NR605 PMHNP LIFESPAN PRACTICUM
FINAL REVIEW: WEEKS 5-8 QUESTIONS
AND ANSWERS
1. A 45-year-old patient diagnosed with Bipolar I Disorder has been taking Lithium for two
years. During a routine check-up, the patient reports severe tremors, ataxia, and persistent
diarrhea. What is the most appropriate immediate action for the PMHNP?
A. Transition the patient to Valproic Acid immediately.
B. Increase fluid intake and decrease the dose by half.
C. Add a low-dose beta-blocker to manage the tremors.
D. Check a stat serum lithium level and instruct the patient to stop the medication.
Answer: D
Conceptual Explanation: Ataxia, severe tremors, and diarrhea are hallmark signs of
lithium toxicity. The therapeutic range is narrow (0.6-1.2 mEq/L), and toxicity above 1.5
mEq/L requires immediate clinical intervention and monitoring.
,2. According to the DSM-5, which of the following criteria is essential for a diagnosis of
Schizoaffective Disorder?
A. A major depressive episode that lasts at least 6 months.
B. Mood symptoms that are present for less than 50% of the total duration of the illness.
C. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode.
D. Symptoms occurring only during a period of substance intoxication.
Answer: C
Conceptual Explanation: Schizoaffective disorder requires that psychotic symptoms
(delusions/hallucinations) persist for at least 2 weeks without prominent mood symptoms,
though mood symptoms must be present for the majority of the total illness duration.
3. A patient with Treatment-Resistant Schizophrenia is starting Clozapine (Clozaril). The
PMHNP knows that the Absolute Neutrophil Count (ANC) must be monitored. At what ANC
level must the medication be interrupted permanently?
A. ANC < 500/µL
B. ANC < 1500/µL
C. ANC < 1000/µL
D. ANC < 2000/µL
Answer: A
, Conceptual Explanation: According to the Clozapine REMS program, an ANC of less than
500/µL is classified as severe neutropenia, requiring immediate cessation of the drug and
typically prohibiting rechallenge.
4. A 10-year-old child presents with a pattern of angry/irritable mood, argumentative
behavior, and vindictiveness for the last 7 months. The behavior occurs with at least one
individual who is not a sibling. What is the most likely diagnosis?
A. Conduct Disorder
B. Attention-Deficit/Hyperactivity Disorder
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Oppositional Defiant Disorder (ODD)
Answer: D
Conceptual Explanation: ODD is characterized by a pattern of irritable mood and defiant
behavior for at least 6 months. Conduct Disorder involves more severe violations of others’
rights (e.g., aggression to people/animals), which is not specified here.
5. A 28-year-old female patient reports a long-standing pattern of unstable relationships,
intense fear of abandonment, and recurrent suicidal gestures. She often fluctuates between
idolizing her therapist and devaluing them. This describes which personality disorder?
A. Narcissistic Personality Disorder
B. Histrionic Personality Disorder
C. Antisocial Personality Disorder
FINAL REVIEW: WEEKS 5-8 QUESTIONS
AND ANSWERS
1. A 45-year-old patient diagnosed with Bipolar I Disorder has been taking Lithium for two
years. During a routine check-up, the patient reports severe tremors, ataxia, and persistent
diarrhea. What is the most appropriate immediate action for the PMHNP?
A. Transition the patient to Valproic Acid immediately.
B. Increase fluid intake and decrease the dose by half.
C. Add a low-dose beta-blocker to manage the tremors.
D. Check a stat serum lithium level and instruct the patient to stop the medication.
Answer: D
Conceptual Explanation: Ataxia, severe tremors, and diarrhea are hallmark signs of
lithium toxicity. The therapeutic range is narrow (0.6-1.2 mEq/L), and toxicity above 1.5
mEq/L requires immediate clinical intervention and monitoring.
,2. According to the DSM-5, which of the following criteria is essential for a diagnosis of
Schizoaffective Disorder?
A. A major depressive episode that lasts at least 6 months.
B. Mood symptoms that are present for less than 50% of the total duration of the illness.
C. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode.
D. Symptoms occurring only during a period of substance intoxication.
Answer: C
Conceptual Explanation: Schizoaffective disorder requires that psychotic symptoms
(delusions/hallucinations) persist for at least 2 weeks without prominent mood symptoms,
though mood symptoms must be present for the majority of the total illness duration.
3. A patient with Treatment-Resistant Schizophrenia is starting Clozapine (Clozaril). The
PMHNP knows that the Absolute Neutrophil Count (ANC) must be monitored. At what ANC
level must the medication be interrupted permanently?
A. ANC < 500/µL
B. ANC < 1500/µL
C. ANC < 1000/µL
D. ANC < 2000/µL
Answer: A
, Conceptual Explanation: According to the Clozapine REMS program, an ANC of less than
500/µL is classified as severe neutropenia, requiring immediate cessation of the drug and
typically prohibiting rechallenge.
4. A 10-year-old child presents with a pattern of angry/irritable mood, argumentative
behavior, and vindictiveness for the last 7 months. The behavior occurs with at least one
individual who is not a sibling. What is the most likely diagnosis?
A. Conduct Disorder
B. Attention-Deficit/Hyperactivity Disorder
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Oppositional Defiant Disorder (ODD)
Answer: D
Conceptual Explanation: ODD is characterized by a pattern of irritable mood and defiant
behavior for at least 6 months. Conduct Disorder involves more severe violations of others’
rights (e.g., aggression to people/animals), which is not specified here.
5. A 28-year-old female patient reports a long-standing pattern of unstable relationships,
intense fear of abandonment, and recurrent suicidal gestures. She often fluctuates between
idolizing her therapist and devaluing them. This describes which personality disorder?
A. Narcissistic Personality Disorder
B. Histrionic Personality Disorder
C. Antisocial Personality Disorder
