NR 606 MANAGEMENT IN
PSYCHIATRIC MENTAL HEALTH EXAM
QUESTIONS AND ANSWERS
1. A patient is prescribed Clozapine for treatment-resistant schizophrenia. According to the
REMS program, what is the minimum Absolute Neutrophil Count (ANC) required to initiate
treatment?
A. 1,000/mm³
B. 2,000/mm³
C. 1,500/mm³
D. 500/mm³
Answer: C
Conceptual Explanation: For the general population, the ANC must be ≥ 1500/mm³ to
start Clozapine. For patients with documented Benign Ethnic Neutropenia (BEN), the
threshold is lower (≥ 1000/mm³).
,2. In the neurobiology of schizophrenia, which dopamine pathway is primarily associated
with negative symptoms such as alogia and avolition?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Tuberoinfundibular pathway
D. Nigrostriatal pathway
Answer: B
Conceptual Explanation: Negative symptoms and cognitive symptoms are associated with
hypofunction (low dopamine) in the mesocortical pathway, specifically the prefrontal
cortex.
3. Which of the following physical examination findings most clearly distinguishes Serotonin
Syndrome from Neuroleptic Malignant Syndrome (NMS)?
A. Hyperthermia
B. Mental status changes
C. Hyperreflexia and myoclonus
D. Autonomic instability
Answer: C
, Conceptual Explanation: While both feature fever and tachycardia, Serotonin Syndrome
presents with neuromuscular hyperactivity (clonus, hyperreflexia), whereas NMS presents
with ‘lead-pipe’ muscle rigidity and bradyreflexia.
4. A 24-year-old female patient presents with a history of one hypomanic episode and several
major depressive episodes. Which diagnosis is most appropriate according to DSM-5-TR?
A. Bipolar I Disorder
B. Bipolar II Disorder
C. Cyclothymic Disorder
D. Major Depressive Disorder with psychotic features
Answer: B
Conceptual Explanation: Bipolar II is characterized by at least one hypomanic episode
and one major depressive episode, without any history of a full manic episode.
5. A patient taking Lithium Carbonate for Bipolar Disorder presents with coarse tremors,
ataxia, and confusion. The serum lithium level is 2.1 mEq/L. What is the priority intervention?
A. Increase fluid intake and monitor at home
B. Reduce the lithium dose by half
C. Discontinue lithium and prepare for hemodialysis if symptoms worsen
D. Administer a benzodiazepine to treat the tremors
Answer: C
PSYCHIATRIC MENTAL HEALTH EXAM
QUESTIONS AND ANSWERS
1. A patient is prescribed Clozapine for treatment-resistant schizophrenia. According to the
REMS program, what is the minimum Absolute Neutrophil Count (ANC) required to initiate
treatment?
A. 1,000/mm³
B. 2,000/mm³
C. 1,500/mm³
D. 500/mm³
Answer: C
Conceptual Explanation: For the general population, the ANC must be ≥ 1500/mm³ to
start Clozapine. For patients with documented Benign Ethnic Neutropenia (BEN), the
threshold is lower (≥ 1000/mm³).
,2. In the neurobiology of schizophrenia, which dopamine pathway is primarily associated
with negative symptoms such as alogia and avolition?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Tuberoinfundibular pathway
D. Nigrostriatal pathway
Answer: B
Conceptual Explanation: Negative symptoms and cognitive symptoms are associated with
hypofunction (low dopamine) in the mesocortical pathway, specifically the prefrontal
cortex.
3. Which of the following physical examination findings most clearly distinguishes Serotonin
Syndrome from Neuroleptic Malignant Syndrome (NMS)?
A. Hyperthermia
B. Mental status changes
C. Hyperreflexia and myoclonus
D. Autonomic instability
Answer: C
, Conceptual Explanation: While both feature fever and tachycardia, Serotonin Syndrome
presents with neuromuscular hyperactivity (clonus, hyperreflexia), whereas NMS presents
with ‘lead-pipe’ muscle rigidity and bradyreflexia.
4. A 24-year-old female patient presents with a history of one hypomanic episode and several
major depressive episodes. Which diagnosis is most appropriate according to DSM-5-TR?
A. Bipolar I Disorder
B. Bipolar II Disorder
C. Cyclothymic Disorder
D. Major Depressive Disorder with psychotic features
Answer: B
Conceptual Explanation: Bipolar II is characterized by at least one hypomanic episode
and one major depressive episode, without any history of a full manic episode.
5. A patient taking Lithium Carbonate for Bipolar Disorder presents with coarse tremors,
ataxia, and confusion. The serum lithium level is 2.1 mEq/L. What is the priority intervention?
A. Increase fluid intake and monitor at home
B. Reduce the lithium dose by half
C. Discontinue lithium and prepare for hemodialysis if symptoms worsen
D. Administer a benzodiazepine to treat the tremors
Answer: C
