NSG 552 Final Exam V3 | NSG 552
Psychopharmacology | Wilkes University |
2026 Q&A with Rationale (Wilkes NSG552
Final Exam 2026)
1. A patient taking Clozapine presents with a sudden fever and a sore throat. Which
laboratory assessment is the most urgent priority for the psychiatric mental health nurse
practitioner to order?
A. Liver Function Tests (LFTs)
B. Serum Clozapine level
C. Absolute Neutrophil Count (ANC)
D. Fastest Blood Glucose
Answer: C
Rationale: Clozapine is associated with a high risk of agranulocytosis, which can lead to
life-threatening infections. Fever and sore throat are common clinical signs of a dropping
white blood cell count. The Absolute Neutrophil Count (ANC) must be monitored strictly
according to the Risk Evaluation and Mitigation Strategy (REMS) protocol.
2. When prescribing Lithium for a patient with Bipolar I Disorder, which of the following
results would be most concerning regarding renal function?
A. BUN of 15 mg/dL
,B. Glomerular Filtration Rate (GFR) of 45 mL/min
C. Serum Sodium of 140 mEq/L
D. Urine specific gravity of 1.010
Answer: B
Rationale: Lithium is primarily excreted by the kidneys and requires adequate renal
clearance to prevent toxicity. A GFR of 45 mL/min indicates moderate renal impairment,
which increases the risk of Lithium accumulation. The clinician must adjust the dose or
consider alternative mood stabilizers if renal function is compromised.
3. A patient is initiated on Lamotrigine for mood stabilization. Which instruction is vital to
include during the patient education session?
A. Limit fluid intake to prevent water intoxication.
B. Avoid foods containing tyramine.
C. Expect a full therapeutic response within 48 hours.
D. Report any new skin rashes immediately.
Answer: D
Rationale: Lamotrigine carries a black box warning for Stevens-Johnson Syndrome (SJS), a
potentially fatal skin reaction. Patients must be taught to identify and report any rash or
mucosal involvement immediately. The titration schedule is deliberately slow to minimize
the risk of this severe dermatological event.
, 4. Which neurotransmitter system is primarily targeted by traditional First-Generation
Antipsychotics (FGAs) like Haloperidol?
A. Serotonin 2A antagonism
B. N-methyl-D-aspartate (NMDA) antagonism
C. GABA-A receptor agonism
D. Dopamine D2 antagonism
Answer: D
Rationale: FGAs act predominantly by blocking Dopamine D2 receptors in the mesolimbic
and nigrostriatal pathways. While effective for positive symptoms of schizophrenia, this
mechanism leads to a high incidence of extrapyramidal symptoms (EPS). Second-
generation agents differ by their additional 5-HT2A antagonism.
5. A patient with depression and chronic neuropathic pain would most likely benefit from
which medication class?
A. Selective Serotonin Reuptake Inhibitors (SSRIs)
B. Beta-Blockers
C. Benzodiazepines
D. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Answer: D
Psychopharmacology | Wilkes University |
2026 Q&A with Rationale (Wilkes NSG552
Final Exam 2026)
1. A patient taking Clozapine presents with a sudden fever and a sore throat. Which
laboratory assessment is the most urgent priority for the psychiatric mental health nurse
practitioner to order?
A. Liver Function Tests (LFTs)
B. Serum Clozapine level
C. Absolute Neutrophil Count (ANC)
D. Fastest Blood Glucose
Answer: C
Rationale: Clozapine is associated with a high risk of agranulocytosis, which can lead to
life-threatening infections. Fever and sore throat are common clinical signs of a dropping
white blood cell count. The Absolute Neutrophil Count (ANC) must be monitored strictly
according to the Risk Evaluation and Mitigation Strategy (REMS) protocol.
2. When prescribing Lithium for a patient with Bipolar I Disorder, which of the following
results would be most concerning regarding renal function?
A. BUN of 15 mg/dL
,B. Glomerular Filtration Rate (GFR) of 45 mL/min
C. Serum Sodium of 140 mEq/L
D. Urine specific gravity of 1.010
Answer: B
Rationale: Lithium is primarily excreted by the kidneys and requires adequate renal
clearance to prevent toxicity. A GFR of 45 mL/min indicates moderate renal impairment,
which increases the risk of Lithium accumulation. The clinician must adjust the dose or
consider alternative mood stabilizers if renal function is compromised.
3. A patient is initiated on Lamotrigine for mood stabilization. Which instruction is vital to
include during the patient education session?
A. Limit fluid intake to prevent water intoxication.
B. Avoid foods containing tyramine.
C. Expect a full therapeutic response within 48 hours.
D. Report any new skin rashes immediately.
Answer: D
Rationale: Lamotrigine carries a black box warning for Stevens-Johnson Syndrome (SJS), a
potentially fatal skin reaction. Patients must be taught to identify and report any rash or
mucosal involvement immediately. The titration schedule is deliberately slow to minimize
the risk of this severe dermatological event.
, 4. Which neurotransmitter system is primarily targeted by traditional First-Generation
Antipsychotics (FGAs) like Haloperidol?
A. Serotonin 2A antagonism
B. N-methyl-D-aspartate (NMDA) antagonism
C. GABA-A receptor agonism
D. Dopamine D2 antagonism
Answer: D
Rationale: FGAs act predominantly by blocking Dopamine D2 receptors in the mesolimbic
and nigrostriatal pathways. While effective for positive symptoms of schizophrenia, this
mechanism leads to a high incidence of extrapyramidal symptoms (EPS). Second-
generation agents differ by their additional 5-HT2A antagonism.
5. A patient with depression and chronic neuropathic pain would most likely benefit from
which medication class?
A. Selective Serotonin Reuptake Inhibitors (SSRIs)
B. Beta-Blockers
C. Benzodiazepines
D. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Answer: D
