NR 546 Week 3 Exam V3 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
3 Exam) | Chamberlain University
1. A patient is prescribed Lithium for the management of Bipolar I disorder. Which of the
following is the standard therapeutic serum level range for maintenance treatment?
A. 0.6 - 1.2 mEq/L
B. 0.4 - 0.8 mEq/L
C. 1.5 - 2.0 mEq/L
D. 2.0 - 2.5 mEq/L
Correct Answer: A
Explanation: Lithium has a narrow therapeutic index, and maintenance levels are typically
targeted between 0.6 and 1.2 mEq/L. Levels above 1.5 mEq/L are generally considered
toxic and require immediate intervention. Regular serum monitoring is essential to ensure
efficacy while minimizing the risk of adverse renal and thyroid effects.
2. When prescribing an MAOI such as Phenelzine, the PMHNP must educate the patient on
avoiding tyramine-rich foods. What is the physiological consequence of consuming tyramine
while on an MAOI?
A. Severe hypotension
B. Serotonin syndrome
,C. Hypertensive crisis
D. Metabolic syndrome
Correct Answer: C
Explanation: MAOIs inhibit the breakdown of tyramine, which can lead to a massive
release of norepinephrine from sympathetic nerve endings. This surge in norepinephrine
results in a potentially fatal hypertensive crisis characterized by headache, palpitations,
and extremely high blood pressure. Patients must strictly follow a low-tyramine diet to
prevent this dangerous sympathetic overactivity.
3. A patient taking Sertraline reports new-onset symptoms of tremors, sweating, agitation,
and hyperreflexia. The PMHNP suspects Serotonin Syndrome. Which of the following
combinations is most likely to have triggered this condition?
A. Sertraline and Ibuprofen
B. Sertraline and Lorazepam
C. Sertraline and Diphenhydramine
D. Sertraline and St. John’s Wort
Correct Answer: D
Explanation: Serotonin syndrome results from excessive serotonergic activity in the
central nervous system. St. John’s Wort is a known herbal remedy with serotonergic
properties that, when combined with an SSRI like Sertraline, can lead to toxic levels of
,serotonin. Management involves immediate discontinuation of the offending agents and
supportive care to stabilize the patient.
4. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or eating disorders due to an increased risk of lowering the seizure threshold?
A. Escitalopram
B. Fluoxetine
C. Mirtazapine
D. Bupropion
Correct Answer: D
Explanation: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that
carries a significant risk for seizures, particularly at high doses. It is contraindicated in
patients with bulimia or anorexia nervosa because these patients are prone to electrolyte
imbalances that further increase seizure risk. Clinicians must carefully screen for these
conditions before initiating Bupropion therapy.
5. A 28-year-old female patient is being started on Lamotrigine for bipolar depression. What
is the most critical safety instruction the PMHNP should provide?
A. Report any new rash immediately
B. Expect significant weight gain
C. Take the medication with food to avoid nausea
, D. Avoid sunlight to prevent photosensitivity
Correct Answer: A
Explanation: Lamotrigine carries a black box warning for Stevens-Johnson Syndrome
(SJS), a life-threatening skin reaction. To minimize this risk, the medication must be titrated
slowly over several weeks. Patients must be educated to stop the medication and seek
emergency care at the first sign of a rash or mucosal involvement.
6. Valproate (Depakote) is commonly used as a mood stabilizer. Which of the following lab
tests is not part of the standard baseline monitoring for this drug?
A. Liver function tests (LFTs)
B. Blood urea nitrogen (BUN) and Creatinine
C. Complete blood count (CBC) with platelets
D. Serum Valproate levels
Correct Answer: B
Explanation: Valproate monitoring focuses on liver toxicity and thrombocytopenia,
making LFTs and CBC essential. While baseline renal function is good practice for overall
health, it is not a primary target for Valproate monitoring as it is for Lithium. Periodic
serum levels of Valproate are also required to ensure the level is within the therapeutic
range (50-125 mcg/mL).
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
3 Exam) | Chamberlain University
1. A patient is prescribed Lithium for the management of Bipolar I disorder. Which of the
following is the standard therapeutic serum level range for maintenance treatment?
A. 0.6 - 1.2 mEq/L
B. 0.4 - 0.8 mEq/L
C. 1.5 - 2.0 mEq/L
D. 2.0 - 2.5 mEq/L
Correct Answer: A
Explanation: Lithium has a narrow therapeutic index, and maintenance levels are typically
targeted between 0.6 and 1.2 mEq/L. Levels above 1.5 mEq/L are generally considered
toxic and require immediate intervention. Regular serum monitoring is essential to ensure
efficacy while minimizing the risk of adverse renal and thyroid effects.
2. When prescribing an MAOI such as Phenelzine, the PMHNP must educate the patient on
avoiding tyramine-rich foods. What is the physiological consequence of consuming tyramine
while on an MAOI?
A. Severe hypotension
B. Serotonin syndrome
,C. Hypertensive crisis
D. Metabolic syndrome
Correct Answer: C
Explanation: MAOIs inhibit the breakdown of tyramine, which can lead to a massive
release of norepinephrine from sympathetic nerve endings. This surge in norepinephrine
results in a potentially fatal hypertensive crisis characterized by headache, palpitations,
and extremely high blood pressure. Patients must strictly follow a low-tyramine diet to
prevent this dangerous sympathetic overactivity.
3. A patient taking Sertraline reports new-onset symptoms of tremors, sweating, agitation,
and hyperreflexia. The PMHNP suspects Serotonin Syndrome. Which of the following
combinations is most likely to have triggered this condition?
A. Sertraline and Ibuprofen
B. Sertraline and Lorazepam
C. Sertraline and Diphenhydramine
D. Sertraline and St. John’s Wort
Correct Answer: D
Explanation: Serotonin syndrome results from excessive serotonergic activity in the
central nervous system. St. John’s Wort is a known herbal remedy with serotonergic
properties that, when combined with an SSRI like Sertraline, can lead to toxic levels of
,serotonin. Management involves immediate discontinuation of the offending agents and
supportive care to stabilize the patient.
4. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or eating disorders due to an increased risk of lowering the seizure threshold?
A. Escitalopram
B. Fluoxetine
C. Mirtazapine
D. Bupropion
Correct Answer: D
Explanation: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that
carries a significant risk for seizures, particularly at high doses. It is contraindicated in
patients with bulimia or anorexia nervosa because these patients are prone to electrolyte
imbalances that further increase seizure risk. Clinicians must carefully screen for these
conditions before initiating Bupropion therapy.
5. A 28-year-old female patient is being started on Lamotrigine for bipolar depression. What
is the most critical safety instruction the PMHNP should provide?
A. Report any new rash immediately
B. Expect significant weight gain
C. Take the medication with food to avoid nausea
, D. Avoid sunlight to prevent photosensitivity
Correct Answer: A
Explanation: Lamotrigine carries a black box warning for Stevens-Johnson Syndrome
(SJS), a life-threatening skin reaction. To minimize this risk, the medication must be titrated
slowly over several weeks. Patients must be educated to stop the medication and seek
emergency care at the first sign of a rash or mucosal involvement.
6. Valproate (Depakote) is commonly used as a mood stabilizer. Which of the following lab
tests is not part of the standard baseline monitoring for this drug?
A. Liver function tests (LFTs)
B. Blood urea nitrogen (BUN) and Creatinine
C. Complete blood count (CBC) with platelets
D. Serum Valproate levels
Correct Answer: B
Explanation: Valproate monitoring focuses on liver toxicity and thrombocytopenia,
making LFTs and CBC essential. While baseline renal function is good practice for overall
health, it is not a primary target for Valproate monitoring as it is for Lithium. Periodic
serum levels of Valproate are also required to ensure the level is within the therapeutic
range (50-125 mcg/mL).
