NSG 552: EXAM 2
ADVANCED PSYCHOPHARMACOLY
COVERAGE : MODULES 4,5 & 6
2026/2027/2028 TESTING CYCLE
VERIFIED Q & A, WITH EXPERT RATIONALES
GUARANTEED PASS | GRADED A+
Q1: A patient on lithium reports coarse hand tremors, slurred speech, and unsteady gait. Which
serum lithium level should the nurse expect?
A. 0.8 mEq/L
B. 1.0 mEq/L
C. 1.5 mEq/L
D. 2.2 mEq/L
Correct Answer: D
Rationale: Coarse tremors, slurred speech, ataxia, vomiting, and diarrhea indicate acute lithium
toxicity. Therapeutic range is 0.6–1.2 mEq/L. A level of 2.2 mEq/L is toxic and requires
immediate intervention.
Q2: Which baseline laboratory test is mandatory before initiating lithium therapy?
A. Serum potassium
B. Serum creatinine and BUN
C. Serum calcium
D. Serum magnesium
Correct Answer: B
,Rationale: Lithium is renally excreted. Baseline serum creatinine and BUN assess renal function.
TSH and beta-hCG are also required. Lithium can cause nephrogenic diabetes insipidus and
thyroid abnormalities.
Q3: A patient on valproic acid has a serum level of 140 mcg/mL. Which action should the nurse
take?
A. Continue the current dose
B. Notify the provider immediately
C. Administer the next dose as scheduled
D. Document and reassess in 1 week
Correct Answer: B
Rationale: The therapeutic range for valproic acid is 50–125 mcg/mL. A level of 140 mcg/mL is
above therapeutic and may indicate toxicity. The nurse should notify the provider.
Q4: Which medication requires strict slow titration to prevent Stevens-Johnson Syndrome?
A. Lithium
B. Valproic acid
C. Lamotrigine
D. Carbamazepine
Correct Answer: C
Rationale: Lamotrigine (Lamictal) requires strict slow titration to prevent Stevens-Johnson
Syndrome (SJS). Any new rash requires immediate discontinuation and medical evaluation.
Q5: A patient of Asian descent is prescribed carbamazepine. Which genetic screening is
required?
A. HLA-B*1502 allele
B. CYP2D6 genotype
C. CYP2C19 genotype
D. HLA-DR4 allele
Correct Answer: A
Rationale: Carbamazepine requires screening for the HLA-B*1502 allele in patients of Asian
descent to prevent toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome.
, Q6: Which medication is associated with benign leukocytosis?
A. Valproic acid
B. Lamotrigine
C. Carbamazepine
D. Lithium
Correct Answer: D
Rationale: Lithium can cause benign leukocytosis (elevated WBC count). This should not be
mistaken for infection in an asymptomatic patient.
Q7: A patient on valproic acid reports hair loss and weight gain. Which additional risk should the
nurse monitor for in young female patients?
A. Osteoporosis
B. Polycystic ovary syndrome (PCOS)
C. Hyperthyroidism
D. Renal failure
Correct Answer: B
Rationale: Valproic acid is associated with weight gain, alopecia (hair loss), and polycystic ovary
syndrome (PCOS) in young female patients. LFTs and platelet counts require routine monitoring.
Q8: A patient on lamotrigine stops taking the medication for 5 days. Which action should the
nurse take?
A. Resume the previous dose
B. Double the dose to catch up
C. Restart the titration from Week 1 (25 mg)
D. Discontinue the medication permanently
Correct Answer: C
Rationale: If lamotrigine is stopped for more than 3–5 days, the titration schedule must be
restarted from Week 1 (25 mg) to prevent Stevens-Johnson Syndrome. The patient cannot resume
at the previous dose.
Q9: Which drug interaction increases lithium levels and risk of toxicity?
ADVANCED PSYCHOPHARMACOLY
COVERAGE : MODULES 4,5 & 6
2026/2027/2028 TESTING CYCLE
VERIFIED Q & A, WITH EXPERT RATIONALES
GUARANTEED PASS | GRADED A+
Q1: A patient on lithium reports coarse hand tremors, slurred speech, and unsteady gait. Which
serum lithium level should the nurse expect?
A. 0.8 mEq/L
B. 1.0 mEq/L
C. 1.5 mEq/L
D. 2.2 mEq/L
Correct Answer: D
Rationale: Coarse tremors, slurred speech, ataxia, vomiting, and diarrhea indicate acute lithium
toxicity. Therapeutic range is 0.6–1.2 mEq/L. A level of 2.2 mEq/L is toxic and requires
immediate intervention.
Q2: Which baseline laboratory test is mandatory before initiating lithium therapy?
A. Serum potassium
B. Serum creatinine and BUN
C. Serum calcium
D. Serum magnesium
Correct Answer: B
,Rationale: Lithium is renally excreted. Baseline serum creatinine and BUN assess renal function.
TSH and beta-hCG are also required. Lithium can cause nephrogenic diabetes insipidus and
thyroid abnormalities.
Q3: A patient on valproic acid has a serum level of 140 mcg/mL. Which action should the nurse
take?
A. Continue the current dose
B. Notify the provider immediately
C. Administer the next dose as scheduled
D. Document and reassess in 1 week
Correct Answer: B
Rationale: The therapeutic range for valproic acid is 50–125 mcg/mL. A level of 140 mcg/mL is
above therapeutic and may indicate toxicity. The nurse should notify the provider.
Q4: Which medication requires strict slow titration to prevent Stevens-Johnson Syndrome?
A. Lithium
B. Valproic acid
C. Lamotrigine
D. Carbamazepine
Correct Answer: C
Rationale: Lamotrigine (Lamictal) requires strict slow titration to prevent Stevens-Johnson
Syndrome (SJS). Any new rash requires immediate discontinuation and medical evaluation.
Q5: A patient of Asian descent is prescribed carbamazepine. Which genetic screening is
required?
A. HLA-B*1502 allele
B. CYP2D6 genotype
C. CYP2C19 genotype
D. HLA-DR4 allele
Correct Answer: A
Rationale: Carbamazepine requires screening for the HLA-B*1502 allele in patients of Asian
descent to prevent toxic epidermal necrolysis (TEN) and Stevens-Johnson Syndrome.
, Q6: Which medication is associated with benign leukocytosis?
A. Valproic acid
B. Lamotrigine
C. Carbamazepine
D. Lithium
Correct Answer: D
Rationale: Lithium can cause benign leukocytosis (elevated WBC count). This should not be
mistaken for infection in an asymptomatic patient.
Q7: A patient on valproic acid reports hair loss and weight gain. Which additional risk should the
nurse monitor for in young female patients?
A. Osteoporosis
B. Polycystic ovary syndrome (PCOS)
C. Hyperthyroidism
D. Renal failure
Correct Answer: B
Rationale: Valproic acid is associated with weight gain, alopecia (hair loss), and polycystic ovary
syndrome (PCOS) in young female patients. LFTs and platelet counts require routine monitoring.
Q8: A patient on lamotrigine stops taking the medication for 5 days. Which action should the
nurse take?
A. Resume the previous dose
B. Double the dose to catch up
C. Restart the titration from Week 1 (25 mg)
D. Discontinue the medication permanently
Correct Answer: C
Rationale: If lamotrigine is stopped for more than 3–5 days, the titration schedule must be
restarted from Week 1 (25 mg) to prevent Stevens-Johnson Syndrome. The patient cannot resume
at the previous dose.
Q9: Which drug interaction increases lithium levels and risk of toxicity?
