NR546 PSYCHOPHARMACOLOGY
ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A patient taking Lithium for Bipolar I Disorder presents with coarse tremors, ataxia, and a
serum lithium level of 1.6 mEq/L. Which action is most appropriate?
A. Continue the current dose and recheck in one week.
B. Increase the dose to reach therapeutic levels.
C. Administer a dose of Benztropine immediately.
D. Hold the dose and evaluate for lithium toxicity.
Answer: D
Conceptual Explanation: Lithium levels above 1.5 mEq/L are generally considered toxic.
Symptoms like coarse tremors and ataxia are signs of moderate to severe toxicity, requiring
immediate cessation of the drug and medical evaluation.
2. Which laboratory value is the most critical to monitor for a patient starting Clozapine
(Clozaril)?
A. Serum Glucose
,B. Liver Function Tests (LFTs)
C. Absolute Neutrophil Count (ANC)
D. Thyroid Stimulating Hormone (TSH)
Answer: C
Conceptual Explanation: Clozapine carries a Black Box Warning for agranulocytosis. The
Absolute Neutrophil Count (ANC) must be monitored weekly for the first six months to
ensure patient safety.
3. When switching a patient from Fluoxetine (Prozac) to a Monoamine Oxidase Inhibitor
(MAOI), how long should the washout period be?
A. 2 days
B. 5 weeks
C. 2 weeks
D. 1 week
Answer: B
Conceptual Explanation: Due to the long half-life of Fluoxetine and its active metabolite
norfluoxetine, a 5-week washout period is required to prevent Serotonin Syndrome when
switching to an MAOI.
4. Which mechanism of action best describes Aripiprazole (Abilify)?
A. Full D2 receptor antagonist
, B. GABA-A receptor modulator
C. Selective serotonin reuptake inhibitor
D. Partial D2 receptor agonist
Answer: D
Conceptual Explanation: Aripiprazole is a third-generation antipsychotic that acts as a
partial agonist at D2 and 5-HT1A receptors, which helps stabilize dopamine activity.
5. A patient develops ‘lead-pipe’ muscle rigidity, high fever, and autonomic instability after
starting Haloperidol. What is the suspected diagnosis?
A. Serotonin Syndrome
B. Acute Dystonia
C. Neuroleptic Malignant Syndrome (NMS)
D. Akathisia
Answer: C
Conceptual Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by severe rigidity, hyperthermia, and autonomic dysfunction. Lead-pipe
rigidity is a hallmark sign.
6. Which medication is considered a first-line treatment for a patient with ADHD and a co-
occurring stimulant use disorder?
A. Atomoxetine
ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A patient taking Lithium for Bipolar I Disorder presents with coarse tremors, ataxia, and a
serum lithium level of 1.6 mEq/L. Which action is most appropriate?
A. Continue the current dose and recheck in one week.
B. Increase the dose to reach therapeutic levels.
C. Administer a dose of Benztropine immediately.
D. Hold the dose and evaluate for lithium toxicity.
Answer: D
Conceptual Explanation: Lithium levels above 1.5 mEq/L are generally considered toxic.
Symptoms like coarse tremors and ataxia are signs of moderate to severe toxicity, requiring
immediate cessation of the drug and medical evaluation.
2. Which laboratory value is the most critical to monitor for a patient starting Clozapine
(Clozaril)?
A. Serum Glucose
,B. Liver Function Tests (LFTs)
C. Absolute Neutrophil Count (ANC)
D. Thyroid Stimulating Hormone (TSH)
Answer: C
Conceptual Explanation: Clozapine carries a Black Box Warning for agranulocytosis. The
Absolute Neutrophil Count (ANC) must be monitored weekly for the first six months to
ensure patient safety.
3. When switching a patient from Fluoxetine (Prozac) to a Monoamine Oxidase Inhibitor
(MAOI), how long should the washout period be?
A. 2 days
B. 5 weeks
C. 2 weeks
D. 1 week
Answer: B
Conceptual Explanation: Due to the long half-life of Fluoxetine and its active metabolite
norfluoxetine, a 5-week washout period is required to prevent Serotonin Syndrome when
switching to an MAOI.
4. Which mechanism of action best describes Aripiprazole (Abilify)?
A. Full D2 receptor antagonist
, B. GABA-A receptor modulator
C. Selective serotonin reuptake inhibitor
D. Partial D2 receptor agonist
Answer: D
Conceptual Explanation: Aripiprazole is a third-generation antipsychotic that acts as a
partial agonist at D2 and 5-HT1A receptors, which helps stabilize dopamine activity.
5. A patient develops ‘lead-pipe’ muscle rigidity, high fever, and autonomic instability after
starting Haloperidol. What is the suspected diagnosis?
A. Serotonin Syndrome
B. Acute Dystonia
C. Neuroleptic Malignant Syndrome (NMS)
D. Akathisia
Answer: C
Conceptual Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by severe rigidity, hyperthermia, and autonomic dysfunction. Lead-pipe
rigidity is a hallmark sign.
6. Which medication is considered a first-line treatment for a patient with ADHD and a co-
occurring stimulant use disorder?
A. Atomoxetine
