NU 643 Final Exam V3 | NU 643 Advanced
Psychopharmacology | Actual Q&A with
Rationale (NU643 Final Exam) | Regis
University
1. A patient taking Clozapine for treatment-resistant schizophrenia reports a sore throat and
fever. What is the most appropriate priority action for the psychiatric nurse practitioner?
A. Advise the patient to take over-the-counter acetaminophen for symptom relief.
B. Order an immediate Absolute Neutrophil Count (ANC) and hold the medication.
C. Increase the dose of Clozapine to cover potential psychotic exacerbation from illness.
D. Refer the patient to a primary care provider for a routine viral swab.
Answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a life-
threatening decrease in white blood cell counts. Fever and sore throat are hallmark clinical
signs of infection that may result from this condition. Immediate laboratory testing of the
ANC is required by the REMS protocol to ensure patient safety and determine if the
medication must be permanently discontinued.
2. Which mood stabilizer is most specifically associated with the rare but life-threatening side
effect of Stevens-Johnson Syndrome (SJS), particularly during the titration phase?
A. Lamotrigine
,B. Valproic Acid
C. Lithium Carbonate
D. Oxcarbazepine
Answer: A
Rationale: Lamotrigine is well-known for the risk of severe dermatological reactions,
including Stevens-Johnson Syndrome. The risk is significantly increased if the medication is
titrated too rapidly or if it is used concurrently with Valproate. Providers must strictly
follow the manufacturer’s titration schedule to mitigate this risk and educate patients to
report any new rash immediately.
3. A patient with Bipolar I Disorder is prescribed Lithium. Which of the following medication
combinations would most likely lead to increased Lithium toxicity?
A. Lithium and Lorazepam
B. Lithium and Acetaminophen
C. Lithium and Amlodipine
D. Lithium and Lisinopril
Answer: D
Rationale: ACE inhibitors like Lisinopril can significantly increase serum Lithium levels by
reducing its renal clearance. Lithium is handled by the kidneys similarly to sodium, and
drugs that affect sodium balance often impact Lithium excretion. Monitoring of serum
,Lithium levels is essential whenever an ACE inhibitor or an NSAID is added to the
treatment regimen.
4. In the treatment of Major Depressive Disorder, which antidepressant is contraindicated for
patients with a known seizure disorder or an active diagnosis of Bulimia Nervosa?
A. Sertraline
B. Mirtazapine
C. Fluoxetine
D. Bupropion
Answer: D
Rationale: Bupropion is known to lower the seizure threshold, especially at higher doses
or in vulnerable populations. It is specifically contraindicated in patients with eating
disorders like Bulimia or Anorexia due to an increased incidence of seizures in these
groups. Clinicians must screen for these conditions before initiating treatment with this
norepinephrine-dopamine reuptake inhibitor.
5. A patient experiences acute dystonia shortly after receiving an intramuscular injection of
Haloperidol. Which medication should be administered to reverse this extrapyramidal
symptom?
A. Propranolol
B. Dantrolene
C. Benztropine
, D. Bromocriptine
Answer: C
Rationale: Benztropine is an anticholinergic medication that effectively reverses acute
dystonic reactions caused by first-generation antipsychotics. These reactions result from
an imbalance between dopamine and acetylcholine in the nigrostriatal pathway.
Administering an anticholinergic restores this balance and provides rapid relief of muscle
spasms.
6. Which neurotransmitter system is primarily targeted by Benzodiazepines to produce their
anxiolytic and sedative effects?
A. Serotonin (5-HT)
B. Norepinephrine
C. Gamma-Aminobutyric Acid (GABA)
D. Glutamate
Answer: C
Rationale: Benzodiazepines act as positive allosteric modulators at the GABA-A receptor
complex. By increasing the frequency of chloride channel opening, they enhance the
inhibitory effect of GABA throughout the central nervous system. This results in the
characteristic calming, anticonvulsant, and muscle-relaxant properties associated with this
drug class.
Psychopharmacology | Actual Q&A with
Rationale (NU643 Final Exam) | Regis
University
1. A patient taking Clozapine for treatment-resistant schizophrenia reports a sore throat and
fever. What is the most appropriate priority action for the psychiatric nurse practitioner?
A. Advise the patient to take over-the-counter acetaminophen for symptom relief.
B. Order an immediate Absolute Neutrophil Count (ANC) and hold the medication.
C. Increase the dose of Clozapine to cover potential psychotic exacerbation from illness.
D. Refer the patient to a primary care provider for a routine viral swab.
Answer: B
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a life-
threatening decrease in white blood cell counts. Fever and sore throat are hallmark clinical
signs of infection that may result from this condition. Immediate laboratory testing of the
ANC is required by the REMS protocol to ensure patient safety and determine if the
medication must be permanently discontinued.
2. Which mood stabilizer is most specifically associated with the rare but life-threatening side
effect of Stevens-Johnson Syndrome (SJS), particularly during the titration phase?
A. Lamotrigine
,B. Valproic Acid
C. Lithium Carbonate
D. Oxcarbazepine
Answer: A
Rationale: Lamotrigine is well-known for the risk of severe dermatological reactions,
including Stevens-Johnson Syndrome. The risk is significantly increased if the medication is
titrated too rapidly or if it is used concurrently with Valproate. Providers must strictly
follow the manufacturer’s titration schedule to mitigate this risk and educate patients to
report any new rash immediately.
3. A patient with Bipolar I Disorder is prescribed Lithium. Which of the following medication
combinations would most likely lead to increased Lithium toxicity?
A. Lithium and Lorazepam
B. Lithium and Acetaminophen
C. Lithium and Amlodipine
D. Lithium and Lisinopril
Answer: D
Rationale: ACE inhibitors like Lisinopril can significantly increase serum Lithium levels by
reducing its renal clearance. Lithium is handled by the kidneys similarly to sodium, and
drugs that affect sodium balance often impact Lithium excretion. Monitoring of serum
,Lithium levels is essential whenever an ACE inhibitor or an NSAID is added to the
treatment regimen.
4. In the treatment of Major Depressive Disorder, which antidepressant is contraindicated for
patients with a known seizure disorder or an active diagnosis of Bulimia Nervosa?
A. Sertraline
B. Mirtazapine
C. Fluoxetine
D. Bupropion
Answer: D
Rationale: Bupropion is known to lower the seizure threshold, especially at higher doses
or in vulnerable populations. It is specifically contraindicated in patients with eating
disorders like Bulimia or Anorexia due to an increased incidence of seizures in these
groups. Clinicians must screen for these conditions before initiating treatment with this
norepinephrine-dopamine reuptake inhibitor.
5. A patient experiences acute dystonia shortly after receiving an intramuscular injection of
Haloperidol. Which medication should be administered to reverse this extrapyramidal
symptom?
A. Propranolol
B. Dantrolene
C. Benztropine
, D. Bromocriptine
Answer: C
Rationale: Benztropine is an anticholinergic medication that effectively reverses acute
dystonic reactions caused by first-generation antipsychotics. These reactions result from
an imbalance between dopamine and acetylcholine in the nigrostriatal pathway.
Administering an anticholinergic restores this balance and provides rapid relief of muscle
spasms.
6. Which neurotransmitter system is primarily targeted by Benzodiazepines to produce their
anxiolytic and sedative effects?
A. Serotonin (5-HT)
B. Norepinephrine
C. Gamma-Aminobutyric Acid (GABA)
D. Glutamate
Answer: C
Rationale: Benzodiazepines act as positive allosteric modulators at the GABA-A receptor
complex. By increasing the frequency of chloride channel opening, they enhance the
inhibitory effect of GABA throughout the central nervous system. This results in the
characteristic calming, anticonvulsant, and muscle-relaxant properties associated with this
drug class.
