NR 605 FINAL EXAM PREP - DIAGNOSIS
MANAGEMENT IN PSYCHIATRIC
NURSING QUESTIONS AND ANSWERS
1. A 45-year-old male with Schizophrenia presents with a temperature of 103°F, severe
muscle rigidity, and autonomic instability after starting Haloperidol. What is the most likely
diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Serotonin Syndrome
C. Anticholinergic Toxicity
D. Acute Dystonia
Answer: A
Conceptual Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by lead-pipe rigidity, hyperpyrexia, and autonomic dysfunction. Serotonin
Syndrome usually involves hyperreflexia rather than lead-pipe rigidity.
,2. When initiating Lithium for a patient with Bipolar I Disorder, which of the following lab
tests is NOT required at baseline?
A. Thyroid Stimulating Hormone (TSH)
B. Liver Function Tests (LFTs)
C. Electrocardiogram (EKG) for patients over 40
D. Serum Creatinine and BUN
Answer: B
Conceptual Explanation: Lithium is primarily excreted by the kidneys and can affect
thyroid and cardiac function. LFTs are required for Valproate, not Lithium.
3. A PMHNP is treating a patient with Clozapine. The patient’s latest labs show an Absolute
Neutrophil Count (ANC) of 900/mm³. What is the appropriate management?
A. Continue Clozapine and monitor monthly
B. Reduce the dose by 50%
C. Interrupt treatment and consult hematology
D. Add a white blood cell booster and continue therapy
Answer: C
Conceptual Explanation: For Clozapine, an ANC below 1000/mm³ indicates moderate
neutropenia, requiring treatment interruption and hematology consultation per the REMS
protocol.
, 4. Which neurotransmitter pathway is primarily associated with the negative symptoms of
Schizophrenia?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: The mesocortical pathway is associated with cognitive and
negative symptoms (hypodopaminergia), while the mesolimbic is associated with positive
symptoms (hyperdopaminergia).
5. According to the DSM-5-TR, what is the minimum duration of symptoms required for a
diagnosis of Generalized Anxiety Disorder?
A. 2 weeks
B. 6 months
C. 3 months
D. 1 month
Answer: B
Conceptual Explanation: GAD requires excessive anxiety and worry occurring more days
than not for at least 6 months about a number of events or activities.
MANAGEMENT IN PSYCHIATRIC
NURSING QUESTIONS AND ANSWERS
1. A 45-year-old male with Schizophrenia presents with a temperature of 103°F, severe
muscle rigidity, and autonomic instability after starting Haloperidol. What is the most likely
diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Serotonin Syndrome
C. Anticholinergic Toxicity
D. Acute Dystonia
Answer: A
Conceptual Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by lead-pipe rigidity, hyperpyrexia, and autonomic dysfunction. Serotonin
Syndrome usually involves hyperreflexia rather than lead-pipe rigidity.
,2. When initiating Lithium for a patient with Bipolar I Disorder, which of the following lab
tests is NOT required at baseline?
A. Thyroid Stimulating Hormone (TSH)
B. Liver Function Tests (LFTs)
C. Electrocardiogram (EKG) for patients over 40
D. Serum Creatinine and BUN
Answer: B
Conceptual Explanation: Lithium is primarily excreted by the kidneys and can affect
thyroid and cardiac function. LFTs are required for Valproate, not Lithium.
3. A PMHNP is treating a patient with Clozapine. The patient’s latest labs show an Absolute
Neutrophil Count (ANC) of 900/mm³. What is the appropriate management?
A. Continue Clozapine and monitor monthly
B. Reduce the dose by 50%
C. Interrupt treatment and consult hematology
D. Add a white blood cell booster and continue therapy
Answer: C
Conceptual Explanation: For Clozapine, an ANC below 1000/mm³ indicates moderate
neutropenia, requiring treatment interruption and hematology consultation per the REMS
protocol.
, 4. Which neurotransmitter pathway is primarily associated with the negative symptoms of
Schizophrenia?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: The mesocortical pathway is associated with cognitive and
negative symptoms (hypodopaminergia), while the mesolimbic is associated with positive
symptoms (hyperdopaminergia).
5. According to the DSM-5-TR, what is the minimum duration of symptoms required for a
diagnosis of Generalized Anxiety Disorder?
A. 2 weeks
B. 6 months
C. 3 months
D. 1 month
Answer: B
Conceptual Explanation: GAD requires excessive anxiety and worry occurring more days
than not for at least 6 months about a number of events or activities.
