NR606 Week 2 Exam V3 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 2 Exam) | Chamberlain University
1. A 9-year-old male is brought to the clinic for an evaluation due to persistent patterns of
irritability and frequent temper outbursts that are disproportionate to the situation. The
mother reports these occur at least three times a week. Which diagnosis is most appropriate
given these symptoms?
A. Bipolar I Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Oppositional Defiant Disorder (ODD)
D. Conduct Disorder
Answer: B
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was added to the DSM-5 to
address the overdiagnosis of Bipolar Disorder in children. It is characterized by severe
temper outbursts and a persistent irritable mood between outbursts. This diagnosis
requires symptoms to be present for at least 12 months in at least two settings.
2. When evaluating a 15-year-old for Major Depressive Disorder, the PMHNP notes that the
patient presents primarily with irritability rather than sadness. How does this align with DSM-
5 diagnostic criteria for adolescents?
A. Irritability is only a criteria for Disruptive Mood Dysregulation Disorder.
B. Sadness must be present for at least two weeks regardless of irritability.
C. Irritability is considered a secondary symptom and cannot satisfy the primary criteria.
D. In children and adolescents, irritable mood can replace depressed mood as a core
symptom.
Answer: D
Explanation: The DSM-5 specifies that while adults must report a depressed mood, in
children and adolescents, the mood can be irritable. This developmental variation is crucial
for accurate diagnosis in the pediatric population. Clinicians must assess if the irritability
represents a change from the patient’s baseline functioning.
3. A 5-year-old child demonstrates significant deficits in social communication and
interaction, along with restricted, repetitive patterns of behavior. Which screening tool is
most validated for this developmental stage?
A. GARS-3
,B. M-CHAT-R/F
C. PHQ-9
D. Vanderbilt Assessment Scale
Answer: A
Explanation: The Gilliam Autism Rating Scale (GARS-3) is widely used to identify autism in
individuals aged 3 to 22. While the M-CHAT is for toddlers (16-30 months), the GARS-3 is
more appropriate for a 5-year-old clinical evaluation. It helps clinicians estimate the
severity of the disorder and plan interventions accordingly.
4. A PMHNP is considering starting a stimulant for a 10-year-old with ADHD. Which pre-
treatment assessment is considered mandatory according to standard clinical guidelines?
A. Brain MRI to rule out structural abnormalities
B. Liver function tests
C. Routine baseline EEG
D. Comprehensive cardiac history and physical exam
Answer: D
Explanation: Clinical guidelines require a thorough cardiac history including family
history of sudden death and a focused physical exam before starting stimulants. Routine
EKGs are not mandatory for all children but should be performed if the history or physical
exam suggests cardiac risk. This step ensures patient safety given the sympathomimetic
effects of stimulant medications.
5. A 16-year-old female presents with a BMI of 16.5, intense fear of gaining weight, and a
distorted body image. She admits to restricting food but denies purging. What is the most
likely diagnosis?
A. Bulimia Nervosa
B. Anorexia Nervosa, Restricting Type
C. Avoidant/Restrictive Food Intake Disorder (ARFID)
D. Binge-Eating Disorder
Answer: B
Explanation: Anorexia Nervosa is characterized by a significantly low body weight, fear of
weight gain, and body image disturbance. The ‘Restricting Type’ is specified when the
individual has not engaged in binge-eating or purging behavior in the last three months.
Early intervention is vital as this disorder carries a high mortality rate compared to other
psychiatric conditions.
, 6. Which legal concept refers to a minor’s willingness to participate in a clinical study or
treatment plan, even though they cannot give legal consent?
A. Informed Consent
B. Emancipation
C. Assent
D. Guardianship
Answer: C
Explanation: Assent is the agreement of someone not able to give legal consent to
participate in an activity. While parents provide the legal ‘informed consent,’ clinicians
should involve children in the decision-making process to foster therapeutic alliance. This
practice respects the developing autonomy of the child or adolescent.
7. In the treatment of ADHD, how does the mechanism of action for Atomoxetine (Strattera)
differ from Methylphenidate?
A. Atomoxetine is a selective norepinephrine reuptake inhibitor, not a stimulant.
B. Atomoxetine increases dopamine levels in the nucleus accumbens.
C. Methylphenidate works primarily on serotonin receptors.
D. Atomoxetine has a much shorter half-life than Methylphenidate.
Answer: A
Explanation: Atomoxetine is a non-stimulant medication that works by inhibiting the
presynaptic norepinephrine transporter. Unlike stimulants, it has a lower potential for
abuse and is not a controlled substance. It typically takes 2-4 weeks to see the full
therapeutic effect compared to the immediate effect of stimulants.
8. A 12-year-old child frequently loses their temper, argues with authority figures, and
actively defies requests. However, they do not violate the basic rights of others or major age-
appropriate societal norms. This presentation is most consistent with:
A. Oppositional Defiant Disorder (ODD)
B. Conduct Disorder
C. Antisocial Personality Disorder
D. Intermittent Explosive Disorder
Answer: A
Explanation: ODD involves a pattern of angry/irritable mood and argumentative behavior.
It is distinguished from Conduct Disorder because ODD does not typically include
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 2 Exam) | Chamberlain University
1. A 9-year-old male is brought to the clinic for an evaluation due to persistent patterns of
irritability and frequent temper outbursts that are disproportionate to the situation. The
mother reports these occur at least three times a week. Which diagnosis is most appropriate
given these symptoms?
A. Bipolar I Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Oppositional Defiant Disorder (ODD)
D. Conduct Disorder
Answer: B
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was added to the DSM-5 to
address the overdiagnosis of Bipolar Disorder in children. It is characterized by severe
temper outbursts and a persistent irritable mood between outbursts. This diagnosis
requires symptoms to be present for at least 12 months in at least two settings.
2. When evaluating a 15-year-old for Major Depressive Disorder, the PMHNP notes that the
patient presents primarily with irritability rather than sadness. How does this align with DSM-
5 diagnostic criteria for adolescents?
A. Irritability is only a criteria for Disruptive Mood Dysregulation Disorder.
B. Sadness must be present for at least two weeks regardless of irritability.
C. Irritability is considered a secondary symptom and cannot satisfy the primary criteria.
D. In children and adolescents, irritable mood can replace depressed mood as a core
symptom.
Answer: D
Explanation: The DSM-5 specifies that while adults must report a depressed mood, in
children and adolescents, the mood can be irritable. This developmental variation is crucial
for accurate diagnosis in the pediatric population. Clinicians must assess if the irritability
represents a change from the patient’s baseline functioning.
3. A 5-year-old child demonstrates significant deficits in social communication and
interaction, along with restricted, repetitive patterns of behavior. Which screening tool is
most validated for this developmental stage?
A. GARS-3
,B. M-CHAT-R/F
C. PHQ-9
D. Vanderbilt Assessment Scale
Answer: A
Explanation: The Gilliam Autism Rating Scale (GARS-3) is widely used to identify autism in
individuals aged 3 to 22. While the M-CHAT is for toddlers (16-30 months), the GARS-3 is
more appropriate for a 5-year-old clinical evaluation. It helps clinicians estimate the
severity of the disorder and plan interventions accordingly.
4. A PMHNP is considering starting a stimulant for a 10-year-old with ADHD. Which pre-
treatment assessment is considered mandatory according to standard clinical guidelines?
A. Brain MRI to rule out structural abnormalities
B. Liver function tests
C. Routine baseline EEG
D. Comprehensive cardiac history and physical exam
Answer: D
Explanation: Clinical guidelines require a thorough cardiac history including family
history of sudden death and a focused physical exam before starting stimulants. Routine
EKGs are not mandatory for all children but should be performed if the history or physical
exam suggests cardiac risk. This step ensures patient safety given the sympathomimetic
effects of stimulant medications.
5. A 16-year-old female presents with a BMI of 16.5, intense fear of gaining weight, and a
distorted body image. She admits to restricting food but denies purging. What is the most
likely diagnosis?
A. Bulimia Nervosa
B. Anorexia Nervosa, Restricting Type
C. Avoidant/Restrictive Food Intake Disorder (ARFID)
D. Binge-Eating Disorder
Answer: B
Explanation: Anorexia Nervosa is characterized by a significantly low body weight, fear of
weight gain, and body image disturbance. The ‘Restricting Type’ is specified when the
individual has not engaged in binge-eating or purging behavior in the last three months.
Early intervention is vital as this disorder carries a high mortality rate compared to other
psychiatric conditions.
, 6. Which legal concept refers to a minor’s willingness to participate in a clinical study or
treatment plan, even though they cannot give legal consent?
A. Informed Consent
B. Emancipation
C. Assent
D. Guardianship
Answer: C
Explanation: Assent is the agreement of someone not able to give legal consent to
participate in an activity. While parents provide the legal ‘informed consent,’ clinicians
should involve children in the decision-making process to foster therapeutic alliance. This
practice respects the developing autonomy of the child or adolescent.
7. In the treatment of ADHD, how does the mechanism of action for Atomoxetine (Strattera)
differ from Methylphenidate?
A. Atomoxetine is a selective norepinephrine reuptake inhibitor, not a stimulant.
B. Atomoxetine increases dopamine levels in the nucleus accumbens.
C. Methylphenidate works primarily on serotonin receptors.
D. Atomoxetine has a much shorter half-life than Methylphenidate.
Answer: A
Explanation: Atomoxetine is a non-stimulant medication that works by inhibiting the
presynaptic norepinephrine transporter. Unlike stimulants, it has a lower potential for
abuse and is not a controlled substance. It typically takes 2-4 weeks to see the full
therapeutic effect compared to the immediate effect of stimulants.
8. A 12-year-old child frequently loses their temper, argues with authority figures, and
actively defies requests. However, they do not violate the basic rights of others or major age-
appropriate societal norms. This presentation is most consistent with:
A. Oppositional Defiant Disorder (ODD)
B. Conduct Disorder
C. Antisocial Personality Disorder
D. Intermittent Explosive Disorder
Answer: A
Explanation: ODD involves a pattern of angry/irritable mood and argumentative behavior.
It is distinguished from Conduct Disorder because ODD does not typically include
