NR606 Week 7 Exam V2 | NR606 Diagnosis & Management in
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 7 Exam) | Chamberlain University
1. A 45-year-old patient diagnosed with Schizophrenia has been on Clozapine for three
months. Which laboratory parameter is the priority for the PMHNP to monitor to ensure
safety?
A. Absolute Neutrophil Count (ANC)
B. Liver function tests
C. Serum creatinine
D. Thyroid Stimulating Hormone
Answer: A
Explanation: Clozapine is associated with a high risk of agranulocytosis, which can be life-
threatening. The PMHNP must monitor the Absolute Neutrophil Count (ANC) regularly
according to the Clozapine REMS program. Monitoring ensures that the medication is
discontinued if the count falls below safe levels to prevent severe infection.
2. When evaluating a child for Attention-Deficit/Hyperactivity Disorder (ADHD), which of the
following is a mandatory diagnostic requirement according to the DSM-5-TR?
A. Symptoms must be present in at least two different settings.
B. The child must exhibit symptoms before the age of 5.
C. Academic failure must be documented by a school official.
D. Symptoms must be solely related to oppositional behavior.
Answer: A
Explanation: The DSM-5-TR requires that ADHD symptoms be present in two or more
settings, such as home and school, to ensure the behavior is pervasive. Symptoms must also
have been present before the age of 12, not 5. This criterion helps differentiate ADHD from
situational behavioral issues or environmental stressors.
3. A PMHNP is considering starting a patient on Lithium for Bipolar I Disorder. Which baseline
test is most critical due to the potential for long-term renal toxicity?
A. Electrocardiogram (ECG)
B. Serum Glucose
C. Serum Creatinine and GFR
,D. Serum Lipids
Answer: C
Explanation: Lithium is primarily excreted by the kidneys and can cause chronic kidney
disease over time. Establishing a baseline Serum Creatinine and Glomerular Filtration Rate
(GFR) is essential for monitoring renal health throughout treatment. Regular follow-up
testing is required to adjust dosing and prevent toxicity.
4. A patient presents with a ‘lead-pipe’ muscle rigidity, high fever, and autonomic instability
after an increase in their Haloperidol dose. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
C. Tardive Dyskinesia
D. Acute Dystonia
Answer: B
Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening reaction to
antipsychotic medications characterized by muscle rigidity, fever, and autonomic
dysfunction. It differs from Serotonin Syndrome, which usually involves hyperreflexia and
myoclonus rather than lead-pipe rigidity. Immediate discontinuation of the offending agent
and supportive care are necessary.
5. Which therapeutic approach focuses on identifying and changing distorted thought
patterns and maladaptive behaviors to improve emotional regulation?
A. Dialectical Behavior Therapy (DBT)
B. Interpersonal Therapy (IPT)
C. Psychodynamic Therapy
D. Cognitive Behavioral Therapy (CBT)
Answer: D
Explanation: Cognitive Behavioral Therapy (CBT) is built on the premise that thoughts,
feelings, and behaviors are interconnected. By identifying cognitive distortions, patients
can learn to reframe their thinking and adopt healthier behaviors. This evidence-based
approach is widely used for depression, anxiety, and PTSD.
6. A 28-year-old female patient reports sudden episodes of intense fear accompanied by
heart palpitations, sweating, and a feeling of impending doom. She now avoids public places.
What is the primary diagnosis?
A. Social Anxiety Disorder
B. Generalized Anxiety Disorder
, C. Specific Phobia
D. Panic Disorder with Agoraphobia
Answer: D
Explanation: Panic Disorder is characterized by recurrent, unexpected panic attacks and
subsequent concern about future attacks. When a patient begins avoiding places where
escape might be difficult, it meets the criteria for Agoraphobia. The PMHNP must address
both the physiological attacks and the behavioral avoidance in the treatment plan.
7. Which medication is considered a first-line treatment for a patient with Generalized
Anxiety Disorder (GAD) who also has a history of substance abuse?
A. Buspirone
B. Alprazolam
C. Diazepam
D. Lorazepam
Answer: A
Explanation: Buspirone is a non-benzodiazepine anxiolytic that does not have a risk for
physical dependence or abuse. This makes it an ideal choice for patients with GAD and a
history of substance use disorders. Unlike benzodiazepines, it requires several weeks of
consistent use to achieve full therapeutic effect.
8. An adolescent patient exhibits a persistent pattern of angry/irritable mood,
argumentative/defiant behavior, and vindictiveness for at least 6 months. These symptoms
do not involve aggression toward people or animals. What is the likely diagnosis?
A. Conduct Disorder
B. Antisocial Personality Disorder
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Oppositional Defiant Disorder (ODD)
Answer: D
Explanation: Oppositional Defiant Disorder (ODD) is characterized by a pattern of
defiance and irritability without the more severe violations of societal norms seen in
Conduct Disorder. ODD focuses on interpersonal conflict with authority figures. Early
intervention with family therapy is often recommended for these patients.
9. A patient taking an MAOI (Monoamine Oxidase Inhibitor) should be strictly educated to
avoid which of the following to prevent a hypertensive crisis?
A. Tyramine-rich foods like aged cheeses
Psychiatric-Mental Health II Practicum | Q&A with Rationale (NR606
Week 7 Exam) | Chamberlain University
1. A 45-year-old patient diagnosed with Schizophrenia has been on Clozapine for three
months. Which laboratory parameter is the priority for the PMHNP to monitor to ensure
safety?
A. Absolute Neutrophil Count (ANC)
B. Liver function tests
C. Serum creatinine
D. Thyroid Stimulating Hormone
Answer: A
Explanation: Clozapine is associated with a high risk of agranulocytosis, which can be life-
threatening. The PMHNP must monitor the Absolute Neutrophil Count (ANC) regularly
according to the Clozapine REMS program. Monitoring ensures that the medication is
discontinued if the count falls below safe levels to prevent severe infection.
2. When evaluating a child for Attention-Deficit/Hyperactivity Disorder (ADHD), which of the
following is a mandatory diagnostic requirement according to the DSM-5-TR?
A. Symptoms must be present in at least two different settings.
B. The child must exhibit symptoms before the age of 5.
C. Academic failure must be documented by a school official.
D. Symptoms must be solely related to oppositional behavior.
Answer: A
Explanation: The DSM-5-TR requires that ADHD symptoms be present in two or more
settings, such as home and school, to ensure the behavior is pervasive. Symptoms must also
have been present before the age of 12, not 5. This criterion helps differentiate ADHD from
situational behavioral issues or environmental stressors.
3. A PMHNP is considering starting a patient on Lithium for Bipolar I Disorder. Which baseline
test is most critical due to the potential for long-term renal toxicity?
A. Electrocardiogram (ECG)
B. Serum Glucose
C. Serum Creatinine and GFR
,D. Serum Lipids
Answer: C
Explanation: Lithium is primarily excreted by the kidneys and can cause chronic kidney
disease over time. Establishing a baseline Serum Creatinine and Glomerular Filtration Rate
(GFR) is essential for monitoring renal health throughout treatment. Regular follow-up
testing is required to adjust dosing and prevent toxicity.
4. A patient presents with a ‘lead-pipe’ muscle rigidity, high fever, and autonomic instability
after an increase in their Haloperidol dose. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
C. Tardive Dyskinesia
D. Acute Dystonia
Answer: B
Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening reaction to
antipsychotic medications characterized by muscle rigidity, fever, and autonomic
dysfunction. It differs from Serotonin Syndrome, which usually involves hyperreflexia and
myoclonus rather than lead-pipe rigidity. Immediate discontinuation of the offending agent
and supportive care are necessary.
5. Which therapeutic approach focuses on identifying and changing distorted thought
patterns and maladaptive behaviors to improve emotional regulation?
A. Dialectical Behavior Therapy (DBT)
B. Interpersonal Therapy (IPT)
C. Psychodynamic Therapy
D. Cognitive Behavioral Therapy (CBT)
Answer: D
Explanation: Cognitive Behavioral Therapy (CBT) is built on the premise that thoughts,
feelings, and behaviors are interconnected. By identifying cognitive distortions, patients
can learn to reframe their thinking and adopt healthier behaviors. This evidence-based
approach is widely used for depression, anxiety, and PTSD.
6. A 28-year-old female patient reports sudden episodes of intense fear accompanied by
heart palpitations, sweating, and a feeling of impending doom. She now avoids public places.
What is the primary diagnosis?
A. Social Anxiety Disorder
B. Generalized Anxiety Disorder
, C. Specific Phobia
D. Panic Disorder with Agoraphobia
Answer: D
Explanation: Panic Disorder is characterized by recurrent, unexpected panic attacks and
subsequent concern about future attacks. When a patient begins avoiding places where
escape might be difficult, it meets the criteria for Agoraphobia. The PMHNP must address
both the physiological attacks and the behavioral avoidance in the treatment plan.
7. Which medication is considered a first-line treatment for a patient with Generalized
Anxiety Disorder (GAD) who also has a history of substance abuse?
A. Buspirone
B. Alprazolam
C. Diazepam
D. Lorazepam
Answer: A
Explanation: Buspirone is a non-benzodiazepine anxiolytic that does not have a risk for
physical dependence or abuse. This makes it an ideal choice for patients with GAD and a
history of substance use disorders. Unlike benzodiazepines, it requires several weeks of
consistent use to achieve full therapeutic effect.
8. An adolescent patient exhibits a persistent pattern of angry/irritable mood,
argumentative/defiant behavior, and vindictiveness for at least 6 months. These symptoms
do not involve aggression toward people or animals. What is the likely diagnosis?
A. Conduct Disorder
B. Antisocial Personality Disorder
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Oppositional Defiant Disorder (ODD)
Answer: D
Explanation: Oppositional Defiant Disorder (ODD) is characterized by a pattern of
defiance and irritability without the more severe violations of societal norms seen in
Conduct Disorder. ODD focuses on interpersonal conflict with authority figures. Early
intervention with family therapy is often recommended for these patients.
9. A patient taking an MAOI (Monoamine Oxidase Inhibitor) should be strictly educated to
avoid which of the following to prevent a hypertensive crisis?
A. Tyramine-rich foods like aged cheeses
