NR607 Exam 1 Actual Exam Style V3 | NR
607 Diagnosis & Management in
Psychiatric-Mental Health III Practicum |
Chamberlain
1. A 45-year-old male presents with sudden onset of high fever, muscle rigidity, and
autonomic instability after starting Haloperidol. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Toxicity
C. Neuroleptic Malignant Syndrome
D. Tardive Dyskinesia
Correct Answer: C
Expert Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening reaction
to antipsychotic medication characterized by lead-pipe rigidity and hyperthermia. Unlike
Serotonin Syndrome, NMS features decreased reflexes and severe muscle stiffness.
Management requires immediate discontinuation of the offending agent and supportive
care in an intensive care setting.
2. When prescribing Lithium, which laboratory test is essential to monitor at baseline and
every 6 months to prevent toxicity?
A. Serum Creatinine and TSH
B. Complete Blood Count
,C. Liver Function Tests
D. Amylase and Lipase
Correct Answer: A
Expert Explanation: Lithium is primarily excreted by the kidneys and can significantly
impact thyroid function over time. Monitoring Serum Creatinine ensures that renal
clearance is adequate to prevent toxic accumulation of the drug. Thyroid Stimulating
Hormone (TSH) is monitored because Lithium-induced hypothyroidism is a common side
effect requiring intervention.
3. A patient expresses a specific plan to harm their neighbor during a therapy session. What is
the PMHNP’s legal obligation based on the Tarasoff ruling?
A. Maintain patient confidentiality at all costs.
B. Inform the police but not the intended victim.
C. Wait until the patient acts before breaching confidentiality.
D. Duty to warn the intended victim and notify law enforcement.
Correct Answer: D
Expert Explanation: The Tarasoff v. Regents of the University of California case
established that mental health professionals have a duty to protect third parties from
foreseeable harm. This involves both notifying law enforcement and attempting to warn
the specific individual targeted by the patient. Failure to take these steps can lead to
professional liability and legal consequences for the provider.
,4. Which antidepressant is most likely to cause a hypertensive crisis if the patient consumes
aged cheese or red wine?
A. Sertraline
B. Phenelzine
C. Venlafaxine
D. Bupropion
Correct Answer: B
Expert Explanation: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that inhibits
the breakdown of tyramine in the gut. Consuming high-tyramine foods like aged cheese or
red wine leads to a massive release of norepinephrine, resulting in dangerously high blood
pressure. Patients on MAOIs must strictly adhere to a low-tyramine diet to avoid this life-
threatening complication.
5. A 28-year-old female patient on Clozapine reports a sore throat and fever. What is the
priority nursing action?
A. Prescribe an antibiotic for a suspected viral infection.
B. Schedule a follow-up appointment in two weeks.
C. Advise the patient to take over-the-counter acetaminophen.
D. Order an immediate Complete Blood Count (CBC) with differential.
Correct Answer: D
, Expert Explanation: Clozapine is associated with a risk of agranulocytosis, which is a
severe drop in white blood cell counts that compromises the immune system. Sore throat
and fever are clinical signs of infection that may indicate the patient is neutropenic.
Immediate CBC testing is required to verify the Absolute Neutrophil Count (ANC) and
determine if the medication must be discontinued.
6. Which CPT code is used for a 45-minute psychotherapy session with a patient when a
medication management service is also performed?
A. 90834
B. 90833
C. 90837
D. 99214
Correct Answer: B
Expert Explanation: Code 90833 is an add-on code specifically used for 38 to 52 minutes
of psychotherapy when performed in conjunction with an Evaluation and Management
(E/M) service. It cannot be billed as a standalone code and must be paired with an
appropriate E/M code like 99213 or 99214. Correct use of add-on codes is essential for
accurate billing and reimbursement in psychiatric practice.
7. In the treatment of Bipolar I Disorder, which medication is FDA-approved for the treatment
of acute depressive episodes?
A. Lamotrigine
607 Diagnosis & Management in
Psychiatric-Mental Health III Practicum |
Chamberlain
1. A 45-year-old male presents with sudden onset of high fever, muscle rigidity, and
autonomic instability after starting Haloperidol. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Toxicity
C. Neuroleptic Malignant Syndrome
D. Tardive Dyskinesia
Correct Answer: C
Expert Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening reaction
to antipsychotic medication characterized by lead-pipe rigidity and hyperthermia. Unlike
Serotonin Syndrome, NMS features decreased reflexes and severe muscle stiffness.
Management requires immediate discontinuation of the offending agent and supportive
care in an intensive care setting.
2. When prescribing Lithium, which laboratory test is essential to monitor at baseline and
every 6 months to prevent toxicity?
A. Serum Creatinine and TSH
B. Complete Blood Count
,C. Liver Function Tests
D. Amylase and Lipase
Correct Answer: A
Expert Explanation: Lithium is primarily excreted by the kidneys and can significantly
impact thyroid function over time. Monitoring Serum Creatinine ensures that renal
clearance is adequate to prevent toxic accumulation of the drug. Thyroid Stimulating
Hormone (TSH) is monitored because Lithium-induced hypothyroidism is a common side
effect requiring intervention.
3. A patient expresses a specific plan to harm their neighbor during a therapy session. What is
the PMHNP’s legal obligation based on the Tarasoff ruling?
A. Maintain patient confidentiality at all costs.
B. Inform the police but not the intended victim.
C. Wait until the patient acts before breaching confidentiality.
D. Duty to warn the intended victim and notify law enforcement.
Correct Answer: D
Expert Explanation: The Tarasoff v. Regents of the University of California case
established that mental health professionals have a duty to protect third parties from
foreseeable harm. This involves both notifying law enforcement and attempting to warn
the specific individual targeted by the patient. Failure to take these steps can lead to
professional liability and legal consequences for the provider.
,4. Which antidepressant is most likely to cause a hypertensive crisis if the patient consumes
aged cheese or red wine?
A. Sertraline
B. Phenelzine
C. Venlafaxine
D. Bupropion
Correct Answer: B
Expert Explanation: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that inhibits
the breakdown of tyramine in the gut. Consuming high-tyramine foods like aged cheese or
red wine leads to a massive release of norepinephrine, resulting in dangerously high blood
pressure. Patients on MAOIs must strictly adhere to a low-tyramine diet to avoid this life-
threatening complication.
5. A 28-year-old female patient on Clozapine reports a sore throat and fever. What is the
priority nursing action?
A. Prescribe an antibiotic for a suspected viral infection.
B. Schedule a follow-up appointment in two weeks.
C. Advise the patient to take over-the-counter acetaminophen.
D. Order an immediate Complete Blood Count (CBC) with differential.
Correct Answer: D
, Expert Explanation: Clozapine is associated with a risk of agranulocytosis, which is a
severe drop in white blood cell counts that compromises the immune system. Sore throat
and fever are clinical signs of infection that may indicate the patient is neutropenic.
Immediate CBC testing is required to verify the Absolute Neutrophil Count (ANC) and
determine if the medication must be discontinued.
6. Which CPT code is used for a 45-minute psychotherapy session with a patient when a
medication management service is also performed?
A. 90834
B. 90833
C. 90837
D. 99214
Correct Answer: B
Expert Explanation: Code 90833 is an add-on code specifically used for 38 to 52 minutes
of psychotherapy when performed in conjunction with an Evaluation and Management
(E/M) service. It cannot be billed as a standalone code and must be paired with an
appropriate E/M code like 99213 or 99214. Correct use of add-on codes is essential for
accurate billing and reimbursement in psychiatric practice.
7. In the treatment of Bipolar I Disorder, which medication is FDA-approved for the treatment
of acute depressive episodes?
A. Lamotrigine
