NR606 Week 6 Exam V1 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 6 Exam) | Chamberlain University
1. A 75-year-old patient presents with acute onset confusion, visual hallucinations, and
fluctuating levels of consciousness. Which diagnosis is most likely?
A. Delirium
B. Vascular Dementia
C. Alzheimer’s Disease
D. Major Depressive Disorder
Answer: A
Explanation: Delirium is characterized by an acute onset and fluctuating course, which
distinguishes it from the progressive nature of most dementias. The presence of visual
hallucinations and altered consciousness further supports this diagnosis over depression
or chronic cognitive disorders. Identifying the underlying medical cause of delirium is a
priority for the PMHNP to ensure patient safety and stabilization.
2. When prescribing stimulants for a child with ADHD, which of the following is a common
side effect that requires monitoring?
A. Increased appetite
B. Hypersomnia
C. Growth suppression
D. Bradycardia
Answer: C
Explanation: Stimulants used in the treatment of ADHD are known to potentially cause
growth suppression and weight loss due to appetite suppression. The PMHNP must
regularly monitor height and weight on growth charts during follow-up visits. Adjustments
to dosing or ‘drug holidays’ may be considered if growth parameters deviate significantly
from the child’s baseline.
3. The M-CHAT-R/F is a screening tool specifically designed to assess for which condition?
A. Autism Spectrum Disorder
B. Major Depressive Disorder
C. Attention-Deficit/Hyperactivity Disorder
,D. Generalized Anxiety Disorder
Answer: A
Explanation: The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-
CHAT-R/F) is a validated tool for children between 16 and 30 months of age. It helps
identify children who may benefit from a more thorough developmental evaluation
regarding social and communication skills. Early detection via screening is essential for
initiating early intervention services which improve long-term outcomes.
4. In family therapy, a PMHNP observes a mother and daughter forming an alliance against
the father. Which Bowenian concept does this represent?
A. Differentiation of Self
B. Multigenerational Transmission
C. Triangulation
D. Emotional Cutoff
Answer: C
Explanation: Triangulation occurs when a two-person system is under stress and draws in
a third person to stabilize the relationship and reduce anxiety. This dynamic often prevents
the original dyad from resolving their conflict directly. Recognizing these patterns allows
the therapist to help family members achieve higher levels of differentiation and healthier
communication.
5. An 8-year-old child demonstrates persistent irritability and frequent, severe temper
outbursts that are out of proportion to the situation. Which diagnosis fits this profile?
A. Disruptive Mood Dysregulation Disorder
B. Oppositional Defiant Disorder
C. Bipolar I Disorder
D. Conduct Disorder
Answer: A
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was introduced to address
the overdiagnosis of pediatric bipolar disorder in children with chronic irritability. The
symptoms must be present for at least 12 months in at least two settings and begin before
age 10. This diagnosis helps clinicians distinguish between episodic mood changes and
persistent, non-episodic irritability.
6. Which of the following is a primary risk factor for the development of Vascular Dementia?
A. Family history of Amyloid plaques
B. Dopamine deficiency in the substantia nigra
, C. Early onset of neurofibrillary tangles
D. Hypertension and cardiovascular disease
Answer: D
Explanation: Vascular dementia is caused by conditions that damage the blood vessels in
the brain, most commonly strokes or chronic hypertension. Unlike Alzheimer’s, it often
follows a ‘step-wise’ decline in cognitive function following specific ischemic events.
Managing cardiovascular risk factors is the primary strategy for preventing further
cognitive deterioration in these patients.
7. According to the Beers Criteria, which class of medication should generally be avoided in
the elderly due to the risk of falls and cognitive impairment?
A. SSRIs
B. Benzodiazepines
C. Statins
D. Beta-blockers
Answer: B
Explanation: Benzodiazepines increase the risk of falls, fractures, and motor vehicle
accidents in older adults due to their sedative effects and impact on balance. They are also
associated with worsened cognitive impairment and delirium in this vulnerable population.
The Beers Criteria recommends avoiding their use for insomnia or agitation in the elderly
unless other treatments have failed.
8. A 14-year-old patient has started an SSRI for depression. What is the most critical FDA
black box warning the PMHNP must discuss with the family?
A. Risk of increased suicidal ideation and behavior
B. Risk of weight gain and metabolic syndrome
C. Risk of permanent movement disorders
D. Risk of sudden cardiac arrest
Answer: A
Explanation: The FDA has issued a black box warning for all antidepressants regarding the
increased risk of suicidal thoughts and behaviors in children, adolescents, and young
adults. Close monitoring by caregivers and clinicians is required, especially during the first
few weeks of treatment or after dose changes. Families must be educated on specific
warning signs, such as increased agitation or social withdrawal, that necessitate immediate
contact with the provider.
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 6 Exam) | Chamberlain University
1. A 75-year-old patient presents with acute onset confusion, visual hallucinations, and
fluctuating levels of consciousness. Which diagnosis is most likely?
A. Delirium
B. Vascular Dementia
C. Alzheimer’s Disease
D. Major Depressive Disorder
Answer: A
Explanation: Delirium is characterized by an acute onset and fluctuating course, which
distinguishes it from the progressive nature of most dementias. The presence of visual
hallucinations and altered consciousness further supports this diagnosis over depression
or chronic cognitive disorders. Identifying the underlying medical cause of delirium is a
priority for the PMHNP to ensure patient safety and stabilization.
2. When prescribing stimulants for a child with ADHD, which of the following is a common
side effect that requires monitoring?
A. Increased appetite
B. Hypersomnia
C. Growth suppression
D. Bradycardia
Answer: C
Explanation: Stimulants used in the treatment of ADHD are known to potentially cause
growth suppression and weight loss due to appetite suppression. The PMHNP must
regularly monitor height and weight on growth charts during follow-up visits. Adjustments
to dosing or ‘drug holidays’ may be considered if growth parameters deviate significantly
from the child’s baseline.
3. The M-CHAT-R/F is a screening tool specifically designed to assess for which condition?
A. Autism Spectrum Disorder
B. Major Depressive Disorder
C. Attention-Deficit/Hyperactivity Disorder
,D. Generalized Anxiety Disorder
Answer: A
Explanation: The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-
CHAT-R/F) is a validated tool for children between 16 and 30 months of age. It helps
identify children who may benefit from a more thorough developmental evaluation
regarding social and communication skills. Early detection via screening is essential for
initiating early intervention services which improve long-term outcomes.
4. In family therapy, a PMHNP observes a mother and daughter forming an alliance against
the father. Which Bowenian concept does this represent?
A. Differentiation of Self
B. Multigenerational Transmission
C. Triangulation
D. Emotional Cutoff
Answer: C
Explanation: Triangulation occurs when a two-person system is under stress and draws in
a third person to stabilize the relationship and reduce anxiety. This dynamic often prevents
the original dyad from resolving their conflict directly. Recognizing these patterns allows
the therapist to help family members achieve higher levels of differentiation and healthier
communication.
5. An 8-year-old child demonstrates persistent irritability and frequent, severe temper
outbursts that are out of proportion to the situation. Which diagnosis fits this profile?
A. Disruptive Mood Dysregulation Disorder
B. Oppositional Defiant Disorder
C. Bipolar I Disorder
D. Conduct Disorder
Answer: A
Explanation: Disruptive Mood Dysregulation Disorder (DMDD) was introduced to address
the overdiagnosis of pediatric bipolar disorder in children with chronic irritability. The
symptoms must be present for at least 12 months in at least two settings and begin before
age 10. This diagnosis helps clinicians distinguish between episodic mood changes and
persistent, non-episodic irritability.
6. Which of the following is a primary risk factor for the development of Vascular Dementia?
A. Family history of Amyloid plaques
B. Dopamine deficiency in the substantia nigra
, C. Early onset of neurofibrillary tangles
D. Hypertension and cardiovascular disease
Answer: D
Explanation: Vascular dementia is caused by conditions that damage the blood vessels in
the brain, most commonly strokes or chronic hypertension. Unlike Alzheimer’s, it often
follows a ‘step-wise’ decline in cognitive function following specific ischemic events.
Managing cardiovascular risk factors is the primary strategy for preventing further
cognitive deterioration in these patients.
7. According to the Beers Criteria, which class of medication should generally be avoided in
the elderly due to the risk of falls and cognitive impairment?
A. SSRIs
B. Benzodiazepines
C. Statins
D. Beta-blockers
Answer: B
Explanation: Benzodiazepines increase the risk of falls, fractures, and motor vehicle
accidents in older adults due to their sedative effects and impact on balance. They are also
associated with worsened cognitive impairment and delirium in this vulnerable population.
The Beers Criteria recommends avoiding their use for insomnia or agitation in the elderly
unless other treatments have failed.
8. A 14-year-old patient has started an SSRI for depression. What is the most critical FDA
black box warning the PMHNP must discuss with the family?
A. Risk of increased suicidal ideation and behavior
B. Risk of weight gain and metabolic syndrome
C. Risk of permanent movement disorders
D. Risk of sudden cardiac arrest
Answer: A
Explanation: The FDA has issued a black box warning for all antidepressants regarding the
increased risk of suicidal thoughts and behaviors in children, adolescents, and young
adults. Close monitoring by caregivers and clinicians is required, especially during the first
few weeks of treatment or after dose changes. Families must be educated on specific
warning signs, such as increased agitation or social withdrawal, that necessitate immediate
contact with the provider.
