NR606 Week 9 Exam V3 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 9 Exam) | Chamberlain University
1. A 9-year-old male is brought to the clinic for evaluation of impulsivity and distractibility at
school. According to the DSM-5-TR, at what age must several inattentive or hyperactive-
impulsive symptoms have been present to meet the diagnostic criteria for ADHD?
A. Before age 12
B. Before age 7
C. Before age 5
D. Before age 15
Answer: A
Explanation: The DSM-5-TR specifies that several inattentive or hyperactive-impulsive
symptoms must be present before the age of 12 years. This represents a change from the
DSM-IV, which required symptoms to be present before age 7. The PMHNP must verify that
symptoms occurred in at least two settings, such as home and school, during this
developmental period.
2. A 15-year-old female presents with severe depressive episodes and occasional periods of
increased energy, decreased need for sleep, and grandiosity lasting 4 days. Which diagnosis is
most appropriate given the duration of these symptoms?
A. Bipolar I Disorder
B. Major Depressive Disorder
C. Cyclothymic Disorder
D. Bipolar II Disorder
Answer: D
Explanation: Bipolar II Disorder requires at least one hypomanic episode lasting at least 4
consecutive days and at least one major depressive episode. Bipolar I requires a manic
episode lasting at least 1 week or requiring hospitalization. The presence of grandiosity
and decreased need for sleep for 4 days aligns specifically with the criteria for hypomania
in Bipolar II.
3. Which of the following physical assessment findings is a critical monitoring parameter for a
pediatric patient initiated on a stimulant medication like Methylphenidate?
A. Serum glucose levels
B. Height and weight percentiles
,C. Deep tendon reflexes
D. Thyroid stimulating hormone
Answer: B
Explanation: Stimulants are associated with potential growth suppression in children due
to appetite suppression. The PMHNP must monitor height and weight percentiles on a
standardized growth chart at every follow-up visit. If significant deviations occur, a
‘medication holiday’ or dose adjustment may be necessary to ensure proper development.
4. A 10-year-old boy demonstrates persistent deficits in social communication, exhibits
repetitive hand-flapping, and has intense fixated interests. Which neurodevelopmental
disorder does this clinical picture suggest?
A. Social Communication Disorder
B. Autism Spectrum Disorder
C. Stereotypic Movement Disorder
D. Intellectual Disability
Answer: B
Explanation: Autism Spectrum Disorder (ASD) is characterized by persistent deficits in
social communication and social interaction across multiple contexts. The diagnosis also
requires restricted, repetitive patterns of behavior, interests, or activities, such as hand-
flapping or fixated interests. Social Communication Disorder is distinguished from ASD by
the absence of these repetitive behaviors.
5. The PMHNP is considering pharmacological treatment for a 13-year-old with moderate
Major Depressive Disorder. Which medication is FDA-approved for the treatment of
depression in this age group?
A. Sertraline
B. Paroxetine
C. Venlafaxine
D. Fluoxetine
Answer: D
Explanation: Fluoxetine is FDA-approved for the treatment of Major Depressive Disorder
in children and adolescents aged 8 years and older. While Escitalopram is approved for
ages 12 and up, Fluoxetine remains the primary evidence-based first-line choice. The
PMHNP must educate the family regarding the Black Box Warning for increased suicidal
ideation in pediatric populations.
, 6. Which clinical feature is a hallmark of Disruptive Mood Dysregulation Disorder (DMDD)
that differentiates it from pediatric Bipolar Disorder?
A. Episodic nature of mood swings
B. Elevated, expansive mood
C. Chronic, persistent irritability between outbursts
D. Presence of psychotic features
Answer: C
Explanation: DMDD is characterized by severe recurrent temper outbursts and a mood
between outbursts that is persistently irritable or angry nearly every day. Unlike Bipolar
Disorder, which is episodic, DMDD symptoms are chronic and persistent. This diagnosis
was created to reduce the over-diagnosis of Bipolar Disorder in children who exhibit
chronic non-episodic irritability.
7. When assessing a 4-year-old for Reactive Attachment Disorder (RAD), which behavioral
pattern is the PMHNP most likely to observe?
A. Excessive seeking of comfort from strangers
B. Consistent pattern of inhibited, emotionally withdrawn behavior toward caregivers
C. Overly affectionate behavior with new clinicians
D. Intense fear of separation from the primary caregiver
Answer: B
Explanation: RAD involves a consistent pattern of inhibited, emotionally withdrawn
behavior toward adult caregivers, where the child rarely seeks or responds to comfort
when distressed. This disorder is often linked to a history of social neglect or changes in
primary caregivers. In contrast, seeking comfort from strangers is more characteristic of
Disinhibited Social Engagement Disorder (DSED).
8. A 16-year-old male is diagnosed with Conduct Disorder after several episodes of animal
cruelty and theft. Which of the following is a known risk factor for the progression of Conduct
Disorder to Antisocial Personality Disorder in adulthood?
A. Late onset of symptoms (after age 10)
B. High levels of anxiety
C. Strong verbal skills
D. Early onset of symptoms (before age 10)
Answer: D
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 9 Exam) | Chamberlain University
1. A 9-year-old male is brought to the clinic for evaluation of impulsivity and distractibility at
school. According to the DSM-5-TR, at what age must several inattentive or hyperactive-
impulsive symptoms have been present to meet the diagnostic criteria for ADHD?
A. Before age 12
B. Before age 7
C. Before age 5
D. Before age 15
Answer: A
Explanation: The DSM-5-TR specifies that several inattentive or hyperactive-impulsive
symptoms must be present before the age of 12 years. This represents a change from the
DSM-IV, which required symptoms to be present before age 7. The PMHNP must verify that
symptoms occurred in at least two settings, such as home and school, during this
developmental period.
2. A 15-year-old female presents with severe depressive episodes and occasional periods of
increased energy, decreased need for sleep, and grandiosity lasting 4 days. Which diagnosis is
most appropriate given the duration of these symptoms?
A. Bipolar I Disorder
B. Major Depressive Disorder
C. Cyclothymic Disorder
D. Bipolar II Disorder
Answer: D
Explanation: Bipolar II Disorder requires at least one hypomanic episode lasting at least 4
consecutive days and at least one major depressive episode. Bipolar I requires a manic
episode lasting at least 1 week or requiring hospitalization. The presence of grandiosity
and decreased need for sleep for 4 days aligns specifically with the criteria for hypomania
in Bipolar II.
3. Which of the following physical assessment findings is a critical monitoring parameter for a
pediatric patient initiated on a stimulant medication like Methylphenidate?
A. Serum glucose levels
B. Height and weight percentiles
,C. Deep tendon reflexes
D. Thyroid stimulating hormone
Answer: B
Explanation: Stimulants are associated with potential growth suppression in children due
to appetite suppression. The PMHNP must monitor height and weight percentiles on a
standardized growth chart at every follow-up visit. If significant deviations occur, a
‘medication holiday’ or dose adjustment may be necessary to ensure proper development.
4. A 10-year-old boy demonstrates persistent deficits in social communication, exhibits
repetitive hand-flapping, and has intense fixated interests. Which neurodevelopmental
disorder does this clinical picture suggest?
A. Social Communication Disorder
B. Autism Spectrum Disorder
C. Stereotypic Movement Disorder
D. Intellectual Disability
Answer: B
Explanation: Autism Spectrum Disorder (ASD) is characterized by persistent deficits in
social communication and social interaction across multiple contexts. The diagnosis also
requires restricted, repetitive patterns of behavior, interests, or activities, such as hand-
flapping or fixated interests. Social Communication Disorder is distinguished from ASD by
the absence of these repetitive behaviors.
5. The PMHNP is considering pharmacological treatment for a 13-year-old with moderate
Major Depressive Disorder. Which medication is FDA-approved for the treatment of
depression in this age group?
A. Sertraline
B. Paroxetine
C. Venlafaxine
D. Fluoxetine
Answer: D
Explanation: Fluoxetine is FDA-approved for the treatment of Major Depressive Disorder
in children and adolescents aged 8 years and older. While Escitalopram is approved for
ages 12 and up, Fluoxetine remains the primary evidence-based first-line choice. The
PMHNP must educate the family regarding the Black Box Warning for increased suicidal
ideation in pediatric populations.
, 6. Which clinical feature is a hallmark of Disruptive Mood Dysregulation Disorder (DMDD)
that differentiates it from pediatric Bipolar Disorder?
A. Episodic nature of mood swings
B. Elevated, expansive mood
C. Chronic, persistent irritability between outbursts
D. Presence of psychotic features
Answer: C
Explanation: DMDD is characterized by severe recurrent temper outbursts and a mood
between outbursts that is persistently irritable or angry nearly every day. Unlike Bipolar
Disorder, which is episodic, DMDD symptoms are chronic and persistent. This diagnosis
was created to reduce the over-diagnosis of Bipolar Disorder in children who exhibit
chronic non-episodic irritability.
7. When assessing a 4-year-old for Reactive Attachment Disorder (RAD), which behavioral
pattern is the PMHNP most likely to observe?
A. Excessive seeking of comfort from strangers
B. Consistent pattern of inhibited, emotionally withdrawn behavior toward caregivers
C. Overly affectionate behavior with new clinicians
D. Intense fear of separation from the primary caregiver
Answer: B
Explanation: RAD involves a consistent pattern of inhibited, emotionally withdrawn
behavior toward adult caregivers, where the child rarely seeks or responds to comfort
when distressed. This disorder is often linked to a history of social neglect or changes in
primary caregivers. In contrast, seeking comfort from strangers is more characteristic of
Disinhibited Social Engagement Disorder (DSED).
8. A 16-year-old male is diagnosed with Conduct Disorder after several episodes of animal
cruelty and theft. Which of the following is a known risk factor for the progression of Conduct
Disorder to Antisocial Personality Disorder in adulthood?
A. Late onset of symptoms (after age 10)
B. High levels of anxiety
C. Strong verbal skills
D. Early onset of symptoms (before age 10)
Answer: D
