NRNP 6665 FINAL EXAM TEST QUESTIONS
STUDY GUIDE WITH COMPLETE SOLUTION!!
WITH CASE STUDIES
Case 1: Christine
Christine is a 9-year-old girl who has recently entered foster care after being
removed from her previous placement. She has been in and out of foster homes and
residential facilities for the past four years following the death of her parents in a
car accident. Given her unstable history and repeated changes in caregivers, the
psychiatric mental health nurse practitioner (PMHNP) recognizes that she is at
high risk for developing:
A. Dissociative disorders
B. Post-traumatic stress disorder (PTSD)
C. Impulse-control disorder
D. Attachment disorder
Case 2: Caylee
Caylee, a 5-year-old girl, has been referred by child protective services for
psychological evaluation. She was removed from her biological family due to
severe neglect and placed in foster care. Her foster mother reports that Caylee
tends to be quiet, withdrawn, and shows little interest in her surroundings. She
appears sad and easily irritated when routines change. Recently, the foster mother
noticed behavior that suggested Caylee might be hallucinating, which raised
concern.
,The PMHNP considers that:
A. Caylee may be at risk for suicidal behavior, and safety precautions should be
implemented.
B. The hallucinations could indicate a brief psychotic episode or schizophrenia.
C. The symptoms and history are consistent with depressive disorder in young
children.
D. Such presentations are common among children separated from biological
parents, even when home environments are dysfunctional.
Case 3: Debi
Debi is a 15-year-old adolescent currently receiving treatment for depression. Her
parents have been actively engaged in her therapy, and she has achieved remission
within two months of starting a combined treatment plan involving medication and
cognitive-behavioral therapy (CBT). During a counseling session, the PMHNP
educates Debi’s parents on ongoing care, explaining that:
A. There is a greater than 50% chance that a younger sibling may experience
depressive symptoms.
B. The average duration of a major depressive episode in adolescents is
approximately four months.
C. Between 20% and 40% of adolescents diagnosed with major depressive disorder
may later develop bipolar I disorder within five years.
D. Depression beginning in adolescence often requires long-term pharmacological
management to prevent recurrence.
Medication Summary
,Agomelatine (Brand: Valdoxan)
Classified as a melatonin-based multimodal antidepressant (Mel-MM)
Acts as an agonist at melatonergic receptors (MT1 and MT2) and an antagonist at
serotonin 5-HT2C receptors
Not FDA-approved (used in some regions for depression and generalized anxiety
disorder)
Dosage: Start at 25 mg nightly; may increase to 50 mg after two weeks if needed
Amitriptyline (Elavil)
A tricyclic antidepressant (TCA) used to treat depression and certain chronic pain
conditions.
Aripiprazole (Abilify)
An atypical antipsychotic used as an adjunct for depression.
Functions as a dopamine stabilizer—acting as an antagonist at high concentrations
and a partial agonist at low concentrations.
, Side effects: Insomnia and akathisia.
Brexpiprazole (Rexulti)
An atypical antipsychotic used for the treatment of depression and schizophrenia.
Bupropion (Wellbutrin)
Functions as an antidepressant and smoking cessation aid.
Used for major depressive disorder and seasonal affective disorder (SAD).
Citalopram (Celexa)
A selective serotonin reuptake inhibitor (SSRI) used to treat depression.
Typical dose: 20–40 mg daily.
Clomipramine (Anafranil)
A tricyclic antidepressant and potent serotonin reuptake inhibitor.
STUDY GUIDE WITH COMPLETE SOLUTION!!
WITH CASE STUDIES
Case 1: Christine
Christine is a 9-year-old girl who has recently entered foster care after being
removed from her previous placement. She has been in and out of foster homes and
residential facilities for the past four years following the death of her parents in a
car accident. Given her unstable history and repeated changes in caregivers, the
psychiatric mental health nurse practitioner (PMHNP) recognizes that she is at
high risk for developing:
A. Dissociative disorders
B. Post-traumatic stress disorder (PTSD)
C. Impulse-control disorder
D. Attachment disorder
Case 2: Caylee
Caylee, a 5-year-old girl, has been referred by child protective services for
psychological evaluation. She was removed from her biological family due to
severe neglect and placed in foster care. Her foster mother reports that Caylee
tends to be quiet, withdrawn, and shows little interest in her surroundings. She
appears sad and easily irritated when routines change. Recently, the foster mother
noticed behavior that suggested Caylee might be hallucinating, which raised
concern.
,The PMHNP considers that:
A. Caylee may be at risk for suicidal behavior, and safety precautions should be
implemented.
B. The hallucinations could indicate a brief psychotic episode or schizophrenia.
C. The symptoms and history are consistent with depressive disorder in young
children.
D. Such presentations are common among children separated from biological
parents, even when home environments are dysfunctional.
Case 3: Debi
Debi is a 15-year-old adolescent currently receiving treatment for depression. Her
parents have been actively engaged in her therapy, and she has achieved remission
within two months of starting a combined treatment plan involving medication and
cognitive-behavioral therapy (CBT). During a counseling session, the PMHNP
educates Debi’s parents on ongoing care, explaining that:
A. There is a greater than 50% chance that a younger sibling may experience
depressive symptoms.
B. The average duration of a major depressive episode in adolescents is
approximately four months.
C. Between 20% and 40% of adolescents diagnosed with major depressive disorder
may later develop bipolar I disorder within five years.
D. Depression beginning in adolescence often requires long-term pharmacological
management to prevent recurrence.
Medication Summary
,Agomelatine (Brand: Valdoxan)
Classified as a melatonin-based multimodal antidepressant (Mel-MM)
Acts as an agonist at melatonergic receptors (MT1 and MT2) and an antagonist at
serotonin 5-HT2C receptors
Not FDA-approved (used in some regions for depression and generalized anxiety
disorder)
Dosage: Start at 25 mg nightly; may increase to 50 mg after two weeks if needed
Amitriptyline (Elavil)
A tricyclic antidepressant (TCA) used to treat depression and certain chronic pain
conditions.
Aripiprazole (Abilify)
An atypical antipsychotic used as an adjunct for depression.
Functions as a dopamine stabilizer—acting as an antagonist at high concentrations
and a partial agonist at low concentrations.
, Side effects: Insomnia and akathisia.
Brexpiprazole (Rexulti)
An atypical antipsychotic used for the treatment of depression and schizophrenia.
Bupropion (Wellbutrin)
Functions as an antidepressant and smoking cessation aid.
Used for major depressive disorder and seasonal affective disorder (SAD).
Citalopram (Celexa)
A selective serotonin reuptake inhibitor (SSRI) used to treat depression.
Typical dose: 20–40 mg daily.
Clomipramine (Anafranil)
A tricyclic antidepressant and potent serotonin reuptake inhibitor.
