NR 546 Week 6 Exam V2 | NR 546
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week 6
Exam) | Chamberlain University
1. A 28-year-old female patient diagnosed with Bipolar I Disorder is being considered for
Lithium therapy. Which baseline laboratory assessment is most critical prior to starting this
medication?
A. Serum Creatinine and TSH
B. Liver function tests (LFTs)
C. Platelet count
D. Fast glucose
Answer: A
Rationale: Lithium is primarily excreted by the kidneys and can significantly impact
thyroid function over time. Therefore, obtaining baseline serum creatinine and thyroid-
stimulating hormone (TSH) levels is essential to monitor for renal impairment and
hypothyroidism. These assessments ensure that the patient can safely clear the drug and
allow for the detection of future medication-induced endocrine changes.
,2. Which mechanism of action correctly describes how Methylphenidate treats symptoms of
ADHD?
A. It acts as a direct agonist at the D2 receptor site.
B. It blocks the reuptake of norepinephrine and dopamine.
C. It increases the release of serotonin in the synaptic cleft.
D. It inhibits the enzyme monoamine oxidase.
Answer: B
Rationale: Methylphenidate functions by blocking the dopamine transporter (DAT) and
norepinephrine transporter (NET). This inhibition prevents the reuptake of these
catecholamines, thereby increasing their availability in the synaptic cleft. Enhanced
catecholamine signaling in the prefrontal cortex is believed to improve attention and
reduce hyperactivity in patients with ADHD.
3. A patient taking Valproate (Depakote) for Bipolar Disorder reports significant hair loss and
weight gain. Which intervention should the PMHNP consider?
A. Supplement with Zinc and Selenium.
B. Discontinue the medication immediately.
C. Increase the dosage to achieve rapid stabilization.
D. Switch to a SSRI monotherapy.
Answer: A
,Rationale: Hair loss, or alopecia, is a known side effect of Valproate therapy that can often
be managed with nutritional supplementation. Zinc and Selenium have been shown to
mitigate this cosmetic concern and improve patient adherence. It is important to address
these side effects proactively rather than discontinuing an effective mood stabilizer
abruptly.
4. When prescribing Lamotrigine, the PMHNP must educate the patient about the risk of
Stevens-Johnson Syndrome (SJS). What is the standard titration schedule to minimize this
risk?
A. Start at 100 mg daily and double every week.
B. Start at 25 mg daily for the first two weeks.
C. Start at 50 mg twice daily for one month.
D. Begin with a loading dose of 200 mg.
Answer: B
Rationale: The risk of developing a life-threatening rash, such as Stevens-Johnson
Syndrome, is highly correlated with the rate of dose escalation. The recommended starting
dose for Lamotrigine is 25 mg daily for two weeks, followed by 50 mg daily for the next two
weeks. This ‘start low and go slow’ approach is the most effective clinical strategy for
preventing serious dermatological reactions.
, 5. A patient on Lithium therapy presents with a serum level of 1.9 mEq/L. Which clinical
symptoms would the PMHNP expect to observe?
A. Increased appetite and sedation.
B. Hypertension and tachycardia.
C. Coarse hand tremors, ataxia, and persistent diarrhea.
D. Hypoglycemia and skin rash.
Answer: C
Rationale: Lithium toxicity typically occurs when serum levels exceed 1.5 mEq/L, with
severe symptoms appearing above 2.0 mEq/L. A level of 1.9 mEq/L is indicative of
moderate toxicity, characterized by neurological signs like ataxia and coarse tremors,
alongside gastrointestinal distress. The PMHNP must recognize these signs as a medical
emergency requiring immediate dose adjustment or cessation.
6. What is the primary pharmacological advantage of Lisdexamfetamine (Vyvanse) over other
amphetamine-based stimulants?
A. It is not a controlled substance.
B. It does not cause cardiovascular side effects.
C. It has a lower potential for abuse due to its prodrug design.
D. It can be taken as needed (PRN) for immediate effect.
Answer: C
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week 6
Exam) | Chamberlain University
1. A 28-year-old female patient diagnosed with Bipolar I Disorder is being considered for
Lithium therapy. Which baseline laboratory assessment is most critical prior to starting this
medication?
A. Serum Creatinine and TSH
B. Liver function tests (LFTs)
C. Platelet count
D. Fast glucose
Answer: A
Rationale: Lithium is primarily excreted by the kidneys and can significantly impact
thyroid function over time. Therefore, obtaining baseline serum creatinine and thyroid-
stimulating hormone (TSH) levels is essential to monitor for renal impairment and
hypothyroidism. These assessments ensure that the patient can safely clear the drug and
allow for the detection of future medication-induced endocrine changes.
,2. Which mechanism of action correctly describes how Methylphenidate treats symptoms of
ADHD?
A. It acts as a direct agonist at the D2 receptor site.
B. It blocks the reuptake of norepinephrine and dopamine.
C. It increases the release of serotonin in the synaptic cleft.
D. It inhibits the enzyme monoamine oxidase.
Answer: B
Rationale: Methylphenidate functions by blocking the dopamine transporter (DAT) and
norepinephrine transporter (NET). This inhibition prevents the reuptake of these
catecholamines, thereby increasing their availability in the synaptic cleft. Enhanced
catecholamine signaling in the prefrontal cortex is believed to improve attention and
reduce hyperactivity in patients with ADHD.
3. A patient taking Valproate (Depakote) for Bipolar Disorder reports significant hair loss and
weight gain. Which intervention should the PMHNP consider?
A. Supplement with Zinc and Selenium.
B. Discontinue the medication immediately.
C. Increase the dosage to achieve rapid stabilization.
D. Switch to a SSRI monotherapy.
Answer: A
,Rationale: Hair loss, or alopecia, is a known side effect of Valproate therapy that can often
be managed with nutritional supplementation. Zinc and Selenium have been shown to
mitigate this cosmetic concern and improve patient adherence. It is important to address
these side effects proactively rather than discontinuing an effective mood stabilizer
abruptly.
4. When prescribing Lamotrigine, the PMHNP must educate the patient about the risk of
Stevens-Johnson Syndrome (SJS). What is the standard titration schedule to minimize this
risk?
A. Start at 100 mg daily and double every week.
B. Start at 25 mg daily for the first two weeks.
C. Start at 50 mg twice daily for one month.
D. Begin with a loading dose of 200 mg.
Answer: B
Rationale: The risk of developing a life-threatening rash, such as Stevens-Johnson
Syndrome, is highly correlated with the rate of dose escalation. The recommended starting
dose for Lamotrigine is 25 mg daily for two weeks, followed by 50 mg daily for the next two
weeks. This ‘start low and go slow’ approach is the most effective clinical strategy for
preventing serious dermatological reactions.
, 5. A patient on Lithium therapy presents with a serum level of 1.9 mEq/L. Which clinical
symptoms would the PMHNP expect to observe?
A. Increased appetite and sedation.
B. Hypertension and tachycardia.
C. Coarse hand tremors, ataxia, and persistent diarrhea.
D. Hypoglycemia and skin rash.
Answer: C
Rationale: Lithium toxicity typically occurs when serum levels exceed 1.5 mEq/L, with
severe symptoms appearing above 2.0 mEq/L. A level of 1.9 mEq/L is indicative of
moderate toxicity, characterized by neurological signs like ataxia and coarse tremors,
alongside gastrointestinal distress. The PMHNP must recognize these signs as a medical
emergency requiring immediate dose adjustment or cessation.
6. What is the primary pharmacological advantage of Lisdexamfetamine (Vyvanse) over other
amphetamine-based stimulants?
A. It is not a controlled substance.
B. It does not cause cardiovascular side effects.
C. It has a lower potential for abuse due to its prodrug design.
D. It can be taken as needed (PRN) for immediate effect.
Answer: C
