NURS 663 Exam 1 V3 | 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. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
B. Mesocortical pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: C
Rationale: The mesolimbic pathway is associated with the reward system and emotional
regulation. Hyperactivity of dopamine in this specific pathway is hypothesized to cause
positive symptoms of schizophrenia. Modern antipsychotics aim to reduce dopamine
activity here to alleviate these symptoms.
2. A patient is prescribed Clozapine for treatment-resistant schizophrenia. Which laboratory
value must be monitored most stringently according to the Risk Evaluation and Mitigation
Strategy (REMS)?
A. Absolute Neutrophil Count (ANC)
,B. Serum Creatinine
C. Liver Function Tests (LFTs)
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Rationale: Clozapine carries a significant risk for agranulocytosis, which is a life-
threatening decrease in white blood cell count. Clinicians must monitor the ANC to ensure
it remains above the threshold for safe continuation of the drug. Treatment must be
interrupted if the ANC falls below 1,000/µL in a general population patient.
3. Which antidepressant is uniquely known for its dual mechanism as a norepinephrine-
dopamine reuptake inhibitor (NDRI) and carries a lower risk of sexual dysfunction?
A. Bupropion
B. Venlafaxine
C. Sertraline
D. Paroxetine
Answer: A
Rationale: Bupropion does not have significant serotonergic activity, which accounts for
its lack of sexual side effects common to SSRIs. It works primarily by inhibiting the
reuptake of dopamine and norepinephrine. This makes it a preferred choice for patients
who prioritize maintaining sexual function or who experience lethargy.
, 4. In the treatment of Bipolar I Disorder, what is the generally accepted therapeutic serum
level range for Lithium?
A. 0.2 - 0.5 mEq/L
B. 2.5 - 3.0 mEq/L
C. 1.5 - 2.0 mEq/L
D. 0.6 - 1.2 mEq/L
Answer: D
Rationale: The standard therapeutic range for lithium is 0.6 to 1.2 mEq/L for acute mania
and maintenance. Levels above 1.5 mEq/L are considered toxic and require immediate
clinical intervention. Monitoring is essential because lithium has a very narrow therapeutic
index.
5. Which mechanism of action explains how benzodiazepines exert their anxiolytic effect?
A. Antagonism of the NMDA receptor
B. Inhibition of Serotonin Reuptake
C. Agonism at the Alpha-2 adrenergic receptor
D. Positive allosteric modulation of GABA-A receptors
Answer: D
Rationale: Benzodiazepines bind to a specific site on the GABA-A receptor complex,
enhancing the effect of the inhibitory neurotransmitter GABA. This increases the frequency
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 1 2026)
1. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
B. Mesocortical pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: C
Rationale: The mesolimbic pathway is associated with the reward system and emotional
regulation. Hyperactivity of dopamine in this specific pathway is hypothesized to cause
positive symptoms of schizophrenia. Modern antipsychotics aim to reduce dopamine
activity here to alleviate these symptoms.
2. A patient is prescribed Clozapine for treatment-resistant schizophrenia. Which laboratory
value must be monitored most stringently according to the Risk Evaluation and Mitigation
Strategy (REMS)?
A. Absolute Neutrophil Count (ANC)
,B. Serum Creatinine
C. Liver Function Tests (LFTs)
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Rationale: Clozapine carries a significant risk for agranulocytosis, which is a life-
threatening decrease in white blood cell count. Clinicians must monitor the ANC to ensure
it remains above the threshold for safe continuation of the drug. Treatment must be
interrupted if the ANC falls below 1,000/µL in a general population patient.
3. Which antidepressant is uniquely known for its dual mechanism as a norepinephrine-
dopamine reuptake inhibitor (NDRI) and carries a lower risk of sexual dysfunction?
A. Bupropion
B. Venlafaxine
C. Sertraline
D. Paroxetine
Answer: A
Rationale: Bupropion does not have significant serotonergic activity, which accounts for
its lack of sexual side effects common to SSRIs. It works primarily by inhibiting the
reuptake of dopamine and norepinephrine. This makes it a preferred choice for patients
who prioritize maintaining sexual function or who experience lethargy.
, 4. In the treatment of Bipolar I Disorder, what is the generally accepted therapeutic serum
level range for Lithium?
A. 0.2 - 0.5 mEq/L
B. 2.5 - 3.0 mEq/L
C. 1.5 - 2.0 mEq/L
D. 0.6 - 1.2 mEq/L
Answer: D
Rationale: The standard therapeutic range for lithium is 0.6 to 1.2 mEq/L for acute mania
and maintenance. Levels above 1.5 mEq/L are considered toxic and require immediate
clinical intervention. Monitoring is essential because lithium has a very narrow therapeutic
index.
5. Which mechanism of action explains how benzodiazepines exert their anxiolytic effect?
A. Antagonism of the NMDA receptor
B. Inhibition of Serotonin Reuptake
C. Agonism at the Alpha-2 adrenergic receptor
D. Positive allosteric modulation of GABA-A receptors
Answer: D
Rationale: Benzodiazepines bind to a specific site on the GABA-A receptor complex,
enhancing the effect of the inhibitory neurotransmitter GABA. This increases the frequency
