1|Page
NR547 FINAL EXAM QUESTIONS WITH CORRECT
VERIFIED SOLUTIONS
(LATEST UPDATE)
Carlo is a 24-year-old married auto mechanic who works full-time. His wife reports that he
began several home repair projects about three weeks ago "out of the blue." He is painting
the exterior of the home, remodeling a bathroom, and digging a new garden. He used to
sleep 6-7 hours per night, but he is now sleeping about 3 ½ hours per night. Although Carlo
has no history of bipolar disorder, his wife is concerned that this may be a manic episode.
Her father was diagnosed with bipolar I disorde - ANS ✓unable to determine
Rationale: Carlo meets category A criteria (abnormal and persistent increased activity lasting
at least one week) and two diagnostic criteria in category B for bipolar I disorder (decreased
need for sleep and increase in goal-directed activity). However, three symptoms are
required for diagnosis; more information is needed to determine if Carlo is experiencing
additional symptoms or if his behaviors are significantly impacting his occupational or social
interactions. In addition, the PMHNP should inquire about the use of medications and/or
legal and illegal stimulants to determine if they may be impacting Carlo's behavior.
Rapid cycling - ANS ✓four or more episodes of depression and mania occur within one year
Cyclothymia - ANS ✓numerous episodes of hypomanic symptoms that do not meet the
criteria for a hypomanic episode and numerous periods of depressive symptoms that do not
meet the criteria for a major depressive episode
-at least two consecutive years during which clients are symptomatic at least half the time
and not symptom-free for more than two consecutive months
Tariq is a 22-year-old who presents with symptoms of racing thoughts and an inability to pay
attention in his college classes. He is currently failing most of his courses. He feels like he
needs to talk constantly. He calls friends at all hours and tries to engage strangers in
conversation. He also reports feeling restless and tense. He has experienced these
symptoms continuously for the past two weeks. His toxicology screen is negative, and he
takes no medications.
,2|Page
What is the appropriate ICD-1 - ANS ✓F31.89
Rationale: The ICD-10 code is F31.89 bipolar 1 disorder with anxious distress. Tariq meets
diagnostic criteria for Bipolar I, with symptoms including racing thoughts, difficulty paying
attention, and constant talking. He is experiencing consequences from his behavior as he is
failing classes. He has experienced the symptoms for two weeks. Because he also has
symptoms of restlessness and increased tension, he also meets the qualifying diagnostic
criteria for anxious distress.
Savannah is a 32-year-old who presents with her husband. Her husband states that
Savannah has spent thousands of dollars on new clothing and shoes in the past month. The
clothing she has purchased is much more revealing than her typical wardrobe. She is
sleeping for just a few hours per night. She is spending hours on Twitter and is constantly
boasting about how many retweets she receives and how many followers she has. Two days
ago, Savannah reported that the drummer of her favorite band began - ANS ✓F31.2
Rationale: The ICD-10 code is F31.2 bipolar 1 disorder with mood-congruent psychotic
features. Savannah meets diagnostic criteria for bipolar I, with symptoms of grandiosity,
decreased sleep, and excessive shopping. She is experiencing impairment in social and
occupational functioning. She has experienced these symptoms for a month. Because
Savannah is also experiencing delusional thinking consistent with her mood, she also meets
the criteria for mood-congruent psychotic features.
Vladimir is a 25-year-old who presents with feelings of racing thoughts. His thoughts are
centered on feelings of worthlessness. He reports feeling very fatigued and continually
paces around the room. He has been irritable and easily distracted for the last two weeks.
He endorses an increase in sexual behavior, including several recent episodes of
unprotected sex with multiple partners. He admits to having suicidal ideations.
What is the appropriate ICD-10 code for Vladimir? - ANS ✓F31.12
Rationale: The ICD-10 code is F31.12 bipolar 1 disorder manic episode with mixed features.
Vladimir meets diagnostic criteria for bipolar I disorder, with symptoms including racing
thoughts, psychomotor agitation, distraction, risky behaviors, and irritability for the past
two weeks. Because he also endorses fatigue, feelings of worthlessness, and suicidal
ideation, he meets the criteria for a manic episode with mixed features.
Screening tools for bipolar disorders: - ANS ✓Mood disorder questionnaire
,3|Page
-a non-diagnostic, self-rated instrument that provides information to clients who may need
additional assessment.
Bipolar spectrum diagnostic scale
-a self-rated instrument presented in story format that is sensitive to subtle symptoms of
bipolar disorder
Medical Diagnoses that Mimic Bipolar Disorder - ANS ✓-hyperthyroidism
-hyperaldosteronism
-brain tumor
-neurocognitive disorder
-delirium
Rationale: Medical conditions that commonly present with symptoms that mimic mania
include hyperthyroidism, hypercortisolemia, hyperaldosteronism, brain tumor,
neurocognitive disorder, acromegaly, delirium, lupus, HIV, or syphilis.
medications or substances commonly cause symptoms that mimic mania? - ANS ✓steroid
medications
hallucinogens
methamphetamine
marijuana
Rationale: Medications and substances with effects that mimic mania include levodopa,
hallucinogens, antidepressants, methamphetamine, marijuana, or cocaine.
Bipolar disorder tx: pharmacological - ANS ✓Antipsychotics
Anticonvulsants
Benzodiazepines
Lithium salts
Antidepressants
, 4|Page
Bipolar disorder tx: _____________Acts as a mood stabilizer, more effective at treating
mania than depressive symptoms. - ANS ✓Lithium salts
Bipolar disorder tx: _____________SSRIs may trigger manic episodes in individuals who are
predisposed to them. - ANS ✓Antidepressants
Bipolar disorder tx: _______________Acts on dopamine receptors to reduce levels of excess
dopamine, exhibit high affinity for D2, D3, 5-HT1A, and 5-HT2A receptors. - ANS
✓Antipsychotics
Bipolar disorder tx: ______________May be combined with other medications to treat
bipolar disorder, may improve both mania and depressive symptoms. - ANS
✓Anticonvulsants
Bipolar disorder tx: ______________Slows the activity of the brain resulting in a reduction
of mania, anxiety, and panic disorder - ANS ✓Benzodiazepines
lab tests required for Lithium: - ANS ✓serum lithium level
renal function
thyroid function
lab tests required for Valproic acid (Depakote): - ANS ✓serum valproate level
liver function
CBC
lab tests required for Carbamazepine: - ANS ✓serum carbamazepine level
renal function
liver function
CBC
NR547 FINAL EXAM QUESTIONS WITH CORRECT
VERIFIED SOLUTIONS
(LATEST UPDATE)
Carlo is a 24-year-old married auto mechanic who works full-time. His wife reports that he
began several home repair projects about three weeks ago "out of the blue." He is painting
the exterior of the home, remodeling a bathroom, and digging a new garden. He used to
sleep 6-7 hours per night, but he is now sleeping about 3 ½ hours per night. Although Carlo
has no history of bipolar disorder, his wife is concerned that this may be a manic episode.
Her father was diagnosed with bipolar I disorde - ANS ✓unable to determine
Rationale: Carlo meets category A criteria (abnormal and persistent increased activity lasting
at least one week) and two diagnostic criteria in category B for bipolar I disorder (decreased
need for sleep and increase in goal-directed activity). However, three symptoms are
required for diagnosis; more information is needed to determine if Carlo is experiencing
additional symptoms or if his behaviors are significantly impacting his occupational or social
interactions. In addition, the PMHNP should inquire about the use of medications and/or
legal and illegal stimulants to determine if they may be impacting Carlo's behavior.
Rapid cycling - ANS ✓four or more episodes of depression and mania occur within one year
Cyclothymia - ANS ✓numerous episodes of hypomanic symptoms that do not meet the
criteria for a hypomanic episode and numerous periods of depressive symptoms that do not
meet the criteria for a major depressive episode
-at least two consecutive years during which clients are symptomatic at least half the time
and not symptom-free for more than two consecutive months
Tariq is a 22-year-old who presents with symptoms of racing thoughts and an inability to pay
attention in his college classes. He is currently failing most of his courses. He feels like he
needs to talk constantly. He calls friends at all hours and tries to engage strangers in
conversation. He also reports feeling restless and tense. He has experienced these
symptoms continuously for the past two weeks. His toxicology screen is negative, and he
takes no medications.
,2|Page
What is the appropriate ICD-1 - ANS ✓F31.89
Rationale: The ICD-10 code is F31.89 bipolar 1 disorder with anxious distress. Tariq meets
diagnostic criteria for Bipolar I, with symptoms including racing thoughts, difficulty paying
attention, and constant talking. He is experiencing consequences from his behavior as he is
failing classes. He has experienced the symptoms for two weeks. Because he also has
symptoms of restlessness and increased tension, he also meets the qualifying diagnostic
criteria for anxious distress.
Savannah is a 32-year-old who presents with her husband. Her husband states that
Savannah has spent thousands of dollars on new clothing and shoes in the past month. The
clothing she has purchased is much more revealing than her typical wardrobe. She is
sleeping for just a few hours per night. She is spending hours on Twitter and is constantly
boasting about how many retweets she receives and how many followers she has. Two days
ago, Savannah reported that the drummer of her favorite band began - ANS ✓F31.2
Rationale: The ICD-10 code is F31.2 bipolar 1 disorder with mood-congruent psychotic
features. Savannah meets diagnostic criteria for bipolar I, with symptoms of grandiosity,
decreased sleep, and excessive shopping. She is experiencing impairment in social and
occupational functioning. She has experienced these symptoms for a month. Because
Savannah is also experiencing delusional thinking consistent with her mood, she also meets
the criteria for mood-congruent psychotic features.
Vladimir is a 25-year-old who presents with feelings of racing thoughts. His thoughts are
centered on feelings of worthlessness. He reports feeling very fatigued and continually
paces around the room. He has been irritable and easily distracted for the last two weeks.
He endorses an increase in sexual behavior, including several recent episodes of
unprotected sex with multiple partners. He admits to having suicidal ideations.
What is the appropriate ICD-10 code for Vladimir? - ANS ✓F31.12
Rationale: The ICD-10 code is F31.12 bipolar 1 disorder manic episode with mixed features.
Vladimir meets diagnostic criteria for bipolar I disorder, with symptoms including racing
thoughts, psychomotor agitation, distraction, risky behaviors, and irritability for the past
two weeks. Because he also endorses fatigue, feelings of worthlessness, and suicidal
ideation, he meets the criteria for a manic episode with mixed features.
Screening tools for bipolar disorders: - ANS ✓Mood disorder questionnaire
,3|Page
-a non-diagnostic, self-rated instrument that provides information to clients who may need
additional assessment.
Bipolar spectrum diagnostic scale
-a self-rated instrument presented in story format that is sensitive to subtle symptoms of
bipolar disorder
Medical Diagnoses that Mimic Bipolar Disorder - ANS ✓-hyperthyroidism
-hyperaldosteronism
-brain tumor
-neurocognitive disorder
-delirium
Rationale: Medical conditions that commonly present with symptoms that mimic mania
include hyperthyroidism, hypercortisolemia, hyperaldosteronism, brain tumor,
neurocognitive disorder, acromegaly, delirium, lupus, HIV, or syphilis.
medications or substances commonly cause symptoms that mimic mania? - ANS ✓steroid
medications
hallucinogens
methamphetamine
marijuana
Rationale: Medications and substances with effects that mimic mania include levodopa,
hallucinogens, antidepressants, methamphetamine, marijuana, or cocaine.
Bipolar disorder tx: pharmacological - ANS ✓Antipsychotics
Anticonvulsants
Benzodiazepines
Lithium salts
Antidepressants
, 4|Page
Bipolar disorder tx: _____________Acts as a mood stabilizer, more effective at treating
mania than depressive symptoms. - ANS ✓Lithium salts
Bipolar disorder tx: _____________SSRIs may trigger manic episodes in individuals who are
predisposed to them. - ANS ✓Antidepressants
Bipolar disorder tx: _______________Acts on dopamine receptors to reduce levels of excess
dopamine, exhibit high affinity for D2, D3, 5-HT1A, and 5-HT2A receptors. - ANS
✓Antipsychotics
Bipolar disorder tx: ______________May be combined with other medications to treat
bipolar disorder, may improve both mania and depressive symptoms. - ANS
✓Anticonvulsants
Bipolar disorder tx: ______________Slows the activity of the brain resulting in a reduction
of mania, anxiety, and panic disorder - ANS ✓Benzodiazepines
lab tests required for Lithium: - ANS ✓serum lithium level
renal function
thyroid function
lab tests required for Valproic acid (Depakote): - ANS ✓serum valproate level
liver function
CBC
lab tests required for Carbamazepine: - ANS ✓serum carbamazepine level
renal function
liver function
CBC
