NR606 Diagnosis & Management in Psychiatric-Mental Health
across the Lifespan Verified Multiple Choice and Conceptual
Actual Emended Exam Questions With Reviewed 100%
Correct Detailed Answers
Guaranteed Pass!!Current Update
Chamberlain
1. Elaine Cho, a 24-year-old client with no history of mental illness gave birth
to a healthy baby girl. Three weeks after the birth, she felt that she was
really "bouncing back." She was energized and excited. She noticed that she
did not need to sleep as much as usual. She started on a few household
projects, including repainting the baby's gender-neutral nursery bright pink
and purchasing expensive new furniture and toys for the nursery despite
receiving everything she needed for the baby - ANSWER yes
Rationale: According to DSM-5-TR criteria, a hypomanic episode is an appropriate
diagnosis for Elaine. Criteria for a manic or hypomanic episode includes:
abnormally ↑ or irritable mood (required)
grandiose thoughts
↓ need for sleep
pressured speech
racing and expansive thoughts
distractibility
hyperactivity
impulsivity/high-risk activities
, After a few weeks, Elaine started to feel more tired. She started to experience
episodes of guilt about being more focused on her projects than her baby. She
began to have difficulty making decisions and withdrew from her friends and
husband. At her 6-week follow-up with her provider, she explained that she was
feeling a little down and described her symptoms. The provider administered an
EPDS. Elaine's score was 15. Since Elaine was breastfeeding, the provider
prescribed sertraline.
Is this t - ANSWER no
Rationale: This is not the correct treatment decision for this client. Clients with
bipolar disorder may present during the depressive phase of the illness and may
not report any symptoms of hypomanic or manic episodes. The provider must
obtain a careful history from the client and/or family members to differentiate
between bipolar disorder and depression. Bipolar disorder should be ruled out as
a cause of depression before prescribing medication as certain antidepressant
medications can precipitate a manic episode or induce rapid-cycling bipolar
depression, which may contribute to the increased incidence of death by suicide
in children and adults younger than 25.
Which of the following screening tools is most appropriate to obtain more
complete information from Elaine?
Mood Disorder Questionnaire (MDQ)
Patient Health Questionnaire-9 (PHQ-9)
Young Mania Rating Scale (YMRS)
Brief Psychiatric Rating Scale (BPRS) - ANSWER Mood Disorder Questionnaire
(MDQ)
,Rationale: The MDQ is the most appropriate screening tool to screen for bipolar
disorder. The PHQ-9 is a tool used to screen for depression. The YMRS is used to
monitor symptoms of bipolar disorder after diagnosis, whereas the BPRS is used
to assess clients who present with symptoms of psychosis.
What is an appropriate prescription for Elaine? - ANSWER lurasidone 20 mg
tablet
Disp: 30
Sig: 1 tab po daily with food at dinner
Refills: 0
The client will return for follow up and medication efficacy prior to 30 days.
Rationale: Lurasidone is a 5HT2A/D2 antagonist approved for use in schizophrenia
and bipolar depression. This compound exhibits high affinity for both 5HT7
receptors and 5HT2A receptors, moderate affinity for 5HT1A and α2 receptors, yet
minimal affinity for H1 histamine and M1 cholinergic receptors, which is a good
choice for a new mother. There is also a low risk of weight gain or metabolic
dysfunction. This medication was approved for pregnancy and postpartum use.
Any medication that is prescribed while nursing requires a risk benefit discussion.
A review of pediatric medical records have not shown adverse outcomes in
breastfed infants, however the data is limited.
Maternal Mental Health, Epigenetics, and Child Health: Lifespan Considerations -
ANSWER -Maternal depression & anxiety can impact:
• fetal development in utero
• increase risk for preterm birth & low birth weight
, • lead to an insecure attachment between mother & infant
• suboptimal breastfeeding practices
• long-term effects:
➣decreased social-emotional, cognitive, language, motor, & adaptive behavior
developmental outcomes
-PTSD following trauma exposure in childbearing people
• lasting detrimental impact on child health
How a caregiver's trauma can impact a child's development: Early development -
ANSWER -Mother releases cortisol
• Baby absorbs cortisol through placenta
➣Can impact baby's: HPA axis, CNS, Limbic system, ANS
-Caregiver struggles to regulate
-Attachment relationship strained
• Can impact child's:
➣Development of a core sense of self
➣Ability to integrate experiences
➣Epigenetic expressions
How a caregiver's trauma can impact a child's development: Adulthood -
ANSWER -person who had a caregiver with untreated trauma may:
• Be more prone to PTSD after trauma
• Struggle to repair after conflict
• Struggle with relationships
across the Lifespan Verified Multiple Choice and Conceptual
Actual Emended Exam Questions With Reviewed 100%
Correct Detailed Answers
Guaranteed Pass!!Current Update
Chamberlain
1. Elaine Cho, a 24-year-old client with no history of mental illness gave birth
to a healthy baby girl. Three weeks after the birth, she felt that she was
really "bouncing back." She was energized and excited. She noticed that she
did not need to sleep as much as usual. She started on a few household
projects, including repainting the baby's gender-neutral nursery bright pink
and purchasing expensive new furniture and toys for the nursery despite
receiving everything she needed for the baby - ANSWER yes
Rationale: According to DSM-5-TR criteria, a hypomanic episode is an appropriate
diagnosis for Elaine. Criteria for a manic or hypomanic episode includes:
abnormally ↑ or irritable mood (required)
grandiose thoughts
↓ need for sleep
pressured speech
racing and expansive thoughts
distractibility
hyperactivity
impulsivity/high-risk activities
, After a few weeks, Elaine started to feel more tired. She started to experience
episodes of guilt about being more focused on her projects than her baby. She
began to have difficulty making decisions and withdrew from her friends and
husband. At her 6-week follow-up with her provider, she explained that she was
feeling a little down and described her symptoms. The provider administered an
EPDS. Elaine's score was 15. Since Elaine was breastfeeding, the provider
prescribed sertraline.
Is this t - ANSWER no
Rationale: This is not the correct treatment decision for this client. Clients with
bipolar disorder may present during the depressive phase of the illness and may
not report any symptoms of hypomanic or manic episodes. The provider must
obtain a careful history from the client and/or family members to differentiate
between bipolar disorder and depression. Bipolar disorder should be ruled out as
a cause of depression before prescribing medication as certain antidepressant
medications can precipitate a manic episode or induce rapid-cycling bipolar
depression, which may contribute to the increased incidence of death by suicide
in children and adults younger than 25.
Which of the following screening tools is most appropriate to obtain more
complete information from Elaine?
Mood Disorder Questionnaire (MDQ)
Patient Health Questionnaire-9 (PHQ-9)
Young Mania Rating Scale (YMRS)
Brief Psychiatric Rating Scale (BPRS) - ANSWER Mood Disorder Questionnaire
(MDQ)
,Rationale: The MDQ is the most appropriate screening tool to screen for bipolar
disorder. The PHQ-9 is a tool used to screen for depression. The YMRS is used to
monitor symptoms of bipolar disorder after diagnosis, whereas the BPRS is used
to assess clients who present with symptoms of psychosis.
What is an appropriate prescription for Elaine? - ANSWER lurasidone 20 mg
tablet
Disp: 30
Sig: 1 tab po daily with food at dinner
Refills: 0
The client will return for follow up and medication efficacy prior to 30 days.
Rationale: Lurasidone is a 5HT2A/D2 antagonist approved for use in schizophrenia
and bipolar depression. This compound exhibits high affinity for both 5HT7
receptors and 5HT2A receptors, moderate affinity for 5HT1A and α2 receptors, yet
minimal affinity for H1 histamine and M1 cholinergic receptors, which is a good
choice for a new mother. There is also a low risk of weight gain or metabolic
dysfunction. This medication was approved for pregnancy and postpartum use.
Any medication that is prescribed while nursing requires a risk benefit discussion.
A review of pediatric medical records have not shown adverse outcomes in
breastfed infants, however the data is limited.
Maternal Mental Health, Epigenetics, and Child Health: Lifespan Considerations -
ANSWER -Maternal depression & anxiety can impact:
• fetal development in utero
• increase risk for preterm birth & low birth weight
, • lead to an insecure attachment between mother & infant
• suboptimal breastfeeding practices
• long-term effects:
➣decreased social-emotional, cognitive, language, motor, & adaptive behavior
developmental outcomes
-PTSD following trauma exposure in childbearing people
• lasting detrimental impact on child health
How a caregiver's trauma can impact a child's development: Early development -
ANSWER -Mother releases cortisol
• Baby absorbs cortisol through placenta
➣Can impact baby's: HPA axis, CNS, Limbic system, ANS
-Caregiver struggles to regulate
-Attachment relationship strained
• Can impact child's:
➣Development of a core sense of self
➣Ability to integrate experiences
➣Epigenetic expressions
How a caregiver's trauma can impact a child's development: Adulthood -
ANSWER -person who had a caregiver with untreated trauma may:
• Be more prone to PTSD after trauma
• Struggle to repair after conflict
• Struggle with relationships
