NR606 Week 2 Exam V2 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 2 Exam) | Chamberlain University
1. A 32-year-old female presents with persistent feelings of sadness, insomnia, and
anhedonia for the last 3 weeks. Which DSM-5 criterion must be met to confirm a diagnosis of
Major Depressive Disorder (MDD)?
A. The patient must have a family history of mood disorders.
B. The patient must report thoughts of self-harm or suicidal ideation.
C. Symptoms must be present for at least six consecutive months.
D. Symptoms must cause clinically significant distress or impairment in functioning.
Answer: D
Explanation: According to the DSM-5, symptoms of MDD must cause clinically significant
distress or impairment in social, occupational, or other important areas of functioning.
Furthermore, at least five symptoms must be present during the same 2-week period, with
at least one being depressed mood or loss of interest. The diagnosis also requires that the
episode is not attributable to the physiological effects of a substance or another medical
condition.
2. When distinguishing between Bipolar I and Bipolar II disorder, which of the following is the
defining clinical feature of Bipolar I?
A. The presence of at least one hypomanic episode.
B. The presence of at least one manic episode.
C. A history of rapid cycling between depression and mania.
D. The requirement of a major depressive episode for diagnosis.
Answer: B
Explanation: Bipolar I disorder is characterized by the occurrence of at least one manic
episode, which may be preceded or followed by hypomanic or major depressive episodes.
Unlike Bipolar I, Bipolar II requires at least one hypomanic episode and at least one major
depressive episode, but never a full manic episode. Mania involves a distinct period of
abnormally elevated mood lasting at least one week and often requiring hospitalization.
3. A PMHNP is considering starting a patient on Lithium for mood stabilization. Which
baseline laboratory test is most critical before initiating therapy?
A. Liver function tests (LFTs)
B. Renal function tests (BUN and Creatinine)
,C. Hemoglobin A1c
D. Serum amylase
Answer: B
Explanation: Lithium is primarily excreted by the kidneys, making renal function
assessment essential before and during treatment. Elevated creatinine levels or decreased
glomerular filtration rates can lead to toxic levels of lithium in the blood. Additionally,
clinicians should monitor thyroid function and electrolytes, as lithium can cause
hypothyroidism and interact with sodium levels.
4. A patient taking an SSRI for Generalized Anxiety Disorder reports sudden onset of muscle
rigidity, diaphoresis, and hyperthermia. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Anticholinergic Toxicity
C. Serotonin Syndrome
D. Panic Attack
Answer: C
Explanation: Serotonin syndrome is a potentially life-threatening condition caused by
excessive serotonergic activity, often resulting from drug interactions. Clinical
manifestations include autonomic instability, neuromuscular hyperactivity (such as clonus
or rigidity), and mental status changes. While NMS shares some symptoms, it is typically
associated with dopamine antagonists rather than serotonergic agents.
5. Which of the following is a ‘positive symptom’ of schizophrenia according to the DSM-5?
A. Alogia
B. Hallucinations
C. Avolition
D. Anhedonia
Answer: B
Explanation: Positive symptoms of schizophrenia represent an excess or distortion of
normal function, including hallucinations, delusions, and disorganized speech. Negative
symptoms, such as alogia (poverty of speech) and avolition (lack of motivation), reflect a
diminution or loss of normal functions. Identifying the balance between positive and
negative symptoms is crucial for selecting the appropriate antipsychotic medication.
6. In the treatment of Bipolar Disorder, which medication is associated with a high risk of
Stevens-Johnson Syndrome (SJS)?
A. Valproic acid
, B. Quetiapine
C. Lamotrigine
D. Lithium
Answer: C
Explanation: Lamotrigine carries a black box warning for serious rashes, including
Stevens-Johnson Syndrome, particularly if the dose is titrated too quickly. To mitigate this
risk, clinicians must follow a slow dose escalation schedule over several weeks. Patients
should be educated to seek immediate medical attention if they develop any new rash or
mucosal involvement while taking this medication.
7. A 45-year-old male with Schizophrenia is prescribed Clozapine. Which laboratory value
must be monitored weekly during the first six months of treatment?
A. Serum glucose
B. Absolute Neutrophil Count (ANC)
C. Platelet count
D. Liver enzymes
Answer: B
Explanation: Clozapine is associated with a risk of severe neutropenia (agranulocytosis),
which can lead to fatal infections. The Clozapine Risk Evaluation and Mitigation Strategy
(REMS) program mandates regular ANC monitoring to ensure patient safety. If the ANC
falls below a specific threshold, the medication must be interrupted or discontinued to
allow the bone marrow to recover.
8. Which neurotransmitter is primarily targeted by benzodiazepines to produce their
anxiolytic and sedative effects?
A. Gamma-aminobutyric acid (GABA)
B. Dopamine
C. Glutamate
D. Norepinephrine
Answer: A
Explanation: Benzodiazepines work by enhancing the effect of GABA, the primary
inhibitory neurotransmitter in the central nervous system. By binding to GABA-A
receptors, they increase chloride ion influx, leading to hyperpolarization and reduced
neuronal excitability. This mechanism results in the rapid relief of anxiety, though it also
carries a risk for dependence and withdrawal.
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 2 Exam) | Chamberlain University
1. A 32-year-old female presents with persistent feelings of sadness, insomnia, and
anhedonia for the last 3 weeks. Which DSM-5 criterion must be met to confirm a diagnosis of
Major Depressive Disorder (MDD)?
A. The patient must have a family history of mood disorders.
B. The patient must report thoughts of self-harm or suicidal ideation.
C. Symptoms must be present for at least six consecutive months.
D. Symptoms must cause clinically significant distress or impairment in functioning.
Answer: D
Explanation: According to the DSM-5, symptoms of MDD must cause clinically significant
distress or impairment in social, occupational, or other important areas of functioning.
Furthermore, at least five symptoms must be present during the same 2-week period, with
at least one being depressed mood or loss of interest. The diagnosis also requires that the
episode is not attributable to the physiological effects of a substance or another medical
condition.
2. When distinguishing between Bipolar I and Bipolar II disorder, which of the following is the
defining clinical feature of Bipolar I?
A. The presence of at least one hypomanic episode.
B. The presence of at least one manic episode.
C. A history of rapid cycling between depression and mania.
D. The requirement of a major depressive episode for diagnosis.
Answer: B
Explanation: Bipolar I disorder is characterized by the occurrence of at least one manic
episode, which may be preceded or followed by hypomanic or major depressive episodes.
Unlike Bipolar I, Bipolar II requires at least one hypomanic episode and at least one major
depressive episode, but never a full manic episode. Mania involves a distinct period of
abnormally elevated mood lasting at least one week and often requiring hospitalization.
3. A PMHNP is considering starting a patient on Lithium for mood stabilization. Which
baseline laboratory test is most critical before initiating therapy?
A. Liver function tests (LFTs)
B. Renal function tests (BUN and Creatinine)
,C. Hemoglobin A1c
D. Serum amylase
Answer: B
Explanation: Lithium is primarily excreted by the kidneys, making renal function
assessment essential before and during treatment. Elevated creatinine levels or decreased
glomerular filtration rates can lead to toxic levels of lithium in the blood. Additionally,
clinicians should monitor thyroid function and electrolytes, as lithium can cause
hypothyroidism and interact with sodium levels.
4. A patient taking an SSRI for Generalized Anxiety Disorder reports sudden onset of muscle
rigidity, diaphoresis, and hyperthermia. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Anticholinergic Toxicity
C. Serotonin Syndrome
D. Panic Attack
Answer: C
Explanation: Serotonin syndrome is a potentially life-threatening condition caused by
excessive serotonergic activity, often resulting from drug interactions. Clinical
manifestations include autonomic instability, neuromuscular hyperactivity (such as clonus
or rigidity), and mental status changes. While NMS shares some symptoms, it is typically
associated with dopamine antagonists rather than serotonergic agents.
5. Which of the following is a ‘positive symptom’ of schizophrenia according to the DSM-5?
A. Alogia
B. Hallucinations
C. Avolition
D. Anhedonia
Answer: B
Explanation: Positive symptoms of schizophrenia represent an excess or distortion of
normal function, including hallucinations, delusions, and disorganized speech. Negative
symptoms, such as alogia (poverty of speech) and avolition (lack of motivation), reflect a
diminution or loss of normal functions. Identifying the balance between positive and
negative symptoms is crucial for selecting the appropriate antipsychotic medication.
6. In the treatment of Bipolar Disorder, which medication is associated with a high risk of
Stevens-Johnson Syndrome (SJS)?
A. Valproic acid
, B. Quetiapine
C. Lamotrigine
D. Lithium
Answer: C
Explanation: Lamotrigine carries a black box warning for serious rashes, including
Stevens-Johnson Syndrome, particularly if the dose is titrated too quickly. To mitigate this
risk, clinicians must follow a slow dose escalation schedule over several weeks. Patients
should be educated to seek immediate medical attention if they develop any new rash or
mucosal involvement while taking this medication.
7. A 45-year-old male with Schizophrenia is prescribed Clozapine. Which laboratory value
must be monitored weekly during the first six months of treatment?
A. Serum glucose
B. Absolute Neutrophil Count (ANC)
C. Platelet count
D. Liver enzymes
Answer: B
Explanation: Clozapine is associated with a risk of severe neutropenia (agranulocytosis),
which can lead to fatal infections. The Clozapine Risk Evaluation and Mitigation Strategy
(REMS) program mandates regular ANC monitoring to ensure patient safety. If the ANC
falls below a specific threshold, the medication must be interrupted or discontinued to
allow the bone marrow to recover.
8. Which neurotransmitter is primarily targeted by benzodiazepines to produce their
anxiolytic and sedative effects?
A. Gamma-aminobutyric acid (GABA)
B. Dopamine
C. Glutamate
D. Norepinephrine
Answer: A
Explanation: Benzodiazepines work by enhancing the effect of GABA, the primary
inhibitory neurotransmitter in the central nervous system. By binding to GABA-A
receptors, they increase chloride ion influx, leading to hyperpolarization and reduced
neuronal excitability. This mechanism results in the rapid relief of anxiety, though it also
carries a risk for dependence and withdrawal.
