NR 606 MIDTERM EXAM – DIAGNOSIS
& MANAGEMENT IN PSYCHIATRIC
MENTAL HEALTH II
1. Which neurotransmitter pathway is primarily associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: The mesolimbic pathway, which projects from the ventral
tegmental area to the nucleus accumbens, is hypothesized to be overactive in
schizophrenia, leading to positive symptoms.
,2. When prescribing Clozapine, the provider must monitor the Absolute Neutrophil Count
(ANC). At what ANC level should the medication be permanently discontinued to prevent
severe neutropenia?
A. Less than 2000/mm³
B. Less than 1500/mm³
C. Less than 1000/mm³
D. Less than 500/mm³
Answer: D
Conceptual Explanation: A Clozapine patient with an ANC below 500/mm³
(agranulocytosis) must have the medication discontinued immediately and permanently to
avoid life-threatening infection.
3. A patient with Bipolar I Disorder presents with a tremor, ataxia, and confusion. Which
medication toxicity should the PMHNP suspect first?
A. Valproic acid
B. Lamotrigine
C. Lithium
D. Quetiapine
Answer: C
, Conceptual Explanation: Lithium toxicity typically presents with gastrointestinal upset,
coarse tremors, ataxia, confusion, and potential seizures when levels exceed the narrow
therapeutic index.
4. According to the DSM-5-TR, what is the minimum duration of symptoms required for a
diagnosis of Generalized Anxiety Disorder (GAD)?
A. 2 weeks
B. 1 month
C. 3 months
D. 6 months
Answer: D
Conceptual Explanation: Generalized Anxiety Disorder requires excessive anxiety and
worry occurring more days than not for at least 6 months.
5. Which antidepressant is considered the first-line treatment for a patient with both Major
Depressive Disorder and Chronic Pain?
A. Duloxetine
B. Fluoxetine
C. Bupropion
D. Mirtazapine
Answer: A
& MANAGEMENT IN PSYCHIATRIC
MENTAL HEALTH II
1. Which neurotransmitter pathway is primarily associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: The mesolimbic pathway, which projects from the ventral
tegmental area to the nucleus accumbens, is hypothesized to be overactive in
schizophrenia, leading to positive symptoms.
,2. When prescribing Clozapine, the provider must monitor the Absolute Neutrophil Count
(ANC). At what ANC level should the medication be permanently discontinued to prevent
severe neutropenia?
A. Less than 2000/mm³
B. Less than 1500/mm³
C. Less than 1000/mm³
D. Less than 500/mm³
Answer: D
Conceptual Explanation: A Clozapine patient with an ANC below 500/mm³
(agranulocytosis) must have the medication discontinued immediately and permanently to
avoid life-threatening infection.
3. A patient with Bipolar I Disorder presents with a tremor, ataxia, and confusion. Which
medication toxicity should the PMHNP suspect first?
A. Valproic acid
B. Lamotrigine
C. Lithium
D. Quetiapine
Answer: C
, Conceptual Explanation: Lithium toxicity typically presents with gastrointestinal upset,
coarse tremors, ataxia, confusion, and potential seizures when levels exceed the narrow
therapeutic index.
4. According to the DSM-5-TR, what is the minimum duration of symptoms required for a
diagnosis of Generalized Anxiety Disorder (GAD)?
A. 2 weeks
B. 1 month
C. 3 months
D. 6 months
Answer: D
Conceptual Explanation: Generalized Anxiety Disorder requires excessive anxiety and
worry occurring more days than not for at least 6 months.
5. Which antidepressant is considered the first-line treatment for a patient with both Major
Depressive Disorder and Chronic Pain?
A. Duloxetine
B. Fluoxetine
C. Bupropion
D. Mirtazapine
Answer: A
