NR 605 DIAGNOSIS AND MANAGEMENT
IN PSYCHIATRIC NURSING
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 45-year-old male with treatment-resistant schizophrenia is started on Clozapine.
According to the REMS program, what is the Absolute Neutrophil Count (ANC) threshold for
immediate cessation of the medication and consultation with hematology?
A. ANC < 1,500/µL
B. ANC < 500/µL
C. ANC < 2,000/µL
D. ANC < 1,000/µL
Answer: D
Conceptual Explanation: For the general population, Clozapine must be interrupted if the
ANC drops below 1,000/µL due to the high risk of agranulocytosis.
2. Which neurotransmitter pathway is primarily associated with the development of the
positive symptoms of schizophrenia, such as hallucinations and delusions?
A. Mesolimbic pathway
,B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: Hyperactivity of dopamine in the mesolimbic pathway is
believed to mediate the positive symptoms of psychosis.
3. A patient is diagnosed with Bipolar II Disorder. To meet the DSM-5 criteria, the patient
must have experienced at least one major depressive episode and at least one of which of the
following?
A. Hypomanic episode lasting at least 4 consecutive days
B. Manic episode lasting at least 1 week
C. Mixed episode requiring hospitalization
D. Cyclothymic fluctuations for 2 years
Answer: A
Conceptual Explanation: Bipolar II is characterized by at least one hypomanic episode
(minimum 4 days) and one major depressive episode, without any full manic episodes.
4. Lithium toxicity can occur even at therapeutic levels if the patient becomes dehydrated.
Which of the following lab findings is most likely to contribute to Lithium retention?
A. Hypernatremia
, B. Hyponatremia
C. Hypokalemia
D. Hypercalcemia
Answer: B
Conceptual Explanation: Sodium and Lithium are handled similarly by the kidneys; when
sodium levels are low (hyponatremia), the kidneys reabsorb more Lithium, leading to
toxicity.
5. A 24-year-old female presents with a 7-month history of excessive worry about work,
health, and finances. She reports restlessness, muscle tension, and difficulty concentrating.
What is the most likely diagnosis?
A. Generalized Anxiety Disorder (GAD)
B. Social Anxiety Disorder
C. Panic Disorder
D. Adjustment Disorder with Anxiety
Answer: A
Conceptual Explanation: GAD requires excessive anxiety and worry occurring more days
than not for at least 6 months, along with symptoms like muscle tension and restlessness.
IN PSYCHIATRIC NURSING
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A 45-year-old male with treatment-resistant schizophrenia is started on Clozapine.
According to the REMS program, what is the Absolute Neutrophil Count (ANC) threshold for
immediate cessation of the medication and consultation with hematology?
A. ANC < 1,500/µL
B. ANC < 500/µL
C. ANC < 2,000/µL
D. ANC < 1,000/µL
Answer: D
Conceptual Explanation: For the general population, Clozapine must be interrupted if the
ANC drops below 1,000/µL due to the high risk of agranulocytosis.
2. Which neurotransmitter pathway is primarily associated with the development of the
positive symptoms of schizophrenia, such as hallucinations and delusions?
A. Mesolimbic pathway
,B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: Hyperactivity of dopamine in the mesolimbic pathway is
believed to mediate the positive symptoms of psychosis.
3. A patient is diagnosed with Bipolar II Disorder. To meet the DSM-5 criteria, the patient
must have experienced at least one major depressive episode and at least one of which of the
following?
A. Hypomanic episode lasting at least 4 consecutive days
B. Manic episode lasting at least 1 week
C. Mixed episode requiring hospitalization
D. Cyclothymic fluctuations for 2 years
Answer: A
Conceptual Explanation: Bipolar II is characterized by at least one hypomanic episode
(minimum 4 days) and one major depressive episode, without any full manic episodes.
4. Lithium toxicity can occur even at therapeutic levels if the patient becomes dehydrated.
Which of the following lab findings is most likely to contribute to Lithium retention?
A. Hypernatremia
, B. Hyponatremia
C. Hypokalemia
D. Hypercalcemia
Answer: B
Conceptual Explanation: Sodium and Lithium are handled similarly by the kidneys; when
sodium levels are low (hyponatremia), the kidneys reabsorb more Lithium, leading to
toxicity.
5. A 24-year-old female presents with a 7-month history of excessive worry about work,
health, and finances. She reports restlessness, muscle tension, and difficulty concentrating.
What is the most likely diagnosis?
A. Generalized Anxiety Disorder (GAD)
B. Social Anxiety Disorder
C. Panic Disorder
D. Adjustment Disorder with Anxiety
Answer: A
Conceptual Explanation: GAD requires excessive anxiety and worry occurring more days
than not for at least 6 months, along with symptoms like muscle tension and restlessness.
