NURS 663 Exam 2 V3 | 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. A 34-year-old male patient with Bipolar I Disorder is being managed with Lithium. He
presents with a tremor, nausea, and ataxia. His serum lithium level is 1.6 mEq/L. Which of the
following is the most appropriate initial intervention?
A. Administer a beta-blocker for the tremor.
B. Initiate immediate hemodialysis.
C. Change the medication to Valproic acid.
D. Increase fluid intake and hold the lithium dose.
Answer: D
Rationale: The patient is exhibiting signs of mild to moderate lithium toxicity, as evidenced
by a serum level above the therapeutic range of 0.6 to 1.2 mEq/L and clinical symptoms
like ataxia. Initial management involves stopping the medication and encouraging
hydration to facilitate renal clearance of the drug. Hemodialysis is usually reserved for
levels exceeding 2.5 mEq/L or severe neurological impairment.
,2. When initiating Lamotrigine for a patient with Bipolar II Disorder, which titration schedule
is recommended to minimize the risk of Stevens-Johnson Syndrome?
A. 50 mg daily for 1 week, then 100 mg daily.
B. 25 mg daily for 2 weeks, then 50 mg daily for 2 weeks.
C. 100 mg daily for 2 weeks, then 200 mg daily.
D. 25 mg twice daily for 1 week, then 50 mg twice daily.
Answer: B
Rationale: The standard titration for lamotrigine is 25 mg daily for the first two weeks,
followed by 50 mg daily for the subsequent two weeks. This slow escalation is critical
because rapid titration is strongly associated with the development of life-threatening
rashes such as Stevens-Johnson Syndrome. Clinicians must educate patients to report any
new skin changes immediately during this titration period.
3. A patient taking Phenelzine (an MAOI) for treatment-resistant depression is cautioned
against eating aged cheeses and cured meats. What is the pharmacological rationale for this
dietary restriction?
A. High protein intake reduces the efficacy of antidepressant therapy.
B. These foods inhibit the metabolism of the MAOI, leading to toxicity.
C. Tyramine in these foods can cause a hypertensive crisis.
D. Phenylalanine in these foods competes for transport across the blood-brain barrier.
,Answer: C
Rationale: Tyramine is a sympathomimetic amine found in aged or fermented foods that is
normally broken down by Monoamine Oxidase (MAO). When MAO is inhibited, tyramine
can cause a massive release of norepinephrine, leading to a potentially fatal hypertensive
crisis. Patients must be strictly educated on a low-tyramine diet to prevent this dangerous
side effect while on MAOI therapy.
4. Which of the following medications is FDA-approved for the treatment of acute bipolar
depression as a monotherapy?
A. Haloperidol
B. Escitalopram
C. Aripiprazole
D. Quetiapine
Answer: D
Rationale: Quetiapine is one of the few medications specifically FDA-approved for the
treatment of acute depressive episodes in Bipolar I and II disorders. Most standard
antidepressants are not recommended as monotherapy for bipolar depression due to the
risk of inducing a manic switch. Other approved monotherapies include Lurasidone and
Olanzapine-Fluoxetine combination.
, 5. A patient with Major Depressive Disorder (MDD) reports that they feel better in the
morning but their mood worsens throughout the day, they have gained weight, and their
limbs feel heavy like lead. Which MDD specifier best fits this description?
A. With Catatonia
B. With Melancholic Features
C. With Anxious Distress
D. With Atypical Features
Answer: D
Rationale: Major Depressive Disorder with Atypical Features is characterized by mood
reactivity, weight gain or increased appetite, hypersomnia, and leaden paralysis (a heavy
feeling in the arms or legs). Unlike melancholic features, where patients often feel worse in
the morning, atypical features involve mood brightening in response to positive events.
Recognition of these features is important as they may respond better to MAOIs or SSRIs
than other classes.
6. What is the black box warning associated with all SSRIs and SNRIs when prescribed to
children, adolescents, and young adults?
A. Increased risk of suicidal ideation and behavior.
B. Potential for sudden cardiac death.
C. Risk of severe hepatotoxicity.
D. Risk of agranulocytosis.
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 2 2026)
1. A 34-year-old male patient with Bipolar I Disorder is being managed with Lithium. He
presents with a tremor, nausea, and ataxia. His serum lithium level is 1.6 mEq/L. Which of the
following is the most appropriate initial intervention?
A. Administer a beta-blocker for the tremor.
B. Initiate immediate hemodialysis.
C. Change the medication to Valproic acid.
D. Increase fluid intake and hold the lithium dose.
Answer: D
Rationale: The patient is exhibiting signs of mild to moderate lithium toxicity, as evidenced
by a serum level above the therapeutic range of 0.6 to 1.2 mEq/L and clinical symptoms
like ataxia. Initial management involves stopping the medication and encouraging
hydration to facilitate renal clearance of the drug. Hemodialysis is usually reserved for
levels exceeding 2.5 mEq/L or severe neurological impairment.
,2. When initiating Lamotrigine for a patient with Bipolar II Disorder, which titration schedule
is recommended to minimize the risk of Stevens-Johnson Syndrome?
A. 50 mg daily for 1 week, then 100 mg daily.
B. 25 mg daily for 2 weeks, then 50 mg daily for 2 weeks.
C. 100 mg daily for 2 weeks, then 200 mg daily.
D. 25 mg twice daily for 1 week, then 50 mg twice daily.
Answer: B
Rationale: The standard titration for lamotrigine is 25 mg daily for the first two weeks,
followed by 50 mg daily for the subsequent two weeks. This slow escalation is critical
because rapid titration is strongly associated with the development of life-threatening
rashes such as Stevens-Johnson Syndrome. Clinicians must educate patients to report any
new skin changes immediately during this titration period.
3. A patient taking Phenelzine (an MAOI) for treatment-resistant depression is cautioned
against eating aged cheeses and cured meats. What is the pharmacological rationale for this
dietary restriction?
A. High protein intake reduces the efficacy of antidepressant therapy.
B. These foods inhibit the metabolism of the MAOI, leading to toxicity.
C. Tyramine in these foods can cause a hypertensive crisis.
D. Phenylalanine in these foods competes for transport across the blood-brain barrier.
,Answer: C
Rationale: Tyramine is a sympathomimetic amine found in aged or fermented foods that is
normally broken down by Monoamine Oxidase (MAO). When MAO is inhibited, tyramine
can cause a massive release of norepinephrine, leading to a potentially fatal hypertensive
crisis. Patients must be strictly educated on a low-tyramine diet to prevent this dangerous
side effect while on MAOI therapy.
4. Which of the following medications is FDA-approved for the treatment of acute bipolar
depression as a monotherapy?
A. Haloperidol
B. Escitalopram
C. Aripiprazole
D. Quetiapine
Answer: D
Rationale: Quetiapine is one of the few medications specifically FDA-approved for the
treatment of acute depressive episodes in Bipolar I and II disorders. Most standard
antidepressants are not recommended as monotherapy for bipolar depression due to the
risk of inducing a manic switch. Other approved monotherapies include Lurasidone and
Olanzapine-Fluoxetine combination.
, 5. A patient with Major Depressive Disorder (MDD) reports that they feel better in the
morning but their mood worsens throughout the day, they have gained weight, and their
limbs feel heavy like lead. Which MDD specifier best fits this description?
A. With Catatonia
B. With Melancholic Features
C. With Anxious Distress
D. With Atypical Features
Answer: D
Rationale: Major Depressive Disorder with Atypical Features is characterized by mood
reactivity, weight gain or increased appetite, hypersomnia, and leaden paralysis (a heavy
feeling in the arms or legs). Unlike melancholic features, where patients often feel worse in
the morning, atypical features involve mood brightening in response to positive events.
Recognition of these features is important as they may respond better to MAOIs or SSRIs
than other classes.
6. What is the black box warning associated with all SSRIs and SNRIs when prescribed to
children, adolescents, and young adults?
A. Increased risk of suicidal ideation and behavior.
B. Potential for sudden cardiac death.
C. Risk of severe hepatotoxicity.
D. Risk of agranulocytosis.
