PSYCHIATRIC MENTAL HEALTH
NURSE PRACTITIONER LMR EXAM
QUESTIONS AND ANSWERS
1. Which dopamine pathway is primarily responsible for the development of extrapyramidal
symptoms (EPS) during treatment with first-generation antipsychotics?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The nigrostriatal pathway regulates motor function. Antagonism
of D2 receptors in this pathway leads to EPS. The mesolimbic pathway is associated with
reward and positive symptoms, mesocortical with negative symptoms, and
tuberoinfundibular with prolactin regulation.
,2. A patient on Lithium Carbonate presents with a coarse tremor, ataxia, and confusion. The
serum lithium level is 2.1 mEq/L. Which is the most appropriate next step?
A. Decrease the dose and re-evaluate in one week.
B. Discontinue lithium and prepare for possible hemodialysis.
C. Advise the patient to increase salt intake and drink more water.
D. Check a thyroid-stimulating hormone (TSH) level.
Answer: B
Conceptual Explanation: A lithium level above 1.5 mEq/L is considered toxic. Severe
toxicity (often >2.0 mEq/L) requires immediate discontinuation and medical intervention,
potentially including hemodialysis to prevent permanent damage or death.
3. Which of the following is a potent inhibitor of the CYP2D6 enzyme, potentially increasing
the levels of medications like beta-blockers and certain tricyclic antidepressants?
A. Carbamazepine
B. Smoking (Tobacco)
C. St. John’s Wort
D. Fluoxetine
Answer: D
, Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of the CYP2D6
enzyme. Carbamazepine and smoking are inducers, which would decrease the levels of
substrate drugs.
4. In the context of evidence-based practice, which of the following provides the highest level
of evidence?
A. Systematic reviews of randomized controlled trials (RCTs)
B. Case-control studies
C. Expert opinion and consensus reports
D. Single descriptive or qualitative studies
Answer: A
Conceptual Explanation: In the hierarchy of evidence, systematic reviews or meta-
analyses of multiple RCTs are considered the ‘gold standard’ or Level I evidence.
5. A 45-year-old male is being treated with Clozapine. Which laboratory value requires
immediate discontinuation of the medication according to the Clozapine REMS program?
A. White blood cell (WBC) count of 4,000/mm³
B. Absolute Neutrophil Count (ANC) of 900/mm³
C. Serum glucose of 140 mg/dL
D. Total cholesterol of 220 mg/dL
Answer: B
NURSE PRACTITIONER LMR EXAM
QUESTIONS AND ANSWERS
1. Which dopamine pathway is primarily responsible for the development of extrapyramidal
symptoms (EPS) during treatment with first-generation antipsychotics?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The nigrostriatal pathway regulates motor function. Antagonism
of D2 receptors in this pathway leads to EPS. The mesolimbic pathway is associated with
reward and positive symptoms, mesocortical with negative symptoms, and
tuberoinfundibular with prolactin regulation.
,2. A patient on Lithium Carbonate presents with a coarse tremor, ataxia, and confusion. The
serum lithium level is 2.1 mEq/L. Which is the most appropriate next step?
A. Decrease the dose and re-evaluate in one week.
B. Discontinue lithium and prepare for possible hemodialysis.
C. Advise the patient to increase salt intake and drink more water.
D. Check a thyroid-stimulating hormone (TSH) level.
Answer: B
Conceptual Explanation: A lithium level above 1.5 mEq/L is considered toxic. Severe
toxicity (often >2.0 mEq/L) requires immediate discontinuation and medical intervention,
potentially including hemodialysis to prevent permanent damage or death.
3. Which of the following is a potent inhibitor of the CYP2D6 enzyme, potentially increasing
the levels of medications like beta-blockers and certain tricyclic antidepressants?
A. Carbamazepine
B. Smoking (Tobacco)
C. St. John’s Wort
D. Fluoxetine
Answer: D
, Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of the CYP2D6
enzyme. Carbamazepine and smoking are inducers, which would decrease the levels of
substrate drugs.
4. In the context of evidence-based practice, which of the following provides the highest level
of evidence?
A. Systematic reviews of randomized controlled trials (RCTs)
B. Case-control studies
C. Expert opinion and consensus reports
D. Single descriptive or qualitative studies
Answer: A
Conceptual Explanation: In the hierarchy of evidence, systematic reviews or meta-
analyses of multiple RCTs are considered the ‘gold standard’ or Level I evidence.
5. A 45-year-old male is being treated with Clozapine. Which laboratory value requires
immediate discontinuation of the medication according to the Clozapine REMS program?
A. White blood cell (WBC) count of 4,000/mm³
B. Absolute Neutrophil Count (ANC) of 900/mm³
C. Serum glucose of 140 mg/dL
D. Total cholesterol of 220 mg/dL
Answer: B
