NR 546 Week 8 Exam V3 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
8 Exam) | Chamberlain University
1. A PMHNP is treating a patient with Lithium for Bipolar I Disorder. Which of the following
lab values would cause the most concern for Lithium toxicity?
A. Lithium level 0.8 mEq/L
B. Sodium level 140 mEq/L
C. Potassium 4.0 mEq/L
D. Creatinine 2.4 mg/dL
Correct Answer: D
Explanation: Lithium is almost exclusively excreted by the kidneys, so an elevated
creatinine indicates impaired renal function which significantly increases the risk of
toxicity. A creatinine of 2.4 mg/dL is well above the normal range and suggests renal
insufficiency. The PMHNP must monitor renal function and lithium levels closely to avoid
life-threatening accumulation.
2. When prescribing Lamotrigine, the PMHNP must educate the patient on the risk of
Stevens-Johnson Syndrome (SJS). Which instruction is most appropriate?
A. Double the dose if you miss a day to maintain steady-state levels.
B. A mild rash is expected and will disappear after two weeks of treatment.
,C. Take the medication with a high-fat meal to prevent skin reactions.
D. Stop the medication immediately if you develop any rash and seek emergency care.
Correct Answer: D
Explanation: Lamotrigine carries a black box warning for serious, potentially life-
threatening rashes including Stevens-Johnson Syndrome. Patients must be instructed to
discontinue the drug at the first sign of a rash and seek immediate medical evaluation. The
titration of Lamotrigine is specifically designed to be slow to reduce the incidence of this
hypersensitivity reaction.
3. A patient taking Phenelzine (an MAOI) presents to the ER with a severe headache,
palpitations, and a blood pressure of 210/120 mmHg. Which dietary indiscretion most likely
occurred?
A. Eating a green leafy salad
B. Eating aged cheese and pepperoni
C. Drinking excessive amounts of water
D. Consuming grapefruit juice
Correct Answer: B
Explanation: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that prevents the
breakdown of tyramine. Ingestion of high-tyramine foods like aged cheese and cured meats
can lead to a hypertensive crisis due to the massive release of norepinephrine. This is a
, medical emergency that requires immediate treatment with antihypertensive agents like
phentolamine.
4. Which antipsychotic medication is most likely to cause significant weight gain and
metabolic syndrome?
A. Ziprasidone
B. Aripiprazole
C. Lurasidone
D. Olanzapine
Correct Answer: D
Explanation: Olanzapine and Clozapine are associated with the highest risk of weight gain,
dyslipidemia, and insulin resistance among the second-generation antipsychotics.
Monitoring for metabolic syndrome including waist circumference, blood pressure, and
fasting glucose is essential. Ziprasidone and Aripiprazole are generally considered weight-
neutral by comparison.
5. A patient with ADHD is prescribed Methylphenidate. What is the primary mechanism of
action for this stimulant?
A. Blockade of dopamine and norepinephrine reuptake via transporters
B. Selective inhibition of serotonin reuptake
C. Antagonism of the NMDA receptor
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
8 Exam) | Chamberlain University
1. A PMHNP is treating a patient with Lithium for Bipolar I Disorder. Which of the following
lab values would cause the most concern for Lithium toxicity?
A. Lithium level 0.8 mEq/L
B. Sodium level 140 mEq/L
C. Potassium 4.0 mEq/L
D. Creatinine 2.4 mg/dL
Correct Answer: D
Explanation: Lithium is almost exclusively excreted by the kidneys, so an elevated
creatinine indicates impaired renal function which significantly increases the risk of
toxicity. A creatinine of 2.4 mg/dL is well above the normal range and suggests renal
insufficiency. The PMHNP must monitor renal function and lithium levels closely to avoid
life-threatening accumulation.
2. When prescribing Lamotrigine, the PMHNP must educate the patient on the risk of
Stevens-Johnson Syndrome (SJS). Which instruction is most appropriate?
A. Double the dose if you miss a day to maintain steady-state levels.
B. A mild rash is expected and will disappear after two weeks of treatment.
,C. Take the medication with a high-fat meal to prevent skin reactions.
D. Stop the medication immediately if you develop any rash and seek emergency care.
Correct Answer: D
Explanation: Lamotrigine carries a black box warning for serious, potentially life-
threatening rashes including Stevens-Johnson Syndrome. Patients must be instructed to
discontinue the drug at the first sign of a rash and seek immediate medical evaluation. The
titration of Lamotrigine is specifically designed to be slow to reduce the incidence of this
hypersensitivity reaction.
3. A patient taking Phenelzine (an MAOI) presents to the ER with a severe headache,
palpitations, and a blood pressure of 210/120 mmHg. Which dietary indiscretion most likely
occurred?
A. Eating a green leafy salad
B. Eating aged cheese and pepperoni
C. Drinking excessive amounts of water
D. Consuming grapefruit juice
Correct Answer: B
Explanation: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that prevents the
breakdown of tyramine. Ingestion of high-tyramine foods like aged cheese and cured meats
can lead to a hypertensive crisis due to the massive release of norepinephrine. This is a
, medical emergency that requires immediate treatment with antihypertensive agents like
phentolamine.
4. Which antipsychotic medication is most likely to cause significant weight gain and
metabolic syndrome?
A. Ziprasidone
B. Aripiprazole
C. Lurasidone
D. Olanzapine
Correct Answer: D
Explanation: Olanzapine and Clozapine are associated with the highest risk of weight gain,
dyslipidemia, and insulin resistance among the second-generation antipsychotics.
Monitoring for metabolic syndrome including waist circumference, blood pressure, and
fasting glucose is essential. Ziprasidone and Aripiprazole are generally considered weight-
neutral by comparison.
5. A patient with ADHD is prescribed Methylphenidate. What is the primary mechanism of
action for this stimulant?
A. Blockade of dopamine and norepinephrine reuptake via transporters
B. Selective inhibition of serotonin reuptake
C. Antagonism of the NMDA receptor
