NR 606 MIDTERM COMPREHENSIVE TEST
PAPER 2026 COMPLETE QUESTIONS AND
SOLUTIONS 100% CORRECT
◉ Johnita has been taking sertraline 100 mg daily for 4 years for
major depressive disorder. Her symptoms have fluctuated over the
past year. She is 10 weeks pregnant.
Which of the following is the most appropriate recommendation for
Johnita?
continue sertraline 100 mg daily
decrease sertraline to 50 mg daily
increase sertraline to 150 mg daily
discontinue sertraline. Answer: continue sertraline 100 mg daily
Rationale: Sertraline is considered a safe medication during
pregnancy. The client's symptoms have fluctuated on her current
medication dose; therefore, decreasing the dose may cause a relapse
of symptoms.
,◉ Alexandra has been taking lithium 1200 mg orally in two divided
doses of 600 mg each for bipolar I disorder. She has been in
remission of symptoms for 14 months. She is 7 weeks pregnant.
Which of the following is the most appropriate recommendation for
Alexandra?
obtain serum lithium levels before tapering the lithium dose
decrease dose to 600 mg daily
decrease dose to 900 mg daily
discontinue lithium and switch to lamotrigine. Answer: obtain
serum lithium levels before tapering the lithium dose
Rationale: Lithium exposure during the first trimester has a small
but statistically significant risk of cardiac malformations; the risk
increases with higher dosages of the medication. Obtaining serum
lithium levels before tapering the dose is indicated since Alexandra
has bipolar I disorder and is stable. The development of the heart
begins as early as the third week of gestation with the 4-chamber
fetal heart formed by gestational week 7. By the time Alexandra is
weaned the risk has passed as the heart is already formed. Although
lamotrigine is considered safe during pregnancy, it may not be
appropriate for clients who have experienced mania in the past.
,◉ Saoirse takes aripiprazole 30 mg daily for a diagnosis of
schizophrenia. She has taken the medication throughout her
pregnancy and is now 34 weeks pregnant. She is concerned about
the risks of neonatal withdrawal syndrome once her child is
delivered. Which of the following is the most appropriate
recommendation for Saoirse?
continue taking aripiprazole 30 mg daily
taper aripiprazole dose over 2 weeks to 15 mg daily and then
increase to 30 mg after delivery
discontinue aripiprazole at 38 weeks. Answer: continue taking
aripiprazole 30 mg daily
Rationale: Although neonatal withdrawal syndrome can occur in
newborns who are exposed to second-generation antipsychotics,
reducing or discontinuing aripiprazole or switching to another
antipsychotic medication may cause destabilization in the client. The
infant may need a few days of additional monitoring after delivery,
but the client should remain on her optimized dose.
, ◉ psychotropic medications & Breastfeeding. Answer: -American
Academy of Pediatrics advocates breastfeeding through the first 6
months of life
-most psychotropic medications pass into breast milk
• If infant exposed to med in utero, may discuss continuing med
during breastfeeding, unless has severe side effects for infant
-req new or additional prescriptions while breastfeeding
• discuss whether benefits of breastfeeding outweigh the risks of
exposure to the infant
• bottle feeding may be the best option
-Pts must be educated to support informed choice & their
preferences must be supported
◉ Safe for Breastfeeding. Answer: -SSRIs
-Benzodiazepines
-Valproic acid
-Quetiapine
◉ Safe for Bottle Feeding. Answer: -Lithium
-Lamotrigine
-Clozapine
PAPER 2026 COMPLETE QUESTIONS AND
SOLUTIONS 100% CORRECT
◉ Johnita has been taking sertraline 100 mg daily for 4 years for
major depressive disorder. Her symptoms have fluctuated over the
past year. She is 10 weeks pregnant.
Which of the following is the most appropriate recommendation for
Johnita?
continue sertraline 100 mg daily
decrease sertraline to 50 mg daily
increase sertraline to 150 mg daily
discontinue sertraline. Answer: continue sertraline 100 mg daily
Rationale: Sertraline is considered a safe medication during
pregnancy. The client's symptoms have fluctuated on her current
medication dose; therefore, decreasing the dose may cause a relapse
of symptoms.
,◉ Alexandra has been taking lithium 1200 mg orally in two divided
doses of 600 mg each for bipolar I disorder. She has been in
remission of symptoms for 14 months. She is 7 weeks pregnant.
Which of the following is the most appropriate recommendation for
Alexandra?
obtain serum lithium levels before tapering the lithium dose
decrease dose to 600 mg daily
decrease dose to 900 mg daily
discontinue lithium and switch to lamotrigine. Answer: obtain
serum lithium levels before tapering the lithium dose
Rationale: Lithium exposure during the first trimester has a small
but statistically significant risk of cardiac malformations; the risk
increases with higher dosages of the medication. Obtaining serum
lithium levels before tapering the dose is indicated since Alexandra
has bipolar I disorder and is stable. The development of the heart
begins as early as the third week of gestation with the 4-chamber
fetal heart formed by gestational week 7. By the time Alexandra is
weaned the risk has passed as the heart is already formed. Although
lamotrigine is considered safe during pregnancy, it may not be
appropriate for clients who have experienced mania in the past.
,◉ Saoirse takes aripiprazole 30 mg daily for a diagnosis of
schizophrenia. She has taken the medication throughout her
pregnancy and is now 34 weeks pregnant. She is concerned about
the risks of neonatal withdrawal syndrome once her child is
delivered. Which of the following is the most appropriate
recommendation for Saoirse?
continue taking aripiprazole 30 mg daily
taper aripiprazole dose over 2 weeks to 15 mg daily and then
increase to 30 mg after delivery
discontinue aripiprazole at 38 weeks. Answer: continue taking
aripiprazole 30 mg daily
Rationale: Although neonatal withdrawal syndrome can occur in
newborns who are exposed to second-generation antipsychotics,
reducing or discontinuing aripiprazole or switching to another
antipsychotic medication may cause destabilization in the client. The
infant may need a few days of additional monitoring after delivery,
but the client should remain on her optimized dose.
, ◉ psychotropic medications & Breastfeeding. Answer: -American
Academy of Pediatrics advocates breastfeeding through the first 6
months of life
-most psychotropic medications pass into breast milk
• If infant exposed to med in utero, may discuss continuing med
during breastfeeding, unless has severe side effects for infant
-req new or additional prescriptions while breastfeeding
• discuss whether benefits of breastfeeding outweigh the risks of
exposure to the infant
• bottle feeding may be the best option
-Pts must be educated to support informed choice & their
preferences must be supported
◉ Safe for Breastfeeding. Answer: -SSRIs
-Benzodiazepines
-Valproic acid
-Quetiapine
◉ Safe for Bottle Feeding. Answer: -Lithium
-Lamotrigine
-Clozapine
