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NR 606 Week 5: Diagnosis & Management in Psychiatric-Mental Health II – ADHD, Disruptive Disorders, and FASD

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This comprehensive study guide covers key topics from NR 606 Week 5, focusing on the diagnosis and management of ADHD, disruptive behavioral disorders (such as ODD and conduct disorder), and fetal alcohol spectrum disorders (FASD). It includes detailed information on stimulant and non-stimulant medications, diagnostic criteria, case studies, treatment strategies, comorbidities, and educational supports. Ideal for PMHNP students preparing for exams or clinical practice.

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August 23, 2025
Number of pages
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Written in
2025/2026
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NR 606 WEEK 5 DIAGNOSIS

& MANAGEMENT IN PSYCHIATRIC-MENTAL HEALTH II
PRACTICUM EXAM QUESTIONS AND ANSWERS LATEST 2025-
2026




Stimulant Medications: Methylphenidate - ANSWER--Low risk of adverse effects

-Available formulations:

• Ritalin - available in immediate release (IR) and extended release (XR) available in beads

that may be sprinkled on food for children who cannot swallow pills

• Concerta biphasic - combined immediate and delayed release in one medication

• Daytrana - patch applied in AM and removed after 9 hour




Stimulant Medications: Dexmethylphenidate (Focalin) - ANSWER--Available in IR and ER

-More potent than Ritalin

-High risk of adverse effects




Stimulant Medications: Amphetamine (Adzenys) - ANSWER--available in orally

disintegrating ER formula for children who cannot swallow pills

-Avoid prescribing when an MAOI has been used within 14 days

,Stimulant Medications: Dextroamphetamine (Adderall) - ANSWER--Available in IR and

extended-release formulations

-Often dosed in morning (IR or XR) with an evening or evening prn (IR) dose if med effects

diminish prior to end of school, study or the workday

-Most abused & diverted prescription stimulant




Stimulant Medications: Lisdexamfetamine (Vyvanse) - ANSWER--Biologically inactive until

metabolized by the body (Prodrug)

-Less abuse & diversion potential than other stimulants

-Higher-cost medication




Non-stimulant medication: Atomoxetine (Strattera) - ANSWER--Noradrenergic (NRI)

-Initial drug of choice for adults with ADHD

-no abuse potential

-tolerated well when prescribed in BID dosing

-appropriate choice for comorbid substance abuse

-may augment the effects of antidepressants & antianxiety meds

-can be dosed at bedtime if fatigue is noted

-unlikely to worsen tics




Non-stimulant medication: Clonidine - ANSWER--α 2 agonist

,• May be taken as monotherapy or with stimulant medications

-enhances precortical function for better mental focus

-appetite neutral

-may help with sleep disturbances, administer at bedtime

-adverse effects:

• sedation, brain fog

-monitor of BP closely during initial titration, risk of hypotension

-tapered to avoid rebound hypertension post discontinuation




Non-stimulant medication: guanfacine - ANSWER--α 2 agonist

• May be taken as monotherapy or with stimulant medications

-may also be used for children with tics, sleep disturbances, or aggression

-tolerability & convenience enhanced by once-daily oral controlled-release formulation

-adverse effects:

• sedation, headache, decreased appetite

-reduced side-effect profile comparable to clonidine

-bedtime administration to avoid daytime sedation




Non-stimulant medication: Bupropion (Wellbutrin) - ANSWER--Norepinephrine Dopamine

Reuptake Inhibitor

, -off-label use for ADHD in adults

-appropriate for clients with concurrent depression or tobacco abuse




Attention-deficit/hyperactivity disorder (ADHD) - ANSWER--one of the most common

neuropsychiatric disorders

-approximately 9.4% of children in the U.S.

-more frequently males than females, ratio 2:1

-symptom burden mild to severe

-characterized by consistent pattern of inattention &/or hyperactivity & impulsivity that

interferes with functioning & development

• affect development of proper cognitive, behavioral, emotional, social, & academic function

-hyperactivity and impulsivity ADHD subtype symptoms: excessive fidgeting or talking,

feelings of restlessness and impatience, frequent interruption, and difficultly playing

quietly

-inattentive ADHD subtype symptoms: difficulty organizing tasks, maintaining a routine,

and paying attention to detail

• may not be distinguishable until eight or nine years of age

-primarily disrupts neuronal connections within the frontal lobe & prefrontal cortex




Without early identification and proper treatment, ADHD can cause disruptions in: -

ANSWER-academic performance

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