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NR 546 Final Exam – Advanced Psychopharmacology for
the PMHNP – (2026-2027) Actual Questions & Answers
(Chamberlain) 100% Guarantee Pass
Question 1
A 32-year-old patient with bipolar I disorder is started on lithium for maintenance treatment.
During a follow-up visit, the patient reports several days of vomiting and diarrhea and states,
“My hands are shaking more than usual, and I feel unsteady when I walk.” The patient also
appears confused. Which action should the PMHNP take first?
A. Increase the lithium dose because the mood symptoms may be worsening
B. Hold lithium and urgently evaluate the patient for lithium toxicity
C. Add an SSRI to improve the patient's current symptoms
D. Reassure the patient that these effects commonly resolve without intervention
Answer: B. Hold lithium and urgently evaluate the patient for lithium toxicity
Explanation: Gastrointestinal symptoms, worsening tremor, ataxia, and confusion are
concerning for lithium toxicity. Dehydration from vomiting and diarrhea can increase lithium
, concentrations. Lithium has a narrow therapeutic index, so suspected toxicity requires prompt
clinical evaluation rather than dose escalation.
Question 2
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A patient taking lithium for bipolar disorder asks what lifestyle factors can affect lithium
concentrations. Which teaching point is most appropriate?
A. “Keep your sodium and fluid intake reasonably consistent.”
B. “Avoid all dietary sodium.”
C. “Restrict fluids whenever your lithium level is high.”
D. “Increase caffeine intake to improve lithium elimination.”
Answer: A. “Keep your sodium and fluid intake reasonably consistent.”
Explanation: Significant changes in sodium and fluid balance can alter lithium concentrations.
Dehydration, excessive sweating, vomiting, diarrhea, and major dietary sodium changes can
increase the risk of lithium toxicity. Patients should maintain consistent hydration and sodium
intake and report significant fluid losses.
Question 3
A patient taking lithium for bipolar disorder develops a painful inflammatory condition and asks
whether ibuprofen can be taken regularly for symptom relief. Which response by the PMHNP is
most appropriate?
A. “Ibuprofen has no clinically important interaction with lithium.”
B. “NSAIDs can increase lithium concentrations, so discuss an alternative with your prescriber.”
, C. “Take twice as much lithium when taking ibuprofen.”
D. “Stop lithium permanently before taking any pain medication.”
Answer: B. “NSAIDs can increase lithium concentrations, so discuss an alternative with
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your prescriber.”
Explanation: Several NSAIDs can reduce renal lithium clearance and increase serum lithium
concentrations, potentially increasing toxicity risk. Patients taking lithium should discuss regular
NSAID use with the prescriber and should not independently alter lithium therapy.
Question 4
A 27-year-old patient with bipolar disorder is prescribed lamotrigine. Two weeks later, the
patient reports a new widespread skin rash accompanied by fever and painful oral lesions. What
is the priority action?
A. Increase the lamotrigine dose gradually
B. Reassure the patient that mild rashes are expected
C. Arrange urgent medical evaluation for a potentially serious cutaneous reaction
D. Add diphenhydramine and continue lamotrigine without further evaluation
Answer: C. Arrange urgent medical evaluation for a potentially serious cutaneous reaction
Explanation: Lamotrigine can cause serious cutaneous reactions, including Stevens-Johnson
syndrome and toxic epidermal necrolysis. A new rash accompanied by fever or mucosal
involvement is particularly concerning and requires urgent medical evaluation. The medication
should not simply be continued without assessment.
Question 5
, A patient taking an antipsychotic develops high fever, severe generalized muscle rigidity,
diaphoresis, altered mental status, and unstable blood pressure. Which adverse reaction should
the PMHNP suspect?
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A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Akathisia
D. Tardive dyskinesia
Answer: B. Neuroleptic malignant syndrome
Explanation: Neuroleptic malignant syndrome is a potentially life-threatening reaction
associated primarily with dopamine-receptor blockade. Severe rigidity, hyperthermia, altered
mental status, and autonomic instability are characteristic findings. The suspected medication
requires urgent evaluation and appropriate emergency management.
Question 6
A patient recently started on an antipsychotic reports, “I cannot sit still. I feel like I have to keep
pacing even though I am exhausted.” Which adverse effect is most likely?
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Pseudoparkinsonism
Answer: A. Akathisia
NR 546 Final Exam – Advanced Psychopharmacology for
the PMHNP – (2026-2027) Actual Questions & Answers
(Chamberlain) 100% Guarantee Pass
Question 1
A 32-year-old patient with bipolar I disorder is started on lithium for maintenance treatment.
During a follow-up visit, the patient reports several days of vomiting and diarrhea and states,
“My hands are shaking more than usual, and I feel unsteady when I walk.” The patient also
appears confused. Which action should the PMHNP take first?
A. Increase the lithium dose because the mood symptoms may be worsening
B. Hold lithium and urgently evaluate the patient for lithium toxicity
C. Add an SSRI to improve the patient's current symptoms
D. Reassure the patient that these effects commonly resolve without intervention
Answer: B. Hold lithium and urgently evaluate the patient for lithium toxicity
Explanation: Gastrointestinal symptoms, worsening tremor, ataxia, and confusion are
concerning for lithium toxicity. Dehydration from vomiting and diarrhea can increase lithium
, concentrations. Lithium has a narrow therapeutic index, so suspected toxicity requires prompt
clinical evaluation rather than dose escalation.
Question 2
Page | 2
A patient taking lithium for bipolar disorder asks what lifestyle factors can affect lithium
concentrations. Which teaching point is most appropriate?
A. “Keep your sodium and fluid intake reasonably consistent.”
B. “Avoid all dietary sodium.”
C. “Restrict fluids whenever your lithium level is high.”
D. “Increase caffeine intake to improve lithium elimination.”
Answer: A. “Keep your sodium and fluid intake reasonably consistent.”
Explanation: Significant changes in sodium and fluid balance can alter lithium concentrations.
Dehydration, excessive sweating, vomiting, diarrhea, and major dietary sodium changes can
increase the risk of lithium toxicity. Patients should maintain consistent hydration and sodium
intake and report significant fluid losses.
Question 3
A patient taking lithium for bipolar disorder develops a painful inflammatory condition and asks
whether ibuprofen can be taken regularly for symptom relief. Which response by the PMHNP is
most appropriate?
A. “Ibuprofen has no clinically important interaction with lithium.”
B. “NSAIDs can increase lithium concentrations, so discuss an alternative with your prescriber.”
, C. “Take twice as much lithium when taking ibuprofen.”
D. “Stop lithium permanently before taking any pain medication.”
Answer: B. “NSAIDs can increase lithium concentrations, so discuss an alternative with
Page | 3
your prescriber.”
Explanation: Several NSAIDs can reduce renal lithium clearance and increase serum lithium
concentrations, potentially increasing toxicity risk. Patients taking lithium should discuss regular
NSAID use with the prescriber and should not independently alter lithium therapy.
Question 4
A 27-year-old patient with bipolar disorder is prescribed lamotrigine. Two weeks later, the
patient reports a new widespread skin rash accompanied by fever and painful oral lesions. What
is the priority action?
A. Increase the lamotrigine dose gradually
B. Reassure the patient that mild rashes are expected
C. Arrange urgent medical evaluation for a potentially serious cutaneous reaction
D. Add diphenhydramine and continue lamotrigine without further evaluation
Answer: C. Arrange urgent medical evaluation for a potentially serious cutaneous reaction
Explanation: Lamotrigine can cause serious cutaneous reactions, including Stevens-Johnson
syndrome and toxic epidermal necrolysis. A new rash accompanied by fever or mucosal
involvement is particularly concerning and requires urgent medical evaluation. The medication
should not simply be continued without assessment.
Question 5
, A patient taking an antipsychotic develops high fever, severe generalized muscle rigidity,
diaphoresis, altered mental status, and unstable blood pressure. Which adverse reaction should
the PMHNP suspect?
Page | 4
A. Serotonin syndrome
B. Neuroleptic malignant syndrome
C. Akathisia
D. Tardive dyskinesia
Answer: B. Neuroleptic malignant syndrome
Explanation: Neuroleptic malignant syndrome is a potentially life-threatening reaction
associated primarily with dopamine-receptor blockade. Severe rigidity, hyperthermia, altered
mental status, and autonomic instability are characteristic findings. The suspected medication
requires urgent evaluation and appropriate emergency management.
Question 6
A patient recently started on an antipsychotic reports, “I cannot sit still. I feel like I have to keep
pacing even though I am exhausted.” Which adverse effect is most likely?
A. Akathisia
B. Acute dystonia
C. Tardive dyskinesia
D. Pseudoparkinsonism
Answer: A. Akathisia
