NURS 660- Exam I- Study Guide 2026 Update
with complete solutions.
1. No one is ever going to come to you and tell you they're having a
medical emergency (for example, neuroleptic malignant
syndrome [NMS] or lithium toxicity). They'll tell you signs and
symptoms they're having and it's your job to put the puzzle
pieces together to recognize that they may be having a severe or
potentially life-threatening reaction.
Lithium Toxicity: Signs & Symptoms
• Mild toxicity (1.5-2.0 mEq/L):
o Nausea, vomiting, diarrhea
o Tremor, muscle weakness
o Ataxia (uncoordinated movements)
o Dizziness, lethargy
• Moderate toxicity (2.0-2.5 mEq/L):
o Confusion, agitation
o Hyperreflexia
o Myoclonus (muscle jerks)
o ECG changes (arrhythmias)
• Severe toxicity (>2.5 mEq/L):
o Seizures
o Coma
o Renal failure
o Severe neurologic impairment
Treatment of Lithium Toxicity
1. Stop lithium immediately.
2. Hydration:
o IV fluids to enhance renal lithium clearance.
3. Monitor electrolytes and renal function.
4. Activated charcoal is NOT effective (lithium is not absorbed this way).
5. Severe cases (e.g., >4.0 mEq/L, severe neurologic symptoms, renal failure):
o Hemodialysis to remove lithium rapidly.
6. Supportive care:
, o Manage seizures, cardiac arrhythmias as needed.
Putting it together clinically:
If a patient on lithium reports symptoms like nausea, vomiting, tremors, confusion, or unsteady gait,
think lithium toxicity and check lithium levels urgently!
, Mechanism of Action of Antipsychotics
Antipsychotics primarily treat psychotic symptoms (delusions, hallucinations, disorganized thinking)
seen in conditions like schizophrenia, bipolar disorder, and psychotic depression.
Main Mechanism:
• D2 dopamine receptor antagonism:
o All antipsychotics block dopamine D2 receptors in the brain.
o This reduces dopamine activity, particularly in the mesolimbic pathway, which
is thought to be overactive in psychosis.
Other Mechanisms (Especially 2nd-Gen):
• Serotonin 5-HT2A receptor antagonism:
o Common in second-generation antipsychotics.
o May improve negative symptoms and reduce extrapyramidal side effects
(movement-related). Low risk EPS.
• Other receptors affected (varies by drug): weight gain seen with H1&5HT2C
o Histamine (H1) → sedation, weight gain,
o Alpha-1 adrenergic → orthostatic hypotension, dizziness, and sedation.
o Muscarinic (M1) → anticholinergic effects (dry mouth, constipation, sedation.)
First-Generation vs. Second-Generation Antipsychotics
First-Generation
Feature Second-Generation (Atypical)
(Typical)
Dopamine blockade Strong D2 antagonism Moderate D2 antagonism
Serotonin effects Minimal or none 5-HT2A antagonism common
EPS risk (e.g., tremor,
High Lower
rigidity)
Tardive dyskinesia risk Higher Lower (but not absent)
Effect on negative
Less effective More effective (some)
symptoms
Haloperidol, Risperidone, Olanzapine, Clozapine,
Examples
Chlorpromazine Aripiprazole
High-Potency vs. Low-Potency Antipsychotics (Mostly 1st-Gen)
with complete solutions.
1. No one is ever going to come to you and tell you they're having a
medical emergency (for example, neuroleptic malignant
syndrome [NMS] or lithium toxicity). They'll tell you signs and
symptoms they're having and it's your job to put the puzzle
pieces together to recognize that they may be having a severe or
potentially life-threatening reaction.
Lithium Toxicity: Signs & Symptoms
• Mild toxicity (1.5-2.0 mEq/L):
o Nausea, vomiting, diarrhea
o Tremor, muscle weakness
o Ataxia (uncoordinated movements)
o Dizziness, lethargy
• Moderate toxicity (2.0-2.5 mEq/L):
o Confusion, agitation
o Hyperreflexia
o Myoclonus (muscle jerks)
o ECG changes (arrhythmias)
• Severe toxicity (>2.5 mEq/L):
o Seizures
o Coma
o Renal failure
o Severe neurologic impairment
Treatment of Lithium Toxicity
1. Stop lithium immediately.
2. Hydration:
o IV fluids to enhance renal lithium clearance.
3. Monitor electrolytes and renal function.
4. Activated charcoal is NOT effective (lithium is not absorbed this way).
5. Severe cases (e.g., >4.0 mEq/L, severe neurologic symptoms, renal failure):
o Hemodialysis to remove lithium rapidly.
6. Supportive care:
, o Manage seizures, cardiac arrhythmias as needed.
Putting it together clinically:
If a patient on lithium reports symptoms like nausea, vomiting, tremors, confusion, or unsteady gait,
think lithium toxicity and check lithium levels urgently!
, Mechanism of Action of Antipsychotics
Antipsychotics primarily treat psychotic symptoms (delusions, hallucinations, disorganized thinking)
seen in conditions like schizophrenia, bipolar disorder, and psychotic depression.
Main Mechanism:
• D2 dopamine receptor antagonism:
o All antipsychotics block dopamine D2 receptors in the brain.
o This reduces dopamine activity, particularly in the mesolimbic pathway, which
is thought to be overactive in psychosis.
Other Mechanisms (Especially 2nd-Gen):
• Serotonin 5-HT2A receptor antagonism:
o Common in second-generation antipsychotics.
o May improve negative symptoms and reduce extrapyramidal side effects
(movement-related). Low risk EPS.
• Other receptors affected (varies by drug): weight gain seen with H1&5HT2C
o Histamine (H1) → sedation, weight gain,
o Alpha-1 adrenergic → orthostatic hypotension, dizziness, and sedation.
o Muscarinic (M1) → anticholinergic effects (dry mouth, constipation, sedation.)
First-Generation vs. Second-Generation Antipsychotics
First-Generation
Feature Second-Generation (Atypical)
(Typical)
Dopamine blockade Strong D2 antagonism Moderate D2 antagonism
Serotonin effects Minimal or none 5-HT2A antagonism common
EPS risk (e.g., tremor,
High Lower
rigidity)
Tardive dyskinesia risk Higher Lower (but not absent)
Effect on negative
Less effective More effective (some)
symptoms
Haloperidol, Risperidone, Olanzapine, Clozapine,
Examples
Chlorpromazine Aripiprazole
High-Potency vs. Low-Potency Antipsychotics (Mostly 1st-Gen)
