NR606 Week 8 Exam V1 | NR606 Diagnosis
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 8 Exam) | Chamberlain
University
1. A patient with treatment-resistant schizophrenia is being started on Clozapine. Which of
the following laboratory values requires immediate interruption of the medication according
to the Clozapine REMS program?
A. White Blood Cell (WBC) count of 4,000/µL
B. Hemoglobin of 11.0 g/dL
C. Platelet count of 150,000/µL
D. Absolute Neutrophil Count (ANC) of 1,450/µL
Answer: D
Rationale: The Clozapine REMS program requires an Absolute Neutrophil Count (ANC) of
at least 1,500/µL to continue treatment in the general population. An ANC of 1,450/µL
indicates mild neutropenia, which necessitates stopping the medication and daily
monitoring until recovery. This protocol is essential for preventing the life-threatening
condition known as agranulocytosis.
,2. A PMHNP is assessing a patient for Serotonin Syndrome. Which physical exam finding
would most likely distinguish this condition from Neuroleptic Malignant Syndrome (NMS)?
A. Hyperreflexia and myoclonus
B. Lead-pipe muscle rigidity
C. Elevated body temperature
D. Diaphoresis and tachycardia
Answer: A
Rationale: Serotonin Syndrome is characterized by neuromuscular hyperexcitability, such
as hyperreflexia and myoclonus, particularly in the lower extremities. In contrast,
Neuroleptic Malignant Syndrome is typically identified by ‘lead-pipe’ rigidity and slower
onset. Recognizing these differences is vital for determining the causative agent and the
appropriate treatment pathway.
3. Which therapeutic modality focuses primarily on the ‘here and now’ and uses the
therapeutic relationship to explore interpersonal patterns and role transitions?
A. Dialectical Behavior Therapy (DBT)
B. Cognitive Behavioral Therapy (CBT)
C. Interpersonal Psychotherapy (IPT)
D. Psychoanalytic Psychotherapy
Answer: C
,Rationale: Interpersonal Psychotherapy (IPT) is a time-limited approach that links
symptoms to current interpersonal problems. It focuses on four main areas: grief, role
disputes, role transitions, and interpersonal deficits. This therapy helps patients improve
their social functioning and reduce depressive symptoms by addressing these specific life
areas.
4. When prescribing Lithium carbonate for a patient with Bipolar I Disorder, which baseline
and ongoing laboratory test is most critical due to the drug’s excretion profile?
A. Liver Function Tests (LFTs)
B. Serum Creatinine and BUN
C. Amylase and Lipase
D. Prothrombin Time (PT/INR)
Answer: B
Rationale: Lithium is primarily excreted by the kidneys and has a narrow therapeutic
index, making renal function monitoring essential. Serum creatinine and BUN should be
checked at baseline and every 6-12 months thereafter. Significant changes in renal
clearance can lead to Lithium toxicity, which is a medical emergency.
5. A 65-year-old patient presents with new-onset depressive symptoms and cognitive decline.
What is the priority assessment to differentiate between Pseudodementia and Alzheimer’s
disease?
A. Assessing for a history of alcohol use
, B. Determining the onset of symptoms and patient effort during testing
C. Performing an MRI of the brain
D. Measuring Vitamin B12 levels
Answer: B
Rationale: Pseudodementia (depression in the elderly) typically has a rapid onset, and
patients often complain about their memory loss or provide ‘I don’t know’ answers on
exams. In contrast, true dementia has an insidious onset, and patients may try to hide their
deficits or provide near-miss answers. Distinguishing these helps determine if
antidepressant treatment or dementia-specific care is required.
6. In the treatment of Opioid Use Disorder (OUD), which medication acts as a partial mu-
opioid agonist and has a ‘ceiling effect’ on respiratory depression?
A. Methadone
B. Buprenorphine
C. Naltrexone
D. Naloxone
Answer: B
Rationale: Buprenorphine is a partial mu-opioid agonist that binds strongly to the
receptor but activates it only partially. This pharmacological property creates a ceiling
effect, which significantly reduces the risk of fatal overdose compared to full agonists. It is
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 8 Exam) | Chamberlain
University
1. A patient with treatment-resistant schizophrenia is being started on Clozapine. Which of
the following laboratory values requires immediate interruption of the medication according
to the Clozapine REMS program?
A. White Blood Cell (WBC) count of 4,000/µL
B. Hemoglobin of 11.0 g/dL
C. Platelet count of 150,000/µL
D. Absolute Neutrophil Count (ANC) of 1,450/µL
Answer: D
Rationale: The Clozapine REMS program requires an Absolute Neutrophil Count (ANC) of
at least 1,500/µL to continue treatment in the general population. An ANC of 1,450/µL
indicates mild neutropenia, which necessitates stopping the medication and daily
monitoring until recovery. This protocol is essential for preventing the life-threatening
condition known as agranulocytosis.
,2. A PMHNP is assessing a patient for Serotonin Syndrome. Which physical exam finding
would most likely distinguish this condition from Neuroleptic Malignant Syndrome (NMS)?
A. Hyperreflexia and myoclonus
B. Lead-pipe muscle rigidity
C. Elevated body temperature
D. Diaphoresis and tachycardia
Answer: A
Rationale: Serotonin Syndrome is characterized by neuromuscular hyperexcitability, such
as hyperreflexia and myoclonus, particularly in the lower extremities. In contrast,
Neuroleptic Malignant Syndrome is typically identified by ‘lead-pipe’ rigidity and slower
onset. Recognizing these differences is vital for determining the causative agent and the
appropriate treatment pathway.
3. Which therapeutic modality focuses primarily on the ‘here and now’ and uses the
therapeutic relationship to explore interpersonal patterns and role transitions?
A. Dialectical Behavior Therapy (DBT)
B. Cognitive Behavioral Therapy (CBT)
C. Interpersonal Psychotherapy (IPT)
D. Psychoanalytic Psychotherapy
Answer: C
,Rationale: Interpersonal Psychotherapy (IPT) is a time-limited approach that links
symptoms to current interpersonal problems. It focuses on four main areas: grief, role
disputes, role transitions, and interpersonal deficits. This therapy helps patients improve
their social functioning and reduce depressive symptoms by addressing these specific life
areas.
4. When prescribing Lithium carbonate for a patient with Bipolar I Disorder, which baseline
and ongoing laboratory test is most critical due to the drug’s excretion profile?
A. Liver Function Tests (LFTs)
B. Serum Creatinine and BUN
C. Amylase and Lipase
D. Prothrombin Time (PT/INR)
Answer: B
Rationale: Lithium is primarily excreted by the kidneys and has a narrow therapeutic
index, making renal function monitoring essential. Serum creatinine and BUN should be
checked at baseline and every 6-12 months thereafter. Significant changes in renal
clearance can lead to Lithium toxicity, which is a medical emergency.
5. A 65-year-old patient presents with new-onset depressive symptoms and cognitive decline.
What is the priority assessment to differentiate between Pseudodementia and Alzheimer’s
disease?
A. Assessing for a history of alcohol use
, B. Determining the onset of symptoms and patient effort during testing
C. Performing an MRI of the brain
D. Measuring Vitamin B12 levels
Answer: B
Rationale: Pseudodementia (depression in the elderly) typically has a rapid onset, and
patients often complain about their memory loss or provide ‘I don’t know’ answers on
exams. In contrast, true dementia has an insidious onset, and patients may try to hide their
deficits or provide near-miss answers. Distinguishing these helps determine if
antidepressant treatment or dementia-specific care is required.
6. In the treatment of Opioid Use Disorder (OUD), which medication acts as a partial mu-
opioid agonist and has a ‘ceiling effect’ on respiratory depression?
A. Methadone
B. Buprenorphine
C. Naltrexone
D. Naloxone
Answer: B
Rationale: Buprenorphine is a partial mu-opioid agonist that binds strongly to the
receptor but activates it only partially. This pharmacological property creates a ceiling
effect, which significantly reduces the risk of fatal overdose compared to full agonists. It is
