NSG 552 Exam 2 V1 | Psychopharmacology | Actual Q&A with
Rationale (NSG 552 Exam 2) | Wilkes University
1. A patient is being started on Lithium for Bipolar I Disorder. What is the standard
therapeutic range for a maintenance dose of Lithium?
A. 0.6 to 1.2 mEq/L
B. 0.4 to 0.8 mEq/L
C. 1.0 to 1.5 mEq/L
D. 1.5 to 2.0 mEq/L
Answer: A
Rationale: The standard therapeutic range for Lithium maintenance is typically 0.6 to 1.2
mEq/L. Levels should be monitored closely as the therapeutic window is narrow and
toxicity can occur rapidly. Acute manic episodes may require slightly higher levels, but
maintenance usually stays within this target range.
2. Which of the following laboratory tests is the most critical to monitor before and during
treatment with Clozapine (Clozaril)?
A. Liver function tests (LFTs)
B. Thyroid-stimulating hormone (TSH)
C. Absolute Neutrophil Count (ANC)
D. Blood urea nitrogen (BUN)
Answer: C
Rationale: Clozapine carries a black box warning for agranulocytosis, a potentially life-
threatening decrease in white blood cells. Providers must monitor the Absolute Neutrophil
Count (ANC) through the Risk Evaluation and Mitigation Strategy (REMS) program. If the
ANC falls below 1500 cells/mm3, the medication may need to be interrupted or
discontinued.
3. A 28-year-old female patient is prescribed Valproic Acid for seizure prophylaxis and mood
stabilization. What is a significant concern for a female of childbearing age taking this
medication?
A. Neural tube defects in the fetus
B. Irreversible vision loss
C. Increased risk of breast cancer
D. Rapid weight loss and malnutrition
,Answer: A
Rationale: Valproic acid is highly teratogenic and is associated with a significant risk of
neural tube defects like spina bifida. Women of childbearing age should be counseled on
effective contraception and the risks of pregnancy while on the drug. Folic acid
supplementation is often recommended, though it does not completely eliminate the risk.
4. Which antidepressant is known for having a very long half-life, meaning it does not require
a tapered discontinuation in most cases?
A. Fluoxetine (Prozac)
B. Sertraline (Zoloft)
C. Paroxetine (Paxil)
D. Venlafaxine (Effexor)
Answer: A
Rationale: Fluoxetine and its active metabolite norfluoxetine have a half-life of
approximately 1 to 2 weeks. This long duration of action provides a ‘self-tapering’ effect,
reducing the risk of discontinuation syndrome. In contrast, short-acting SSRIs like
Paroxetine require careful tapering to avoid withdrawal symptoms.
5. A patient taking an MAOI, such as Phenelzine, must avoid which of the following foods to
prevent a hypertensive crisis?
A. Green leafy vegetables
B. Whole grain breads
C. Citrus fruits and juices
D. Aged cheeses and cured meats
Answer: D
Rationale: MAOIs inhibit the breakdown of tyramine, an amino acid found in fermented,
aged, or cured foods. Excessive tyramine causes a massive release of norepinephrine,
leading to a dangerous spike in blood pressure known as a hypertensive crisis. Patients
must be strictly educated on a low-tyramine diet during treatment.
6. Which mechanism of action is primarily responsible for the ‘atypical’ nature of second-
generation antipsychotics?
A. Strong D2 receptor antagonism
B. GABA-A receptor agonism
C. 5-HT2A receptor antagonism and D2 receptor antagonism
D. Alpha-1 adrenergic blockade
, Answer: C
Rationale: Atypical antipsychotics differ from typical ones by their higher affinity for 5-
HT2A serotonin receptors compared to D2 dopamine receptors. This dual action is thought
to reduce the incidence of extrapyramidal symptoms (EPS) and improve negative
symptoms of schizophrenia. The modulation of dopamine in different pathways helps
balance efficacy and side effects.
7. A patient on Haloperidol presents with muscle rigidity, high fever, and autonomic
instability. What life-threatening condition is most likely occurring?
A. Serotonin Syndrome
B. Metabolic Syndrome
C. Neuroleptic Malignant Syndrome (NMS)
D. Acute Dystonia
Answer: C
Rationale: Neuroleptic Malignant Syndrome (NMS) is a medical emergency associated
with dopamine-blocking agents. It is characterized by the ‘lead pipe’ muscle rigidity,
hyperpyrexia, and mental status changes. Treatment involves immediate discontinuation of
the antipsychotic and supportive care, often in an ICU setting.
8. Which mood stabilizer is most frequently associated with a rare but life-threatening rash
known as Stevens-Johnson Syndrome (SJS)?
A. Lithium
B. Topiramate (Topamax)
C. Oxcarbazepine (Trileptal)
D. Lamotrigine (Lamictal)
Answer: D
Rationale: Lamotrigine carries a risk for serious dermatologic reactions, including
Stevens-Johnson Syndrome. The risk is minimized by a very slow titration schedule when
starting the medication. Patients must be instructed to report any new rash, especially if
accompanied by fever or mucosal involvement.
9. When switching a patient from an SSRI to an MAOI, how long is the recommended
washout period to avoid Serotonin Syndrome?
A. 24 hours
B. 2 weeks
C. 5 days
Rationale (NSG 552 Exam 2) | Wilkes University
1. A patient is being started on Lithium for Bipolar I Disorder. What is the standard
therapeutic range for a maintenance dose of Lithium?
A. 0.6 to 1.2 mEq/L
B. 0.4 to 0.8 mEq/L
C. 1.0 to 1.5 mEq/L
D. 1.5 to 2.0 mEq/L
Answer: A
Rationale: The standard therapeutic range for Lithium maintenance is typically 0.6 to 1.2
mEq/L. Levels should be monitored closely as the therapeutic window is narrow and
toxicity can occur rapidly. Acute manic episodes may require slightly higher levels, but
maintenance usually stays within this target range.
2. Which of the following laboratory tests is the most critical to monitor before and during
treatment with Clozapine (Clozaril)?
A. Liver function tests (LFTs)
B. Thyroid-stimulating hormone (TSH)
C. Absolute Neutrophil Count (ANC)
D. Blood urea nitrogen (BUN)
Answer: C
Rationale: Clozapine carries a black box warning for agranulocytosis, a potentially life-
threatening decrease in white blood cells. Providers must monitor the Absolute Neutrophil
Count (ANC) through the Risk Evaluation and Mitigation Strategy (REMS) program. If the
ANC falls below 1500 cells/mm3, the medication may need to be interrupted or
discontinued.
3. A 28-year-old female patient is prescribed Valproic Acid for seizure prophylaxis and mood
stabilization. What is a significant concern for a female of childbearing age taking this
medication?
A. Neural tube defects in the fetus
B. Irreversible vision loss
C. Increased risk of breast cancer
D. Rapid weight loss and malnutrition
,Answer: A
Rationale: Valproic acid is highly teratogenic and is associated with a significant risk of
neural tube defects like spina bifida. Women of childbearing age should be counseled on
effective contraception and the risks of pregnancy while on the drug. Folic acid
supplementation is often recommended, though it does not completely eliminate the risk.
4. Which antidepressant is known for having a very long half-life, meaning it does not require
a tapered discontinuation in most cases?
A. Fluoxetine (Prozac)
B. Sertraline (Zoloft)
C. Paroxetine (Paxil)
D. Venlafaxine (Effexor)
Answer: A
Rationale: Fluoxetine and its active metabolite norfluoxetine have a half-life of
approximately 1 to 2 weeks. This long duration of action provides a ‘self-tapering’ effect,
reducing the risk of discontinuation syndrome. In contrast, short-acting SSRIs like
Paroxetine require careful tapering to avoid withdrawal symptoms.
5. A patient taking an MAOI, such as Phenelzine, must avoid which of the following foods to
prevent a hypertensive crisis?
A. Green leafy vegetables
B. Whole grain breads
C. Citrus fruits and juices
D. Aged cheeses and cured meats
Answer: D
Rationale: MAOIs inhibit the breakdown of tyramine, an amino acid found in fermented,
aged, or cured foods. Excessive tyramine causes a massive release of norepinephrine,
leading to a dangerous spike in blood pressure known as a hypertensive crisis. Patients
must be strictly educated on a low-tyramine diet during treatment.
6. Which mechanism of action is primarily responsible for the ‘atypical’ nature of second-
generation antipsychotics?
A. Strong D2 receptor antagonism
B. GABA-A receptor agonism
C. 5-HT2A receptor antagonism and D2 receptor antagonism
D. Alpha-1 adrenergic blockade
, Answer: C
Rationale: Atypical antipsychotics differ from typical ones by their higher affinity for 5-
HT2A serotonin receptors compared to D2 dopamine receptors. This dual action is thought
to reduce the incidence of extrapyramidal symptoms (EPS) and improve negative
symptoms of schizophrenia. The modulation of dopamine in different pathways helps
balance efficacy and side effects.
7. A patient on Haloperidol presents with muscle rigidity, high fever, and autonomic
instability. What life-threatening condition is most likely occurring?
A. Serotonin Syndrome
B. Metabolic Syndrome
C. Neuroleptic Malignant Syndrome (NMS)
D. Acute Dystonia
Answer: C
Rationale: Neuroleptic Malignant Syndrome (NMS) is a medical emergency associated
with dopamine-blocking agents. It is characterized by the ‘lead pipe’ muscle rigidity,
hyperpyrexia, and mental status changes. Treatment involves immediate discontinuation of
the antipsychotic and supportive care, often in an ICU setting.
8. Which mood stabilizer is most frequently associated with a rare but life-threatening rash
known as Stevens-Johnson Syndrome (SJS)?
A. Lithium
B. Topiramate (Topamax)
C. Oxcarbazepine (Trileptal)
D. Lamotrigine (Lamictal)
Answer: D
Rationale: Lamotrigine carries a risk for serious dermatologic reactions, including
Stevens-Johnson Syndrome. The risk is minimized by a very slow titration schedule when
starting the medication. Patients must be instructed to report any new rash, especially if
accompanied by fever or mucosal involvement.
9. When switching a patient from an SSRI to an MAOI, how long is the recommended
washout period to avoid Serotonin Syndrome?
A. 24 hours
B. 2 weeks
C. 5 days
