NR 605 ADVANCED PSYCHIATRIC
DIAGNOSIS AND MANAGEMENT EXAM
QUESTIONS AND CORRECT ANSWERS
A+ GRADE
1. A 45-year-old patient with Bipolar I Disorder presents with acute mania. The PMHNP
initiates Lithium. Which of the following lab values would be most concerning regarding
Lithium toxicity?
A. Serum Lithium level of 0.8 mEq/L
B. Creatinine clearance of 40 mL/min
C. Sodium level of 140 mEq/L
D. TSH level of 3.5 mU/L
Answer: B
Conceptual Explanation: Lithium is almost exclusively excreted by the kidneys. A low
creatinine clearance (normal >90 mL/min) indicates renal impairment, which significantly
increases the risk of Lithium toxicity.
2. Which neuroanatomical structure is primarily responsible for the ‘fear circuitry’ and is
often overactive in patients with Panic Disorder?
A. Hippocampus
B. Prefrontal Cortex
,C. Amygdala
D. Basal Ganglia
Answer: C
Conceptual Explanation: The amygdala is the core structure for processing fear and
emotional stimuli. Hyperactivity in the amygdala is a hallmark of anxiety and panic
disorders.
3. A patient is prescribed Clozapine for treatment-resistant Schizophrenia. What is the
absolute neutrophil count (ANC) threshold required to continue treatment without
interruption?
A. 1000/mm³
B. 1500/mm³
C. 2000/mm³
D. 500/mm³
Answer: B
Conceptual Explanation: For the general population, the ANC must be ≥1500/mm³ to
initiate and continue Clozapine therapy due to the risk of agranulocytosis.
4. Which characteristic distinguishes Bipolar II Disorder from Bipolar I Disorder according to
DSM-5-TR?
A. The presence of at least one full manic episode
, B. The absence of depressive symptoms
C. The duration of symptoms must be at least 2 years
D. The presence of hypomanic episodes and at least one major depressive episode
Answer: D
Conceptual Explanation: Bipolar II requires at least one hypomanic episode and one
major depressive episode, but never a full manic episode (which would classify it as Bipolar
I).
5. A patient taking Phenelzine (an MAOI) presents to the ER with a severe headache,
palpitations, and a BP of 210/120. Which food item is likely responsible?
A. Fresh cottage cheese
B. Green leafy vegetables
C. Roasted chicken
D. Aged cheddar cheese
Answer: D
Conceptual Explanation: Aged cheeses contain high levels of tyramine, which can trigger
a hypertensive crisis in patients taking MAOIs by causing a massive release of
norepinephrine.
DIAGNOSIS AND MANAGEMENT EXAM
QUESTIONS AND CORRECT ANSWERS
A+ GRADE
1. A 45-year-old patient with Bipolar I Disorder presents with acute mania. The PMHNP
initiates Lithium. Which of the following lab values would be most concerning regarding
Lithium toxicity?
A. Serum Lithium level of 0.8 mEq/L
B. Creatinine clearance of 40 mL/min
C. Sodium level of 140 mEq/L
D. TSH level of 3.5 mU/L
Answer: B
Conceptual Explanation: Lithium is almost exclusively excreted by the kidneys. A low
creatinine clearance (normal >90 mL/min) indicates renal impairment, which significantly
increases the risk of Lithium toxicity.
2. Which neuroanatomical structure is primarily responsible for the ‘fear circuitry’ and is
often overactive in patients with Panic Disorder?
A. Hippocampus
B. Prefrontal Cortex
,C. Amygdala
D. Basal Ganglia
Answer: C
Conceptual Explanation: The amygdala is the core structure for processing fear and
emotional stimuli. Hyperactivity in the amygdala is a hallmark of anxiety and panic
disorders.
3. A patient is prescribed Clozapine for treatment-resistant Schizophrenia. What is the
absolute neutrophil count (ANC) threshold required to continue treatment without
interruption?
A. 1000/mm³
B. 1500/mm³
C. 2000/mm³
D. 500/mm³
Answer: B
Conceptual Explanation: For the general population, the ANC must be ≥1500/mm³ to
initiate and continue Clozapine therapy due to the risk of agranulocytosis.
4. Which characteristic distinguishes Bipolar II Disorder from Bipolar I Disorder according to
DSM-5-TR?
A. The presence of at least one full manic episode
, B. The absence of depressive symptoms
C. The duration of symptoms must be at least 2 years
D. The presence of hypomanic episodes and at least one major depressive episode
Answer: D
Conceptual Explanation: Bipolar II requires at least one hypomanic episode and one
major depressive episode, but never a full manic episode (which would classify it as Bipolar
I).
5. A patient taking Phenelzine (an MAOI) presents to the ER with a severe headache,
palpitations, and a BP of 210/120. Which food item is likely responsible?
A. Fresh cottage cheese
B. Green leafy vegetables
C. Roasted chicken
D. Aged cheddar cheese
Answer: D
Conceptual Explanation: Aged cheeses contain high levels of tyramine, which can trigger
a hypertensive crisis in patients taking MAOIs by causing a massive release of
norepinephrine.
