NR606 Week 8 Exam V2 | NR606 Diagnosis
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 8 Exam) | Chamberlain
University
1. A 10-year-old patient diagnosed with ADHD continues to struggle with impulsivity despite
behavioral therapy. Which pharmacological intervention is considered the first-line gold
standard for this population?
A. Atomoxetine (Strattera)
B. Risperidone (Risperdal)
C. Guanfacine (Intuniv)
D. Methylphenidate (Ritalin)
Answer: D
Rationale: Stimulants such as Methylphenidate are the first-line treatment for ADHD due
to their high efficacy in improving focus and reducing impulsivity. These medications work
by increasing the availability of dopamine and norepinephrine in the prefrontal cortex.
Clinicians must monitor for side effects such as appetite suppression, insomnia, and
potential growth delays.
,2. When treating an elderly patient with Major Depressive Disorder, the PMHNP should be
cautious of which side effect associated with SSRIs like Paroxetine?
A. Hypertension
B. Hyperglycemia
C. Anticholinergic effects and sedation
D. Liver toxicity
Answer: C
Rationale: Paroxetine has a higher affinity for muscarinic receptors compared to other
SSRIs, leading to significant anticholinergic side effects. In the elderly, these effects can
cause confusion, urinary retention, and increased fall risks. It is often recommended to use
SSRIs with fewer anticholinergic properties, such as Escitalopram or Sertraline, in geriatric
populations.
3. A 24-year-old female patient is diagnosed with Bipolar I Disorder. Which medication is
contraindicated due to a high risk of neural tube defects if she were to become pregnant?
A. Lithium
B. Valproate (Depakote)
C. Lamotrigine
D. Quetiapine
Answer: B
,Rationale: Valproate is associated with a high incidence of teratogenicity, specifically
neural tube defects like spina bifida. Women of childbearing age should be counseled on
effective contraception or switched to safer alternatives. If Valproate must be used, high-
dose folic acid supplementation is mandatory, though it does not eliminate all risks.
4. A patient on Clozapine therapy presents with a fever, sore throat, and a white blood cell
count of 2,000/mm³. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome
B. Serotonin Syndrome
C. Agranulocytosis
D. Acute Myocarditis
Answer: C
Rationale: Agranulocytosis is a rare but life-threatening side effect of Clozapine
characterized by a severe drop in the absolute neutrophil count. Frequent blood
monitoring is required by the FDA’s Risk Evaluation and Mitigation Strategy (REMS)
program. If the ANC falls below a critical threshold, the medication must be discontinued
immediately and the patient managed for potential infection.
5. Which therapeutic approach is considered the standard of care for patients diagnosed with
Borderline Personality Disorder exhibiting suicidal behaviors?
A. Dialectical Behavior Therapy (DBT)
B. Interpersonal Therapy (IPT)
, C. Cognitive Behavioral Therapy (CBT)
D. Exposure Therapy
Answer: A
Rationale: Dialectical Behavior Therapy (DBT) was specifically designed to treat the
emotional dysregulation and self-harming behaviors found in Borderline Personality
Disorder. It focuses on mindfulness, distress tolerance, and interpersonal effectiveness to
help patients manage intense emotions. Research consistently shows DBT reduces
hospitalization rates and suicide attempts in this population.
6. A patient with PTSD reports frequent nightmares that interrupt their sleep. Which
medication is most effective as an off-label treatment for trauma-related nightmares?
A. Lorazepam
B. Prazosin
C. Trazodone
D. Melatonin
Answer: B
Rationale: Prazosin is an alpha-1 adrenergic antagonist that has been shown to reduce the
frequency and intensity of PTSD nightmares. It works by blocking the excessive
sympathetic response that occurs during sleep in traumatized individuals. Patients should
be monitored for orthostatic hypotension, particularly when initiating the medication or
increasing the dose.
& Management in Psychiatric-Mental
Health II Practicum | Q&A with Rationale
(NR606 Week 8 Exam) | Chamberlain
University
1. A 10-year-old patient diagnosed with ADHD continues to struggle with impulsivity despite
behavioral therapy. Which pharmacological intervention is considered the first-line gold
standard for this population?
A. Atomoxetine (Strattera)
B. Risperidone (Risperdal)
C. Guanfacine (Intuniv)
D. Methylphenidate (Ritalin)
Answer: D
Rationale: Stimulants such as Methylphenidate are the first-line treatment for ADHD due
to their high efficacy in improving focus and reducing impulsivity. These medications work
by increasing the availability of dopamine and norepinephrine in the prefrontal cortex.
Clinicians must monitor for side effects such as appetite suppression, insomnia, and
potential growth delays.
,2. When treating an elderly patient with Major Depressive Disorder, the PMHNP should be
cautious of which side effect associated with SSRIs like Paroxetine?
A. Hypertension
B. Hyperglycemia
C. Anticholinergic effects and sedation
D. Liver toxicity
Answer: C
Rationale: Paroxetine has a higher affinity for muscarinic receptors compared to other
SSRIs, leading to significant anticholinergic side effects. In the elderly, these effects can
cause confusion, urinary retention, and increased fall risks. It is often recommended to use
SSRIs with fewer anticholinergic properties, such as Escitalopram or Sertraline, in geriatric
populations.
3. A 24-year-old female patient is diagnosed with Bipolar I Disorder. Which medication is
contraindicated due to a high risk of neural tube defects if she were to become pregnant?
A. Lithium
B. Valproate (Depakote)
C. Lamotrigine
D. Quetiapine
Answer: B
,Rationale: Valproate is associated with a high incidence of teratogenicity, specifically
neural tube defects like spina bifida. Women of childbearing age should be counseled on
effective contraception or switched to safer alternatives. If Valproate must be used, high-
dose folic acid supplementation is mandatory, though it does not eliminate all risks.
4. A patient on Clozapine therapy presents with a fever, sore throat, and a white blood cell
count of 2,000/mm³. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome
B. Serotonin Syndrome
C. Agranulocytosis
D. Acute Myocarditis
Answer: C
Rationale: Agranulocytosis is a rare but life-threatening side effect of Clozapine
characterized by a severe drop in the absolute neutrophil count. Frequent blood
monitoring is required by the FDA’s Risk Evaluation and Mitigation Strategy (REMS)
program. If the ANC falls below a critical threshold, the medication must be discontinued
immediately and the patient managed for potential infection.
5. Which therapeutic approach is considered the standard of care for patients diagnosed with
Borderline Personality Disorder exhibiting suicidal behaviors?
A. Dialectical Behavior Therapy (DBT)
B. Interpersonal Therapy (IPT)
, C. Cognitive Behavioral Therapy (CBT)
D. Exposure Therapy
Answer: A
Rationale: Dialectical Behavior Therapy (DBT) was specifically designed to treat the
emotional dysregulation and self-harming behaviors found in Borderline Personality
Disorder. It focuses on mindfulness, distress tolerance, and interpersonal effectiveness to
help patients manage intense emotions. Research consistently shows DBT reduces
hospitalization rates and suicide attempts in this population.
6. A patient with PTSD reports frequent nightmares that interrupt their sleep. Which
medication is most effective as an off-label treatment for trauma-related nightmares?
A. Lorazepam
B. Prazosin
C. Trazodone
D. Melatonin
Answer: B
Rationale: Prazosin is an alpha-1 adrenergic antagonist that has been shown to reduce the
frequency and intensity of PTSD nightmares. It works by blocking the excessive
sympathetic response that occurs during sleep in traumatized individuals. Patients should
be monitored for orthostatic hypotension, particularly when initiating the medication or
increasing the dose.
