NU 643 Exam 3 V2 | NU 643 Advanced
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 3) | Regis University
1. A 24-year-old female patient is being started on Lithium for Bipolar I Disorder. Before
initiating therapy, which of the following sets of baseline laboratory tests is most critical for
the psychiatric-mental health nurse practitioner (PMHNP) to order?
A. Liver function tests, CBC with differential, and Vitamin B12.
B. Lipid panel, fasting blood glucose, and A1C.
C. Serum creatinine, BUN, thyroid-stimulating hormone (TSH), and pregnancy test.
D. ECG, troponin levels, and brain natriuretic peptide (BNP).
Correct Answer: C
Explanation: Lithium is primarily excreted by the kidneys, making baseline renal function
tests such as serum creatinine and BUN essential to determine proper dosing. Furthermore,
Lithium can interfere with thyroid hormone synthesis, potentially leading to
hypothyroidism, which necessitates a baseline TSH level. Given the risk of Ebstein’s
anomaly in the first trimester, a pregnancy test is mandatory for females of childbearing
age before starting this medication.
,2. When managing a patient on Clozapine, the PMHNP must monitor the Absolute Neutrophil
Count (ANC). Which of the following ANC values would require the immediate
discontinuation of Clozapine and preclude rechallenge unless the benefits outweigh the risks?
A. ANC < 500/uL
B. ANC < 2000/uL
C. ANC < 1500/uL
D. ANC < 1000/uL
Correct Answer: A
Explanation: A Clozapine patient with an ANC of less than 500/uL is classified as having
severe neutropenia, which requires immediate and permanent discontinuation of the drug.
According to the Clozapine REMS program, this level presents a life-threatening risk for
infection and sepsis. The patient must be monitored closely for signs of infection and
should not be restarted on the medication without specialized consultation and clearance.
3. Which mechanism of action distinguishes second-generation antipsychotics (SGAs) from
first-generation antipsychotics (FGAs) and contributes to their lower risk of Extrapyramidal
Symptoms (EPS)?
A. 5-HT2A receptor antagonism combined with D2 receptor antagonism.
B. Potent D2 receptor antagonism in the mesolimbic pathway.
C. Selective alpha-1 adrenergic receptor blockade.
D. GABAergic modulation in the nigrostriatal pathway.
,Correct Answer: A
Explanation: Second-generation antipsychotics act by blocking both dopamine D2
receptors and serotonin 5-HT2A receptors. The 5-HT2A antagonism increases dopamine
release in the nigrostriatal pathway, which mitigates the D2 blockade effects that typically
cause EPS. This dual action provides the therapeutic benefit of reducing positive symptoms
while minimizing movement-related side effects compared to traditional FGAs like
Haloperidol.
4. A patient with a history of Bipolar Disorder presents with a new onset of a severe,
blistering rash after starting a new medication. Which of the following medications is most
likely responsible for this potentially life-threatening reaction?
A. Lamotrigine
B. Lithium
C. Valproic Acid
D. Quetiapine
Correct Answer: A
Explanation: Lamotrigine is associated with a risk of Stevens-Johnson Syndrome (SJS) and
Toxic Epidermal Necrolysis (TEN), especially during the initial titration phase. To minimize
this risk, the medication must be titrated very slowly according to a specific schedule. Any
patient developing a rash while taking Lamotrigine should be evaluated immediately, as SJS
can be fatal if not managed promptly.
, 5. Which medication is considered a first-line stimulant treatment for a 10-year-old child
diagnosed with ADHD, primarily hyperactive-impulsive type?
A. Atomoxetine
B. Modafinil
C. Guanfacine
D. Methylphenidate
Correct Answer: D
Explanation: Stimulants like Methylphenidate are generally considered the first-line
pharmacological treatment for ADHD in school-aged children due to their high efficacy
rates. They work by increasing the synaptic concentrations of dopamine and
norepinephrine in the prefrontal cortex. While non-stimulants are options, they are
typically reserved for patients who do not tolerate or respond to stimulants.
6. A 72-year-old patient with Alzheimer’s disease is prescribed Donepezil (Aricept). What is
the primary mechanism of action for this medication?
A. NMDA receptor antagonism
B. Dopamine D2 receptor agonism
C. Reversible inhibition of acetylcholinesterase
D. Serotonin reuptake inhibition
Correct Answer: C
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 3) | Regis University
1. A 24-year-old female patient is being started on Lithium for Bipolar I Disorder. Before
initiating therapy, which of the following sets of baseline laboratory tests is most critical for
the psychiatric-mental health nurse practitioner (PMHNP) to order?
A. Liver function tests, CBC with differential, and Vitamin B12.
B. Lipid panel, fasting blood glucose, and A1C.
C. Serum creatinine, BUN, thyroid-stimulating hormone (TSH), and pregnancy test.
D. ECG, troponin levels, and brain natriuretic peptide (BNP).
Correct Answer: C
Explanation: Lithium is primarily excreted by the kidneys, making baseline renal function
tests such as serum creatinine and BUN essential to determine proper dosing. Furthermore,
Lithium can interfere with thyroid hormone synthesis, potentially leading to
hypothyroidism, which necessitates a baseline TSH level. Given the risk of Ebstein’s
anomaly in the first trimester, a pregnancy test is mandatory for females of childbearing
age before starting this medication.
,2. When managing a patient on Clozapine, the PMHNP must monitor the Absolute Neutrophil
Count (ANC). Which of the following ANC values would require the immediate
discontinuation of Clozapine and preclude rechallenge unless the benefits outweigh the risks?
A. ANC < 500/uL
B. ANC < 2000/uL
C. ANC < 1500/uL
D. ANC < 1000/uL
Correct Answer: A
Explanation: A Clozapine patient with an ANC of less than 500/uL is classified as having
severe neutropenia, which requires immediate and permanent discontinuation of the drug.
According to the Clozapine REMS program, this level presents a life-threatening risk for
infection and sepsis. The patient must be monitored closely for signs of infection and
should not be restarted on the medication without specialized consultation and clearance.
3. Which mechanism of action distinguishes second-generation antipsychotics (SGAs) from
first-generation antipsychotics (FGAs) and contributes to their lower risk of Extrapyramidal
Symptoms (EPS)?
A. 5-HT2A receptor antagonism combined with D2 receptor antagonism.
B. Potent D2 receptor antagonism in the mesolimbic pathway.
C. Selective alpha-1 adrenergic receptor blockade.
D. GABAergic modulation in the nigrostriatal pathway.
,Correct Answer: A
Explanation: Second-generation antipsychotics act by blocking both dopamine D2
receptors and serotonin 5-HT2A receptors. The 5-HT2A antagonism increases dopamine
release in the nigrostriatal pathway, which mitigates the D2 blockade effects that typically
cause EPS. This dual action provides the therapeutic benefit of reducing positive symptoms
while minimizing movement-related side effects compared to traditional FGAs like
Haloperidol.
4. A patient with a history of Bipolar Disorder presents with a new onset of a severe,
blistering rash after starting a new medication. Which of the following medications is most
likely responsible for this potentially life-threatening reaction?
A. Lamotrigine
B. Lithium
C. Valproic Acid
D. Quetiapine
Correct Answer: A
Explanation: Lamotrigine is associated with a risk of Stevens-Johnson Syndrome (SJS) and
Toxic Epidermal Necrolysis (TEN), especially during the initial titration phase. To minimize
this risk, the medication must be titrated very slowly according to a specific schedule. Any
patient developing a rash while taking Lamotrigine should be evaluated immediately, as SJS
can be fatal if not managed promptly.
, 5. Which medication is considered a first-line stimulant treatment for a 10-year-old child
diagnosed with ADHD, primarily hyperactive-impulsive type?
A. Atomoxetine
B. Modafinil
C. Guanfacine
D. Methylphenidate
Correct Answer: D
Explanation: Stimulants like Methylphenidate are generally considered the first-line
pharmacological treatment for ADHD in school-aged children due to their high efficacy
rates. They work by increasing the synaptic concentrations of dopamine and
norepinephrine in the prefrontal cortex. While non-stimulants are options, they are
typically reserved for patients who do not tolerate or respond to stimulants.
6. A 72-year-old patient with Alzheimer’s disease is prescribed Donepezil (Aricept). What is
the primary mechanism of action for this medication?
A. NMDA receptor antagonism
B. Dopamine D2 receptor agonism
C. Reversible inhibition of acetylcholinesterase
D. Serotonin reuptake inhibition
Correct Answer: C
