NR607 Exam 1 Actual Exam Style V2 | NR
607 Diagnosis & Management in
Psychiatric-Mental Health III Practicum |
Chamberlain
1. A 24-year-old patient diagnosed with Bipolar I Disorder is started on Lithium. What is the
target therapeutic serum level for acute mania, and what is the PMHNP’s priority for
monitoring?
A. 0.4 to 0.8 mEq/L; monitoring for weight gain
B. 0.8 to 1.2 mEq/L; monitoring for toxicity signs like ataxia and tremors
C. 1.2 to 2.0 mEq/L; monitoring for hypertensive crisis
D. 0.5 to 1.5 mEq/L; monitoring for agranulocytosis
Correct Answer: B
Expert Explanation: The therapeutic range for Lithium in acute mania is typically 0.8 to
1.2 mEq/L. Levels exceeding 1.5 mEq/L can lead to toxicity, which manifests as ataxia,
coarse tremors, and confusion. The PMHNP must monitor renal function and thyroid levels
periodically while the patient is on this medication.
2. A patient is prescribed Clozapine for treatment-resistant Schizophrenia. Which lab value is
most critical for the PMHNP to monitor to prevent life-threatening complications?
A. Liver function tests (LFTs)
B. Serum creatinine
,C. Thyroid Stimulating Hormone (TSH)
D. Absolute Neutrophil Count (ANC)
Correct Answer: D
Expert Explanation: Clozapine carries a black box warning for agranulocytosis,
necessitating strict monitoring of the ANC. According to the REMS program, the ANC must
be 1500/mm3 or higher to initiate treatment. If the ANC drops significantly, the medication
must be discontinued to prevent fatal infections.
3. A patient presents with high fever, ‘lead-pipe’ muscle rigidity, and autonomic instability
after starting Haloperidol. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Anticholinergic Toxicity
C. Serotonin Syndrome
D. Acute Dystonic Reaction
Correct Answer: A
Expert Explanation: Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening
reaction to antipsychotics characterized by severe rigidity and hyperpyrexia. It differs from
Serotonin Syndrome, which usually involves hyperreflexia rather than lead-pipe rigidity.
Immediate discontinuation of the offending agent and supportive care are essential
interventions for the PMHNP.
, 4. During a diagnostic interview, a patient reports feeling depressed most of the day, nearly
every day, for at least 2 years. Which diagnosis should the PMHNP consider?
A. Persistent Depressive Disorder (Dysthymia)
B. Major Depressive Disorder
C. Cyclothymic Disorder
D. Adjustment Disorder with Depressed Mood
Correct Answer: A
Expert Explanation: Persistent Depressive Disorder is characterized by a depressed mood
that occurs for most of the day for at least two years in adults. In children and adolescents,
the duration requirement is one year and the mood may be irritable. This condition
involves chronic low-grade depression rather than the episodic nature of Major Depressive
Disorder.
5. Which medication is considered first-line for a patient with Generalized Anxiety Disorder
(GAD) who also has a history of substance abuse?
A. Alprazolam
B. Buspirone
C. Diazepam
D. Lorazepam
Correct Answer: B
607 Diagnosis & Management in
Psychiatric-Mental Health III Practicum |
Chamberlain
1. A 24-year-old patient diagnosed with Bipolar I Disorder is started on Lithium. What is the
target therapeutic serum level for acute mania, and what is the PMHNP’s priority for
monitoring?
A. 0.4 to 0.8 mEq/L; monitoring for weight gain
B. 0.8 to 1.2 mEq/L; monitoring for toxicity signs like ataxia and tremors
C. 1.2 to 2.0 mEq/L; monitoring for hypertensive crisis
D. 0.5 to 1.5 mEq/L; monitoring for agranulocytosis
Correct Answer: B
Expert Explanation: The therapeutic range for Lithium in acute mania is typically 0.8 to
1.2 mEq/L. Levels exceeding 1.5 mEq/L can lead to toxicity, which manifests as ataxia,
coarse tremors, and confusion. The PMHNP must monitor renal function and thyroid levels
periodically while the patient is on this medication.
2. A patient is prescribed Clozapine for treatment-resistant Schizophrenia. Which lab value is
most critical for the PMHNP to monitor to prevent life-threatening complications?
A. Liver function tests (LFTs)
B. Serum creatinine
,C. Thyroid Stimulating Hormone (TSH)
D. Absolute Neutrophil Count (ANC)
Correct Answer: D
Expert Explanation: Clozapine carries a black box warning for agranulocytosis,
necessitating strict monitoring of the ANC. According to the REMS program, the ANC must
be 1500/mm3 or higher to initiate treatment. If the ANC drops significantly, the medication
must be discontinued to prevent fatal infections.
3. A patient presents with high fever, ‘lead-pipe’ muscle rigidity, and autonomic instability
after starting Haloperidol. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Anticholinergic Toxicity
C. Serotonin Syndrome
D. Acute Dystonic Reaction
Correct Answer: A
Expert Explanation: Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening
reaction to antipsychotics characterized by severe rigidity and hyperpyrexia. It differs from
Serotonin Syndrome, which usually involves hyperreflexia rather than lead-pipe rigidity.
Immediate discontinuation of the offending agent and supportive care are essential
interventions for the PMHNP.
, 4. During a diagnostic interview, a patient reports feeling depressed most of the day, nearly
every day, for at least 2 years. Which diagnosis should the PMHNP consider?
A. Persistent Depressive Disorder (Dysthymia)
B. Major Depressive Disorder
C. Cyclothymic Disorder
D. Adjustment Disorder with Depressed Mood
Correct Answer: A
Expert Explanation: Persistent Depressive Disorder is characterized by a depressed mood
that occurs for most of the day for at least two years in adults. In children and adolescents,
the duration requirement is one year and the mood may be irritable. This condition
involves chronic low-grade depression rather than the episodic nature of Major Depressive
Disorder.
5. Which medication is considered first-line for a patient with Generalized Anxiety Disorder
(GAD) who also has a history of substance abuse?
A. Alprazolam
B. Buspirone
C. Diazepam
D. Lorazepam
Correct Answer: B
