NSG 552 Exam 2 V1 | NSG 552
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 2) | Wilkes
1. A patient taking Lithium for Bipolar I Disorder presents with a tremor, nausea, and ataxia.
The Lithium level is 1.6 mEq/L. What is the most appropriate initial action for the PMHNP?
A. Increase the dose to reach therapeutic levels
B. Continue the current dose and recheck in one week
C. Hold the next dose and assess for dehydration
D. Administer a benzodiazepine for the tremor
Correct Answer: C
Explanation: The patient’s Lithium level of 1.6 mEq/L indicates mild to moderate toxicity,
as the standard therapeutic range is typically 0.6 to 1.2 mEq/L. Holding the dose and
assessing for contributing factors like dehydration or drug interactions is critical for safety.
Further evaluation of renal function and electrolyte balance is required to prevent
progression to severe toxicity.
2. When initiating Lamotrigine (Lamictal), which titration schedule is essential to minimize
the risk of Stevens-Johnson Syndrome (SJS)?
A. 25 mg twice daily for the first week
B. 50 mg daily for 1 week, then 100 mg daily
,C. 100 mg daily starting dose
D. 25 mg daily for 2 weeks, then 50 mg daily for 2 weeks
Correct Answer: D
Explanation: Lamotrigine requires a very slow titration to reduce the incidence of life-
threatening rashes such as Stevens-Johnson Syndrome. The standard protocol begins at 25
mg daily for the first 14 days before doubling the dose. Patients must be educated to report
any new skin changes or mucosal involvement immediately.
3. A 32-year-old female patient on Valproate (Depakote) for mood stabilization expresses a
desire to become pregnant. Which risk should the PMHNP discuss most prominently?
A. Neural tube defects
B. Ebstein’s anomaly
C. Persistent pulmonary hypertension
D. Neonatal abstinence syndrome
Correct Answer: A
Explanation: Valproate is highly teratogenic and is associated with a significantly
increased risk of neural tube defects like spina bifida. The risk is estimated to be
approximately 1-2%, compared to 0.1% in the general population. If a patient of
childbearing age must use Valproate, folic acid supplementation and strict contraception
are mandatory.
, 4. Which antipsychotic medication is most likely to cause significant elevation in prolactin
levels leading to galactorrhea or gynecomastia?
A. Quetiapine
B. Risperidone
C. Aripiprazole
D. Clozapine
Correct Answer: B
Explanation: Risperidone is known for its strong D2 antagonism in the tuberoinfundibular
pathway, which directly leads to hyperprolactinemia. Unlike most second-generation
antipsychotics, it lacks significant 5-HT2A opposition at this specific pathway to offset the
prolactin rise. Clinical monitoring for sexual dysfunction and bone mineral density loss is
indicated for patients on long-term Risperidone.
5. A patient on Clozapine (Clozaril) has an Absolute Neutrophil Count (ANC) of 900/mm³.
What action is required according to the Clozapine REMS protocol?
A. Continue medication and recheck in one month
B. Interrupt treatment and monitor ANC daily until >1000/mm³
C. Increase the dose to stimulate marrow response
D. Switch the patient to Olanzapine immediately
Correct Answer: B
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 2) | Wilkes
1. A patient taking Lithium for Bipolar I Disorder presents with a tremor, nausea, and ataxia.
The Lithium level is 1.6 mEq/L. What is the most appropriate initial action for the PMHNP?
A. Increase the dose to reach therapeutic levels
B. Continue the current dose and recheck in one week
C. Hold the next dose and assess for dehydration
D. Administer a benzodiazepine for the tremor
Correct Answer: C
Explanation: The patient’s Lithium level of 1.6 mEq/L indicates mild to moderate toxicity,
as the standard therapeutic range is typically 0.6 to 1.2 mEq/L. Holding the dose and
assessing for contributing factors like dehydration or drug interactions is critical for safety.
Further evaluation of renal function and electrolyte balance is required to prevent
progression to severe toxicity.
2. When initiating Lamotrigine (Lamictal), which titration schedule is essential to minimize
the risk of Stevens-Johnson Syndrome (SJS)?
A. 25 mg twice daily for the first week
B. 50 mg daily for 1 week, then 100 mg daily
,C. 100 mg daily starting dose
D. 25 mg daily for 2 weeks, then 50 mg daily for 2 weeks
Correct Answer: D
Explanation: Lamotrigine requires a very slow titration to reduce the incidence of life-
threatening rashes such as Stevens-Johnson Syndrome. The standard protocol begins at 25
mg daily for the first 14 days before doubling the dose. Patients must be educated to report
any new skin changes or mucosal involvement immediately.
3. A 32-year-old female patient on Valproate (Depakote) for mood stabilization expresses a
desire to become pregnant. Which risk should the PMHNP discuss most prominently?
A. Neural tube defects
B. Ebstein’s anomaly
C. Persistent pulmonary hypertension
D. Neonatal abstinence syndrome
Correct Answer: A
Explanation: Valproate is highly teratogenic and is associated with a significantly
increased risk of neural tube defects like spina bifida. The risk is estimated to be
approximately 1-2%, compared to 0.1% in the general population. If a patient of
childbearing age must use Valproate, folic acid supplementation and strict contraception
are mandatory.
, 4. Which antipsychotic medication is most likely to cause significant elevation in prolactin
levels leading to galactorrhea or gynecomastia?
A. Quetiapine
B. Risperidone
C. Aripiprazole
D. Clozapine
Correct Answer: B
Explanation: Risperidone is known for its strong D2 antagonism in the tuberoinfundibular
pathway, which directly leads to hyperprolactinemia. Unlike most second-generation
antipsychotics, it lacks significant 5-HT2A opposition at this specific pathway to offset the
prolactin rise. Clinical monitoring for sexual dysfunction and bone mineral density loss is
indicated for patients on long-term Risperidone.
5. A patient on Clozapine (Clozaril) has an Absolute Neutrophil Count (ANC) of 900/mm³.
What action is required according to the Clozapine REMS protocol?
A. Continue medication and recheck in one month
B. Interrupt treatment and monitor ANC daily until >1000/mm³
C. Increase the dose to stimulate marrow response
D. Switch the patient to Olanzapine immediately
Correct Answer: B
