NURS 663 Exam 3 V2 | NURS 663
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 3 2026)
1. A 32-year-old female patient diagnosed with Bipolar I Disorder is currently taking Lithium
carbonate 600 mg BID. During her follow-up, she complains of increased thirst and frequent
urination. The PMHNP should first assess for which of the following?
A. Acute renal failure due to lithium toxicity
B. Lithium-induced nephrogenic diabetes insipidus
C. Development of Type 2 Diabetes Mellitus
D. Psychogenic polydipsia related to mania
Answer: B
Rationale: Lithium is known to interfere with the action of antidiuretic hormone (ADH) on
the renal collecting ducts, leading to nephrogenic diabetes insipidus. Polyuria and
polydipsia are common side effects reported by patients on long-term lithium therapy. The
PMHNP must monitor urine specific gravity and serum electrolytes to manage this
condition effectively.
,2. Which laboratory monitoring protocol is essential for a patient being treated with
Clozapine (Clozaril) for treatment-resistant schizophrenia?
A. Absolute Neutrophil Count (ANC) monitoring via the Risk Evaluation and Mitigation
Strategy (REMS) program
B. Weekly liver function tests for the first 6 months
C. Serum potassium levels every two weeks to prevent cardiac arrhythmias
D. Annual Thyroid Stimulating Hormone (TSH) screenings
Answer: A
Rationale: Clozapine carries a significant risk of severe neutropenia, which can lead to life-
threatening infections. The REMS program mandates strict monitoring of the Absolute
Neutrophil Count (ANC) to ensure patient safety. This monitoring occurs weekly for the
first six months, then biweekly, and eventually monthly if results remain stable.
3. A patient started on Lamotrigine (Lamictal) for Bipolar II depression calls the clinic
reporting a new, slightly itchy rash on her chest. Which action should the PMHNP take
immediately?
A. Instruct the patient to discontinue Lamotrigine immediately and seek emergency
evaluation
B. Advise the patient to take Diphenhydramine and continue the medication
C. Reduce the Lamotrigine dose by half and monitor for 24 hours
D. Switch the patient to Carbamazepine to manage the mood symptoms
,Answer: A
Rationale: Lamotrigine is associated with a risk of Stevens-Johnson Syndrome (SJS), a
potentially fatal dermatological condition. Any new rash during the titration phase must be
treated as a medical emergency until proven otherwise. The PMHNP must instruct the
patient to stop the medication immediately and go to the nearest emergency room for
assessment.
4. A 45-year-old male presents with symptoms of Generalized Anxiety Disorder (GAD). He has
a history of heavy alcohol use but has been sober for three months. Which medication is the
most appropriate first-line treatment for his anxiety?
A. Alprazolam (Xanax)
B. Buspirone (Buspar)
C. Diazepam (Valium)
D. Escitalopram (Lexapro)
Answer: D
Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) like Escitalopram are
considered first-line pharmacological treatments for Generalized Anxiety Disorder. Given
the patient’s history of alcohol use disorder, benzodiazepines like Alprazolam or Diazepam
should be avoided due to the high risk of dependence and misuse. Buspirone is an option,
but SSRIs generally have a broader evidence base for initial management.
, 5. A patient with Bipolar I Disorder is experiencing a severe manic episode and is currently
hospitalized. Which combination therapy is often recommended for rapid stabilization of
severe mania?
A. Lamotrigine plus Quetiapine
B. Fluoxetine plus Olanzapine
C. Lithium or Valproate plus an atypical antipsychotic
D. Sertraline plus Lorazepam
Answer: C
Rationale: Clinical guidelines suggest that combination therapy with a mood stabilizer
(Lithium or Valproate) and an atypical antipsychotic is more effective than monotherapy
for severe manic episodes. This approach addresses the acuity of the symptoms more
rapidly and provides better long-term stability. The choice between Lithium and Valproate
depends on the patient’s renal and hepatic health status.
6. A PMHNP is treating a patient for Major Depressive Disorder who is currently taking
Phenelzine (Nardil). The patient asks if they can take Pseudoephedrine for cold symptoms.
What is the appropriate response?
A. Yes, but only in low doses for 3 days
B. No, it will decrease the effectiveness of the antidepressant
C. Yes, but you must monitor your heart rate for bradycardia
D. No, combining these can cause a hypertensive crisis
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 3 2026)
1. A 32-year-old female patient diagnosed with Bipolar I Disorder is currently taking Lithium
carbonate 600 mg BID. During her follow-up, she complains of increased thirst and frequent
urination. The PMHNP should first assess for which of the following?
A. Acute renal failure due to lithium toxicity
B. Lithium-induced nephrogenic diabetes insipidus
C. Development of Type 2 Diabetes Mellitus
D. Psychogenic polydipsia related to mania
Answer: B
Rationale: Lithium is known to interfere with the action of antidiuretic hormone (ADH) on
the renal collecting ducts, leading to nephrogenic diabetes insipidus. Polyuria and
polydipsia are common side effects reported by patients on long-term lithium therapy. The
PMHNP must monitor urine specific gravity and serum electrolytes to manage this
condition effectively.
,2. Which laboratory monitoring protocol is essential for a patient being treated with
Clozapine (Clozaril) for treatment-resistant schizophrenia?
A. Absolute Neutrophil Count (ANC) monitoring via the Risk Evaluation and Mitigation
Strategy (REMS) program
B. Weekly liver function tests for the first 6 months
C. Serum potassium levels every two weeks to prevent cardiac arrhythmias
D. Annual Thyroid Stimulating Hormone (TSH) screenings
Answer: A
Rationale: Clozapine carries a significant risk of severe neutropenia, which can lead to life-
threatening infections. The REMS program mandates strict monitoring of the Absolute
Neutrophil Count (ANC) to ensure patient safety. This monitoring occurs weekly for the
first six months, then biweekly, and eventually monthly if results remain stable.
3. A patient started on Lamotrigine (Lamictal) for Bipolar II depression calls the clinic
reporting a new, slightly itchy rash on her chest. Which action should the PMHNP take
immediately?
A. Instruct the patient to discontinue Lamotrigine immediately and seek emergency
evaluation
B. Advise the patient to take Diphenhydramine and continue the medication
C. Reduce the Lamotrigine dose by half and monitor for 24 hours
D. Switch the patient to Carbamazepine to manage the mood symptoms
,Answer: A
Rationale: Lamotrigine is associated with a risk of Stevens-Johnson Syndrome (SJS), a
potentially fatal dermatological condition. Any new rash during the titration phase must be
treated as a medical emergency until proven otherwise. The PMHNP must instruct the
patient to stop the medication immediately and go to the nearest emergency room for
assessment.
4. A 45-year-old male presents with symptoms of Generalized Anxiety Disorder (GAD). He has
a history of heavy alcohol use but has been sober for three months. Which medication is the
most appropriate first-line treatment for his anxiety?
A. Alprazolam (Xanax)
B. Buspirone (Buspar)
C. Diazepam (Valium)
D. Escitalopram (Lexapro)
Answer: D
Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) like Escitalopram are
considered first-line pharmacological treatments for Generalized Anxiety Disorder. Given
the patient’s history of alcohol use disorder, benzodiazepines like Alprazolam or Diazepam
should be avoided due to the high risk of dependence and misuse. Buspirone is an option,
but SSRIs generally have a broader evidence base for initial management.
, 5. A patient with Bipolar I Disorder is experiencing a severe manic episode and is currently
hospitalized. Which combination therapy is often recommended for rapid stabilization of
severe mania?
A. Lamotrigine plus Quetiapine
B. Fluoxetine plus Olanzapine
C. Lithium or Valproate plus an atypical antipsychotic
D. Sertraline plus Lorazepam
Answer: C
Rationale: Clinical guidelines suggest that combination therapy with a mood stabilizer
(Lithium or Valproate) and an atypical antipsychotic is more effective than monotherapy
for severe manic episodes. This approach addresses the acuity of the symptoms more
rapidly and provides better long-term stability. The choice between Lithium and Valproate
depends on the patient’s renal and hepatic health status.
6. A PMHNP is treating a patient for Major Depressive Disorder who is currently taking
Phenelzine (Nardil). The patient asks if they can take Pseudoephedrine for cold symptoms.
What is the appropriate response?
A. Yes, but only in low doses for 3 days
B. No, it will decrease the effectiveness of the antidepressant
C. Yes, but you must monitor your heart rate for bradycardia
D. No, combining these can cause a hypertensive crisis
