NR 606 WEEK 8 FINAL EXAM (2025/2026) LATEST COMPLETE QUESTIONS AND VERIFIED ANSWERS (GRADED A+) DETAILED ANSWERS!!

NR 606 WEEK 8 FINAL EXAM (2025/2026) LATEST COMPLETE QUESTIONS AND VERIFIED ANSWERS (GRADED A+) DETAILED ANSWERS!! Stimulant Medications: Methylphenidate Correct 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) Correct Answer -Available in IR and ER -More potent than Ritalin -High risk of adverse effects Stimulant Medications: Amphetamine (Adzenys) Correct 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) Correct 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) Correct Answer -Biologically inactive until metabolized by the body (Prodrug) 1 -Less abuse & diversion potential than other stimulants -Higher-cost medication Non-stimulant medication: Atomoxetine (Strattera) Correct 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 Correct 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 Correct 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 2 Non-stimulant medication: Bupropion (Wellbutrin) Correct 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) Correct 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: Correct Answer academic performance family stress difficulties in social relationships accidental injuries ADHD is associated with: 3 Correct Answer increased rates of depression & SUD Symptoms of ADHD Correct Answer -Selective Attention • Lack of attention to detail • Careless mistakes • Not listening • Losing things • Diverting attention • Forgetfulness -Lack of Sustained Attention • Poor problem solving • Difficulty completing tasks • Disorganization • Difficulty sustaining mental effort -Impulsivity • Excessive talking • Blurting things out • Not waiting for one's turn • Interrupting -Hyperactivity • Fidgeting • Leaving one's seat • Running, climbing • Trouble playing quietly When is ADHD most often diagnosed Correct Answer -preschool and elementary school • inattentive features become more prominent ADHD Lifespan Considerations: Symptoms Change with Age 4 Correct Answer -Young children with ADHD • often have developmental delays • may engage in behaviors less mature than peers -Teens with ADHD at risk for: • poor academic performance • problems with driving • difficulties with social situations • risky sexual behavior • substance abuse ->75% of children with ADHD experience symptoms in adulthood -Adolescents & Adults with ADHD • may struggle with executive function, attention, working memory • problems with day-to-day functioning, performance at work, relationships ADHD is a deficiency of neurotransmitters, mainly _________ & _________ Correct Answer dopamine and norepinephrine ADHD diagnostic criteria Correct Answer -A pattern of at least six symptoms of inattention and/or hyperactivity impulsivity that interfere with functioning or development. -Symptoms persist for six months or longer. -Symptoms interfere with social, academic, or occupational functioning. -Symptoms are present in two or more settings • for instance, home & school Kelsey is a 7-year-old first-grader who is the youngest of four children. During parent-teacher conferences, her teacher reported that she is polite, respectful, and gets along well with her peers. She has a hard time keeping her desk neat and she frequently misplaces her supplies and loses library books. She must often be told more than once to complete instructions. Her work is appropriate for her grade level, but she often makes careless mistakes on her assignments. She struggles with math and avoids doing arithmetic assignments. Her parents 5 endorse that Kelsey's room is "sloppy" but do not notice any of the other concerns in the home environment. What is the most likely diagnosis for Kelsey? ADHD predominantly inattentive presentation ADHD predominantly hyperactive-impulsive ADHD combined presentation unlikely ADHD diagnosis Correct Answer ADHD predominantly inattentive presentation Rationale: Kelsey meets diagnostic criteria for ADHD with a predominantly inattentive presentation. Inattentive symptoms include lack of attention to detail, making careless mistakes, difficulty listening and following instructions, frequent disorganization and misplacing items, distractibility, avoiding tasks that require sustained mental effort, and forgetfulness. Although Kelsey's parents identify only one symptom in the home setting, she exhibits multiple symptoms in the school setting. Logan is a 6-year-old kindergartener who has a newborn sister. His parents are concerned that Logan seems to be unable to occupy himself quietly when his sister is napping. Logan interrupts both his parents and other adults in the home who come to visit his sister. He gets impatient when his questions are ignored by adults. His parents endorse that the behaviors began about the same time as his mom's pregnancy was announced. Logan's teacher does not endorse the same behaviors at school; his teacher states he is quiet, reserved, and plays well with others. What is the most likely diagnosis for Logan? ADHD predominantly inattentive presentation ADHD predominantly hyperactive-impulsive presentation ADHD combined presentation unlikely ADHD diagnosis Correct Answer unlikely ADHD diagnosis 6 Rationale: Although Logan has some symptoms that are consistent with a diagnosis of ADHD, the symptom onset coincides with his mother's pregnancy. There are no concerns of symptoms at school; more information is needed to assign a diagnosis of ADHD. Xander is an 8-year-old second-grader who is the youngest of two children. His mother notes that he acts as if he has "non-stop energy." He pesters and interrupts his older sister to play when she is reading or doing homework, and he has little patience for completing his homework. Xander's mom endorses that his behavior has been consistent for the past few years. Xander's teacher notes that he fidgets during seat time, speaks out of turn in class, and runs or skips in the halls. What is the most likely diagnosis for Xander? ADHD predominantly inattentive presentation ADHD predominantly hyperactive-impulsive presentation ADHD combined presentation unlikely ADHD diagnosis Correct Answer ADHD predominantly hyperactive-impulsive presentation Rationale: Xander meets diagnostic criteria for ADHD with a hyperactive impulsive presentation, including fidgeting, "non-stop" energy, difficulty in engaging in quiet activities, speaking out of turn, excessive running, and interrupting others. The behaviors occur in school and at home and have been present consistently for several years. Belle is a 10-year-old fourth-grader who is the oldest of two children. During parent-teacher conferences, her teachers expressed concerns that she has difficulty listening and paying attention in class. She plays with her pencil and eraser constantly during lessons and, when she does pay attention, she blurts out answers to questions without waiting to be called upon. She talks to her peers during class and often interrupts the teacher to share with the class. Belle often forgets to bring her backpack or lunch to school and often leaves school without her jacket. Belle's mother notes that her daughter has always been talkative and energetic; she has difficulty keeping her things organized and must be reminded of daily chores, such as feeding her hamster. 7 What is the most likely diagnosis for Belle? ADHD predominantly inattentive presentation ADHD predominantly hyperactive-impulsive presentation ADHD combined pres Correct Answer ADHD combined presentation Rationale: Belle meets diagnostic criteria for ADHD combined presentation. She has several symptoms of hyperactive-impulsive presentation, including fidgeting, speaking out of turn, excessive talking, and interrupting. She also has symptoms of inattentive presentation, including difficulty listening, paying attention, forgetfulness, and difficulty with organization. Although her symptoms at school differ from those seen at home, she has symptoms in both environments. Rating scales for ADHD Correct Answer -ADHD Rating Scales (ADHD-RS-IV and 5) -Swanson, Nolan and Pelham (SNAP) scale -Adult ADHD Self Report Scale (ASRS) -Vanderbilt scales -Conners' scales ADHD Comorbidities Correct Answer >2/3 of children dx'd with ADHD have at least one coexisting psychiatric condition -learning disabilities -conduct disorders -tics -anxiety -depression -language disorders -SUD's • adolescents at increased risk 8 *often tx ADHD 1st then comorbidities, may reduce overall stress levels, provide clearer picture of comorbid symptoms Tenzing is a 15-year-old who presents with restlessness, distractability, impulsive behavior, and inattention at school. He sleeps very little most nights and is often irritable. His parents describe him as "moody" and state that the smallest changes cause his mood to shift. He has had these symptoms for a few years, but recently the symptoms have gotten worse. The PMHNP diagnoses Tenzing with ADHD. Which of the following is the most likely comorbid diagnosis for Tenzing? bipolar disorder (BPD) unipolar depression generalized anxiety disorder Correct Answer bipolar disorder (BPD) Rationale: After beginning medication for ADHD, Tenzing's remaining symptoms are consistent with bipolar disorder. Although mood dysregulation is common in clients with ADHD, mood changes are typically situational. Bipolar disorder presents with more random and cyclical mood changes. Both ADHD and BPD can present with irritability, sleep issues, restlessness, and impulsive behavior. Onyenna is a 12-year-old whose teacher has concerns related to her school performance. She makes careless mistakes with her work and has difficulty listening in class and following directions. She frequently forgets to bring homework assignments and misplaces her personal belongings. She appears fatigued most days and complains of being tired frequently. Onyenna's parents endorse that she always seems irritable and disorganized at home, and they often have to ask her to complete tasks more than once. Onyenna states that she has no interest in school or extracurricular activities and does not care that she is not doing well in her classes. The PMHNP diagnoses Onyenna with ADHD and prescribes atomoxetine 25 mg once daily. Which of the following is the most likely comorbid diagnosis for Onyenna? bipolar disorder (BPD) 9 unipolar depression generalized anxiety disorder learning disability Correct Answer unipolar depression Rationale: After beginning medication for ADHD, Onyenna's remaining symptoms are consistent with unipolar depression. In children, depression often presents with irritability, fatigue, and a decreased interest in school or peer activities. Both ADHD and depression can cause diminished concentration and attention. Forgetfulness, carelessness, difficulty following directions and disorganization are common symptoms of ADHD with a predominantly inattentive presentation. Elijah is a 6-year-old whose teacher is concerned with his behavior at school. She reports that he is frequently irritable. He gets angry when he must wait his turn for an activity, and often speaks out of turn, interrupts, and talks "nonstop." He has difficulty sitting still. Elijah's custodial grandmother endorses that he has high energy at home. She also notes that he loses his temper often and appears to purposely antagonize his older sister. He often blames her for leaving messes around the house that are his. He argues with both his grandparents when asked to complete chores. The PMHNP diagnoses Elijah with ADHD and prescribes methylphenidate extended-release 20 mg daily. Which of the following is the most likely comorbid diagnosis for Elijah? bipolar disorder (BPD) oppositional defiant disorder conduct disorder generalized anxiety disorder learning disability Correct Answer oppositional defiant disorder Rationale: After beginning medication for ADHD, Elijah's remaining symptoms are consistent with oppositional defiant disorder (ODD), which presents with symptoms including anger, arguing with adults, refusing to follow rules, deliberately annoying others, and blaming others for their mistakes. Both 10 ADHD and ODD can present with irritability. Interrupting, talkativeness and high energy are common symptoms of ADHD with hyperactive-impulsive presentation. ADHD tx Correct Answer -multimodal, often requiring medical, educational, behavioral, & psychological intervention -Pharmacologic • stimulants effective for 70-80% of clients meds of choice for children • non-stimulants used when client doen't respond to stimulant meds used when stimulants are contraindicated can help lower distractibility, improve attention, working memory, & impulsivity -combination sometimes used • when argumentative or oppositional symptoms ADHD tx clinical pearls Correct Answer • Stimulant - ECG req if cardiac hx present in a first-degree relative • Monitor BP, height, weight regularly during tx • Assess for bipolar disorder before tx. CNS stimulants may cause psychotic or manic symptoms or may exacerbate behavior disturbance symptoms and thought disorders in clients with pre-existing psychosis. • CNS stimulants may exacerbate comorbid anxiety and substance use disorders. • Tx efficacy noted within first week • Increased irritability & insomnia tx'd with low dose of nonstimulant med • stimulants may unmask the presence of tics • Switching stimulants, D/C current med & start new med at a starting dose the next day ADHD Prescribing Advisory 11 Correct Answer -Several stimulant meds are Schedule II indicating high potential for abuse • short-acting meds are at higher risk for diversion -Occasional urine drug screens should be obtained • verify the presence of amphetamines and the absence of other substances of abuse Education for clients taking stimulant medications includes: Correct Answer -common side effects: • restlessness, irritability, anxiety, insomnia, stomachache, headaches, tics, worsening aggression symptoms -worsening of symptoms or "crash" may occur when med wears off • especially with IR meds -take med with breakfast to decrease anorexia or associated weight loss Teddy is a 7-year-old who was diagnosed with ADHD with hyperactive impulsive presentation. The PMHNP prescribed dexmethylphenidate extended release 10 mg once daily. His mother has been giving him the medication before school. Teddy's teachers report that his symptoms are much improved, but his parents note that he has a significant rebound of symptoms in the late afternoon, and he struggles on days he has homework and after-school activities. Which of the following medication adjustments are appropriate for Teddy? prescribe a daily afternoon dose of dexmethylphenidate immediate release 2.5 mg in addition to the morning dose increase the daily dose of dexmethylphenidate extended-release to 20 mg recommend a PRN afternoon dose of dexmethylphenidate 5mg IR when Teddy has after school commitments switch to lisdexamfetamine dimesylate 10 mg daily add atomoxetine 0.5mg/kg/day 12 Correct Answer prescribe a daily afternoon dose of dexmethylphenidate immediate release 2.5 mg in addition to the morning dose Rationale: Although long-acting medications typically act for 8-12 hours, some clients experience a shorter window of symptom control. A "booster" dose of short-acting stimulant medication can reduce problems of rebound when the earlier dose wears off. Josué is an 11-year-old who was diagnosed with ADHD combined presentation. He was prescribed amphetamine/dextroamphetamine immediate release 10mg twice daily. He takes the medication in the morning and after school. His symptoms have improved; however, he now complains of difficulty falling and staying asleep. Which of the following medication adjustments is appropriate for Josué? Select all that apply. switch to amphetamine/dextroamphetamine extended-release 20 mg daily decrease the dose of amphetamine/dextroamphetamine immediate release to 5 mg twice daily decrease the frequency of amphetamine/dextroamphetamine immediate release to once daily recommend sleep hygiene techniques prescribe zolpidem as needed Correct Answer switch to amphetamine/dextroamphetamine extended-release 20 mg daily recommend sleep hygiene techniques Rationale: Stimulant medications may cause sleep disturbances, especially if the doses are taken later in the day. Amphetamine/dextroamphetamine immediate release has a duration of 4-8 hours, while extended-release has a duration of 8 12 hours. Switching to extended-release dosing and improving sleep hygiene may help improve sleep. Alternatively, the second dose