NR 546 Week 4 Exam V3 | NR 546
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week 4
Exam) | Chamberlain University
1. A 28-year-old female patient is being started on Lithium for Bipolar I Disorder. Which of the
following laboratory tests is most critical to obtain at baseline before starting this
medication?
A. Thyroid stimulating hormone (TSH) and Serum Creatinine
B. Liver function tests (LFTs)
C. Lipid panel and Hemoglobin A1c
D. Vitamin B12 and Folate levels
Answer: A
Rationale: Lithium is primarily excreted by the kidneys and can significantly impact renal
function over time. It is also known to cause hypothyroidism in a subset of patients by
interfering with thyroid hormone synthesis. Therefore, baseline serum creatinine and TSH
are essential to monitor for potential toxicity and endocrine changes.
2. Which of the following antidepressants is strictly contraindicated in a patient with a known
history of a seizure disorder or an active eating disorder?
A. Sertraline (Zoloft)
,B. Venlafaxine (Effexor XR)
C. Bupropion (Wellbutrin)
D. Mirtazapine (Remeron)
Answer: C
Rationale: Bupropion is known to lower the seizure threshold, especially at higher doses
or in patients with specific risk factors. Patients with bulimia or anorexia nervosa are at
higher risk for electrolyte imbalances, which further increases the seizure risk when taking
bupropion. Consequently, its use is contraindicated in these specific patient populations to
ensure clinical safety.
3. A patient taking a Monoamine Oxidase Inhibitor (MAOI) for treatment-resistant depression
is at risk for a hypertensive crisis if they consume which of the following?
A. Fresh cottage cheese
B. Leafy green vegetables
C. Aged cheddar cheese
D. Whole grain bread
Answer: C
Rationale: Aged foods like cheddar cheese contain high levels of tyramine, which is a
potent vasopressor. When MAOIs inhibit the breakdown of tyramine, it can lead to a
,dangerous surge in blood pressure. Patients on MAOIs must follow a low-tyramine diet to
prevent life-threatening hypertensive events.
4. What is the recommended therapeutic range for serum Lithium levels when treating an
acute manic episode?
A. 0.4 to 0.8 mEq/L
B. 1.5 to 2.0 mEq/L
C. 2.0 to 2.5 mEq/L
D. 0.8 to 1.2 mEq/L
Answer: D
Rationale: The therapeutic range for lithium is narrow and requires careful monitoring to
ensure efficacy and avoid toxicity. For acute mania, a level between 0.8 and 1.2 mEq/L is
generally targeted to achieve stabilization. Maintenance levels are typically lower, often
ranging from 0.6 to 1.0 mEq/L depending on individual patient tolerance.
5. Which side effect of Lamotrigine (Lamictal) requires immediate discontinuation and
medical evaluation to prevent a life-threatening complication?
A. A widespread skin rash
B. Sedation
C. Weight gain
D. Dry mouth
, Answer: A
Rationale: Lamotrigine carries a black box warning for serious, potentially fatal rashes,
including Stevens-Johnson Syndrome (SJS). Any new rash appearing during the first few
weeks of treatment must be treated as a medical emergency. Slow titration is used in
clinical practice specifically to minimize the risk of this serious dermatological reaction.
6. A PMHNP is considering Valproic Acid (Depakote) for a female patient of childbearing age.
Which of the following is the most significant concern regarding its use in pregnancy?
A. Persistent Pulmonary Hypertension of the Newborn
B. Ebstein’s anomaly
C. Neural tube defects
D. Gray baby syndrome
Answer: C
Rationale: Valproic Acid is a known teratogen that significantly increases the risk of neural
tube defects like spina bifida if used during the first trimester. It is generally avoided in
women of childbearing potential unless other treatments have failed. PMHNPs must
provide thorough education on contraception and the risks involved with this medication.
7. Which serotonin-norepinephrine reuptake inhibitor (SNRI) is also FDA-approved for the
management of chronic musculoskeletal pain and fibromyalgia?
A. Duloxetine (Cymbalta)
B. Desvenlafaxine (Pristiq)
Advanced Pharmacology
Psychopharmacology for the PMHNP |
Actual Q&A with Rationale (NR546 Week 4
Exam) | Chamberlain University
1. A 28-year-old female patient is being started on Lithium for Bipolar I Disorder. Which of the
following laboratory tests is most critical to obtain at baseline before starting this
medication?
A. Thyroid stimulating hormone (TSH) and Serum Creatinine
B. Liver function tests (LFTs)
C. Lipid panel and Hemoglobin A1c
D. Vitamin B12 and Folate levels
Answer: A
Rationale: Lithium is primarily excreted by the kidneys and can significantly impact renal
function over time. It is also known to cause hypothyroidism in a subset of patients by
interfering with thyroid hormone synthesis. Therefore, baseline serum creatinine and TSH
are essential to monitor for potential toxicity and endocrine changes.
2. Which of the following antidepressants is strictly contraindicated in a patient with a known
history of a seizure disorder or an active eating disorder?
A. Sertraline (Zoloft)
,B. Venlafaxine (Effexor XR)
C. Bupropion (Wellbutrin)
D. Mirtazapine (Remeron)
Answer: C
Rationale: Bupropion is known to lower the seizure threshold, especially at higher doses
or in patients with specific risk factors. Patients with bulimia or anorexia nervosa are at
higher risk for electrolyte imbalances, which further increases the seizure risk when taking
bupropion. Consequently, its use is contraindicated in these specific patient populations to
ensure clinical safety.
3. A patient taking a Monoamine Oxidase Inhibitor (MAOI) for treatment-resistant depression
is at risk for a hypertensive crisis if they consume which of the following?
A. Fresh cottage cheese
B. Leafy green vegetables
C. Aged cheddar cheese
D. Whole grain bread
Answer: C
Rationale: Aged foods like cheddar cheese contain high levels of tyramine, which is a
potent vasopressor. When MAOIs inhibit the breakdown of tyramine, it can lead to a
,dangerous surge in blood pressure. Patients on MAOIs must follow a low-tyramine diet to
prevent life-threatening hypertensive events.
4. What is the recommended therapeutic range for serum Lithium levels when treating an
acute manic episode?
A. 0.4 to 0.8 mEq/L
B. 1.5 to 2.0 mEq/L
C. 2.0 to 2.5 mEq/L
D. 0.8 to 1.2 mEq/L
Answer: D
Rationale: The therapeutic range for lithium is narrow and requires careful monitoring to
ensure efficacy and avoid toxicity. For acute mania, a level between 0.8 and 1.2 mEq/L is
generally targeted to achieve stabilization. Maintenance levels are typically lower, often
ranging from 0.6 to 1.0 mEq/L depending on individual patient tolerance.
5. Which side effect of Lamotrigine (Lamictal) requires immediate discontinuation and
medical evaluation to prevent a life-threatening complication?
A. A widespread skin rash
B. Sedation
C. Weight gain
D. Dry mouth
, Answer: A
Rationale: Lamotrigine carries a black box warning for serious, potentially fatal rashes,
including Stevens-Johnson Syndrome (SJS). Any new rash appearing during the first few
weeks of treatment must be treated as a medical emergency. Slow titration is used in
clinical practice specifically to minimize the risk of this serious dermatological reaction.
6. A PMHNP is considering Valproic Acid (Depakote) for a female patient of childbearing age.
Which of the following is the most significant concern regarding its use in pregnancy?
A. Persistent Pulmonary Hypertension of the Newborn
B. Ebstein’s anomaly
C. Neural tube defects
D. Gray baby syndrome
Answer: C
Rationale: Valproic Acid is a known teratogen that significantly increases the risk of neural
tube defects like spina bifida if used during the first trimester. It is generally avoided in
women of childbearing potential unless other treatments have failed. PMHNPs must
provide thorough education on contraception and the risks involved with this medication.
7. Which serotonin-norepinephrine reuptake inhibitor (SNRI) is also FDA-approved for the
management of chronic musculoskeletal pain and fibromyalgia?
A. Duloxetine (Cymbalta)
B. Desvenlafaxine (Pristiq)
