NU664 PMHNP ADVANCED
PSYCHIATRIC NURSING EXAM
QUESTIONS AND ANSWERS
1. A 24-year-old male patient with treatment-resistant schizophrenia is being started on
Clozapine. Which of the following absolute neutrophil counts (ANC) is the minimum required
to initiate treatment?
A. 1,500/mm³
B. 1,000/mm³
C. 2,000/mm³
D. 500/mm³
Answer: A
Conceptual Explanation: According to the Clozapine REMS program, the ANC must be
≥1,500/mm³ for the general population to initiate treatment. For those with benign ethnic
neutropenia (BEN), the threshold is ≥1,000/mm³.
2. Which dopamine pathway is associated with the development of extrapyramidal
symptoms (EPS) when blocked by first-generation antipsychotics?
A. Mesolimbic
,B. Nigrostriatal
C. Mesocortical
D. Tuberoinfundibular
Answer: B
Conceptual Explanation: The nigrostriatal pathway controls motor movement. Blockade
of D2 receptors in this pathway leads to EPS, such as parkinsonism and dystonia.
3. A patient on Lithium therapy presents with coarse hand tremors, ataxia, and confusion.
Their lithium level is 2.2 mEq/L. What is the most appropriate next step?
A. Hold the dose and recheck level in 24 hours
B. Decrease the dose by half
C. Immediately discontinue lithium and prepare for hydration/hemodialysis
D. Administer a beta-blocker for the tremors
Answer: C
Conceptual Explanation: Lithium levels above 2.0 mEq/L are considered severe toxicity,
requiring immediate cessation of the drug and medical intervention, often including
hemodialysis for levels >2.5 or severe symptoms.
4. Which of the following antidepressants is contraindicated in patients with a history of
seizure disorders or eating disorders?
A. Fluoxetine
, B. Venlafaxine
C. Bupropion
D. Mirtazapine
Answer: C
Conceptual Explanation: Bupropion lowers the seizure threshold and is specifically
contraindicated in patients with seizures or those with bulimia/anorexia due to
electrolyte-induced seizure risks.
5. A 32-year-old pregnant woman in her first trimester requires treatment for Bipolar I
Disorder. Which medication carries the highest risk for Ebstein’s anomaly?
A. Lithium
B. Valproate
C. Lamotrigine
D. Quetiapine
Answer: A
Conceptual Explanation: Lithium is associated with Ebstein’s anomaly, a cardiac defect
involving the tricuspid valve, though the absolute risk is lower than previously thought.
6. What is the mechanism of action of Atomoxetine in the treatment of ADHD?
A. Alpha-2 Adrenergic Agonist
B. Dopamine Agonist
PSYCHIATRIC NURSING EXAM
QUESTIONS AND ANSWERS
1. A 24-year-old male patient with treatment-resistant schizophrenia is being started on
Clozapine. Which of the following absolute neutrophil counts (ANC) is the minimum required
to initiate treatment?
A. 1,500/mm³
B. 1,000/mm³
C. 2,000/mm³
D. 500/mm³
Answer: A
Conceptual Explanation: According to the Clozapine REMS program, the ANC must be
≥1,500/mm³ for the general population to initiate treatment. For those with benign ethnic
neutropenia (BEN), the threshold is ≥1,000/mm³.
2. Which dopamine pathway is associated with the development of extrapyramidal
symptoms (EPS) when blocked by first-generation antipsychotics?
A. Mesolimbic
,B. Nigrostriatal
C. Mesocortical
D. Tuberoinfundibular
Answer: B
Conceptual Explanation: The nigrostriatal pathway controls motor movement. Blockade
of D2 receptors in this pathway leads to EPS, such as parkinsonism and dystonia.
3. A patient on Lithium therapy presents with coarse hand tremors, ataxia, and confusion.
Their lithium level is 2.2 mEq/L. What is the most appropriate next step?
A. Hold the dose and recheck level in 24 hours
B. Decrease the dose by half
C. Immediately discontinue lithium and prepare for hydration/hemodialysis
D. Administer a beta-blocker for the tremors
Answer: C
Conceptual Explanation: Lithium levels above 2.0 mEq/L are considered severe toxicity,
requiring immediate cessation of the drug and medical intervention, often including
hemodialysis for levels >2.5 or severe symptoms.
4. Which of the following antidepressants is contraindicated in patients with a history of
seizure disorders or eating disorders?
A. Fluoxetine
, B. Venlafaxine
C. Bupropion
D. Mirtazapine
Answer: C
Conceptual Explanation: Bupropion lowers the seizure threshold and is specifically
contraindicated in patients with seizures or those with bulimia/anorexia due to
electrolyte-induced seizure risks.
5. A 32-year-old pregnant woman in her first trimester requires treatment for Bipolar I
Disorder. Which medication carries the highest risk for Ebstein’s anomaly?
A. Lithium
B. Valproate
C. Lamotrigine
D. Quetiapine
Answer: A
Conceptual Explanation: Lithium is associated with Ebstein’s anomaly, a cardiac defect
involving the tricuspid valve, though the absolute risk is lower than previously thought.
6. What is the mechanism of action of Atomoxetine in the treatment of ADHD?
A. Alpha-2 Adrenergic Agonist
B. Dopamine Agonist
