NR 546 Exam 4 V3 | NR 546 Advanced
Psychopharmacology | Chamberlain | Q&A
with Rationale (Chamberlain NR546 Exam
4)
1. A patient taking Lithium for Bipolar I Disorder presents with coarse tremors, ataxia, and a
serum lithium level of 2.1 mEq/L. Which of the following is the most appropriate next step?
A. Hold the medication and evaluate for toxicity
B. Maintain current dose but increase fluid intake
C. Increase the lithium dose to stabilize mood
D. Add a benzodiazepine to treat the tremors
Answer: A
Rationale: Lithium levels above 1.5 mEq/L are considered toxic and require immediate
intervention. Clinical signs of toxicity include coarse tremors, ataxia, slurred speech, and
confusion. Holding the dose and assessing the patient’s renal function and electrolyte
balance is the standard of care to prevent further neurological damage.
2. When initiating Lamotrigine for a patient with Bipolar Disorder, why is a slow titration
schedule necessary?
A. To allow the liver enzymes to adjust to the medication
B. To avoid immediate sedation and weight gain
,C. To prevent the development of Stevens-Johnson Syndrome
D. To reduce the risk of hypertensive crisis
Answer: C
Rationale: Lamotrigine carries a black box warning for serious dermatological reactions,
including Stevens-Johnson Syndrome (SJS). A slow titration is mandatory to reduce the risk
of this potentially fatal skin reaction. Clinicians must educate patients to report any new
rash immediately, regardless of how minor it may seem.
3. Which neurotransmitter is primarily targeted by stimulants such as Methylphenidate in the
treatment of ADHD?
A. Serotonin and GABA
B. Dopamine and Norepinephrine
C. Acetylcholine and Glutamate
D. Histamine and Oxytocin
Answer: B
Rationale: Methylphenidate works by blocking the reuptake of dopamine and
norepinephrine in the prefrontal cortex. This increases the availability of these
neurotransmitters in the synaptic cleft, improving focus and impulse control. Enhancing
these catecholamines helps regulate the circuits responsible for executive functioning and
attention.
, 4. A patient with PTSD reports frequent, distressing nightmares that disrupt sleep. Which
medication is specifically recommended to address this symptom?
A. Zolpidem
B. Alprazolam
C. Trazodone
D. Prazosin
Answer: D
Rationale: Prazosin is an alpha-1 adrenergic antagonist that is effective in reducing the
frequency and intensity of PTSD-related nightmares. It works by inhibiting the overactive
norepinephrine response that occurs during sleep in these patients. It is important to
monitor for orthostatic hypotension, especially with the initial dose.
5. Which of the following is a symptom of Serotonin Syndrome that distinguishes it from
Neuroleptic Malignant Syndrome (NMS)?
A. Hyperthermia
B. Lead-pipe muscle rigidity
C. Hyperreflexia and Myoclonus
D. Autonomic instability
Answer: C
Psychopharmacology | Chamberlain | Q&A
with Rationale (Chamberlain NR546 Exam
4)
1. A patient taking Lithium for Bipolar I Disorder presents with coarse tremors, ataxia, and a
serum lithium level of 2.1 mEq/L. Which of the following is the most appropriate next step?
A. Hold the medication and evaluate for toxicity
B. Maintain current dose but increase fluid intake
C. Increase the lithium dose to stabilize mood
D. Add a benzodiazepine to treat the tremors
Answer: A
Rationale: Lithium levels above 1.5 mEq/L are considered toxic and require immediate
intervention. Clinical signs of toxicity include coarse tremors, ataxia, slurred speech, and
confusion. Holding the dose and assessing the patient’s renal function and electrolyte
balance is the standard of care to prevent further neurological damage.
2. When initiating Lamotrigine for a patient with Bipolar Disorder, why is a slow titration
schedule necessary?
A. To allow the liver enzymes to adjust to the medication
B. To avoid immediate sedation and weight gain
,C. To prevent the development of Stevens-Johnson Syndrome
D. To reduce the risk of hypertensive crisis
Answer: C
Rationale: Lamotrigine carries a black box warning for serious dermatological reactions,
including Stevens-Johnson Syndrome (SJS). A slow titration is mandatory to reduce the risk
of this potentially fatal skin reaction. Clinicians must educate patients to report any new
rash immediately, regardless of how minor it may seem.
3. Which neurotransmitter is primarily targeted by stimulants such as Methylphenidate in the
treatment of ADHD?
A. Serotonin and GABA
B. Dopamine and Norepinephrine
C. Acetylcholine and Glutamate
D. Histamine and Oxytocin
Answer: B
Rationale: Methylphenidate works by blocking the reuptake of dopamine and
norepinephrine in the prefrontal cortex. This increases the availability of these
neurotransmitters in the synaptic cleft, improving focus and impulse control. Enhancing
these catecholamines helps regulate the circuits responsible for executive functioning and
attention.
, 4. A patient with PTSD reports frequent, distressing nightmares that disrupt sleep. Which
medication is specifically recommended to address this symptom?
A. Zolpidem
B. Alprazolam
C. Trazodone
D. Prazosin
Answer: D
Rationale: Prazosin is an alpha-1 adrenergic antagonist that is effective in reducing the
frequency and intensity of PTSD-related nightmares. It works by inhibiting the overactive
norepinephrine response that occurs during sleep in these patients. It is important to
monitor for orthostatic hypotension, especially with the initial dose.
5. Which of the following is a symptom of Serotonin Syndrome that distinguishes it from
Neuroleptic Malignant Syndrome (NMS)?
A. Hyperthermia
B. Lead-pipe muscle rigidity
C. Hyperreflexia and Myoclonus
D. Autonomic instability
Answer: C
