NURS 660 Exam 4 V2 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 4 2026)
1. A 32-year-old female patient diagnosed with Bipolar I Disorder is being initiated on
Lithium. Which of the following baseline laboratory tests is most critical for the PMHNP to
order to ensure safe excretion of the medication?
A. Liver Function Tests (LFTs)
B. Complete Blood Count (CBC) with differential
C. Amylase and Lipase
D. Serum Creatinine and BUN
Answer: D
Rationale: Lithium is almost exclusively excreted by the kidneys, unlike many other
psychotropic medications that undergo hepatic metabolism. Therefore, assessing renal
function through Serum Creatinine and BUN is essential to determine the patient’s ability
to clear the drug and prevent toxicity. The PMHNP must monitor these values regularly
throughout treatment to ensure the narrow therapeutic window is maintained safely.
,2. A patient taking Clozapine presents for a routine check-up. The Absolute Neutrophil Count
(ANC) is reported as 1,200/mm³. According to the Clozapine REMS program, what is the most
appropriate next step for the PMHNP?
A. Continue current dosage and retest in one month
B. Increase the dose to manage breakthrough psychosis
C. Continue treatment but monitor ANC three times weekly
D. Interrupt treatment and monitor ANC daily
Answer: C
Rationale: An ANC of 1,200/mm³ falls into the category of Mild Neutropenia (1,000–
1,499/mm³) for the general population. In this range, the Clozapine REMS guidelines
suggest continuing treatment but increasing monitoring frequency to three times weekly
until the ANC returns to ≥1,500/mm³. This protocol is vital to prevent the progression to
severe agranulocytosis, a life-threatening complication of Clozapine therapy.
3. A 45-year-old male recently started on Haloperidol presents with high fever, muscle
rigidity, and autonomic instability. Which medication should the PMHNP anticipate
administering to treat this condition?
A. Benztropine
B. Propranolol
C. Diphenhydramine
D. Dantrolene
,Answer: D
Rationale: The patient is presenting with classic symptoms of Neuroleptic Malignant
Syndrome (NMS), which is a medical emergency associated with dopamine antagonists.
Dantrolene, a muscle relaxant, is frequently used to treat the malignant hyperthermia and
muscle rigidity associated with this syndrome. Immediate cessation of the antipsychotic
and supportive care are also mandatory components of NMS management.
4. When prescribing Lamotrigine for Bipolar Depression, the PMHNP must educate the
patient on the importance of a slow titration schedule to primarily minimize the risk of which
condition?
A. Weight gain and metabolic syndrome
B. Stevens-Johnson Syndrome (SJS)
C. Agranulocytosis
D. Hyperprolactinemia
Answer: B
Rationale: Stevens-Johnson Syndrome is a rare but life-threatening dermatological
reaction associated with Lamotrigine, especially during the first few weeks of therapy. A
very slow dose titration is required to mitigate this risk, as rapid escalation is a known risk
factor for the development of toxic epidermal necrolysis. Patients must be instructed to
stop the medication and seek emergency care immediately if any rash or mucosal
involvement occurs.
, 5. A patient with Alcohol Use Disorder asks about a medication that will reduce the ‘high’ or
‘reward’ associated with drinking. Which mechanism of action describes the appropriate
medication for this patient?
A. Aldehyde dehydrogenase inhibition
B. Mu-opioid receptor antagonism
C. GABA-A receptor agonism
D. NMDA receptor modulation
Answer: B
Rationale: Naltrexone functions as a mu-opioid receptor antagonist, which blocks the
pleasurable effects (reward) of alcohol consumption. By blocking these receptors, the
patient experiences less reinforcement when drinking, which helps in reducing heavy
drinking days. This is distinct from Disulfiram, which causes a physical reaction by
inhibiting aldehyde dehydrogenase, or Acamprosate, which focuses on glutamate/GABA
balance during withdrawal.
6. Valproic acid (Depakote) requires regular blood monitoring. In addition to valproate levels,
which laboratory parameters must be monitored due to potential black-box warnings?
A. Thyroid Stimulating Hormone (TSH)
B. Liver function tests and Platelet count
C. Serum potassium and sodium
D. BUN and Creatinine
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 4 2026)
1. A 32-year-old female patient diagnosed with Bipolar I Disorder is being initiated on
Lithium. Which of the following baseline laboratory tests is most critical for the PMHNP to
order to ensure safe excretion of the medication?
A. Liver Function Tests (LFTs)
B. Complete Blood Count (CBC) with differential
C. Amylase and Lipase
D. Serum Creatinine and BUN
Answer: D
Rationale: Lithium is almost exclusively excreted by the kidneys, unlike many other
psychotropic medications that undergo hepatic metabolism. Therefore, assessing renal
function through Serum Creatinine and BUN is essential to determine the patient’s ability
to clear the drug and prevent toxicity. The PMHNP must monitor these values regularly
throughout treatment to ensure the narrow therapeutic window is maintained safely.
,2. A patient taking Clozapine presents for a routine check-up. The Absolute Neutrophil Count
(ANC) is reported as 1,200/mm³. According to the Clozapine REMS program, what is the most
appropriate next step for the PMHNP?
A. Continue current dosage and retest in one month
B. Increase the dose to manage breakthrough psychosis
C. Continue treatment but monitor ANC three times weekly
D. Interrupt treatment and monitor ANC daily
Answer: C
Rationale: An ANC of 1,200/mm³ falls into the category of Mild Neutropenia (1,000–
1,499/mm³) for the general population. In this range, the Clozapine REMS guidelines
suggest continuing treatment but increasing monitoring frequency to three times weekly
until the ANC returns to ≥1,500/mm³. This protocol is vital to prevent the progression to
severe agranulocytosis, a life-threatening complication of Clozapine therapy.
3. A 45-year-old male recently started on Haloperidol presents with high fever, muscle
rigidity, and autonomic instability. Which medication should the PMHNP anticipate
administering to treat this condition?
A. Benztropine
B. Propranolol
C. Diphenhydramine
D. Dantrolene
,Answer: D
Rationale: The patient is presenting with classic symptoms of Neuroleptic Malignant
Syndrome (NMS), which is a medical emergency associated with dopamine antagonists.
Dantrolene, a muscle relaxant, is frequently used to treat the malignant hyperthermia and
muscle rigidity associated with this syndrome. Immediate cessation of the antipsychotic
and supportive care are also mandatory components of NMS management.
4. When prescribing Lamotrigine for Bipolar Depression, the PMHNP must educate the
patient on the importance of a slow titration schedule to primarily minimize the risk of which
condition?
A. Weight gain and metabolic syndrome
B. Stevens-Johnson Syndrome (SJS)
C. Agranulocytosis
D. Hyperprolactinemia
Answer: B
Rationale: Stevens-Johnson Syndrome is a rare but life-threatening dermatological
reaction associated with Lamotrigine, especially during the first few weeks of therapy. A
very slow dose titration is required to mitigate this risk, as rapid escalation is a known risk
factor for the development of toxic epidermal necrolysis. Patients must be instructed to
stop the medication and seek emergency care immediately if any rash or mucosal
involvement occurs.
, 5. A patient with Alcohol Use Disorder asks about a medication that will reduce the ‘high’ or
‘reward’ associated with drinking. Which mechanism of action describes the appropriate
medication for this patient?
A. Aldehyde dehydrogenase inhibition
B. Mu-opioid receptor antagonism
C. GABA-A receptor agonism
D. NMDA receptor modulation
Answer: B
Rationale: Naltrexone functions as a mu-opioid receptor antagonist, which blocks the
pleasurable effects (reward) of alcohol consumption. By blocking these receptors, the
patient experiences less reinforcement when drinking, which helps in reducing heavy
drinking days. This is distinct from Disulfiram, which causes a physical reaction by
inhibiting aldehyde dehydrogenase, or Acamprosate, which focuses on glutamate/GABA
balance during withdrawal.
6. Valproic acid (Depakote) requires regular blood monitoring. In addition to valproate levels,
which laboratory parameters must be monitored due to potential black-box warnings?
A. Thyroid Stimulating Hormone (TSH)
B. Liver function tests and Platelet count
C. Serum potassium and sodium
D. BUN and Creatinine
