NR605 Diagnosis & Management in Psychiatric-Mental Health
Across the Lifespan I Practicum Review Final Exam (Weeks 5-8)
Question Bank (Latest 2026/2027 Edition) – Questions, Answers &
Detailed Rationales
──────────────────────────────
SECTION 1: ADVANCED CHILD & ADOLESCENT PSYCHIATRIC MANAGEMENT
──────────────────────────────
Question 1
A 7-year-old male is being evaluated for ADHD. He snores loudly, has restless sleep, and
his mother has a history of major depression. Before initiating stimulant medication,
which assessment is most important?
A. Comprehensive metabolic panel
B. Polysomnography to rule out obstructive sleep apnea
C. Thyroid stimulating hormone level
D. Electroencephalogram
Correct Answer:
B — Polysomnography to rule out obstructive sleep apnea
Rationale:
Obstructive sleep apnea can cause inattention and hyperactivity mimicking ADHD;
stimulants may worsen sleep architecture and are less effective when sleep deprivation
is present. While thyroid dysfunction and seizures should be considered, sleep apnea is
the most immediately relevant given the history of snoring and restless sleep.
Question 2
,A 16-year-old female presents with major depression, PHQ-9 score of 18, and passive
suicidal ideation without a plan. Her parents refuse antidepressants because of the
black box warning. Which response by the PMHNP is most appropriate?
A. Respect parental wishes and provide supportive therapy only
B. Explain that the black box warning requires close monitoring and that fluoxetine plus
CBT has the strongest evidence for adolescent depression
C. Recommend immediate hospitalization for the suicidal ideation
D. Recommend St. John's wort as a natural alternative
Correct Answer:
B — Explain that the black box warning requires close monitoring and that fluoxetine
plus CBT has the strongest evidence for adolescent depression
Rationale:
The FDA black box warning for suicidality in patients under 24 mandates close
monitoring but does not preclude pharmacotherapy; fluoxetine combined with CBT is
the most evidence-based treatment for moderate-to-severe adolescent depression.
Supportive therapy alone is insufficient for this severity. St. John's wort has significant
drug interactions and lacks FDA approval.
Question 3
A 6-year-old male with autism spectrum disorder exhibits severe irritability, aggression,
and self-injurious behavior that has not responded to behavioral interventions. Which
atypical antipsychotic is FDA-approved for irritability associated with autism in children
ages 5–16 years?
A. Risperidone
B. Olanzapine
C. Quetiapine
D. Ziprasidone
Correct Answer:
,A — Risperidone
Rationale:
Risperidone is FDA-approved for the treatment of irritability associated with autistic
disorder in children and adolescents ages 5–16 years, including symptoms of
aggression, self-injury, and tantrums. Aripiprazole is also approved but not listed;
olanzapine, quetiapine, and ziprasidone lack this specific pediatric indication.
Question 4
A 15-year-old female with anorexia nervosa is admitted to a medical unit with a BMI of
15.5, heart rate of 48 bpm, blood pressure of 88/58 mmHg, potassium of 3.2 mEq/L,
and phosphate of 2.8 mg/dL. Which complication is most likely during the initial 72
hours of refeeding?
A. Superior mesenteric artery syndrome
B. Refeeding syndrome with hypophosphatemia
C. Acute gastric dilation
D. Wernicke encephalopathy
Correct Answer:
B — Refeeding syndrome with hypophosphatemia
Rationale:
Refeeding syndrome is a potentially fatal shift in fluids and electrolytes that occurs
when nutrition is reintroduced after starvation; hypophosphatemia is the hallmark and
can lead to cardiac failure, respiratory failure, and seizures. The patient's low baseline
phosphate and potassium significantly increase this risk.
Question 5
, A 12-year-old male presents with severe chronic irritability, temper outbursts three to
four times per week, and moodiness between outbursts, but no discrete manic
episodes. Which diagnosis is most appropriate?
A. Bipolar I disorder
B. Disruptive mood dysregulation disorder
C. Oppositional defiant disorder
D. Conduct disorder
Correct Answer:
B — Disruptive mood dysregulation disorder
Rationale:
Disruptive mood dysregulation disorder is characterized by severe, recurrent temper
outbursts and chronic persistent irritability between outbursts, without discrete manic
or hypomanic episodes. Bipolar I requires distinct manic episodes. Oppositional defiant
disorder features defiance and negativity but not the severe, pervasive irritability of
DMDD. Conduct disorder involves violation of others' rights.
Question 6
A 17-year-old female presents six months after sexual assault with intrusive memories,
nightmares, avoidance, and hypervigilance that impair school attendance. Which
first-line treatment is most appropriate?
A. Prazosin monotherapy for nightmares
B. Sertraline plus trauma-focused cognitive-behavioral therapy
C. Quetiapine 100 mg at bedtime for sleep and anxiety
D. Supportive counseling alone
Correct Answer:
B — Sertraline plus trauma-focused cognitive-behavioral therapy
Rationale:
Across the Lifespan I Practicum Review Final Exam (Weeks 5-8)
Question Bank (Latest 2026/2027 Edition) – Questions, Answers &
Detailed Rationales
──────────────────────────────
SECTION 1: ADVANCED CHILD & ADOLESCENT PSYCHIATRIC MANAGEMENT
──────────────────────────────
Question 1
A 7-year-old male is being evaluated for ADHD. He snores loudly, has restless sleep, and
his mother has a history of major depression. Before initiating stimulant medication,
which assessment is most important?
A. Comprehensive metabolic panel
B. Polysomnography to rule out obstructive sleep apnea
C. Thyroid stimulating hormone level
D. Electroencephalogram
Correct Answer:
B — Polysomnography to rule out obstructive sleep apnea
Rationale:
Obstructive sleep apnea can cause inattention and hyperactivity mimicking ADHD;
stimulants may worsen sleep architecture and are less effective when sleep deprivation
is present. While thyroid dysfunction and seizures should be considered, sleep apnea is
the most immediately relevant given the history of snoring and restless sleep.
Question 2
,A 16-year-old female presents with major depression, PHQ-9 score of 18, and passive
suicidal ideation without a plan. Her parents refuse antidepressants because of the
black box warning. Which response by the PMHNP is most appropriate?
A. Respect parental wishes and provide supportive therapy only
B. Explain that the black box warning requires close monitoring and that fluoxetine plus
CBT has the strongest evidence for adolescent depression
C. Recommend immediate hospitalization for the suicidal ideation
D. Recommend St. John's wort as a natural alternative
Correct Answer:
B — Explain that the black box warning requires close monitoring and that fluoxetine
plus CBT has the strongest evidence for adolescent depression
Rationale:
The FDA black box warning for suicidality in patients under 24 mandates close
monitoring but does not preclude pharmacotherapy; fluoxetine combined with CBT is
the most evidence-based treatment for moderate-to-severe adolescent depression.
Supportive therapy alone is insufficient for this severity. St. John's wort has significant
drug interactions and lacks FDA approval.
Question 3
A 6-year-old male with autism spectrum disorder exhibits severe irritability, aggression,
and self-injurious behavior that has not responded to behavioral interventions. Which
atypical antipsychotic is FDA-approved for irritability associated with autism in children
ages 5–16 years?
A. Risperidone
B. Olanzapine
C. Quetiapine
D. Ziprasidone
Correct Answer:
,A — Risperidone
Rationale:
Risperidone is FDA-approved for the treatment of irritability associated with autistic
disorder in children and adolescents ages 5–16 years, including symptoms of
aggression, self-injury, and tantrums. Aripiprazole is also approved but not listed;
olanzapine, quetiapine, and ziprasidone lack this specific pediatric indication.
Question 4
A 15-year-old female with anorexia nervosa is admitted to a medical unit with a BMI of
15.5, heart rate of 48 bpm, blood pressure of 88/58 mmHg, potassium of 3.2 mEq/L,
and phosphate of 2.8 mg/dL. Which complication is most likely during the initial 72
hours of refeeding?
A. Superior mesenteric artery syndrome
B. Refeeding syndrome with hypophosphatemia
C. Acute gastric dilation
D. Wernicke encephalopathy
Correct Answer:
B — Refeeding syndrome with hypophosphatemia
Rationale:
Refeeding syndrome is a potentially fatal shift in fluids and electrolytes that occurs
when nutrition is reintroduced after starvation; hypophosphatemia is the hallmark and
can lead to cardiac failure, respiratory failure, and seizures. The patient's low baseline
phosphate and potassium significantly increase this risk.
Question 5
, A 12-year-old male presents with severe chronic irritability, temper outbursts three to
four times per week, and moodiness between outbursts, but no discrete manic
episodes. Which diagnosis is most appropriate?
A. Bipolar I disorder
B. Disruptive mood dysregulation disorder
C. Oppositional defiant disorder
D. Conduct disorder
Correct Answer:
B — Disruptive mood dysregulation disorder
Rationale:
Disruptive mood dysregulation disorder is characterized by severe, recurrent temper
outbursts and chronic persistent irritability between outbursts, without discrete manic
or hypomanic episodes. Bipolar I requires distinct manic episodes. Oppositional defiant
disorder features defiance and negativity but not the severe, pervasive irritability of
DMDD. Conduct disorder involves violation of others' rights.
Question 6
A 17-year-old female presents six months after sexual assault with intrusive memories,
nightmares, avoidance, and hypervigilance that impair school attendance. Which
first-line treatment is most appropriate?
A. Prazosin monotherapy for nightmares
B. Sertraline plus trauma-focused cognitive-behavioral therapy
C. Quetiapine 100 mg at bedtime for sleep and anxiety
D. Supportive counseling alone
Correct Answer:
B — Sertraline plus trauma-focused cognitive-behavioral therapy
Rationale:
