NURS 663 Exam 1 V1 | NURS 663
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 1 2026)
1. A 28-year-old female patient is being started on Fluoxetine for Major Depressive Disorder.
Which characteristic of Fluoxetine distinguishes it most significantly from other SSRIs
regarding its washout period?
A. It has the shortest half-life among all SSRIs.
B. It causes immediate weight loss upon initiation.
C. It has an exceptionally long half-life due to its active metabolite, norfluoxetine.
D. It requires a twice-daily dosing schedule to maintain therapeutic levels.
Answer: C
Rationale: Fluoxetine is unique among SSRIs because its active metabolite, norfluoxetine,
has a half-life of up to 1-2 weeks. This necessitates a 5-week washout period before starting
a Monoamine Oxidase Inhibitor (MAOI) to prevent serotonin syndrome. Other SSRIs
typically only require a 2-week washout period due to shorter half-lives.
,2. When prescribing Clozapine for a patient with treatment-resistant schizophrenia, the
PMHNP must monitor the Absolute Neutrophil Count (ANC). Which ANC level requires
immediate discontinuation of the medication according to the Clozapine REMS program for a
general population patient?
A. ANC < 1500/µL
B. ANC < 2000/µL
C. ANC < 500/µL
D. ANC < 1000/µL
Answer: D
Rationale: For the general population, a Clozapine treatment interruption is required if the
ANC drops below 1000/µL. This protocol is strictly enforced to manage the risk of severe
neutropenia and potential agranulocytosis. Monitoring is done weekly for the first six
months, then biweekly, and eventually monthly if levels remain stable.
3. A patient with Bipolar I Disorder is started on Lithium. The PMHNP explains that Lithium
has a narrow therapeutic index. What is the standard therapeutic range for Lithium in the
maintenance phase of treatment?
A. 0.1 to 0.5 mEq/L
B. 0.6 to 1.2 mEq/L
C. 1.5 to 2.0 mEq/L
D. 2.5 to 3.0 mEq/L
, Answer: B
Rationale: The standard therapeutic maintenance range for Lithium is typically 0.6 to 1.2
mEq/L. Levels exceeding 1.5 mEq/L are generally considered toxic and can lead to
symptoms such as tremors, ataxia, and confusion. Regular blood draws are essential to
ensure the dose is both effective and safe for the patient’s renal system.
4. A PMHNP is considering Lamotrigine for a patient with Bipolar II Disorder. What is the most
critical instruction regarding the titration schedule to minimize the risk of Stevens-Johnson
Syndrome (SJS)?
A. Start at 100 mg daily and double the dose every three days.
B. Discontinue immediately if any mild gastrointestinal upset occurs.
C. Take the medication with high-fat meals to increase absorption.
D. Start at 25 mg daily for two weeks and follow a slow titration schedule.
Answer: D
Rationale: A slow titration of Lamotrigine, starting at 25 mg daily for two weeks, is
mandatory to reduce the risk of life-threatening rashes like SJS. Rapid escalation is the
primary risk factor for developing severe dermatological reactions. Patients must be
educated to report any new rash immediately, regardless of how minor it appears.
5. Which dopamine pathway is primarily responsible for the ‘positive’ symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 1 2026)
1. A 28-year-old female patient is being started on Fluoxetine for Major Depressive Disorder.
Which characteristic of Fluoxetine distinguishes it most significantly from other SSRIs
regarding its washout period?
A. It has the shortest half-life among all SSRIs.
B. It causes immediate weight loss upon initiation.
C. It has an exceptionally long half-life due to its active metabolite, norfluoxetine.
D. It requires a twice-daily dosing schedule to maintain therapeutic levels.
Answer: C
Rationale: Fluoxetine is unique among SSRIs because its active metabolite, norfluoxetine,
has a half-life of up to 1-2 weeks. This necessitates a 5-week washout period before starting
a Monoamine Oxidase Inhibitor (MAOI) to prevent serotonin syndrome. Other SSRIs
typically only require a 2-week washout period due to shorter half-lives.
,2. When prescribing Clozapine for a patient with treatment-resistant schizophrenia, the
PMHNP must monitor the Absolute Neutrophil Count (ANC). Which ANC level requires
immediate discontinuation of the medication according to the Clozapine REMS program for a
general population patient?
A. ANC < 1500/µL
B. ANC < 2000/µL
C. ANC < 500/µL
D. ANC < 1000/µL
Answer: D
Rationale: For the general population, a Clozapine treatment interruption is required if the
ANC drops below 1000/µL. This protocol is strictly enforced to manage the risk of severe
neutropenia and potential agranulocytosis. Monitoring is done weekly for the first six
months, then biweekly, and eventually monthly if levels remain stable.
3. A patient with Bipolar I Disorder is started on Lithium. The PMHNP explains that Lithium
has a narrow therapeutic index. What is the standard therapeutic range for Lithium in the
maintenance phase of treatment?
A. 0.1 to 0.5 mEq/L
B. 0.6 to 1.2 mEq/L
C. 1.5 to 2.0 mEq/L
D. 2.5 to 3.0 mEq/L
, Answer: B
Rationale: The standard therapeutic maintenance range for Lithium is typically 0.6 to 1.2
mEq/L. Levels exceeding 1.5 mEq/L are generally considered toxic and can lead to
symptoms such as tremors, ataxia, and confusion. Regular blood draws are essential to
ensure the dose is both effective and safe for the patient’s renal system.
4. A PMHNP is considering Lamotrigine for a patient with Bipolar II Disorder. What is the most
critical instruction regarding the titration schedule to minimize the risk of Stevens-Johnson
Syndrome (SJS)?
A. Start at 100 mg daily and double the dose every three days.
B. Discontinue immediately if any mild gastrointestinal upset occurs.
C. Take the medication with high-fat meals to increase absorption.
D. Start at 25 mg daily for two weeks and follow a slow titration schedule.
Answer: D
Rationale: A slow titration of Lamotrigine, starting at 25 mg daily for two weeks, is
mandatory to reduce the risk of life-threatening rashes like SJS. Rapid escalation is the
primary risk factor for developing severe dermatological reactions. Patients must be
educated to report any new rash immediately, regardless of how minor it appears.
5. Which dopamine pathway is primarily responsible for the ‘positive’ symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
