NU 643 Final Exam V3 | NU 643 Advanced
Psychopharmacology | Actual Q&A with Rationale
(NU643 Final Exam) | Regis University
1. A patient is being started on Clozapine for treatment-resistant schizophrenia. Which lab
value must be monitored through the REMS program?
A. Blood Urea Nitrogen (BUN)
B. Aspartate Aminotransferase (AST)
C. Thyroid Stimulating Hormone (TSH)
D. Absolute Neutrophil Count (ANC)
Correct Answer: D
Explanation: Clozapine carries a black box warning for agranulocytosis, requiring strict
monitoring of the ANC. The Risk Evaluation and Mitigation Strategy (REMS) program
ensures that patients have safe levels of neutrophils before the medication is dispensed.
This monitoring is critical for preventing life-threatening infections in psychiatric patients.
2. Which mood stabilizer is most associated with the risk of Stevens-Johnson Syndrome (SJS),
particularly during rapid titration?
A. Lithium
B. Lamotrigine
C. Valproic Acid
,D. Gabapentin
Correct Answer: B
Explanation: Lamotrigine requires a slow titration schedule to minimize the risk of a
severe, life-threatening rash known as Stevens-Johnson Syndrome. If a patient misses more
than five days of the medication, the titration must be restarted from the beginning. This
protocol is essential for patient safety when managing bipolar depression.
3. A patient taking a high dose of Fluoxetine presents with autonomic instability,
hyperreflexia, and agitation. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome
B. Tardive Dyskinesia
C. Anticholinergic Toxicity
D. Serotonin Syndrome
Correct Answer: D
Explanation: Serotonin Syndrome is characterized by the triad of mental status changes,
autonomic hyperactivity, and neuromuscular abnormalities. It often occurs when multiple
serotonergic agents are combined or during an overdose of an SSRI. Management involves
immediate discontinuation of the offending agents and supportive care.
4. Which antidepressant is contraindicated in patients with a history of seizure disorders or
eating disorders?
A. Bupropion
, B. Sertraline
C. Mirtazapine
D. Duloxetine
Correct Answer: A
Explanation: Bupropion lowers the seizure threshold and is specifically contraindicated in
patients with epilepsy or eating disorders such as bulimia or anorexia nervosa. Patients
with electrolyte imbalances from purging are at an even higher risk for seizures while on
this drug. It remains a popular choice for smoking cessation and depression due to its lack
of sexual side effects.
5. A 70-year-old patient is prescribed a benzodiazepine. According to the Beers Criteria, which
of the following is the primary concern?
A. Hypertension
B. Weight gain
C. Hyperglycemia
D. Increased risk of falls and fractures
Correct Answer: D
Explanation: The Beers Criteria warns against the use of benzodiazepines in older adults
due to increased sensitivity and decreased metabolism. These medications significantly
Psychopharmacology | Actual Q&A with Rationale
(NU643 Final Exam) | Regis University
1. A patient is being started on Clozapine for treatment-resistant schizophrenia. Which lab
value must be monitored through the REMS program?
A. Blood Urea Nitrogen (BUN)
B. Aspartate Aminotransferase (AST)
C. Thyroid Stimulating Hormone (TSH)
D. Absolute Neutrophil Count (ANC)
Correct Answer: D
Explanation: Clozapine carries a black box warning for agranulocytosis, requiring strict
monitoring of the ANC. The Risk Evaluation and Mitigation Strategy (REMS) program
ensures that patients have safe levels of neutrophils before the medication is dispensed.
This monitoring is critical for preventing life-threatening infections in psychiatric patients.
2. Which mood stabilizer is most associated with the risk of Stevens-Johnson Syndrome (SJS),
particularly during rapid titration?
A. Lithium
B. Lamotrigine
C. Valproic Acid
,D. Gabapentin
Correct Answer: B
Explanation: Lamotrigine requires a slow titration schedule to minimize the risk of a
severe, life-threatening rash known as Stevens-Johnson Syndrome. If a patient misses more
than five days of the medication, the titration must be restarted from the beginning. This
protocol is essential for patient safety when managing bipolar depression.
3. A patient taking a high dose of Fluoxetine presents with autonomic instability,
hyperreflexia, and agitation. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome
B. Tardive Dyskinesia
C. Anticholinergic Toxicity
D. Serotonin Syndrome
Correct Answer: D
Explanation: Serotonin Syndrome is characterized by the triad of mental status changes,
autonomic hyperactivity, and neuromuscular abnormalities. It often occurs when multiple
serotonergic agents are combined or during an overdose of an SSRI. Management involves
immediate discontinuation of the offending agents and supportive care.
4. Which antidepressant is contraindicated in patients with a history of seizure disorders or
eating disorders?
A. Bupropion
, B. Sertraline
C. Mirtazapine
D. Duloxetine
Correct Answer: A
Explanation: Bupropion lowers the seizure threshold and is specifically contraindicated in
patients with epilepsy or eating disorders such as bulimia or anorexia nervosa. Patients
with electrolyte imbalances from purging are at an even higher risk for seizures while on
this drug. It remains a popular choice for smoking cessation and depression due to its lack
of sexual side effects.
5. A 70-year-old patient is prescribed a benzodiazepine. According to the Beers Criteria, which
of the following is the primary concern?
A. Hypertension
B. Weight gain
C. Hyperglycemia
D. Increased risk of falls and fractures
Correct Answer: D
Explanation: The Beers Criteria warns against the use of benzodiazepines in older adults
due to increased sensitivity and decreased metabolism. These medications significantly
