PSYCHIATRIC ADVANCED PRACTICE
NURSING COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A 45-year-old patient diagnosed with schizophrenia has been taking clozapine for 6
months. During a routine follow-up, the PMHNP notes the Absolute Neutrophil Count (ANC)
is 1,200/mm³. Which of the following is the most appropriate clinical intervention?
A. Continue the medication and monitor ANC monthly.
B. Stop clozapine immediately and initiate a hematology consultation.
C. Continue clozapine but increase the frequency of ANC monitoring to twice weekly.
D. Interrupt clozapine treatment and monitor ANC daily until it rises above 1,500/mm³.
Answer: C
Conceptual Explanation: According to the Clozapine REMS program, for mild neutropenia
(ANC 1,000-1,499/mm³), the clinician should continue treatment but increase monitoring
to three times weekly (or at least twice weekly depending on specific protocols) until ANC
≥ 1,500/mm³.
,2. Which neurotransmitter pathway is primarily associated with the negative symptoms of
schizophrenia, such as alogia and avolition?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The mesocortical pathway, particularly the projection to the
dorsolateral prefrontal cortex, is associated with negative symptoms and cognitive
impairment when dopamine levels are low.
3. A PMHNP is treating a patient with Bipolar I Disorder. The patient is currently experiencing
a manic episode. Which medication is contraindicated for monotherapy in this phase?
A. Lithium
B. Fluoxetine
C. Valproate
D. Quetiapine
Answer: B
, Conceptual Explanation: Antidepressants like Fluoxetine should not be used as
monotherapy for Bipolar I Disorder, especially during mania, as they can exacerbate manic
symptoms or induce rapid cycling.
4. In the context of Pharmacokinetics, which CYP450 enzyme is responsible for the
metabolism of approximately 50% of all clinically used drugs, including many psychotropics?
A. CYP2D6
B. CYP1A2
C. CYP3A4
D. CYP2C19
Answer: C
Conceptual Explanation: CYP3A4 is the most abundant CYP enzyme in the liver and is
responsible for the metabolism of a vast majority of medications.
5. A patient presents with ‘lead pipe’ muscle rigidity, hyperthermia, and autonomic instability
after starting Haloperidol. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Extrapyramidal Side Effects (EPS)
C. Neuroleptic Malignant Syndrome (NMS)
D. Tardive Dyskinesia
Answer: C
NURSING COMPREHENSIVE EXAM
QUESTIONS AND ANSWERS
1. A 45-year-old patient diagnosed with schizophrenia has been taking clozapine for 6
months. During a routine follow-up, the PMHNP notes the Absolute Neutrophil Count (ANC)
is 1,200/mm³. Which of the following is the most appropriate clinical intervention?
A. Continue the medication and monitor ANC monthly.
B. Stop clozapine immediately and initiate a hematology consultation.
C. Continue clozapine but increase the frequency of ANC monitoring to twice weekly.
D. Interrupt clozapine treatment and monitor ANC daily until it rises above 1,500/mm³.
Answer: C
Conceptual Explanation: According to the Clozapine REMS program, for mild neutropenia
(ANC 1,000-1,499/mm³), the clinician should continue treatment but increase monitoring
to three times weekly (or at least twice weekly depending on specific protocols) until ANC
≥ 1,500/mm³.
,2. Which neurotransmitter pathway is primarily associated with the negative symptoms of
schizophrenia, such as alogia and avolition?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The mesocortical pathway, particularly the projection to the
dorsolateral prefrontal cortex, is associated with negative symptoms and cognitive
impairment when dopamine levels are low.
3. A PMHNP is treating a patient with Bipolar I Disorder. The patient is currently experiencing
a manic episode. Which medication is contraindicated for monotherapy in this phase?
A. Lithium
B. Fluoxetine
C. Valproate
D. Quetiapine
Answer: B
, Conceptual Explanation: Antidepressants like Fluoxetine should not be used as
monotherapy for Bipolar I Disorder, especially during mania, as they can exacerbate manic
symptoms or induce rapid cycling.
4. In the context of Pharmacokinetics, which CYP450 enzyme is responsible for the
metabolism of approximately 50% of all clinically used drugs, including many psychotropics?
A. CYP2D6
B. CYP1A2
C. CYP3A4
D. CYP2C19
Answer: C
Conceptual Explanation: CYP3A4 is the most abundant CYP enzyme in the liver and is
responsible for the metabolism of a vast majority of medications.
5. A patient presents with ‘lead pipe’ muscle rigidity, hyperthermia, and autonomic instability
after starting Haloperidol. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Extrapyramidal Side Effects (EPS)
C. Neuroleptic Malignant Syndrome (NMS)
D. Tardive Dyskinesia
Answer: C
