NR 606 MANAGEMENT IN
PSYCHIATRIC MENTAL HEALTH II -
ADVANCED COMPREHENSIVE EXAM
1. A 28-year-old female patient with a history of Bipolar I Disorder is planning to become
pregnant. She is currently stable on Lithium. What is the most significant risk associated with
Lithium use during the first trimester of pregnancy?
A. Neural tube defects
B. Cleft lip and palate
C. Fetal hydantoin syndrome
D. Ebstein’s anomaly
Answer: D
Conceptual Explanation: Lithium exposure during the first trimester is specifically
associated with Ebstein’s anomaly, a rare cardiac defect involving the tricuspid valve.
2. Which cytochrome P450 enzyme is primarily responsible for the metabolism of many
antipsychotics and is inhibited by fluoxetine and paroxetine?
A. CYP1A2
,B. CYP2D6
C. CYP2C19
D. CYP3A4
Answer: B
Conceptual Explanation: CYP2D6 metabolizes many psychotropic medications, including
several antipsychotics and TCAs. Fluoxetine and paroxetine are potent inhibitors of this
enzyme, leading to potential toxicity of substrates.
3. A patient taking Clozapine presents with a fever, sore throat, and mouth sores. The
Absolute Neutrophil Count (ANC) is 450/mm³. What is the most appropriate clinical action?
A. Continue the medication but monitor CBC daily
B. Reduce the dose by 50% and retest ANC in 48 hours
C. Add an antibiotic and continue Clozapine at the current dose
D. Discontinue Clozapine immediately and do not rechallenge
Answer: D
Conceptual Explanation: An ANC below 500/mm³ indicates severe neutropenia
(agranulocytosis). The Clozapine REMS protocol requires immediate discontinuation and
usually prohibits rechallenge.
, 4. Which of the following symptoms best differentiates Neuroleptic Malignant Syndrome
(NMS) from Serotonin Syndrome?
A. Lead-pipe muscle rigidity
B. Autonomic instability
C. Hyperthermia
D. Altered mental status
Answer: A
Conceptual Explanation: While both present with fever and AMS, NMS is characterized by
‘lead-pipe’ rigidity and elevated CK, whereas Serotonin Syndrome typically involves
hyperreflexia and myoclonus.
5. In the treatment of Major Depressive Disorder, a ‘washout’ period is required when
switching from a Monoamine Oxidase Inhibitor (MAOI) to an SSRI. How long should this
period be?
A. 14 days
B. 7 days
C. 3 days
D. 30 days
Answer: A
PSYCHIATRIC MENTAL HEALTH II -
ADVANCED COMPREHENSIVE EXAM
1. A 28-year-old female patient with a history of Bipolar I Disorder is planning to become
pregnant. She is currently stable on Lithium. What is the most significant risk associated with
Lithium use during the first trimester of pregnancy?
A. Neural tube defects
B. Cleft lip and palate
C. Fetal hydantoin syndrome
D. Ebstein’s anomaly
Answer: D
Conceptual Explanation: Lithium exposure during the first trimester is specifically
associated with Ebstein’s anomaly, a rare cardiac defect involving the tricuspid valve.
2. Which cytochrome P450 enzyme is primarily responsible for the metabolism of many
antipsychotics and is inhibited by fluoxetine and paroxetine?
A. CYP1A2
,B. CYP2D6
C. CYP2C19
D. CYP3A4
Answer: B
Conceptual Explanation: CYP2D6 metabolizes many psychotropic medications, including
several antipsychotics and TCAs. Fluoxetine and paroxetine are potent inhibitors of this
enzyme, leading to potential toxicity of substrates.
3. A patient taking Clozapine presents with a fever, sore throat, and mouth sores. The
Absolute Neutrophil Count (ANC) is 450/mm³. What is the most appropriate clinical action?
A. Continue the medication but monitor CBC daily
B. Reduce the dose by 50% and retest ANC in 48 hours
C. Add an antibiotic and continue Clozapine at the current dose
D. Discontinue Clozapine immediately and do not rechallenge
Answer: D
Conceptual Explanation: An ANC below 500/mm³ indicates severe neutropenia
(agranulocytosis). The Clozapine REMS protocol requires immediate discontinuation and
usually prohibits rechallenge.
, 4. Which of the following symptoms best differentiates Neuroleptic Malignant Syndrome
(NMS) from Serotonin Syndrome?
A. Lead-pipe muscle rigidity
B. Autonomic instability
C. Hyperthermia
D. Altered mental status
Answer: A
Conceptual Explanation: While both present with fever and AMS, NMS is characterized by
‘lead-pipe’ rigidity and elevated CK, whereas Serotonin Syndrome typically involves
hyperreflexia and myoclonus.
5. In the treatment of Major Depressive Disorder, a ‘washout’ period is required when
switching from a Monoamine Oxidase Inhibitor (MAOI) to an SSRI. How long should this
period be?
A. 14 days
B. 7 days
C. 3 days
D. 30 days
Answer: A
