diagnostic threshold.
2. When prescribing Clozapine (Clozaril), the PMHNP must monitor the Absolute Neutrophil
Count (ANC) closely. What is the minimum ANC level required to initiate treatment in a non-
benign ethnic neutropenia patient?
A. 500/µL
,B. 1,500/µL
C. 1,000/µL
D. 2,000/µL
Answer: B
Rationale: Standard protocol requires an ANC of at least 1,500/µL before initiating
Clozapine therapy to mitigate the risk of agranulocytosis. This monitoring is mandated by
the FDA Clozapine REMS program to ensure patient safety. If the ANC falls below specific
thresholds during treatment, the medication must be interrupted or discontinued.
3. A patient is experiencing a hypertensive crisis after consuming aged cheese while on an
antidepressant. Which class of medication is the patient likely taking?
A. Selective Serotonin Reuptake Inhibitors (SSRIs)
B. Tricyclic Antidepressants (TCAs)
C. Monoamine Oxidase Inhibitors (MAOIs)
D. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Answer: C
Rationale: Monoamine Oxidase Inhibitors (MAOIs) interact with tyramine-rich foods like
aged cheese, cured meats, and red wine. This interaction leads to an accumulation of
norepinephrine, causing a dangerous increase in blood pressure known as a hypertensive
,crisis. Patients on MAOIs must adhere to a strict low-tyramine diet to prevent this life-
threatening complication.
4. Which legal concept refers to the PMHNP’s responsibility to protect a third party from a
patient’s threat of violence?
A. Duty to Warn (Tarasoff)
B. Beneficence
C. Informed Consent
D. Res Ipsa Loquitur
Answer: A
Rationale: The ‘Duty to Warn’ originated from the Tarasoff v. Regents of the University of
California case, establishing that mental health professionals have a duty to protect
individuals being threatened with bodily harm by a patient. This involves notifying the
intended victim and law enforcement. This principle creates a legal exception to patient
confidentiality when there is a clear and present danger to others.
5. A 45-year-old male with Bipolar I Disorder presents with a Lithium level of 1.8 mEq/L.
Which clinical manifestation is most consistent with this level?
A. Fine hand tremors and mild thirst
B. Seizures, coma, and cardiovascular collapse
C. Coarse tremors, confusion, and ataxia
, D. Polyuria and increased appetite
Answer: C
Rationale: A Lithium level of 1.8 mEq/L indicates moderate toxicity, which typically
manifests as coarse tremors, persistent gastrointestinal upset, mental confusion, and
ataxia. Fine tremors are common at therapeutic levels (0.6-1.2 mEq/L), while levels above
2.5 mEq/L are considered severe emergencies. The PMHNP must immediately assess the
patient and potentially discontinue the medication to prevent further neurological damage.
6. A PMHNP is treating a 10-year-old child for ADHD. According to clinical guidelines, which
medication is considered the first-line pharmacological treatment?
A. Guanfacine
B. Atomoxetine
C. Bupropion
D. Methylphenidate
Answer: D
Rationale: Stimulants such as Methylphenidate or Amphetamines are established as first-
line pharmacological treatments for ADHD in children and adolescents. They work by
increasing the availability of dopamine and norepinephrine in the prefrontal cortex to
improve focus and impulse control. Non-stimulants like Atomoxetine are typically reserved
for patients who do not tolerate stimulants or have a history of substance abuse.
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 7 Exam) | Chamberlain
University
1. A 24-year-old female presents with symptoms of Major Depressive Disorder (MDD).
According to the DSM-5, which symptom must be present for a diagnosis to be made?
A. Depressed mood or loss of interest/pleasure
B. Psychomotor agitation or retardation
C. Feelings of worthlessness or guilt
D. Recurrent thoughts of death or suicidal ideation
Answer: A
Rationale: The DSM-5 criteria for Major Depressive Disorder require at least five
symptoms to be present during the same 2-week period. At least one of the symptoms must
be either depressed mood or loss of interest or pleasure (anhedonia). The other symptoms
listed are part of the criteria but are not mandatory for the primary diagnostic threshold.
2. When prescribing Clozapine (Clozaril), the PMHNP must monitor the Absolute Neutrophil
Count (ANC) closely. What is the minimum ANC level required to initiate treatment in a non-
benign ethnic neutropenia patient?
A. 500/µL
,B. 1,500/µL
C. 1,000/µL
D. 2,000/µL
Answer: B
Rationale: Standard protocol requires an ANC of at least 1,500/µL before initiating
Clozapine therapy to mitigate the risk of agranulocytosis. This monitoring is mandated by
the FDA Clozapine REMS program to ensure patient safety. If the ANC falls below specific
thresholds during treatment, the medication must be interrupted or discontinued.
3. A patient is experiencing a hypertensive crisis after consuming aged cheese while on an
antidepressant. Which class of medication is the patient likely taking?
A. Selective Serotonin Reuptake Inhibitors (SSRIs)
B. Tricyclic Antidepressants (TCAs)
C. Monoamine Oxidase Inhibitors (MAOIs)
D. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Answer: C
Rationale: Monoamine Oxidase Inhibitors (MAOIs) interact with tyramine-rich foods like
aged cheese, cured meats, and red wine. This interaction leads to an accumulation of
norepinephrine, causing a dangerous increase in blood pressure known as a hypertensive
,crisis. Patients on MAOIs must adhere to a strict low-tyramine diet to prevent this life-
threatening complication.
4. Which legal concept refers to the PMHNP’s responsibility to protect a third party from a
patient’s threat of violence?
A. Duty to Warn (Tarasoff)
B. Beneficence
C. Informed Consent
D. Res Ipsa Loquitur
Answer: A
Rationale: The ‘Duty to Warn’ originated from the Tarasoff v. Regents of the University of
California case, establishing that mental health professionals have a duty to protect
individuals being threatened with bodily harm by a patient. This involves notifying the
intended victim and law enforcement. This principle creates a legal exception to patient
confidentiality when there is a clear and present danger to others.
5. A 45-year-old male with Bipolar I Disorder presents with a Lithium level of 1.8 mEq/L.
Which clinical manifestation is most consistent with this level?
A. Fine hand tremors and mild thirst
B. Seizures, coma, and cardiovascular collapse
C. Coarse tremors, confusion, and ataxia
, D. Polyuria and increased appetite
Answer: C
Rationale: A Lithium level of 1.8 mEq/L indicates moderate toxicity, which typically
manifests as coarse tremors, persistent gastrointestinal upset, mental confusion, and
ataxia. Fine tremors are common at therapeutic levels (0.6-1.2 mEq/L), while levels above
2.5 mEq/L are considered severe emergencies. The PMHNP must immediately assess the
patient and potentially discontinue the medication to prevent further neurological damage.
6. A PMHNP is treating a 10-year-old child for ADHD. According to clinical guidelines, which
medication is considered the first-line pharmacological treatment?
A. Guanfacine
B. Atomoxetine
C. Bupropion
D. Methylphenidate
Answer: D
Rationale: Stimulants such as Methylphenidate or Amphetamines are established as first-
line pharmacological treatments for ADHD in children and adolescents. They work by
increasing the availability of dopamine and norepinephrine in the prefrontal cortex to
improve focus and impulse control. Non-stimulants like Atomoxetine are typically reserved
for patients who do not tolerate stimulants or have a history of substance abuse.
