NURS 663 Exam 2 V1 | NURS 663
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 2 2026)
1. Which of the following is the primary mechanism of action for Selective Serotonin
Reuptake Inhibitors (SSRIs) in treating Major Depressive Disorder?
A. Inhibition of the enzyme monoamine oxidase
B. Stimulating the release of GABA in the amygdala
C. Antagonizing dopamine receptors in the mesolimbic pathway
D. Blocking the reuptake pump for serotonin at the presynaptic neuron
Answer: D
Rationale: SSRIs work by specifically inhibiting the serotonin transporter protein, which
prevents the reabsorption of serotonin back into the presynaptic terminal. This action
increases the availability of serotonin within the synaptic cleft to bind to postsynaptic
receptors. Chronic administration leads to down-regulation of autoreceptors, which is
thought to mediate the therapeutic response.
2. When initiating Lithium for a patient with Bipolar I Disorder, which laboratory test is most
critical to monitor for potential toxicity and renal function?
A. Liver Function Tests (LFTs)
,B. Serum Creatinine and Blood Urea Nitrogen (BUN)
C. Hemoglobin A1c
D. Serum Amylase
Answer: B
Rationale: Lithium is primarily excreted by the kidneys, making renal monitoring essential
for safety. Elevated serum creatinine or BUN levels can indicate impaired renal clearance,
which significantly increases the risk of lithium toxicity. Practitioners must establish
baseline renal function and monitor it periodically throughout the course of treatment.
3. A patient presents with sudden onset of high fever, muscle rigidity, and autonomic
instability after starting Haloperidol. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Serotonin Syndrome
C. Tardive Dyskinesia
D. Acute Dystonia
Answer: A
Rationale: Neuroleptic Malignant Syndrome is a life-threatening reaction to antipsychotic
medications characterized by ‘lead-pipe’ muscle rigidity and hyperthermia. It differs from
Serotonin Syndrome, which usually involves hyperreflexia and myoclonus rather than
,extreme rigidity. Immediate cessation of the causative agent and supportive care are
required to prevent mortality.
4. Which neurotransmitter system is the primary target for Benzodiazepines used in the
treatment of Acute Anxiety?
A. Glutamate
B. Dopamine
C. Gamma-Aminobutyric Acid (GABA)
D. Acetylcholine
Answer: C
Rationale: Benzodiazepines act as positive allosteric modulators at the GABA-A receptor
complex. By enhancing the inhibitory effects of GABA, these medications increase chloride
ion influx, leading to hyperpolarization of neurons. This physiological change results in the
sedative, anxiolytic, and muscle-relaxant properties observed clinically.
5. In the treatment of Bipolar Depression, why is it recommended to use a mood stabilizer
before adding an antidepressant?
A. To prevent the development of Stevens-Johnson Syndrome
B. To reduce the risk of metabolic syndrome
C. To increase the absorption of the antidepressant
D. To prevent the risk of treatment-emergent switch to mania
, Answer: D
Rationale: Antidepressant monotherapy in patients with Bipolar Disorder can trigger a
‘switch’ from depression into a manic or hypomanic episode. Mood stabilizers like Lithium
or Valproate provide a protective effect against this destabilization of mood. Clinical
guidelines emphasize establishing mood stabilization first to maintain long-term cycling
control.
6. Which of the following side effects is most specifically associated with the use of Clozapine,
requiring frequent blood monitoring?
A. Agranulocytosis
B. Hyperprolactinemia
C. Nephrogenic diabetes insipidus
D. Ototoxicity
Answer: A
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a severe and
potentially fatal drop in the white blood cell count. Because of this risk, the Absolute
Neutrophil Count (ANC) must be monitored regularly via a national registry. Patients and
providers must adhere to strict monitoring protocols to continue the medication safely.
7. A 28-year-old female patient is being started on Lamotrigine. What is the most critical
education point regarding the dosing schedule?
A. Double the dose if a day is missed to maintain steady state
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 2 2026)
1. Which of the following is the primary mechanism of action for Selective Serotonin
Reuptake Inhibitors (SSRIs) in treating Major Depressive Disorder?
A. Inhibition of the enzyme monoamine oxidase
B. Stimulating the release of GABA in the amygdala
C. Antagonizing dopamine receptors in the mesolimbic pathway
D. Blocking the reuptake pump for serotonin at the presynaptic neuron
Answer: D
Rationale: SSRIs work by specifically inhibiting the serotonin transporter protein, which
prevents the reabsorption of serotonin back into the presynaptic terminal. This action
increases the availability of serotonin within the synaptic cleft to bind to postsynaptic
receptors. Chronic administration leads to down-regulation of autoreceptors, which is
thought to mediate the therapeutic response.
2. When initiating Lithium for a patient with Bipolar I Disorder, which laboratory test is most
critical to monitor for potential toxicity and renal function?
A. Liver Function Tests (LFTs)
,B. Serum Creatinine and Blood Urea Nitrogen (BUN)
C. Hemoglobin A1c
D. Serum Amylase
Answer: B
Rationale: Lithium is primarily excreted by the kidneys, making renal monitoring essential
for safety. Elevated serum creatinine or BUN levels can indicate impaired renal clearance,
which significantly increases the risk of lithium toxicity. Practitioners must establish
baseline renal function and monitor it periodically throughout the course of treatment.
3. A patient presents with sudden onset of high fever, muscle rigidity, and autonomic
instability after starting Haloperidol. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Serotonin Syndrome
C. Tardive Dyskinesia
D. Acute Dystonia
Answer: A
Rationale: Neuroleptic Malignant Syndrome is a life-threatening reaction to antipsychotic
medications characterized by ‘lead-pipe’ muscle rigidity and hyperthermia. It differs from
Serotonin Syndrome, which usually involves hyperreflexia and myoclonus rather than
,extreme rigidity. Immediate cessation of the causative agent and supportive care are
required to prevent mortality.
4. Which neurotransmitter system is the primary target for Benzodiazepines used in the
treatment of Acute Anxiety?
A. Glutamate
B. Dopamine
C. Gamma-Aminobutyric Acid (GABA)
D. Acetylcholine
Answer: C
Rationale: Benzodiazepines act as positive allosteric modulators at the GABA-A receptor
complex. By enhancing the inhibitory effects of GABA, these medications increase chloride
ion influx, leading to hyperpolarization of neurons. This physiological change results in the
sedative, anxiolytic, and muscle-relaxant properties observed clinically.
5. In the treatment of Bipolar Depression, why is it recommended to use a mood stabilizer
before adding an antidepressant?
A. To prevent the development of Stevens-Johnson Syndrome
B. To reduce the risk of metabolic syndrome
C. To increase the absorption of the antidepressant
D. To prevent the risk of treatment-emergent switch to mania
, Answer: D
Rationale: Antidepressant monotherapy in patients with Bipolar Disorder can trigger a
‘switch’ from depression into a manic or hypomanic episode. Mood stabilizers like Lithium
or Valproate provide a protective effect against this destabilization of mood. Clinical
guidelines emphasize establishing mood stabilization first to maintain long-term cycling
control.
6. Which of the following side effects is most specifically associated with the use of Clozapine,
requiring frequent blood monitoring?
A. Agranulocytosis
B. Hyperprolactinemia
C. Nephrogenic diabetes insipidus
D. Ototoxicity
Answer: A
Rationale: Clozapine carries a black box warning for agranulocytosis, which is a severe and
potentially fatal drop in the white blood cell count. Because of this risk, the Absolute
Neutrophil Count (ANC) must be monitored regularly via a national registry. Patients and
providers must adhere to strict monitoring protocols to continue the medication safely.
7. A 28-year-old female patient is being started on Lamotrigine. What is the most critical
education point regarding the dosing schedule?
A. Double the dose if a day is missed to maintain steady state
