NURS 663 Exam 1 V2 | NURS 663
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 1 2026)
1. A 28-year-old male patient with Bipolar I Disorder is being started on Lithium. Which of the
following lab tests is most critical to obtain at baseline before initiating therapy?
A. Liver function tests (LFTs)
B. Serum creatinine and BUN
C. Amylase and lipase
D. Complete blood count with differential
Answer: B
Rationale: Lithium is primarily excreted by the kidneys, making renal function assessment
essential before starting the medication. Chronic lithium use can potentially lead to
nephrogenic diabetes insipidus or interstitial nephritis. Therefore, baseline serum
creatinine and BUN are mandatory to ensure safe clearance of the drug.
2. Which of the following symptoms is characteristic of Neuroleptic Malignant Syndrome
(NMS) rather than Serotonin Syndrome?
A. Lead-pipe muscle rigidity
,B. Myoclonus
C. Hyperreflexia
D. Diarrhea
Answer: A
Rationale: NMS is characterized by ‘lead-pipe’ muscle rigidity, whereas Serotonin
Syndrome typically presents with hyperreflexia and myoclonus. NMS is an idiosyncratic
reaction to dopamine antagonists, whereas Serotonin Syndrome results from excess
serotonin. Differentiating these two is crucial as the treatments, such as dantrolene for
NMS versus cyproheptadine for Serotonin Syndrome, differ significantly.
3. A patient is prescribed Clozapine for treatment-resistant schizophrenia. According to the
REMS program, the medication must be discontinued if the Absolute Neutrophil Count (ANC)
falls below which threshold?
A. 1000/mm3
B. 1500/mm3
C. 2000/mm3
D. 500/mm3
Answer: A
Rationale: The Clozapine REMS program mandates monitoring to prevent severe
agranulocytosis. In a general population patient, treatment must be interrupted if the ANC
, drops below 1000/mm3. This strict monitoring ensures that life-threatening infections are
avoided during therapy.
4. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or eating disorders like bulimia?
A. Bupropion
B. Fluoxetine
C. Venlafaxine
D. Sertraline
Answer: A
Rationale: Bupropion lowers the seizure threshold, particularly at high doses or in
vulnerable populations. Patients with eating disorders are at higher risk for electrolyte
imbalances, which further increases seizure risk when taking this medication. Therefore, it
is strictly contraindicated in individuals with active or historical seizure or eating
disorders.
5. A 45-year-old female presents with symptoms of Major Depressive Disorder (MDD). She is
concerned about weight gain and sexual dysfunction. Which of the following would be the
most appropriate initial choice?
A. Paroxetine
B. Mirtazapine
C. Bupropion
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 1 2026)
1. A 28-year-old male patient with Bipolar I Disorder is being started on Lithium. Which of the
following lab tests is most critical to obtain at baseline before initiating therapy?
A. Liver function tests (LFTs)
B. Serum creatinine and BUN
C. Amylase and lipase
D. Complete blood count with differential
Answer: B
Rationale: Lithium is primarily excreted by the kidneys, making renal function assessment
essential before starting the medication. Chronic lithium use can potentially lead to
nephrogenic diabetes insipidus or interstitial nephritis. Therefore, baseline serum
creatinine and BUN are mandatory to ensure safe clearance of the drug.
2. Which of the following symptoms is characteristic of Neuroleptic Malignant Syndrome
(NMS) rather than Serotonin Syndrome?
A. Lead-pipe muscle rigidity
,B. Myoclonus
C. Hyperreflexia
D. Diarrhea
Answer: A
Rationale: NMS is characterized by ‘lead-pipe’ muscle rigidity, whereas Serotonin
Syndrome typically presents with hyperreflexia and myoclonus. NMS is an idiosyncratic
reaction to dopamine antagonists, whereas Serotonin Syndrome results from excess
serotonin. Differentiating these two is crucial as the treatments, such as dantrolene for
NMS versus cyproheptadine for Serotonin Syndrome, differ significantly.
3. A patient is prescribed Clozapine for treatment-resistant schizophrenia. According to the
REMS program, the medication must be discontinued if the Absolute Neutrophil Count (ANC)
falls below which threshold?
A. 1000/mm3
B. 1500/mm3
C. 2000/mm3
D. 500/mm3
Answer: A
Rationale: The Clozapine REMS program mandates monitoring to prevent severe
agranulocytosis. In a general population patient, treatment must be interrupted if the ANC
, drops below 1000/mm3. This strict monitoring ensures that life-threatening infections are
avoided during therapy.
4. Which antidepressant is specifically contraindicated in patients with a history of seizure
disorders or eating disorders like bulimia?
A. Bupropion
B. Fluoxetine
C. Venlafaxine
D. Sertraline
Answer: A
Rationale: Bupropion lowers the seizure threshold, particularly at high doses or in
vulnerable populations. Patients with eating disorders are at higher risk for electrolyte
imbalances, which further increases seizure risk when taking this medication. Therefore, it
is strictly contraindicated in individuals with active or historical seizure or eating
disorders.
5. A 45-year-old female presents with symptoms of Major Depressive Disorder (MDD). She is
concerned about weight gain and sexual dysfunction. Which of the following would be the
most appropriate initial choice?
A. Paroxetine
B. Mirtazapine
C. Bupropion
