NR607 Exam 2 Actual Exam Style V2 | NR
607 Diagnosis & Management in
Psychiatric-Mental Health III Practicum |
Chamberlain
1. A 28-year-old female presents with recurrent episodes of intense fear accompanied by
palpitations, sweating, and a feeling of impending doom. She has started avoiding crowded
places for fear of having another attack. Which of the following is the most appropriate first-
line pharmacological treatment?
A. Protokol for acute relief only
B. Low-dose Haloperidol
C. Tricyclic Antidepressant (TCA)
D. Selective Serotonin Reuptake Inhibitor (SSRI)
Answer: D
Rationale: SSRIs are considered the first-line treatment for panic disorder due to their
safety profile and efficacy in long-term symptom management. This patient is showing
signs of both panic disorder and secondary agoraphobia. Treatment should be initiated at a
low dose to avoid early exacerbation of anxiety symptoms before the full therapeutic effect
is reached.
,2. Which neurobiological pathway is primarily implicated in the development of
extrapyramidal symptoms (EPS) when using first-generation antipsychotics?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: C
Rationale: The nigrostriatal pathway is responsible for motor control, and blockade of
dopamine D2 receptors here results in EPS. This pathway projects from the substantia
nigra to the striatum and is a critical component of the basal ganglia motor loop. In
contrast, the mesolimbic pathway is associated with the therapeutic effects on positive
symptoms of schizophrenia.
3. A patient taking Lithium for Bipolar I Disorder presents with coarse tremors, ataxia, and
confusion. What is the most likely interpretation of these symptoms?
A. Expected therapeutic side effects
B. Lithium toxicity
C. Serotonin syndrome
D. Neuroleptic malignant syndrome
Answer: B
,Rationale: Coarse tremors and ataxia are hallmark signs of moderate to severe lithium
toxicity, which requires immediate medical intervention. Lithium has a narrow therapeutic
index, meaning the margin between therapeutic and toxic doses is very small. Clinicians
must monitor serum levels frequently and educate patients on signs of toxicity like
confusion and worsening motor coordination.
4. A 15-year-old male is brought to the clinic for irritability, frequent temper outbursts, and a
persistently sad or angry mood between outbursts for the last 14 months. What is the most
appropriate DSM-5 diagnosis?
A. Bipolar I Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Oppositional Defiant Disorder
D. Conduct Disorder
Answer: B
Rationale: DMDD is characterized by severe recurrent temper outbursts that are grossly
out of proportion to the situation and occur in children aged 6 to 18. The outbursts must
occur at least three times per week, and the mood between outbursts remains persistently
irritable or angry. This diagnosis was created to reduce the overdiagnosis of pediatric
bipolar disorder in children who do not exhibit episodic mania.
, 5. Which of the following laboratory values is the most critical to monitor for a patient
prescribed Clozapine?
A. Serum Potassium
B. Absolute Neutrophil Count (ANC)
C. Liver Function Tests (LFTs)
D. Thyroid Stimulating Hormone (TSH)
Answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a life-
threatening decrease in white blood cells. Providers must monitor the ANC weekly for the
first six months of treatment according to the REMS program. If the ANC falls below specific
thresholds, the medication must be discontinued to prevent severe infection or death.
6. A PMHNP is treating a patient with Borderline Personality Disorder who frequently uses
‘splitting’ as a defense mechanism. Which therapy modality is specifically designed to address
this disorder by teaching mindfulness and emotional regulation?
A. Cognitive Behavioral Therapy (CBT)
B. Exposure and Response Prevention (ERP)
C. Interpersonal Therapy (IPT)
D. Dialectical Behavior Therapy (DBT)
Answer: D
607 Diagnosis & Management in
Psychiatric-Mental Health III Practicum |
Chamberlain
1. A 28-year-old female presents with recurrent episodes of intense fear accompanied by
palpitations, sweating, and a feeling of impending doom. She has started avoiding crowded
places for fear of having another attack. Which of the following is the most appropriate first-
line pharmacological treatment?
A. Protokol for acute relief only
B. Low-dose Haloperidol
C. Tricyclic Antidepressant (TCA)
D. Selective Serotonin Reuptake Inhibitor (SSRI)
Answer: D
Rationale: SSRIs are considered the first-line treatment for panic disorder due to their
safety profile and efficacy in long-term symptom management. This patient is showing
signs of both panic disorder and secondary agoraphobia. Treatment should be initiated at a
low dose to avoid early exacerbation of anxiety symptoms before the full therapeutic effect
is reached.
,2. Which neurobiological pathway is primarily implicated in the development of
extrapyramidal symptoms (EPS) when using first-generation antipsychotics?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: C
Rationale: The nigrostriatal pathway is responsible for motor control, and blockade of
dopamine D2 receptors here results in EPS. This pathway projects from the substantia
nigra to the striatum and is a critical component of the basal ganglia motor loop. In
contrast, the mesolimbic pathway is associated with the therapeutic effects on positive
symptoms of schizophrenia.
3. A patient taking Lithium for Bipolar I Disorder presents with coarse tremors, ataxia, and
confusion. What is the most likely interpretation of these symptoms?
A. Expected therapeutic side effects
B. Lithium toxicity
C. Serotonin syndrome
D. Neuroleptic malignant syndrome
Answer: B
,Rationale: Coarse tremors and ataxia are hallmark signs of moderate to severe lithium
toxicity, which requires immediate medical intervention. Lithium has a narrow therapeutic
index, meaning the margin between therapeutic and toxic doses is very small. Clinicians
must monitor serum levels frequently and educate patients on signs of toxicity like
confusion and worsening motor coordination.
4. A 15-year-old male is brought to the clinic for irritability, frequent temper outbursts, and a
persistently sad or angry mood between outbursts for the last 14 months. What is the most
appropriate DSM-5 diagnosis?
A. Bipolar I Disorder
B. Disruptive Mood Dysregulation Disorder (DMDD)
C. Oppositional Defiant Disorder
D. Conduct Disorder
Answer: B
Rationale: DMDD is characterized by severe recurrent temper outbursts that are grossly
out of proportion to the situation and occur in children aged 6 to 18. The outbursts must
occur at least three times per week, and the mood between outbursts remains persistently
irritable or angry. This diagnosis was created to reduce the overdiagnosis of pediatric
bipolar disorder in children who do not exhibit episodic mania.
, 5. Which of the following laboratory values is the most critical to monitor for a patient
prescribed Clozapine?
A. Serum Potassium
B. Absolute Neutrophil Count (ANC)
C. Liver Function Tests (LFTs)
D. Thyroid Stimulating Hormone (TSH)
Answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a life-
threatening decrease in white blood cells. Providers must monitor the ANC weekly for the
first six months of treatment according to the REMS program. If the ANC falls below specific
thresholds, the medication must be discontinued to prevent severe infection or death.
6. A PMHNP is treating a patient with Borderline Personality Disorder who frequently uses
‘splitting’ as a defense mechanism. Which therapy modality is specifically designed to address
this disorder by teaching mindfulness and emotional regulation?
A. Cognitive Behavioral Therapy (CBT)
B. Exposure and Response Prevention (ERP)
C. Interpersonal Therapy (IPT)
D. Dialectical Behavior Therapy (DBT)
Answer: D
