NR 607 Advanced Psychiatric-Mental
Health Nursing III: Final Exam Study
Compendium || Chamberlain College of
Nursing – Academic Year 2026/2027 –
Final Comprehensive Examination with
100 Verified Questions and Correct
Answer Rationales
SECTION A: PSYCHOPHARMACOLOGY (Questions 1–20)
1. A 34-year-old patient with schizophrenia has been on clozapine for 6
months. She reports a new onset of fever, sore throat, and malaise. What is the
priority action?
• A) Order a STAT comprehensive metabolic panel (CMP)
• B) Prescribe a broad-spectrum antibiotic
• C) Hold the clozapine and order a STAT white blood cell (WBC) count with
differential
• D) Increase the clozapine dose to overcome the infection
• Answer: C
• Rationale: Clozapine carries a black-box warning for agranulocytosis (severe
neutropenia). Fever and sore throat are hallmark signs of infection due to
neutropenia. The medication must be held immediately, and a STAT WBC with
differential is required to check the absolute neutrophil count (ANC).
2. A patient on lithium carbonate presents with coarse tremors, ataxia,
vomiting, and diarrhea. His serum lithium level is 2.1 mEq/L. How should the
provider interpret this?
• A) Subtherapeutic level; increase the dose
• B) Therapeutic level; reassure the patient
, • C) Mild toxicity; hold the next dose and recheck
• D) Severe toxicity; prepare for hemodialysis
• Answer: C
• Rationale: The therapeutic range for lithium is 0.6–1.2 mEq/L. Levels between
1.5 and 2.5 mEq/L indicate moderate to severe toxicity, presenting with GI
distress, coarse tremors, and ataxia. The medication should be held, and fluids
should be encouraged. Hemodialysis is typically reserved for levels > 2.5
mEq/L or severe neurological symptoms.
3. Which of the following atypical antipsychotics is MOST associated with
significant weight gain, dyslipidemia, and diabetes?
• A) Aripiprazole
• B) Ziprasidone
• C) Olanzapine
• D) Lurasidone
• Answer: C
• Rationale: Olanzapine has the highest metabolic side-effect profile among
atypical antipsychotics. Aripiprazole, ziprasidone, and lurasidone are
considered more metabolically neutral.
4. A patient with treatment-resistant depression is started on phenelzine (an
MAOI). Which dietary restriction is critical to prevent a hypertensive crisis?
• A) Foods high in tyramine (aged cheese, cured meats, red wine)
• B) Foods high in potassium (bananas, oranges)
• C) Foods high in carbohydrates (bread, pasta)
• D) High-protein diets only
• Answer: A
• Rationale: MAOIs inhibit the breakdown of tyramine. Consuming tyramine-
rich foods causes a massive release of norepinephrine, leading to a
hypertensive crisis (severe headache, tachycardia, and potential stroke).
,5. A patient is switching from fluoxetine (Prozac) to phenelzine (Nardil). How
long should the provider wait between stopping fluoxetine and starting the
MAOI?
• A) 7 days
• B) 14 days
• C) 3 weeks
• D) 5 weeks
• Answer: D
• Rationale: Fluoxetine has a very long half-life (due to its active metabolite,
norfluoxetine). A minimum washout period of 5 weeks is required before
starting an MAOI to prevent serotonin syndrome.
6. A 72-year-old patient with Parkinson's disease is experiencing vivid,
terrifying visual hallucinations of bugs crawling on the walls. She is not agitated
but is distressed. Which medication is most likely responsible?
• A) Carbidopa-levodopa
• B) Donepezil
• C) Sertraline
• D) Trazodone
• Answer: A
• Rationale: Dopaminergic agents used for Parkinson's disease (like carbidopa-
levodopa and dopamine agonists) are notorious for causing visual
hallucinations in the elderly. Pimavanserin is specifically approved for
Parkinson's disease psychosis.
7. A patient on valproic acid (Depakote) for bipolar disorder is planning to
become pregnant. What is the most significant teratogenic risk?
• A) Cleft palate
• B) Neural tube defects (spina bifida)
• C) Cardiac anomalies
• D) Hypospadias
• Answer: B
, • Rationale: Valproic acid is a known teratogen with a high risk of neural tube
defects. It is pregnancy category X and should be avoided in women of
childbearing age if possible.
8. A patient with generalized anxiety disorder is prescribed buspirone. Which
statement indicates the patient correctly understands the medication?
• A) "I can take this as needed when I feel a panic attack coming on."
• B) "It will take about 2 to 4 weeks to feel the full effect."
• C) "I need to avoid eating aged cheese while taking this."
• D) "This medication is highly addictive, so I must be careful."
• Answer: B
• Rationale: Buspirone has a delayed onset of action (2–4 weeks) and is not
effective for PRN (as-needed) use. It is not a benzodiazepine and does not
carry a significant addiction risk or tyramine restriction.
9. Which lab value must be monitored closely in a patient taking quetiapine
(Seroquel) for bipolar depression?
• A) Serum creatinine
• B) Fasting blood glucose and lipid panel
• C) Serum sodium
• D) Platelet count
• Answer: B
• Rationale: Quetiapine carries a significant risk of metabolic syndrome,
including hyperglycemia and hyperlipidemia. Baseline and follow-up fasting
glucose and lipid panels are required.
10. A patient on aripiprazole (Abilify) develops an uncontrollable urge to
gamble and shop excessively. This is most likely due to which mechanism?
• A) Serotonin 5-HT2A antagonism
• B) Dopamine D2 partial agonism
• C) Histamine H1 antagonism
• D) Muscarinic M1 antagonism
Health Nursing III: Final Exam Study
Compendium || Chamberlain College of
Nursing – Academic Year 2026/2027 –
Final Comprehensive Examination with
100 Verified Questions and Correct
Answer Rationales
SECTION A: PSYCHOPHARMACOLOGY (Questions 1–20)
1. A 34-year-old patient with schizophrenia has been on clozapine for 6
months. She reports a new onset of fever, sore throat, and malaise. What is the
priority action?
• A) Order a STAT comprehensive metabolic panel (CMP)
• B) Prescribe a broad-spectrum antibiotic
• C) Hold the clozapine and order a STAT white blood cell (WBC) count with
differential
• D) Increase the clozapine dose to overcome the infection
• Answer: C
• Rationale: Clozapine carries a black-box warning for agranulocytosis (severe
neutropenia). Fever and sore throat are hallmark signs of infection due to
neutropenia. The medication must be held immediately, and a STAT WBC with
differential is required to check the absolute neutrophil count (ANC).
2. A patient on lithium carbonate presents with coarse tremors, ataxia,
vomiting, and diarrhea. His serum lithium level is 2.1 mEq/L. How should the
provider interpret this?
• A) Subtherapeutic level; increase the dose
• B) Therapeutic level; reassure the patient
, • C) Mild toxicity; hold the next dose and recheck
• D) Severe toxicity; prepare for hemodialysis
• Answer: C
• Rationale: The therapeutic range for lithium is 0.6–1.2 mEq/L. Levels between
1.5 and 2.5 mEq/L indicate moderate to severe toxicity, presenting with GI
distress, coarse tremors, and ataxia. The medication should be held, and fluids
should be encouraged. Hemodialysis is typically reserved for levels > 2.5
mEq/L or severe neurological symptoms.
3. Which of the following atypical antipsychotics is MOST associated with
significant weight gain, dyslipidemia, and diabetes?
• A) Aripiprazole
• B) Ziprasidone
• C) Olanzapine
• D) Lurasidone
• Answer: C
• Rationale: Olanzapine has the highest metabolic side-effect profile among
atypical antipsychotics. Aripiprazole, ziprasidone, and lurasidone are
considered more metabolically neutral.
4. A patient with treatment-resistant depression is started on phenelzine (an
MAOI). Which dietary restriction is critical to prevent a hypertensive crisis?
• A) Foods high in tyramine (aged cheese, cured meats, red wine)
• B) Foods high in potassium (bananas, oranges)
• C) Foods high in carbohydrates (bread, pasta)
• D) High-protein diets only
• Answer: A
• Rationale: MAOIs inhibit the breakdown of tyramine. Consuming tyramine-
rich foods causes a massive release of norepinephrine, leading to a
hypertensive crisis (severe headache, tachycardia, and potential stroke).
,5. A patient is switching from fluoxetine (Prozac) to phenelzine (Nardil). How
long should the provider wait between stopping fluoxetine and starting the
MAOI?
• A) 7 days
• B) 14 days
• C) 3 weeks
• D) 5 weeks
• Answer: D
• Rationale: Fluoxetine has a very long half-life (due to its active metabolite,
norfluoxetine). A minimum washout period of 5 weeks is required before
starting an MAOI to prevent serotonin syndrome.
6. A 72-year-old patient with Parkinson's disease is experiencing vivid,
terrifying visual hallucinations of bugs crawling on the walls. She is not agitated
but is distressed. Which medication is most likely responsible?
• A) Carbidopa-levodopa
• B) Donepezil
• C) Sertraline
• D) Trazodone
• Answer: A
• Rationale: Dopaminergic agents used for Parkinson's disease (like carbidopa-
levodopa and dopamine agonists) are notorious for causing visual
hallucinations in the elderly. Pimavanserin is specifically approved for
Parkinson's disease psychosis.
7. A patient on valproic acid (Depakote) for bipolar disorder is planning to
become pregnant. What is the most significant teratogenic risk?
• A) Cleft palate
• B) Neural tube defects (spina bifida)
• C) Cardiac anomalies
• D) Hypospadias
• Answer: B
, • Rationale: Valproic acid is a known teratogen with a high risk of neural tube
defects. It is pregnancy category X and should be avoided in women of
childbearing age if possible.
8. A patient with generalized anxiety disorder is prescribed buspirone. Which
statement indicates the patient correctly understands the medication?
• A) "I can take this as needed when I feel a panic attack coming on."
• B) "It will take about 2 to 4 weeks to feel the full effect."
• C) "I need to avoid eating aged cheese while taking this."
• D) "This medication is highly addictive, so I must be careful."
• Answer: B
• Rationale: Buspirone has a delayed onset of action (2–4 weeks) and is not
effective for PRN (as-needed) use. It is not a benzodiazepine and does not
carry a significant addiction risk or tyramine restriction.
9. Which lab value must be monitored closely in a patient taking quetiapine
(Seroquel) for bipolar depression?
• A) Serum creatinine
• B) Fasting blood glucose and lipid panel
• C) Serum sodium
• D) Platelet count
• Answer: B
• Rationale: Quetiapine carries a significant risk of metabolic syndrome,
including hyperglycemia and hyperlipidemia. Baseline and follow-up fasting
glucose and lipid panels are required.
10. A patient on aripiprazole (Abilify) develops an uncontrollable urge to
gamble and shop excessively. This is most likely due to which mechanism?
• A) Serotonin 5-HT2A antagonism
• B) Dopamine D2 partial agonism
• C) Histamine H1 antagonism
• D) Muscarinic M1 antagonism
