NR605 Exam 1 Actual Exam Style V3 | NR 605
Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan | Chamberlain
1. A 24-year-old female patient reports symptoms of fatigue, low mood, and
hypersomnia for the past three weeks. She has a history of a manic episode two years
ago. Which of the following is the most appropriate initial diagnostic consideration?
A. Bipolar I Disorder, Current Episode Depressed
B. Major Depressive Disorder, Single Episode
C. Cyclothymic Disorder
D. Persistent Depressive Disorder
Correct Answer: A
Expert Explanation: The presence of a prior manic episode automatically moves
the diagnosis into the Bipolar I category regardless of the current depressive
symptoms. Major Depressive Disorder is excluded because the patient has
experienced mania in the past. Accurate diagnosis is critical because treating Bipolar
depression with antidepressants alone can trigger a switch into mania or rapid
cycling.
,2. Which cytochrome P450 enzyme is primarily responsible for the metabolism of
many antipsychotics and can be inhibited by Fluoxetine?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C19
Correct Answer: B
Expert Explanation: CYP2D6 is a major metabolic pathway for many psychotropic
medications, including several antipsychotics and tricyclic antidepressants.
Fluoxetine and Paroxetine are known potent inhibitors of this enzyme, which can
lead to increased serum levels of co-administered drugs. Understanding these
interactions is vital for preventing drug toxicity in psychiatric practice.
3. During a physical examination, the PMHNP notices a ‘lead-pipe’ rigidity in a patient
recently started on Haloperidol. The patient also has a high fever and autonomic
instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Akathisia
C. Neuroleptic Malignant Syndrome (NMS)
,D. Tardive Dyskinesia
Correct Answer: C
Expert Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening
reaction to dopamine antagonists characterized by muscle rigidity, fever, and
autonomic instability. Serotonin Syndrome presents similarly but usually features
hyperreflexia rather than lead-pipe rigidity. Immediate cessation of the
antipsychotic and supportive care are the primary interventions for NMS.
4. A patient is prescribed Lithium for Bipolar Disorder. Which of the following
laboratory values requires immediate intervention?
A. Lithium level of 0.8 mEq/L
B. Sodium level of 138 mEq/L
C. Creatinine level of 2.4 mg/dL
D. White Blood Cell count of 10,000/mm3
Correct Answer: C
Expert Explanation: Lithium is excreted almost entirely by the kidneys, and an
elevated creatinine level indicates renal impairment that could lead to toxic lithium
accumulation. A creatinine of 2.4 mg/dL is significantly above the normal range and
poses a high risk for lithium toxicity. Monitoring renal function (BUN/Creatinine) is
a standard of care for any patient on long-term lithium therapy.
, 5. Which brain structure is primarily involved in the ‘fear response’ and is often
overactive in patients with Panic Disorder?
A. Hippocampus
B. Amygdala
C. Prefrontal Cortex
D. Basal Ganglia
Correct Answer: B
Expert Explanation: The amygdala is the core structure of the brain’s limbic
system responsible for processing emotions and triggering the fight-or-flight
response. In anxiety disorders, particularly Panic Disorder, the amygdala shows
heightened sensitivity and hyperactivity. The hippocampus, by contrast, is more
focused on memory and context related to those emotional responses.
6. A 10-year-old child presents with persistent irritability and frequent out-of-
proportion temper outbursts occurring at least three times a week for the last year.
What is the most likely DSM-5 diagnosis?
A. Oppositional Defiant Disorder
B. Attention-Deficit/Hyperactivity Disorder
C. Pediatric Bipolar Disorder
Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan | Chamberlain
1. A 24-year-old female patient reports symptoms of fatigue, low mood, and
hypersomnia for the past three weeks. She has a history of a manic episode two years
ago. Which of the following is the most appropriate initial diagnostic consideration?
A. Bipolar I Disorder, Current Episode Depressed
B. Major Depressive Disorder, Single Episode
C. Cyclothymic Disorder
D. Persistent Depressive Disorder
Correct Answer: A
Expert Explanation: The presence of a prior manic episode automatically moves
the diagnosis into the Bipolar I category regardless of the current depressive
symptoms. Major Depressive Disorder is excluded because the patient has
experienced mania in the past. Accurate diagnosis is critical because treating Bipolar
depression with antidepressants alone can trigger a switch into mania or rapid
cycling.
,2. Which cytochrome P450 enzyme is primarily responsible for the metabolism of
many antipsychotics and can be inhibited by Fluoxetine?
A. CYP1A2
B. CYP2D6
C. CYP3A4
D. CYP2C19
Correct Answer: B
Expert Explanation: CYP2D6 is a major metabolic pathway for many psychotropic
medications, including several antipsychotics and tricyclic antidepressants.
Fluoxetine and Paroxetine are known potent inhibitors of this enzyme, which can
lead to increased serum levels of co-administered drugs. Understanding these
interactions is vital for preventing drug toxicity in psychiatric practice.
3. During a physical examination, the PMHNP notices a ‘lead-pipe’ rigidity in a patient
recently started on Haloperidol. The patient also has a high fever and autonomic
instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Akathisia
C. Neuroleptic Malignant Syndrome (NMS)
,D. Tardive Dyskinesia
Correct Answer: C
Expert Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening
reaction to dopamine antagonists characterized by muscle rigidity, fever, and
autonomic instability. Serotonin Syndrome presents similarly but usually features
hyperreflexia rather than lead-pipe rigidity. Immediate cessation of the
antipsychotic and supportive care are the primary interventions for NMS.
4. A patient is prescribed Lithium for Bipolar Disorder. Which of the following
laboratory values requires immediate intervention?
A. Lithium level of 0.8 mEq/L
B. Sodium level of 138 mEq/L
C. Creatinine level of 2.4 mg/dL
D. White Blood Cell count of 10,000/mm3
Correct Answer: C
Expert Explanation: Lithium is excreted almost entirely by the kidneys, and an
elevated creatinine level indicates renal impairment that could lead to toxic lithium
accumulation. A creatinine of 2.4 mg/dL is significantly above the normal range and
poses a high risk for lithium toxicity. Monitoring renal function (BUN/Creatinine) is
a standard of care for any patient on long-term lithium therapy.
, 5. Which brain structure is primarily involved in the ‘fear response’ and is often
overactive in patients with Panic Disorder?
A. Hippocampus
B. Amygdala
C. Prefrontal Cortex
D. Basal Ganglia
Correct Answer: B
Expert Explanation: The amygdala is the core structure of the brain’s limbic
system responsible for processing emotions and triggering the fight-or-flight
response. In anxiety disorders, particularly Panic Disorder, the amygdala shows
heightened sensitivity and hyperactivity. The hippocampus, by contrast, is more
focused on memory and context related to those emotional responses.
6. A 10-year-old child presents with persistent irritability and frequent out-of-
proportion temper outbursts occurring at least three times a week for the last year.
What is the most likely DSM-5 diagnosis?
A. Oppositional Defiant Disorder
B. Attention-Deficit/Hyperactivity Disorder
C. Pediatric Bipolar Disorder
