NR606 Week 10 Exam V2 | NR606
Diagnosis & Management in Psychiatric-
Mental Health II Practicum | Q&A with
Rationale (NR606 Week 10 Exam) |
Chamberlain University
1. A 24-year-old patient diagnosed with schizophrenia has been taking Clozapine for six
months. During a routine follow-up, the patient reports a persistent sore throat and a fever
of 101.5°F. Which of the following is the priority action for the PMHNP?
A. Prescribe a broad-spectrum antibiotic and reassess in 48 hours.
B. Advise the patient to increase fluid intake and take acetaminophen.
C. Order an immediate complete blood count (CBC) with differential.
D. Discontinue Clozapine and switch the patient to Risperidone immediately.
Answer: C
Rationale: Clozapine carries a significant risk of agranulocytosis, which is a life-
threatening reduction in white blood cell count. Fever and sore throat are early warning
signs of infection that necessitate an immediate CBC to check the Absolute Neutrophil
Count (ANC). Prompt monitoring and adherence to the Clozapine REMS program are
critical components of patient safety in psychiatric management.
,2. Which of the following laboratory values is most critical to monitor for a patient newly
prescribed Lithium carbonate for Bipolar I Disorder?
A. Serum creatinine and Thyroid Stimulating Hormone (TSH).
B. Liver function tests (LFTs) and bilirubin.
C. Serum electrolytes and glucose levels.
D. Hemoglobin A1c and lipid panel.
Answer: A
Rationale: Lithium is primarily excreted by the kidneys and can have long-term effects on
renal function and thyroid health. Monitoring serum creatinine and TSH is essential to
ensure the patient does not develop Lithium-induced nephrotoxicity or hypothyroidism.
Clinicians must establish baseline values and perform regular follow-ups to maintain
therapeutic levels while preventing organ damage.
3. A PMHNP is evaluating a 35-year-old female for Major Depressive Disorder (MDD). The
patient reports that she also experiences significant anxiety and insomnia. Which medication
would be most appropriate to address all three symptoms?
A. Buspirone
B. Bupropion
C. Methylphenidate
D. Mirtazapine
,Answer: D
Rationale: Mirtazapine is an atypical antidepressant that acts as an alpha-2 antagonist,
increasing serotonin and norepinephrine. Its sedative properties make it highly effective
for patients with insomnia associated with depression. Additionally, its anxiolytic profile
helps manage concurrent anxiety symptoms without the risk of sexual dysfunction
common in SSRIs.
4. According to the DSM-5 criteria, what is the primary difference between Bipolar I Disorder
and Bipolar II Disorder?
A. Bipolar I requires a depressive episode, while Bipolar II does not.
B. Bipolar I requires at least one manic episode, while Bipolar II requires a hypomanic
episode and a depressive episode.
C. Bipolar I involves hypomanic episodes, whereas Bipolar II involves full manic episodes.
D. Bipolar II disorder symptoms must last for at least two weeks, whereas Bipolar I lasts
only one week.
Answer: B
Rationale: The diagnosis of Bipolar I is defined by the occurrence of at least one manic
episode that lasts at least one week or requires hospitalization. In contrast, Bipolar II is
characterized by at least one hypomanic episode and at least one major depressive episode.
This distinction is vital for determining the intensity of pharmacological intervention and
identifying the risk of psychosis.
, 5. A patient taking Phenelzine (Nardil) presents to the emergency department with a severe
headache, nausea, and a blood pressure of 190/110 mmHg. Which question is most pertinent
to include in the assessment?
A. Have you recently increased your dosage of Phenelzine?
B. When was the last time you checked your blood sugar levels?
C. Have you been experiencing any suicidal ideations?
D. Did you consume any aged cheese or red wine recently?
Answer: D
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI), which can lead to a
hypertensive crisis if the patient consumes high-tyramine foods. Tyramine is found in aged
cheeses, fermented meats, and certain alcoholic beverages like red wine. This reaction
occurs because MAOIs prevent the breakdown of tyramine, leading to massive
catecholamine release and dangerous blood pressure spikes.
6. A 45-year-old male is being treated for chronic schizophrenia. He exhibits smacking of the
lips, tongue protrusion, and involuntary rhythmic movements of the limbs. These symptoms
are characteristic of which condition?
A. Akathisia
B. Dystonia
C. Tardive Dyskinesia
D. Pseudoparkinsonism
Diagnosis & Management in Psychiatric-
Mental Health II Practicum | Q&A with
Rationale (NR606 Week 10 Exam) |
Chamberlain University
1. A 24-year-old patient diagnosed with schizophrenia has been taking Clozapine for six
months. During a routine follow-up, the patient reports a persistent sore throat and a fever
of 101.5°F. Which of the following is the priority action for the PMHNP?
A. Prescribe a broad-spectrum antibiotic and reassess in 48 hours.
B. Advise the patient to increase fluid intake and take acetaminophen.
C. Order an immediate complete blood count (CBC) with differential.
D. Discontinue Clozapine and switch the patient to Risperidone immediately.
Answer: C
Rationale: Clozapine carries a significant risk of agranulocytosis, which is a life-
threatening reduction in white blood cell count. Fever and sore throat are early warning
signs of infection that necessitate an immediate CBC to check the Absolute Neutrophil
Count (ANC). Prompt monitoring and adherence to the Clozapine REMS program are
critical components of patient safety in psychiatric management.
,2. Which of the following laboratory values is most critical to monitor for a patient newly
prescribed Lithium carbonate for Bipolar I Disorder?
A. Serum creatinine and Thyroid Stimulating Hormone (TSH).
B. Liver function tests (LFTs) and bilirubin.
C. Serum electrolytes and glucose levels.
D. Hemoglobin A1c and lipid panel.
Answer: A
Rationale: Lithium is primarily excreted by the kidneys and can have long-term effects on
renal function and thyroid health. Monitoring serum creatinine and TSH is essential to
ensure the patient does not develop Lithium-induced nephrotoxicity or hypothyroidism.
Clinicians must establish baseline values and perform regular follow-ups to maintain
therapeutic levels while preventing organ damage.
3. A PMHNP is evaluating a 35-year-old female for Major Depressive Disorder (MDD). The
patient reports that she also experiences significant anxiety and insomnia. Which medication
would be most appropriate to address all three symptoms?
A. Buspirone
B. Bupropion
C. Methylphenidate
D. Mirtazapine
,Answer: D
Rationale: Mirtazapine is an atypical antidepressant that acts as an alpha-2 antagonist,
increasing serotonin and norepinephrine. Its sedative properties make it highly effective
for patients with insomnia associated with depression. Additionally, its anxiolytic profile
helps manage concurrent anxiety symptoms without the risk of sexual dysfunction
common in SSRIs.
4. According to the DSM-5 criteria, what is the primary difference between Bipolar I Disorder
and Bipolar II Disorder?
A. Bipolar I requires a depressive episode, while Bipolar II does not.
B. Bipolar I requires at least one manic episode, while Bipolar II requires a hypomanic
episode and a depressive episode.
C. Bipolar I involves hypomanic episodes, whereas Bipolar II involves full manic episodes.
D. Bipolar II disorder symptoms must last for at least two weeks, whereas Bipolar I lasts
only one week.
Answer: B
Rationale: The diagnosis of Bipolar I is defined by the occurrence of at least one manic
episode that lasts at least one week or requires hospitalization. In contrast, Bipolar II is
characterized by at least one hypomanic episode and at least one major depressive episode.
This distinction is vital for determining the intensity of pharmacological intervention and
identifying the risk of psychosis.
, 5. A patient taking Phenelzine (Nardil) presents to the emergency department with a severe
headache, nausea, and a blood pressure of 190/110 mmHg. Which question is most pertinent
to include in the assessment?
A. Have you recently increased your dosage of Phenelzine?
B. When was the last time you checked your blood sugar levels?
C. Have you been experiencing any suicidal ideations?
D. Did you consume any aged cheese or red wine recently?
Answer: D
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI), which can lead to a
hypertensive crisis if the patient consumes high-tyramine foods. Tyramine is found in aged
cheeses, fermented meats, and certain alcoholic beverages like red wine. This reaction
occurs because MAOIs prevent the breakdown of tyramine, leading to massive
catecholamine release and dangerous blood pressure spikes.
6. A 45-year-old male is being treated for chronic schizophrenia. He exhibits smacking of the
lips, tongue protrusion, and involuntary rhythmic movements of the limbs. These symptoms
are characteristic of which condition?
A. Akathisia
B. Dystonia
C. Tardive Dyskinesia
D. Pseudoparkinsonism
