PSYCHIATRIC ADVANCED PRACTICE
NURSING: A BIOPSYCHOSOCIAL
FOUNDATION COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. Which neurobiological pathway is primarily associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions, due to dopamine overactivity?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The mesolimbic pathway involves the projection of dopamine
from the ventral tegmental area to the nucleus accumbens. Hyperactivity in this pathway is
linked to positive psychotic symptoms.
,2. A patient taking Olanzapine (Zyprexa) informs the PMHNP that they have started smoking
a pack of cigarettes a day. How should the PMHNP adjust the dosage?
A. Decrease the dose because smoking inhibits CYP1A2.
B. Increase the dose because smoking induces CYP1A2.
C. Maintain the dose because smoking only affects CYP2D6.
D. Increase the dose because smoking inhibits CYP3A4.
Answer: B
Conceptual Explanation: Polycyclic aromatic hydrocarbons in cigarette smoke induce the
CYP1A2 enzyme, which increases the metabolism of olanzapine, necessitating a higher dose
for therapeutic effect.
3. According to Erik Erikson’s stages of psychosocial development, a 45-year-old adult
struggling with a sense of stagnation and lack of purpose is likely failing to resolve which
conflict?
A. Identity vs. Role Confusion
B. Intimacy vs. Isolation
C. Integrity vs. Despair
D. Generativity vs. Stagnation
Answer: D
, Conceptual Explanation: Generativity vs. Stagnation is the developmental stage for
middle adulthood (40–65 years), focusing on contributing to the next generation versus
feeling unproductive.
4. Which laboratory finding is the most critical to monitor for a patient newly initiated on
Clozapine (Clozaril)?
A. Absolute Neutrophil Count (ANC)
B. Serum Potassium levels
C. Liver function tests (ALT/AST)
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis. Strict
monitoring of the ANC is required to prevent life-threatening infections.
5. During a Mental Status Exam (MSE), a patient provides unnecessary and tedious details
before finally answering the clinician’s question. This thought process is described as:
A. Tangentiality
B. Circumstantiality
C. Flight of ideas
D. Derailment
Answer: B
NURSING: A BIOPSYCHOSOCIAL
FOUNDATION COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. Which neurobiological pathway is primarily associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions, due to dopamine overactivity?
A. Mesocortical pathway
B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The mesolimbic pathway involves the projection of dopamine
from the ventral tegmental area to the nucleus accumbens. Hyperactivity in this pathway is
linked to positive psychotic symptoms.
,2. A patient taking Olanzapine (Zyprexa) informs the PMHNP that they have started smoking
a pack of cigarettes a day. How should the PMHNP adjust the dosage?
A. Decrease the dose because smoking inhibits CYP1A2.
B. Increase the dose because smoking induces CYP1A2.
C. Maintain the dose because smoking only affects CYP2D6.
D. Increase the dose because smoking inhibits CYP3A4.
Answer: B
Conceptual Explanation: Polycyclic aromatic hydrocarbons in cigarette smoke induce the
CYP1A2 enzyme, which increases the metabolism of olanzapine, necessitating a higher dose
for therapeutic effect.
3. According to Erik Erikson’s stages of psychosocial development, a 45-year-old adult
struggling with a sense of stagnation and lack of purpose is likely failing to resolve which
conflict?
A. Identity vs. Role Confusion
B. Intimacy vs. Isolation
C. Integrity vs. Despair
D. Generativity vs. Stagnation
Answer: D
, Conceptual Explanation: Generativity vs. Stagnation is the developmental stage for
middle adulthood (40–65 years), focusing on contributing to the next generation versus
feeling unproductive.
4. Which laboratory finding is the most critical to monitor for a patient newly initiated on
Clozapine (Clozaril)?
A. Absolute Neutrophil Count (ANC)
B. Serum Potassium levels
C. Liver function tests (ALT/AST)
D. Thyroid Stimulating Hormone (TSH)
Answer: A
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis. Strict
monitoring of the ANC is required to prevent life-threatening infections.
5. During a Mental Status Exam (MSE), a patient provides unnecessary and tedious details
before finally answering the clinician’s question. This thought process is described as:
A. Tangentiality
B. Circumstantiality
C. Flight of ideas
D. Derailment
Answer: B
