NSG 552 Exam 2 V3 | NSG 552
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 2) | Wilkes
1. A patient diagnosed with Bipolar I Disorder has a serum lithium level of 1.8 mEq/L. Which
clinical presentation is most consistent with this lab value?
A. Fine hand tremor, mild thirst, and polyuria.
B. No clinical symptoms as this level is within the therapeutic range.
C. Generalized tonic-clonic seizures, oliguria, and cardiovascular collapse.
D. Persistent gastrointestinal upset, coarse hand tremor, and mental confusion.
Correct Answer: D
Explanation: A serum lithium level of 1.8 mEq/L indicates mild to moderate toxicity, as the
standard therapeutic range is 0.6 to 1.2 mEq/L. At this level, patients commonly exhibit
signs such as persistent diarrhea, vomiting, and a coarse hand tremor. It is imperative for
the provider to instruct the patient to withhold the medication and seek immediate medical
evaluation.
2. The psychiatric-mental health nurse practitioner (PMHNP) is initiating Clozapine therapy
for a patient with treatment-resistant schizophrenia. According to the Clozapine REMS
program, what is the minimum Absolute Neutrophil Count (ANC) required to begin
treatment?
A. 500/mm3
,B. 1,500/mm3
C. 1,000/mm3
D. 2,000/mm3
Correct Answer: B
Explanation: For the general population, the ANC must be at least 1,500/mm3 before
starting Clozapine to minimize the risk of severe neutropenia. Clozapine is associated with
a risk of agranulocytosis, which necessitates strict monitoring of the white blood cell count
and ANC. If the ANC falls below the mandated thresholds during treatment, the medication
must be suspended or discontinued depending on the severity.
3. When prescribing Lamotrigine for a patient with bipolar depression, the PMHNP must
follow a specific titration schedule. What is the primary clinical reason for this ‘start low, go
slow’ approach?
A. To decrease the risk of Stevens-Johnson Syndrome (SJS).
B. To minimize the risk of weight gain and sedation.
C. To reduce the risk of hepatotoxicity.
D. To prevent the development of metabolic syndrome.
Correct Answer: A
Explanation: The rapid titration of Lamotrigine is significantly associated with an
increased risk of severe, life-threatening rashes, including Stevens-Johnson Syndrome. By
,starting at a low dose, typically 25 mg daily for two weeks, and increasing gradually, the
incidence of this reaction is greatly reduced. Patients should be educated to immediately
report any new skin changes or rashes while taking this medication.
4. A patient treated with Haloperidol for acute psychosis develops a sudden, sustained
contraction of the neck muscles (torticollis). Which medication should the PMHNP order for
immediate treatment?
A. Lorazepam (Ativan)
B. Propranolol (Inderal)
C. Benztropine (Cogentin)
D. Dantrolene (Dantrium)
Correct Answer: C
Explanation: The patient is experiencing an acute dystonic reaction, a common
extrapyramidal side effect (EPS) associated with first-generation antipsychotics like
Haloperidol. Anticholinergic medications such as Benztropine or Diphenhydramine are the
first-line treatments for reversing these painful muscle spasms. Rapid intervention is
necessary to alleviate patient distress and prevent airway compromise in cases of laryngeal
dystonia.
5. Which baseline and periodic laboratory tests are most critical for a patient being
maintained on Valproic Acid (Depakote)?
A. Liver Function Tests (LFTs) and Platelet Count
, B. Serum creatinine and BUN
C. Thyroid Stimulating Hormone (TSH) and Calcium
D. Electrocardiogram (ECG) and Potassium
Correct Answer: A
Explanation: Valproic acid carries black box warnings for hepatotoxicity and pancreatitis,
making regular liver function monitoring essential. Additionally, it can cause dose-related
thrombocytopenia, necessitating periodic platelet counts to ensure patient safety.
Practitioners must remain vigilant for signs of bruising, bleeding, or abdominal pain that
might suggest these adverse effects.
6. Aripiprazole (Abilify) is often described as a ‘dopamine stabilizer.’ What is the
pharmacodynamic mechanism that accounts for this description?
A. Partial agonism at the Dopamine D2 receptor.
B. Potent antagonism at the Dopamine D2 receptor.
C. Selective inhibition of Dopamine reuptake.
D. Irreversible binding to the Dopamine D4 receptor.
Correct Answer: A
Explanation: Aripiprazole acts as a partial agonist at the D2 receptor, meaning it competes
with endogenous dopamine and exerts a moderate effect. In areas of high dopamine
activity, it acts as an antagonist, while in areas of low dopamine activity, it acts as an
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 2) | Wilkes
1. A patient diagnosed with Bipolar I Disorder has a serum lithium level of 1.8 mEq/L. Which
clinical presentation is most consistent with this lab value?
A. Fine hand tremor, mild thirst, and polyuria.
B. No clinical symptoms as this level is within the therapeutic range.
C. Generalized tonic-clonic seizures, oliguria, and cardiovascular collapse.
D. Persistent gastrointestinal upset, coarse hand tremor, and mental confusion.
Correct Answer: D
Explanation: A serum lithium level of 1.8 mEq/L indicates mild to moderate toxicity, as the
standard therapeutic range is 0.6 to 1.2 mEq/L. At this level, patients commonly exhibit
signs such as persistent diarrhea, vomiting, and a coarse hand tremor. It is imperative for
the provider to instruct the patient to withhold the medication and seek immediate medical
evaluation.
2. The psychiatric-mental health nurse practitioner (PMHNP) is initiating Clozapine therapy
for a patient with treatment-resistant schizophrenia. According to the Clozapine REMS
program, what is the minimum Absolute Neutrophil Count (ANC) required to begin
treatment?
A. 500/mm3
,B. 1,500/mm3
C. 1,000/mm3
D. 2,000/mm3
Correct Answer: B
Explanation: For the general population, the ANC must be at least 1,500/mm3 before
starting Clozapine to minimize the risk of severe neutropenia. Clozapine is associated with
a risk of agranulocytosis, which necessitates strict monitoring of the white blood cell count
and ANC. If the ANC falls below the mandated thresholds during treatment, the medication
must be suspended or discontinued depending on the severity.
3. When prescribing Lamotrigine for a patient with bipolar depression, the PMHNP must
follow a specific titration schedule. What is the primary clinical reason for this ‘start low, go
slow’ approach?
A. To decrease the risk of Stevens-Johnson Syndrome (SJS).
B. To minimize the risk of weight gain and sedation.
C. To reduce the risk of hepatotoxicity.
D. To prevent the development of metabolic syndrome.
Correct Answer: A
Explanation: The rapid titration of Lamotrigine is significantly associated with an
increased risk of severe, life-threatening rashes, including Stevens-Johnson Syndrome. By
,starting at a low dose, typically 25 mg daily for two weeks, and increasing gradually, the
incidence of this reaction is greatly reduced. Patients should be educated to immediately
report any new skin changes or rashes while taking this medication.
4. A patient treated with Haloperidol for acute psychosis develops a sudden, sustained
contraction of the neck muscles (torticollis). Which medication should the PMHNP order for
immediate treatment?
A. Lorazepam (Ativan)
B. Propranolol (Inderal)
C. Benztropine (Cogentin)
D. Dantrolene (Dantrium)
Correct Answer: C
Explanation: The patient is experiencing an acute dystonic reaction, a common
extrapyramidal side effect (EPS) associated with first-generation antipsychotics like
Haloperidol. Anticholinergic medications such as Benztropine or Diphenhydramine are the
first-line treatments for reversing these painful muscle spasms. Rapid intervention is
necessary to alleviate patient distress and prevent airway compromise in cases of laryngeal
dystonia.
5. Which baseline and periodic laboratory tests are most critical for a patient being
maintained on Valproic Acid (Depakote)?
A. Liver Function Tests (LFTs) and Platelet Count
, B. Serum creatinine and BUN
C. Thyroid Stimulating Hormone (TSH) and Calcium
D. Electrocardiogram (ECG) and Potassium
Correct Answer: A
Explanation: Valproic acid carries black box warnings for hepatotoxicity and pancreatitis,
making regular liver function monitoring essential. Additionally, it can cause dose-related
thrombocytopenia, necessitating periodic platelet counts to ensure patient safety.
Practitioners must remain vigilant for signs of bruising, bleeding, or abdominal pain that
might suggest these adverse effects.
6. Aripiprazole (Abilify) is often described as a ‘dopamine stabilizer.’ What is the
pharmacodynamic mechanism that accounts for this description?
A. Partial agonism at the Dopamine D2 receptor.
B. Potent antagonism at the Dopamine D2 receptor.
C. Selective inhibition of Dopamine reuptake.
D. Irreversible binding to the Dopamine D4 receptor.
Correct Answer: A
Explanation: Aripiprazole acts as a partial agonist at the D2 receptor, meaning it competes
with endogenous dopamine and exerts a moderate effect. In areas of high dopamine
activity, it acts as an antagonist, while in areas of low dopamine activity, it acts as an
