NR 546 PSYCHOPHARMACOLOGY
EXAM 3 - ADVANCED PRACTICE
NURSING QUESTIONS & ANSWERS
(CHAMBERLAIN) 100% GUARANTEE
PASS
1. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions, when dopamine is in excess?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The mesolimbic pathway projects from the ventral tegmental
area to the nucleus accumbens; overactivity here is associated with positive symptoms.
2. A patient taking Clozapine presents with a fever, sore throat, and an Absolute Neutrophil
Count (ANC) of 450/mm3. What is the most appropriate clinical action?
A. Immediately discontinue Clozapine and do not rechallenge
B. Continue the medication and monitor ANC daily
,C. Reduce the dose by 50% until the ANC rises above 1000/mm3
D. Switch to Olanzapine immediately without a washout period
Answer: A
Conceptual Explanation: An ANC below 500/mm3 is classified as severe neutropenia
(agranulocytosis), requiring immediate cessation of Clozapine and typically a permanent
ban on rechallenge.
3. Which mechanism of action distinguishes second-generation (atypical) antipsychotics from
first-generation (typical) antipsychotics?
A. Muscarinic M1 receptor antagonism
B. Serotonin 5-HT2A receptor antagonism
C. D2 receptor antagonism only
D. GABA-A receptor modulation
Answer: B
Conceptual Explanation: Atypical antipsychotics are defined by their 5-HT2A antagonism
combined with D2 antagonism, which helps mitigate EPS and treat negative symptoms.
4. A patient on Lithium for Bipolar I Disorder reports coarse hand tremors, ataxia, and
confusion. The serum lithium level is 2.2 mEq/L. What is the diagnosis?
A. Therapeutic Lithium effect
B. Severe Lithium toxicity
, C. Mild Lithium toxicity
D. Serotonin syndrome
Answer: B
Conceptual Explanation: Lithium levels above 1.5 mEq/L indicate toxicity, and levels
above 2.0 mEq/L are considered severe, often presenting with neurological impairment
and ataxia.
5. Which mood stabilizer is most associated with the rare but life-threatening side effect of
Stevens-Johnson Syndrome (SJS)?
A. Valproic Acid
B. Lamotrigine
C. Lithium
D. Oxcarbazepine
Answer: B
Conceptual Explanation: Lamotrigine carries a black box warning for SJS, necessitating a
very slow titration schedule to minimize risk.
6. In the treatment of Bipolar Depression, which medication is FDA-approved for
monotherapy?
A. Quetiapine
B. Aripiprazole
EXAM 3 - ADVANCED PRACTICE
NURSING QUESTIONS & ANSWERS
(CHAMBERLAIN) 100% GUARANTEE
PASS
1. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions, when dopamine is in excess?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The mesolimbic pathway projects from the ventral tegmental
area to the nucleus accumbens; overactivity here is associated with positive symptoms.
2. A patient taking Clozapine presents with a fever, sore throat, and an Absolute Neutrophil
Count (ANC) of 450/mm3. What is the most appropriate clinical action?
A. Immediately discontinue Clozapine and do not rechallenge
B. Continue the medication and monitor ANC daily
,C. Reduce the dose by 50% until the ANC rises above 1000/mm3
D. Switch to Olanzapine immediately without a washout period
Answer: A
Conceptual Explanation: An ANC below 500/mm3 is classified as severe neutropenia
(agranulocytosis), requiring immediate cessation of Clozapine and typically a permanent
ban on rechallenge.
3. Which mechanism of action distinguishes second-generation (atypical) antipsychotics from
first-generation (typical) antipsychotics?
A. Muscarinic M1 receptor antagonism
B. Serotonin 5-HT2A receptor antagonism
C. D2 receptor antagonism only
D. GABA-A receptor modulation
Answer: B
Conceptual Explanation: Atypical antipsychotics are defined by their 5-HT2A antagonism
combined with D2 antagonism, which helps mitigate EPS and treat negative symptoms.
4. A patient on Lithium for Bipolar I Disorder reports coarse hand tremors, ataxia, and
confusion. The serum lithium level is 2.2 mEq/L. What is the diagnosis?
A. Therapeutic Lithium effect
B. Severe Lithium toxicity
, C. Mild Lithium toxicity
D. Serotonin syndrome
Answer: B
Conceptual Explanation: Lithium levels above 1.5 mEq/L indicate toxicity, and levels
above 2.0 mEq/L are considered severe, often presenting with neurological impairment
and ataxia.
5. Which mood stabilizer is most associated with the rare but life-threatening side effect of
Stevens-Johnson Syndrome (SJS)?
A. Valproic Acid
B. Lamotrigine
C. Lithium
D. Oxcarbazepine
Answer: B
Conceptual Explanation: Lamotrigine carries a black box warning for SJS, necessitating a
very slow titration schedule to minimize risk.
6. In the treatment of Bipolar Depression, which medication is FDA-approved for
monotherapy?
A. Quetiapine
B. Aripiprazole
