NR 546 Final Exam V3 | NR 546 Advanced
Psychopharmacology | Chamberlain | Q&A
with Rationale (Chamberlain NR546 Final
Exam)
1. A 28-year-old female patient with Bipolar I Disorder is being treated with Lithium. She
presents with coarse tremors, diarrhea, and confusion. Which of the following is the most
appropriate initial action?
A. Check a stat lithium level and discontinue the medication
B. Increase the dose to manage acute mania
C. Add a benzodiazepine to treat the tremors
D. Switch her to Valproic acid immediately
Answer: A
Rationale: These symptoms are indicative of lithium toxicity, which is a medical
emergency due to its narrow therapeutic index. Lithium levels above 1.5 mEq/L typically
present with gastrointestinal distress and neurological signs like ataxia or coarse tremors.
Discontinuing the drug and obtaining a serum level is critical to preventing further renal or
neurological damage.
2. Which dopaminergic pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
,B. Mesolimbic pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: B
Rationale: Overactivity of dopamine in the mesolimbic pathway is associated with the
positive symptoms of schizophrenia. In contrast, the mesocortical pathway is linked to
negative and cognitive symptoms. Blocking D2 receptors in the mesolimbic pathway is the
primary mechanism of action for antipsychotic efficacy against psychosis.
3. A patient taking Clozapine must have their Absolute Neutrophil Count (ANC) monitored
regularly. What is the minimum ANC required to initiate Clozapine therapy in a non-benign
ethnic neutropenia (BEN) patient?
A. 1500/mm³
B. 500/mm³
C. 1000/mm³
D. 2000/mm³
Answer: A
Rationale: To initiate Clozapine, the ANC must be at least 1500/mm³ to reduce the risk of
severe agranulocytosis. Agranulocytosis is a rare but potentially fatal side effect
, characterized by a severe drop in white blood cell counts. Regular monitoring through the
REMS program is mandated to ensure patient safety during treatment.
4. Which of the following medications is considered a first-line non-stimulant treatment for
ADHD by inhibiting the reuptake of norepinephrine?
A. Guanfacine
B. Atomoxetine
C. Methylphenidate
D. Lisdexamfetamine
Answer: B
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) approved
for the treatment of ADHD in both children and adults. Unlike stimulants, it does not have a
high potential for abuse and is not a controlled substance. It is particularly useful for
patients with comorbid anxiety or substance use disorders who cannot tolerate stimulants.
5. A patient recently started on Fluoxetine presents with autonomic instability, hyperreflexia,
and agitation. Which condition should the PMHNP suspect?
A. Neuroleptic Malignant Syndrome
B. Anticholinergic Toxicity
C. Hypertensive Crisis
D. Serotonin Syndrome
Psychopharmacology | Chamberlain | Q&A
with Rationale (Chamberlain NR546 Final
Exam)
1. A 28-year-old female patient with Bipolar I Disorder is being treated with Lithium. She
presents with coarse tremors, diarrhea, and confusion. Which of the following is the most
appropriate initial action?
A. Check a stat lithium level and discontinue the medication
B. Increase the dose to manage acute mania
C. Add a benzodiazepine to treat the tremors
D. Switch her to Valproic acid immediately
Answer: A
Rationale: These symptoms are indicative of lithium toxicity, which is a medical
emergency due to its narrow therapeutic index. Lithium levels above 1.5 mEq/L typically
present with gastrointestinal distress and neurological signs like ataxia or coarse tremors.
Discontinuing the drug and obtaining a serum level is critical to preventing further renal or
neurological damage.
2. Which dopaminergic pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
,B. Mesolimbic pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: B
Rationale: Overactivity of dopamine in the mesolimbic pathway is associated with the
positive symptoms of schizophrenia. In contrast, the mesocortical pathway is linked to
negative and cognitive symptoms. Blocking D2 receptors in the mesolimbic pathway is the
primary mechanism of action for antipsychotic efficacy against psychosis.
3. A patient taking Clozapine must have their Absolute Neutrophil Count (ANC) monitored
regularly. What is the minimum ANC required to initiate Clozapine therapy in a non-benign
ethnic neutropenia (BEN) patient?
A. 1500/mm³
B. 500/mm³
C. 1000/mm³
D. 2000/mm³
Answer: A
Rationale: To initiate Clozapine, the ANC must be at least 1500/mm³ to reduce the risk of
severe agranulocytosis. Agranulocytosis is a rare but potentially fatal side effect
, characterized by a severe drop in white blood cell counts. Regular monitoring through the
REMS program is mandated to ensure patient safety during treatment.
4. Which of the following medications is considered a first-line non-stimulant treatment for
ADHD by inhibiting the reuptake of norepinephrine?
A. Guanfacine
B. Atomoxetine
C. Methylphenidate
D. Lisdexamfetamine
Answer: B
Rationale: Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI) approved
for the treatment of ADHD in both children and adults. Unlike stimulants, it does not have a
high potential for abuse and is not a controlled substance. It is particularly useful for
patients with comorbid anxiety or substance use disorders who cannot tolerate stimulants.
5. A patient recently started on Fluoxetine presents with autonomic instability, hyperreflexia,
and agitation. Which condition should the PMHNP suspect?
A. Neuroleptic Malignant Syndrome
B. Anticholinergic Toxicity
C. Hypertensive Crisis
D. Serotonin Syndrome
