NR605 Final Exam Actual Exam Style V3 | NR 605
Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan | Chamberlain
1. A 72-year-old patient recently started on Sertraline presents with confusion,
headache, and a sodium level of 122 mEq/L. Which of the following is the most likely
diagnosis?
A. Serotonin Syndrome
B. SIADH
C. Hypertensive Crisis
D. Anticholinergic Toxicity
Correct Answer: B
Expert Explanation: Selective Serotonin Reuptake Inhibitors (SSRIs) are frequently
associated with the development of SIADH, particularly in the elderly population.
This condition leads to dilutional hyponatremia, which manifests as neurological
changes and low serum sodium levels. Providers must monitor electrolytes closely
when initiating antidepressants in older adults.
,2. When prescribing Clozapine (Clozaril), the PMHNP must monitor the Absolute
Neutrophil Count (ANC). What is the minimum ANC required to initiate treatment in a
non-benign ethnic neutropenia patient?
A. 500/mm³
B. 1000/mm³
C. 2000/mm³
D. 1500/mm³
Correct Answer: D
Expert Explanation: A baseline ANC of at least 1500/mm³ is required before
starting Clozapine to ensure patient safety regarding agranulocytosis. This strict
monitoring is part of the Risk Evaluation and Mitigation Strategy (REMS) program. If
the ANC falls below certain thresholds, the medication must be interrupted or
discontinued to prevent life-threatening infections.
3. A patient with Bipolar I Disorder presents with coarse tremors, ataxia, and a lithium
level of 2.1 mEq/L. What is the most appropriate immediate intervention?
A. Increase the dose to stabilize the mood.
B. Hold the lithium dose and encourage fluid intake.
C. Administer a dose of Valproate.
,D. Refer for immediate hemodialysis.
Correct Answer: B
Expert Explanation: A lithium level of 2.1 mEq/L indicates moderate to severe
toxicity, requiring immediate cessation of the drug. Symptoms like coarse tremors
and ataxia are hallmark signs of lithium poisoning. While severe cases over 2.5
mEq/L often require dialysis, initial management for this level involves hydration
and holding the medication.
4. Which antidepressant is strictly contraindicated in patients with a history of
seizures or eating disorders due to an increased risk of lowering the seizure threshold?
A. Bupropion
B. Fluoxetine
C. Mirtazapine
D. Venlafaxine
Correct Answer: A
Expert Explanation: Bupropion is known to significantly lower the seizure
threshold, especially in patients with electrolyte imbalances common in eating
disorders. It is specifically contraindicated in individuals with anorexia or bulimia
nervosa. PMHNPs should screen for these conditions before prescribing any
formulation of Wellbutrin.
, 5. A patient is brought to the ED with a temperature of 104°F, ‘lead-pipe’ muscle
rigidity, and autonomic instability after starting Haloperidol. What is the likely
diagnosis?
A. Acute Dystonia
B. Serotonin Syndrome
C. Malignant Hyperthermia
D. Neuroleptic Malignant Syndrome
Correct Answer: D
Expert Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening
reaction to dopamine antagonists characterized by extreme muscle rigidity and high
fever. It is distinguished from Serotonin Syndrome by the presence of ‘lead-pipe’
rigidity rather than hyperreflexia. Treatment involves immediate discontinuation of
the antipsychotic and supportive care.
6. According to the DSM-5-TR, what is the minimum duration of symptoms required to
diagnose a patient with Generalized Anxiety Disorder?
A. 2 weeks
B. 6 months
C. 3 months
Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan | Chamberlain
1. A 72-year-old patient recently started on Sertraline presents with confusion,
headache, and a sodium level of 122 mEq/L. Which of the following is the most likely
diagnosis?
A. Serotonin Syndrome
B. SIADH
C. Hypertensive Crisis
D. Anticholinergic Toxicity
Correct Answer: B
Expert Explanation: Selective Serotonin Reuptake Inhibitors (SSRIs) are frequently
associated with the development of SIADH, particularly in the elderly population.
This condition leads to dilutional hyponatremia, which manifests as neurological
changes and low serum sodium levels. Providers must monitor electrolytes closely
when initiating antidepressants in older adults.
,2. When prescribing Clozapine (Clozaril), the PMHNP must monitor the Absolute
Neutrophil Count (ANC). What is the minimum ANC required to initiate treatment in a
non-benign ethnic neutropenia patient?
A. 500/mm³
B. 1000/mm³
C. 2000/mm³
D. 1500/mm³
Correct Answer: D
Expert Explanation: A baseline ANC of at least 1500/mm³ is required before
starting Clozapine to ensure patient safety regarding agranulocytosis. This strict
monitoring is part of the Risk Evaluation and Mitigation Strategy (REMS) program. If
the ANC falls below certain thresholds, the medication must be interrupted or
discontinued to prevent life-threatening infections.
3. A patient with Bipolar I Disorder presents with coarse tremors, ataxia, and a lithium
level of 2.1 mEq/L. What is the most appropriate immediate intervention?
A. Increase the dose to stabilize the mood.
B. Hold the lithium dose and encourage fluid intake.
C. Administer a dose of Valproate.
,D. Refer for immediate hemodialysis.
Correct Answer: B
Expert Explanation: A lithium level of 2.1 mEq/L indicates moderate to severe
toxicity, requiring immediate cessation of the drug. Symptoms like coarse tremors
and ataxia are hallmark signs of lithium poisoning. While severe cases over 2.5
mEq/L often require dialysis, initial management for this level involves hydration
and holding the medication.
4. Which antidepressant is strictly contraindicated in patients with a history of
seizures or eating disorders due to an increased risk of lowering the seizure threshold?
A. Bupropion
B. Fluoxetine
C. Mirtazapine
D. Venlafaxine
Correct Answer: A
Expert Explanation: Bupropion is known to significantly lower the seizure
threshold, especially in patients with electrolyte imbalances common in eating
disorders. It is specifically contraindicated in individuals with anorexia or bulimia
nervosa. PMHNPs should screen for these conditions before prescribing any
formulation of Wellbutrin.
, 5. A patient is brought to the ED with a temperature of 104°F, ‘lead-pipe’ muscle
rigidity, and autonomic instability after starting Haloperidol. What is the likely
diagnosis?
A. Acute Dystonia
B. Serotonin Syndrome
C. Malignant Hyperthermia
D. Neuroleptic Malignant Syndrome
Correct Answer: D
Expert Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening
reaction to dopamine antagonists characterized by extreme muscle rigidity and high
fever. It is distinguished from Serotonin Syndrome by the presence of ‘lead-pipe’
rigidity rather than hyperreflexia. Treatment involves immediate discontinuation of
the antipsychotic and supportive care.
6. According to the DSM-5-TR, what is the minimum duration of symptoms required to
diagnose a patient with Generalized Anxiety Disorder?
A. 2 weeks
B. 6 months
C. 3 months
