NRNP 6675 PMHNP ADVANCED CARE
EXAM QUESTIONS AND ANSWERS 2027
1. A 34-year-old male with Schizophrenia is started on Clozapine after failing two other
antipsychotics. After 6 months of treatment, his Absolute Neutrophil Count (ANC) drops to
1,250/mm³. Which of the following is the most appropriate action according to the Clozapine
REMS program?
A. Continue treatment and monitor ANC weekly
B. Immediately discontinue Clozapine and never rechallenge the patient
C. Interrupt treatment, consult hematology, and monitor ANC daily until it returns to
≥1500/mm³
D. Reduce the dose by 50% and repeat the lab in 48 hours
Answer: C
Conceptual Explanation: For mild neutropenia (ANC 1000-1499/mm³), the REMS
program guidelines suggest continuing treatment but increasing monitoring to 3 times
weekly. However, if the clinical situation or a sharper drop is noted, interrupting treatment
and daily monitoring until recovery is a standard high-level safety protocol before making a
rechallenge decision.
,2. Which neuroanatomical pathway is primarily associated with the ‘negative’ symptoms of
schizophrenia, such as alogia and avolition?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: Negative symptoms are thought to be caused by
hypodopaminergic activity in the mesocortical pathway, specifically the prefrontal cortex.
3. A 24-year-old female presents with rapid-cycling Bipolar I Disorder. She is currently taking
Valproate but reports significant hair loss and weight gain. Which of the following mood
stabilizers is the most appropriate alternative that also provides robust evidence for reducing
suicidal ideation?
A. Lithium
B. Lamotrigine
C. Carbamazepine
D. Topiramate
Answer: A
, Conceptual Explanation: Lithium is the gold standard for reducing suicide risk in Bipolar
Disorder and is often used when other mood stabilizers are poorly tolerated or insufficient.
4. In the treatment of Obsessive-Compulsive Disorder (OCD), which pharmacological
intervention is considered a gold-standard second-line treatment when SSRIs fail?
A. Bupropion
B. Buspirone
C. Quetiapine
D. Clomipramine
Answer: D
Conceptual Explanation: Clomipramine, a tricyclic antidepressant with high serotonin
reuptake inhibition, is highly effective for OCD but is often second-line due to its side effect
profile compared to SSRIs.
5. According to Erik Erikson’s stages of psychosocial development, a 70-year-old patient
struggling with the meaning of their life and feeling that they have made too many poor
choices is likely experiencing a crisis in which stage?
A. Generativity vs. Stagnation
B. Intimacy vs. Isolation
C. Autonomy vs. Shame and Doubt
D. Integrity vs. Despair
EXAM QUESTIONS AND ANSWERS 2027
1. A 34-year-old male with Schizophrenia is started on Clozapine after failing two other
antipsychotics. After 6 months of treatment, his Absolute Neutrophil Count (ANC) drops to
1,250/mm³. Which of the following is the most appropriate action according to the Clozapine
REMS program?
A. Continue treatment and monitor ANC weekly
B. Immediately discontinue Clozapine and never rechallenge the patient
C. Interrupt treatment, consult hematology, and monitor ANC daily until it returns to
≥1500/mm³
D. Reduce the dose by 50% and repeat the lab in 48 hours
Answer: C
Conceptual Explanation: For mild neutropenia (ANC 1000-1499/mm³), the REMS
program guidelines suggest continuing treatment but increasing monitoring to 3 times
weekly. However, if the clinical situation or a sharper drop is noted, interrupting treatment
and daily monitoring until recovery is a standard high-level safety protocol before making a
rechallenge decision.
,2. Which neuroanatomical pathway is primarily associated with the ‘negative’ symptoms of
schizophrenia, such as alogia and avolition?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: Negative symptoms are thought to be caused by
hypodopaminergic activity in the mesocortical pathway, specifically the prefrontal cortex.
3. A 24-year-old female presents with rapid-cycling Bipolar I Disorder. She is currently taking
Valproate but reports significant hair loss and weight gain. Which of the following mood
stabilizers is the most appropriate alternative that also provides robust evidence for reducing
suicidal ideation?
A. Lithium
B. Lamotrigine
C. Carbamazepine
D. Topiramate
Answer: A
, Conceptual Explanation: Lithium is the gold standard for reducing suicide risk in Bipolar
Disorder and is often used when other mood stabilizers are poorly tolerated or insufficient.
4. In the treatment of Obsessive-Compulsive Disorder (OCD), which pharmacological
intervention is considered a gold-standard second-line treatment when SSRIs fail?
A. Bupropion
B. Buspirone
C. Quetiapine
D. Clomipramine
Answer: D
Conceptual Explanation: Clomipramine, a tricyclic antidepressant with high serotonin
reuptake inhibition, is highly effective for OCD but is often second-line due to its side effect
profile compared to SSRIs.
5. According to Erik Erikson’s stages of psychosocial development, a 70-year-old patient
struggling with the meaning of their life and feeling that they have made too many poor
choices is likely experiencing a crisis in which stage?
A. Generativity vs. Stagnation
B. Intimacy vs. Isolation
C. Autonomy vs. Shame and Doubt
D. Integrity vs. Despair
