NURS 663 Exam 3 V1 | 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 28-year-old female patient with Bipolar I Disorder is planning to become pregnant.
Which mood stabilizer carries the highest risk for neural tube defects and should be avoided
if possible?
A. Lithium
B. Lamotrigine
C. Valproate
D. Quetiapine
Answer: C
Rationale: Valproate is associated with a significantly higher risk of teratogenicity,
specifically neural tube defects like spina bifida, compared to other mood stabilizers.
Current guidelines recommend avoiding valproate in women of childbearing age unless all
other treatments have failed. If a patient must remain on a mood stabilizer, lamotrigine or
certain second-generation antipsychotics are often preferred alternatives with lower
known teratogenic profiles.
,2. Which neurotransmitter pathway is primarily responsible for the development of
Extrapyramidal Symptoms (EPS) when blocked by first-generation antipsychotics?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: B
Rationale: The nigrostriatal pathway controls motor movement, and its blockade leads to
symptoms like dystonia, akathisia, and Parkinsonism. Second-generation antipsychotics
have a lower affinity for D2 receptors in this specific pathway, which accounts for their
reduced EPS risk. Maintaining a balance between dopamine and acetylcholine in this region
is essential for normal motor function.
3. A patient taking Clozapine presents with a sudden sore throat, fever, and malaise. What is
the most urgent diagnostic test the PMHNP should order?
A. Rapid Strep Test
B. Liver Function Tests
C. Serum Clozapine Level
D. Complete Blood Count (CBC) with Differential
Answer: D
,Rationale: Clozapine carries a Black Box Warning for agranulocytosis, which is a severe
and potentially fatal drop in the white blood cell count. Flu-like symptoms or signs of
infection can be early indicators of this condition in patients taking Clozapine. The Absolute
Neutrophil Count (ANC) must be checked immediately to determine if the medication
needs to be discontinued per REMS guidelines.
4. In the treatment of Alcohol Use Disorder, which medication acts by creating an adverse
physical reaction when alcohol is consumed?
A. Naltrexone
B. Acamprosate
C. Disulfiram
D. Gabapentin
Answer: C
Rationale: Disulfiram inhibits the enzyme acetaldehyde dehydrogenase, leading to an
accumulation of acetaldehyde if alcohol is ingested. This results in highly unpleasant
symptoms such as flushing, nausea, tachycardia, and hypotension. It is considered an
aversion therapy and requires highly motivated patients who are committed to total
abstinence.
5. Which of the following is a primary mechanism of action for Lithium in the management of
Bipolar Disorder?
A. Selective inhibition of serotonin reuptake
, B. Potentiation of GABA-A receptors
C. Inhibition of the inositol monophosphatase enzyme
D. Antagonism of NMDA glutamate receptors
Answer: C
Rationale: Lithium’s precise mechanism remains complex, but it is known to inhibit the
inositol depletion cycle and GSK-3 signaling. By inhibiting inositol monophosphatase, it
modulates intracellular signaling pathways that are thought to be overactive in manic
states. Additionally, lithium provides neuroprotective effects by increasing the expression
of brain-derived neurotrophic factor (BDNF).
6. What is the recommended target serum concentration range for Lithium during the
maintenance phase of Bipolar Disorder treatment?
A. 0.4 - 0.6 mEq/L
B. 1.5 - 2.0 mEq/L
C. 1.2 - 1.5 mEq/L
D. 0.6 - 1.2 mEq/L
Answer: D
Rationale: While acute mania may require levels on the higher end of the spectrum (up to
1.2 mEq/L), maintenance therapy is typically targeted between 0.6 and 1.2 mEq/L. Levels
above 1.5 mEq/L are associated with early signs of toxicity, such as coarse tremors and
Psychiatric Mental Health Diagnosis and
Management II | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS663 Exam 3 2026)
1. A 28-year-old female patient with Bipolar I Disorder is planning to become pregnant.
Which mood stabilizer carries the highest risk for neural tube defects and should be avoided
if possible?
A. Lithium
B. Lamotrigine
C. Valproate
D. Quetiapine
Answer: C
Rationale: Valproate is associated with a significantly higher risk of teratogenicity,
specifically neural tube defects like spina bifida, compared to other mood stabilizers.
Current guidelines recommend avoiding valproate in women of childbearing age unless all
other treatments have failed. If a patient must remain on a mood stabilizer, lamotrigine or
certain second-generation antipsychotics are often preferred alternatives with lower
known teratogenic profiles.
,2. Which neurotransmitter pathway is primarily responsible for the development of
Extrapyramidal Symptoms (EPS) when blocked by first-generation antipsychotics?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: B
Rationale: The nigrostriatal pathway controls motor movement, and its blockade leads to
symptoms like dystonia, akathisia, and Parkinsonism. Second-generation antipsychotics
have a lower affinity for D2 receptors in this specific pathway, which accounts for their
reduced EPS risk. Maintaining a balance between dopamine and acetylcholine in this region
is essential for normal motor function.
3. A patient taking Clozapine presents with a sudden sore throat, fever, and malaise. What is
the most urgent diagnostic test the PMHNP should order?
A. Rapid Strep Test
B. Liver Function Tests
C. Serum Clozapine Level
D. Complete Blood Count (CBC) with Differential
Answer: D
,Rationale: Clozapine carries a Black Box Warning for agranulocytosis, which is a severe
and potentially fatal drop in the white blood cell count. Flu-like symptoms or signs of
infection can be early indicators of this condition in patients taking Clozapine. The Absolute
Neutrophil Count (ANC) must be checked immediately to determine if the medication
needs to be discontinued per REMS guidelines.
4. In the treatment of Alcohol Use Disorder, which medication acts by creating an adverse
physical reaction when alcohol is consumed?
A. Naltrexone
B. Acamprosate
C. Disulfiram
D. Gabapentin
Answer: C
Rationale: Disulfiram inhibits the enzyme acetaldehyde dehydrogenase, leading to an
accumulation of acetaldehyde if alcohol is ingested. This results in highly unpleasant
symptoms such as flushing, nausea, tachycardia, and hypotension. It is considered an
aversion therapy and requires highly motivated patients who are committed to total
abstinence.
5. Which of the following is a primary mechanism of action for Lithium in the management of
Bipolar Disorder?
A. Selective inhibition of serotonin reuptake
, B. Potentiation of GABA-A receptors
C. Inhibition of the inositol monophosphatase enzyme
D. Antagonism of NMDA glutamate receptors
Answer: C
Rationale: Lithium’s precise mechanism remains complex, but it is known to inhibit the
inositol depletion cycle and GSK-3 signaling. By inhibiting inositol monophosphatase, it
modulates intracellular signaling pathways that are thought to be overactive in manic
states. Additionally, lithium provides neuroprotective effects by increasing the expression
of brain-derived neurotrophic factor (BDNF).
6. What is the recommended target serum concentration range for Lithium during the
maintenance phase of Bipolar Disorder treatment?
A. 0.4 - 0.6 mEq/L
B. 1.5 - 2.0 mEq/L
C. 1.2 - 1.5 mEq/L
D. 0.6 - 1.2 mEq/L
Answer: D
Rationale: While acute mania may require levels on the higher end of the spectrum (up to
1.2 mEq/L), maintenance therapy is typically targeted between 0.6 and 1.2 mEq/L. Levels
above 1.5 mEq/L are associated with early signs of toxicity, such as coarse tremors and
