NU664 ADVANCED PSYCHIATRIC
NURSING EXAM PREP QUESTIONS AND
ANSWERS
1. A patient taking Clozapine for treatment-resistant schizophrenia must have their Absolute
Neutrophil Count (ANC) monitored. At what ANC level must the medication be discontinued
immediately?
A. Below 1,000/mm3
B. Below 1,500/mm3
C. Below 2,000/mm3
D. Below 500/mm3
Answer: A
Conceptual Explanation: According to the Clozapine REMS program, the medication must
be interrupted if the ANC drops below 1,000/mm3 to prevent life-threatening
agranulocytosis.
,2. Which of the following neurotransmitter pathways is primarily associated with the positive
symptoms of schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: Hyperactivity in the mesolimbic pathway is linked to positive
symptoms, while hypoactivity in the mesocortical pathway is linked to negative symptoms.
3. A patient presents with high fever, muscle rigidity, autonomic instability, and altered
mental status after starting Haloperidol. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Serotonin Syndrome
C. Anticholinergic Toxicity
D. Akathisia
Answer: A
Conceptual Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by ‘lead-pipe’ rigidity, hyperpyrexia, and autonomic dysfunction.
, 4. When prescribing Lithium, which lab value is most critical to monitor due to the risk of
toxicity related to renal clearance?
A. Serum Creatinine
B. Serum Potassium
C. Liver Function Tests (LFTs)
D. Alanine Aminotransferase (ALT)
Answer: A
Conceptual Explanation: Lithium is excreted almost entirely by the kidneys; therefore,
renal function (Creatinine and GFR) must be monitored closely to avoid toxicity.
5. Which class of antidepressants is most likely to cause hypertensive crisis when consumed
with tyramine-rich foods?
A. Selective Serotonin Reuptake Inhibitors (SSRIs)
B. Tricyclic Antidepressants (TCAs)
C. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
D. Monoamine Oxidase Inhibitors (MAOIs)
Answer: D
Conceptual Explanation: MAOIs inhibit the breakdown of tyramine, which can lead to a
massive release of norepinephrine, causing a hypertensive crisis.
NURSING EXAM PREP QUESTIONS AND
ANSWERS
1. A patient taking Clozapine for treatment-resistant schizophrenia must have their Absolute
Neutrophil Count (ANC) monitored. At what ANC level must the medication be discontinued
immediately?
A. Below 1,000/mm3
B. Below 1,500/mm3
C. Below 2,000/mm3
D. Below 500/mm3
Answer: A
Conceptual Explanation: According to the Clozapine REMS program, the medication must
be interrupted if the ANC drops below 1,000/mm3 to prevent life-threatening
agranulocytosis.
,2. Which of the following neurotransmitter pathways is primarily associated with the positive
symptoms of schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesolimbic pathway
Answer: D
Conceptual Explanation: Hyperactivity in the mesolimbic pathway is linked to positive
symptoms, while hypoactivity in the mesocortical pathway is linked to negative symptoms.
3. A patient presents with high fever, muscle rigidity, autonomic instability, and altered
mental status after starting Haloperidol. What is the most likely diagnosis?
A. Neuroleptic Malignant Syndrome (NMS)
B. Serotonin Syndrome
C. Anticholinergic Toxicity
D. Akathisia
Answer: A
Conceptual Explanation: NMS is a life-threatening reaction to antipsychotics
characterized by ‘lead-pipe’ rigidity, hyperpyrexia, and autonomic dysfunction.
, 4. When prescribing Lithium, which lab value is most critical to monitor due to the risk of
toxicity related to renal clearance?
A. Serum Creatinine
B. Serum Potassium
C. Liver Function Tests (LFTs)
D. Alanine Aminotransferase (ALT)
Answer: A
Conceptual Explanation: Lithium is excreted almost entirely by the kidneys; therefore,
renal function (Creatinine and GFR) must be monitored closely to avoid toxicity.
5. Which class of antidepressants is most likely to cause hypertensive crisis when consumed
with tyramine-rich foods?
A. Selective Serotonin Reuptake Inhibitors (SSRIs)
B. Tricyclic Antidepressants (TCAs)
C. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
D. Monoamine Oxidase Inhibitors (MAOIs)
Answer: D
Conceptual Explanation: MAOIs inhibit the breakdown of tyramine, which can lead to a
massive release of norepinephrine, causing a hypertensive crisis.
