NUR 5461 FINAL EXAM PRACTICE
2026/2027 QUESTIONS AND CORRECT
ANSWERS 2026/2027
1. A 24-year-old male is started on Risperidone. He presents two weeks later with muscle
rigidity, high fever, and autonomic instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Acute Dystonia
C. Neuroleptic Malignant Syndrome
D. Tardive Dyskinesia
Answer: C
Conceptual Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening
reaction to antipsychotics characterized by lead-pipe rigidity, hyperthermia, and
autonomic instability. Serotonin Syndrome usually involves hyperreflexia rather than lead-
pipe rigidity.
2. Which dopaminergic pathway is primarily responsible for the development of
extrapyramidal symptoms (EPS) during treatment with first-generation antipsychotics?
A. Mesolimbic pathway
B. Nigrostriatal pathway
,C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The Nigrostriatal pathway controls motor function; D2 blockade
here leads to EPS. The Mesolimbic pathway is associated with positive symptoms of
schizophrenia, while the Tuberoinfundibular pathway controls prolactin secretion.
3. A patient taking Clozapine must have regular blood draws to monitor for which life-
threatening condition?
A. Agranulocytosis
B. Thrombocytopenia
C. Aplastic Anemia
D. Hepatotoxicity
Answer: A
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis (a
dangerous drop in ANC). Mandatory monitoring of the Absolute Neutrophil Count (ANC) is
required via the REMS program.
4. Which antidepressant 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, particularly in patients
with bulimia or anorexia nervosa, due to potential electrolyte imbalances.
5. A 30-year-old female patient on Lithium for Bipolar I Disorder is planning to become
pregnant. Which fetal malformation is most closely associated with Lithium use during the
first trimester?
A. Neural tube defects
B. Fetal hydantoin syndrome
C. Cleft palate
D. Ebstein’s anomaly
Answer: D
Conceptual Explanation: Ebstein’s anomaly is a rare cardiac defect (apical displacement
of the tricuspid valve) associated specifically with Lithium exposure in utero.
6. What is the mechanism of action of Memantine, used in the treatment of moderate to
severe Alzheimer’s disease?
A. Cholinesterase inhibition
2026/2027 QUESTIONS AND CORRECT
ANSWERS 2026/2027
1. A 24-year-old male is started on Risperidone. He presents two weeks later with muscle
rigidity, high fever, and autonomic instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Acute Dystonia
C. Neuroleptic Malignant Syndrome
D. Tardive Dyskinesia
Answer: C
Conceptual Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening
reaction to antipsychotics characterized by lead-pipe rigidity, hyperthermia, and
autonomic instability. Serotonin Syndrome usually involves hyperreflexia rather than lead-
pipe rigidity.
2. Which dopaminergic pathway is primarily responsible for the development of
extrapyramidal symptoms (EPS) during treatment with first-generation antipsychotics?
A. Mesolimbic pathway
B. Nigrostriatal pathway
,C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The Nigrostriatal pathway controls motor function; D2 blockade
here leads to EPS. The Mesolimbic pathway is associated with positive symptoms of
schizophrenia, while the Tuberoinfundibular pathway controls prolactin secretion.
3. A patient taking Clozapine must have regular blood draws to monitor for which life-
threatening condition?
A. Agranulocytosis
B. Thrombocytopenia
C. Aplastic Anemia
D. Hepatotoxicity
Answer: A
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis (a
dangerous drop in ANC). Mandatory monitoring of the Absolute Neutrophil Count (ANC) is
required via the REMS program.
4. Which antidepressant 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, particularly in patients
with bulimia or anorexia nervosa, due to potential electrolyte imbalances.
5. A 30-year-old female patient on Lithium for Bipolar I Disorder is planning to become
pregnant. Which fetal malformation is most closely associated with Lithium use during the
first trimester?
A. Neural tube defects
B. Fetal hydantoin syndrome
C. Cleft palate
D. Ebstein’s anomaly
Answer: D
Conceptual Explanation: Ebstein’s anomaly is a rare cardiac defect (apical displacement
of the tricuspid valve) associated specifically with Lithium exposure in utero.
6. What is the mechanism of action of Memantine, used in the treatment of moderate to
severe Alzheimer’s disease?
A. Cholinesterase inhibition
