NR 546 Week 10 Exam V3 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
10 Exam) | Chamberlain University
1. A 28-year-old female patient diagnosed with Bipolar I Disorder is prescribed Lithium.
Which of the following therapeutic serum levels is considered standard for maintenance
therapy?
A. 0.4 - 0.8 mEq/L
B. 0.6 - 1.2 mEq/L
C. 1.5 - 2.0 mEq/L
D. 2.0 - 2.5 mEq/L
Correct Answer: B
Explanation: The therapeutic range for lithium in the treatment of acute mania and
maintenance of Bipolar Disorder is generally 0.6 to 1.2 mEq/L. Monitoring serum levels is
critical because lithium has a narrow therapeutic index, meaning toxicity can occur at
levels slightly above the therapeutic range. Providers must also monitor renal and thyroid
functions regularly as lithium is excreted by the kidneys and can induce hypothyroidism.
2. A patient with treatment-resistant schizophrenia is starting Clozapine. What is the
minimum Absolute Neutrophil Count (ANC) required to initiate therapy?
A. 500/mm³
,B. 1000/mm³
C. 2000/mm³
D. 1500/mm³
Correct Answer: D
Explanation: To initiate Clozapine, the patient must have an Absolute Neutrophil Count
(ANC) of at least 1500/mm³ (or 1000/mm³ for patients with documented Benign Ethnic
Neutropenia). This requirement is strictly enforced through the Clozapine REMS program
to mitigate the risk of severe neutropenia and agranulocytosis. Ongoing monitoring is
mandatory, initially occurring weekly for the first six months of treatment.
3. Which medication is considered a first-line treatment for a patient experiencing acute
dystonia following the administration of a first-generation antipsychotic?
A. Benztropine
B. Propranolol
C. Lorazepam
D. Bromocriptine
Correct Answer: A
Explanation: Acute dystonia is an extrapyramidal side effect (EPS) characterized by
muscle spasms and abnormal postures, often treated with anticholinergic medications like
Benztropine or Diphenhydramine. These medications help restore the balance between
,dopamine and acetylcholine in the nigrostriatal pathway. Prompt administration, often via
intramuscular injection, provides rapid relief of symptoms.
4. A patient taking Phenelzine (an MAOI) consumes a large amount of aged cheese and wine.
The provider should monitor for which life-threatening condition?
A. Serotonin Syndrome
B. Hypertensive Crisis
C. Neuroleptic Malignant Syndrome
D. Metabolic Syndrome
Correct Answer: B
Explanation: MAOIs inhibit the breakdown of tyramine, an amino acid found in aged and
fermented foods. Consuming high-tyramine foods while on an MAOI leads to a surge in
norepinephrine, causing a dangerous hypertensive crisis. Clinical management involves
blood pressure reduction and strict dietary education to prevent recurrence.
5. Which of the following antidepressants is most likely to cause a seizure if prescribed at high
doses or to a patient with a history of bulimia?
A. Bupropion
B. Fluoxetine
C. Sertraline
D. Mirtazapine
, Correct Answer: A
Explanation: Bupropion is contraindicated in patients with a history of seizure disorders,
anorexia, or bulimia because it lowers the seizure threshold. The risk is particularly high
during electrolyte imbalances associated with purging behaviors. Providers should screen
for these eating disorders prior to prescribing Bupropion for depression or smoking
cessation.
6. A 45-year-old male on Risperidone reports breast enlargement and nipple discharge. This is
likely due to which mechanism?
A. D2 blockade in the Mesolimbic pathway
B. D2 blockade in the Tuberoinfundibular pathway
C. D2 blockade in the Nigrostriatal pathway
D. 5-HT2A antagonism in the Mesocortical pathway
Correct Answer: B
Explanation: Blocking dopamine in the tuberoinfundibular pathway leads to an increase in
prolactin levels, a condition known as hyperprolactinemia. This can result in gynecomastia,
galactorrhea, and sexual dysfunction in both men and women. Risperidone and
Paliperidone are particularly noted for their high affinity for D2 receptors in this specific
pathway.
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
10 Exam) | Chamberlain University
1. A 28-year-old female patient diagnosed with Bipolar I Disorder is prescribed Lithium.
Which of the following therapeutic serum levels is considered standard for maintenance
therapy?
A. 0.4 - 0.8 mEq/L
B. 0.6 - 1.2 mEq/L
C. 1.5 - 2.0 mEq/L
D. 2.0 - 2.5 mEq/L
Correct Answer: B
Explanation: The therapeutic range for lithium in the treatment of acute mania and
maintenance of Bipolar Disorder is generally 0.6 to 1.2 mEq/L. Monitoring serum levels is
critical because lithium has a narrow therapeutic index, meaning toxicity can occur at
levels slightly above the therapeutic range. Providers must also monitor renal and thyroid
functions regularly as lithium is excreted by the kidneys and can induce hypothyroidism.
2. A patient with treatment-resistant schizophrenia is starting Clozapine. What is the
minimum Absolute Neutrophil Count (ANC) required to initiate therapy?
A. 500/mm³
,B. 1000/mm³
C. 2000/mm³
D. 1500/mm³
Correct Answer: D
Explanation: To initiate Clozapine, the patient must have an Absolute Neutrophil Count
(ANC) of at least 1500/mm³ (or 1000/mm³ for patients with documented Benign Ethnic
Neutropenia). This requirement is strictly enforced through the Clozapine REMS program
to mitigate the risk of severe neutropenia and agranulocytosis. Ongoing monitoring is
mandatory, initially occurring weekly for the first six months of treatment.
3. Which medication is considered a first-line treatment for a patient experiencing acute
dystonia following the administration of a first-generation antipsychotic?
A. Benztropine
B. Propranolol
C. Lorazepam
D. Bromocriptine
Correct Answer: A
Explanation: Acute dystonia is an extrapyramidal side effect (EPS) characterized by
muscle spasms and abnormal postures, often treated with anticholinergic medications like
Benztropine or Diphenhydramine. These medications help restore the balance between
,dopamine and acetylcholine in the nigrostriatal pathway. Prompt administration, often via
intramuscular injection, provides rapid relief of symptoms.
4. A patient taking Phenelzine (an MAOI) consumes a large amount of aged cheese and wine.
The provider should monitor for which life-threatening condition?
A. Serotonin Syndrome
B. Hypertensive Crisis
C. Neuroleptic Malignant Syndrome
D. Metabolic Syndrome
Correct Answer: B
Explanation: MAOIs inhibit the breakdown of tyramine, an amino acid found in aged and
fermented foods. Consuming high-tyramine foods while on an MAOI leads to a surge in
norepinephrine, causing a dangerous hypertensive crisis. Clinical management involves
blood pressure reduction and strict dietary education to prevent recurrence.
5. Which of the following antidepressants is most likely to cause a seizure if prescribed at high
doses or to a patient with a history of bulimia?
A. Bupropion
B. Fluoxetine
C. Sertraline
D. Mirtazapine
, Correct Answer: A
Explanation: Bupropion is contraindicated in patients with a history of seizure disorders,
anorexia, or bulimia because it lowers the seizure threshold. The risk is particularly high
during electrolyte imbalances associated with purging behaviors. Providers should screen
for these eating disorders prior to prescribing Bupropion for depression or smoking
cessation.
6. A 45-year-old male on Risperidone reports breast enlargement and nipple discharge. This is
likely due to which mechanism?
A. D2 blockade in the Mesolimbic pathway
B. D2 blockade in the Tuberoinfundibular pathway
C. D2 blockade in the Nigrostriatal pathway
D. 5-HT2A antagonism in the Mesocortical pathway
Correct Answer: B
Explanation: Blocking dopamine in the tuberoinfundibular pathway leads to an increase in
prolactin levels, a condition known as hyperprolactinemia. This can result in gynecomastia,
galactorrhea, and sexual dysfunction in both men and women. Risperidone and
Paliperidone are particularly noted for their high affinity for D2 receptors in this specific
pathway.
