NSG 552 Midterm Comprehensive Exam
Complete Review with Rationales Latest
202/27 Academic Year
1. A patient with bipolar disorder is prescribed lithium. Which
laboratory value should the nurse monitor most closely?
• A) Serum potassium
• B) Serum sodium
• C) Serum calcium
• D) Serum magnesium
Answer: B) Serum sodium
Rationale: Lithium competes with sodium at the cellular level. Low
sodium levels can lead to lithium toxicity, while high sodium levels
can reduce lithium efficacy. Serum sodium should be monitored
regularly, especially during periods of dehydration, sweating, or
dietary changes.
2. Which neurotransmitter is primarily implicated in the
pathophysiology of schizophrenia?
• A) Norepinephrine
• B) Serotonin
• C) Dopamine
• D) Acetylcholine
, Answer: C) Dopamine
Rationale: The dopamine hypothesis suggests that schizophrenia is
related to excess dopaminergic activity, particularly in the
mesolimbic pathway. This forms the basis for the mechanism of
action of many antipsychotic medications, which work by blocking
dopamine D2 receptors.
3. A patient presents with sudden onset of severe headache,
photophobia, and nuchal rigidity. What is the priority nursing
intervention?
• A) Administer analgesic
• B) Prepare for lumbar puncture
• C) Place in dark, quiet room
• D) Initiate seizure precautions
Answer: B) Prepare for lumbar puncture
Rationale: The classic triad of severe headache, photophobia, and
nuchal rigidity suggests meningitis. A lumbar puncture is the
definitive diagnostic test to confirm meningitis by analyzing
cerebrospinal fluid. This is the priority to establish diagnosis and
guide treatment.
4. Which benzodiazepine has the shortest half-life and is most
appropriate for treating insomnia?
• A) Diazepam
• B) Clonazepam
• C) Triazolam
• D) Chlordiazepoxide
Answer: C) Triazolam
Rationale: Triazolam has a short half-life (1.5-5 hours), making it
, ideal for sleep induction without causing significant next-day
sedation. Diazepam and chlordiazepoxide have long half-lives,
while clonazepam has an intermediate half-life, making triazolam
the preferred choice for insomnia.
5. A patient with Parkinson's disease is experiencing "on-off"
phenomena. Which medication is most likely to be added to
manage this complication?
• A) Carbidopa
• B) Entacapone
• C) Selegiline
• D) Amantadine
Answer: B) Entacapone
Rationale: Entacapone is a COMT inhibitor that prolongs the action
of levodopa by preventing its breakdown. It is specifically used to
manage "on-off" phenomena in patients with Parkinson's disease
who are experiencing fluctuating responses to levodopa therapy.
6. What is the therapeutic range for serum lithium levels?
• A) 0.6-1.2 mEq/L
• B) 1.5-2.0 mEq/L
• C) 0.3-0.5 mEq/L
• D) 2.0-2.5 mEq/L
Answer: A) 0.6-1.2 mEq/L
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L for
maintenance therapy and up to 1.5 mEq/L for acute mania. Levels
above 1.5 mEq/L may indicate toxicity, with levels above 2.0 mEq/L
considered potentially life-threatening.
, 7. Which finding is characteristic of Wernicke's encephalopathy?
• A) Memory loss and confabulation
• B) Ataxia, ophthalmoplegia, and confusion
• C) Tremor and rigidity
• D) Muscle weakness and fasciculations
Answer: B) Ataxia, ophthalmoplegia, and confusion
Rationale: Wernicke's encephalopathy is a neurological emergency
caused by thiamine deficiency, most commonly seen in alcohol use
disorder. The classic triad includes ataxia (gait disturbance),
ophthalmoplegia (eye movement abnormalities), and
confusion/mental status changes.
8. A patient is started on carbamazepine for seizure disorder. Which
laboratory monitoring is essential?
• A) Liver function tests and complete blood count
• B) Renal function tests and electrolytes
• C) Thyroid function tests
• D) Cardiac enzymes
Answer: A) Liver function tests and complete blood count
Rationale: Carbamazepine can cause serious hematological effects
(agranulocytosis, aplastic anemia) and hepatotoxicity. Complete
blood count and liver function tests should be monitored regularly,
especially during the first few months of therapy.
9. Which SSRI has the longest half-life and lowest risk of withdrawal
symptoms?
Complete Review with Rationales Latest
202/27 Academic Year
1. A patient with bipolar disorder is prescribed lithium. Which
laboratory value should the nurse monitor most closely?
• A) Serum potassium
• B) Serum sodium
• C) Serum calcium
• D) Serum magnesium
Answer: B) Serum sodium
Rationale: Lithium competes with sodium at the cellular level. Low
sodium levels can lead to lithium toxicity, while high sodium levels
can reduce lithium efficacy. Serum sodium should be monitored
regularly, especially during periods of dehydration, sweating, or
dietary changes.
2. Which neurotransmitter is primarily implicated in the
pathophysiology of schizophrenia?
• A) Norepinephrine
• B) Serotonin
• C) Dopamine
• D) Acetylcholine
, Answer: C) Dopamine
Rationale: The dopamine hypothesis suggests that schizophrenia is
related to excess dopaminergic activity, particularly in the
mesolimbic pathway. This forms the basis for the mechanism of
action of many antipsychotic medications, which work by blocking
dopamine D2 receptors.
3. A patient presents with sudden onset of severe headache,
photophobia, and nuchal rigidity. What is the priority nursing
intervention?
• A) Administer analgesic
• B) Prepare for lumbar puncture
• C) Place in dark, quiet room
• D) Initiate seizure precautions
Answer: B) Prepare for lumbar puncture
Rationale: The classic triad of severe headache, photophobia, and
nuchal rigidity suggests meningitis. A lumbar puncture is the
definitive diagnostic test to confirm meningitis by analyzing
cerebrospinal fluid. This is the priority to establish diagnosis and
guide treatment.
4. Which benzodiazepine has the shortest half-life and is most
appropriate for treating insomnia?
• A) Diazepam
• B) Clonazepam
• C) Triazolam
• D) Chlordiazepoxide
Answer: C) Triazolam
Rationale: Triazolam has a short half-life (1.5-5 hours), making it
, ideal for sleep induction without causing significant next-day
sedation. Diazepam and chlordiazepoxide have long half-lives,
while clonazepam has an intermediate half-life, making triazolam
the preferred choice for insomnia.
5. A patient with Parkinson's disease is experiencing "on-off"
phenomena. Which medication is most likely to be added to
manage this complication?
• A) Carbidopa
• B) Entacapone
• C) Selegiline
• D) Amantadine
Answer: B) Entacapone
Rationale: Entacapone is a COMT inhibitor that prolongs the action
of levodopa by preventing its breakdown. It is specifically used to
manage "on-off" phenomena in patients with Parkinson's disease
who are experiencing fluctuating responses to levodopa therapy.
6. What is the therapeutic range for serum lithium levels?
• A) 0.6-1.2 mEq/L
• B) 1.5-2.0 mEq/L
• C) 0.3-0.5 mEq/L
• D) 2.0-2.5 mEq/L
Answer: A) 0.6-1.2 mEq/L
Rationale: The therapeutic range for lithium is 0.6-1.2 mEq/L for
maintenance therapy and up to 1.5 mEq/L for acute mania. Levels
above 1.5 mEq/L may indicate toxicity, with levels above 2.0 mEq/L
considered potentially life-threatening.
, 7. Which finding is characteristic of Wernicke's encephalopathy?
• A) Memory loss and confabulation
• B) Ataxia, ophthalmoplegia, and confusion
• C) Tremor and rigidity
• D) Muscle weakness and fasciculations
Answer: B) Ataxia, ophthalmoplegia, and confusion
Rationale: Wernicke's encephalopathy is a neurological emergency
caused by thiamine deficiency, most commonly seen in alcohol use
disorder. The classic triad includes ataxia (gait disturbance),
ophthalmoplegia (eye movement abnormalities), and
confusion/mental status changes.
8. A patient is started on carbamazepine for seizure disorder. Which
laboratory monitoring is essential?
• A) Liver function tests and complete blood count
• B) Renal function tests and electrolytes
• C) Thyroid function tests
• D) Cardiac enzymes
Answer: A) Liver function tests and complete blood count
Rationale: Carbamazepine can cause serious hematological effects
(agranulocytosis, aplastic anemia) and hepatotoxicity. Complete
blood count and liver function tests should be monitored regularly,
especially during the first few months of therapy.
9. Which SSRI has the longest half-life and lowest risk of withdrawal
symptoms?
