NR606 Week 3 Exam V1 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 3 Exam) | Chamberlain University
1. A 9-year-old male presents with persistent irritability and frequent temper outbursts that
are out of proportion to the situation, occurring at least three times per week. The symptoms
have been present for over a year across multiple settings. Which diagnosis is most likely?
A. Disruptive Mood Dysregulation Disorder (DMDD)
B. Oppositional Defiant Disorder
C. Bipolar I Disorder
D. Attention-Deficit/Hyperactivity Disorder
Answer: A
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was introduced in the
DSM-5 to address the over-diagnosis of bipolar disorder in children. The criteria include
severe recurrent temper outbursts and a persistently irritable or angry mood between
outbursts for at least 12 months. This diagnosis cannot be made before age 6 or after age
18, and symptoms must begin before age 10.
2. When assessing a child for Autism Spectrum Disorder (ASD), which of the following is
considered a core deficit according to DSM-5 criteria?
A. Intellectual disability with an IQ below 70
B. Persistent deficits in social communication and social interaction
C. High levels of physical aggression toward peers
D. Auditory hallucinations and formal thought disorder
Answer: B
Explanation: The core diagnostic criteria for ASD involve persistent deficits in social
communication and social interaction across multiple contexts. These deficits include
social-emotional reciprocity, nonverbal communicative behaviors, and developing or
maintaining relationships. Additionally, restricted and repetitive patterns of behavior,
interests, or activities must be present.
3. A PMHNP is considering starting a 10-year-old on a stimulant for ADHD. Which baseline
assessment is mandatory before initiating stimulant therapy?
A. Cardiac history assessment and blood pressure/heart rate monitoring
B. Liver function tests (LFTs)
,C. Serum creatinine and BUN levels
D. Thyroid stimulating hormone (TSH)
Answer: A
Explanation: Before initiating stimulants like methylphenidate or amphetamines, the
provider must conduct a thorough cardiac history and physical exam. Stimulants are
associated with increased heart rate and blood pressure, which could exacerbate
underlying structural heart abnormalities. While routine EKGs are not required for all
children, they should be performed if the personal or family history suggests cardiac risk.
4. Which therapeutic approach is most evidence-based for the treatment of Oppositional
Defiant Disorder (ODD) in younger children?
A. Parent Management Training (PMT)
B. Individual Psychoanalysis
C. High-dose SSRI therapy
D. Long-term residential placement
Answer: A
Explanation: Parent Management Training (PMT) is the primary intervention for ODD,
focusing on teaching parents how to use positive reinforcement and consistent
consequences. It addresses the transactional nature of the parent-child relationship which
often maintains defiant behaviors. Medication is typically reserved for comorbid conditions
like ADHD rather than treating ODD directly.
5. An adolescent patient is diagnosed with Major Depressive Disorder and started on
Fluoxetine. What is the most critical FDA warning the PMHNP must discuss with the patient
and family?
A. Risk of weight gain and metabolic syndrome
B. Risk of Stevens-Johnson Syndrome
C. Increased risk of suicidal ideation and behavior in children and young adults
D. Permanent tardive dyskinesia
Answer: C
Explanation: Fluoxetine and other SSRIs carry an FDA Black Box Warning regarding the
increased risk of suicidal thinking and behavior in children, adolescents, and young adults
up to age 24. Providers must monitor patients closely for clinical worsening or unusual
changes in behavior, especially during the first few months of treatment. Education on
monitoring for these signs is a vital component of the informed consent process.
, 6. A 7-year-old child exhibits significant difficulty separating from his mother, frequent
nightmares about being lost, and physical complaints (headaches) when forced to go to
school. These symptoms have lasted for 2 months. What is the most likely diagnosis?
A. Separation Anxiety Disorder
B. Social Anxiety Disorder
C. Selective Mutism
D. Agoraphobia
Answer: A
Explanation: Separation Anxiety Disorder is characterized by developmentally
inappropriate and excessive fear concerning separation from those to whom the individual
is attached. For children, the symptoms must persist for at least 4 weeks and cause
significant impairment in social or academic functioning. Somatic complaints like
headaches and stomachaches are common manifestations of this anxiety in pediatric
populations.
7. Which medication is FDA-approved for the treatment of irritability associated with Autism
Spectrum Disorder in children aged 5 to 16 years?
A. Lithium
B. Risperidone
C. Valproate
D. Clonidine
Answer: B
Explanation: Risperidone was the first medication FDA-approved to treat irritability
(including aggression and self-injury) in children with ASD. Aripiprazole is also FDA-
approved for this indication in children aged 6 to 17. Monitoring for side effects like weight
gain, hyperprolactinemia, and extrapyramidal symptoms is necessary when using these
second-generation antipsychotics.
8. A 16-year-old is brought to the clinic for repeatedly violating the basic rights of others,
including physical cruelty to animals, staying out past curfew, and stealing. These behaviors
have occurred for 18 months. What is the most appropriate diagnosis?
A. Conduct Disorder
B. Oppositional Defiant Disorder
C. Antisocial Personality Disorder
D. Intermittent Explosive Disorder
Answer: A
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 3 Exam) | Chamberlain University
1. A 9-year-old male presents with persistent irritability and frequent temper outbursts that
are out of proportion to the situation, occurring at least three times per week. The symptoms
have been present for over a year across multiple settings. Which diagnosis is most likely?
A. Disruptive Mood Dysregulation Disorder (DMDD)
B. Oppositional Defiant Disorder
C. Bipolar I Disorder
D. Attention-Deficit/Hyperactivity Disorder
Answer: A
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was introduced in the
DSM-5 to address the over-diagnosis of bipolar disorder in children. The criteria include
severe recurrent temper outbursts and a persistently irritable or angry mood between
outbursts for at least 12 months. This diagnosis cannot be made before age 6 or after age
18, and symptoms must begin before age 10.
2. When assessing a child for Autism Spectrum Disorder (ASD), which of the following is
considered a core deficit according to DSM-5 criteria?
A. Intellectual disability with an IQ below 70
B. Persistent deficits in social communication and social interaction
C. High levels of physical aggression toward peers
D. Auditory hallucinations and formal thought disorder
Answer: B
Explanation: The core diagnostic criteria for ASD involve persistent deficits in social
communication and social interaction across multiple contexts. These deficits include
social-emotional reciprocity, nonverbal communicative behaviors, and developing or
maintaining relationships. Additionally, restricted and repetitive patterns of behavior,
interests, or activities must be present.
3. A PMHNP is considering starting a 10-year-old on a stimulant for ADHD. Which baseline
assessment is mandatory before initiating stimulant therapy?
A. Cardiac history assessment and blood pressure/heart rate monitoring
B. Liver function tests (LFTs)
,C. Serum creatinine and BUN levels
D. Thyroid stimulating hormone (TSH)
Answer: A
Explanation: Before initiating stimulants like methylphenidate or amphetamines, the
provider must conduct a thorough cardiac history and physical exam. Stimulants are
associated with increased heart rate and blood pressure, which could exacerbate
underlying structural heart abnormalities. While routine EKGs are not required for all
children, they should be performed if the personal or family history suggests cardiac risk.
4. Which therapeutic approach is most evidence-based for the treatment of Oppositional
Defiant Disorder (ODD) in younger children?
A. Parent Management Training (PMT)
B. Individual Psychoanalysis
C. High-dose SSRI therapy
D. Long-term residential placement
Answer: A
Explanation: Parent Management Training (PMT) is the primary intervention for ODD,
focusing on teaching parents how to use positive reinforcement and consistent
consequences. It addresses the transactional nature of the parent-child relationship which
often maintains defiant behaviors. Medication is typically reserved for comorbid conditions
like ADHD rather than treating ODD directly.
5. An adolescent patient is diagnosed with Major Depressive Disorder and started on
Fluoxetine. What is the most critical FDA warning the PMHNP must discuss with the patient
and family?
A. Risk of weight gain and metabolic syndrome
B. Risk of Stevens-Johnson Syndrome
C. Increased risk of suicidal ideation and behavior in children and young adults
D. Permanent tardive dyskinesia
Answer: C
Explanation: Fluoxetine and other SSRIs carry an FDA Black Box Warning regarding the
increased risk of suicidal thinking and behavior in children, adolescents, and young adults
up to age 24. Providers must monitor patients closely for clinical worsening or unusual
changes in behavior, especially during the first few months of treatment. Education on
monitoring for these signs is a vital component of the informed consent process.
, 6. A 7-year-old child exhibits significant difficulty separating from his mother, frequent
nightmares about being lost, and physical complaints (headaches) when forced to go to
school. These symptoms have lasted for 2 months. What is the most likely diagnosis?
A. Separation Anxiety Disorder
B. Social Anxiety Disorder
C. Selective Mutism
D. Agoraphobia
Answer: A
Explanation: Separation Anxiety Disorder is characterized by developmentally
inappropriate and excessive fear concerning separation from those to whom the individual
is attached. For children, the symptoms must persist for at least 4 weeks and cause
significant impairment in social or academic functioning. Somatic complaints like
headaches and stomachaches are common manifestations of this anxiety in pediatric
populations.
7. Which medication is FDA-approved for the treatment of irritability associated with Autism
Spectrum Disorder in children aged 5 to 16 years?
A. Lithium
B. Risperidone
C. Valproate
D. Clonidine
Answer: B
Explanation: Risperidone was the first medication FDA-approved to treat irritability
(including aggression and self-injury) in children with ASD. Aripiprazole is also FDA-
approved for this indication in children aged 6 to 17. Monitoring for side effects like weight
gain, hyperprolactinemia, and extrapyramidal symptoms is necessary when using these
second-generation antipsychotics.
8. A 16-year-old is brought to the clinic for repeatedly violating the basic rights of others,
including physical cruelty to animals, staying out past curfew, and stealing. These behaviors
have occurred for 18 months. What is the most appropriate diagnosis?
A. Conduct Disorder
B. Oppositional Defiant Disorder
C. Antisocial Personality Disorder
D. Intermittent Explosive Disorder
Answer: A
