NR 546 Week 6 Exam V1 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
6 Exam) | Chamberlain University
1. A 28-year-old female patient diagnosed with Bipolar I Disorder is being considered for
lithium therapy. Which of the following baseline laboratory tests is the most essential prior to
starting this medication?
A. Liver function tests (LFTs)
B. Serum creatinine and Bun
C. Amylase and lipase
D. Hemoglobin A1c
Correct Answer: B
Explanation: Lithium is excreted almost exclusively by the kidneys, making renal function
assessment critical before initiation. Abnormal renal function can lead to lithium
accumulation and toxicity even at standard doses. Therefore, baseline serum creatinine and
BUN are mandatory to ensure safe clearance of the drug.
2. A patient taking lithium for Bipolar Disorder reports a new onset of coarse hand tremors,
nausea, and slurred speech. The PMHNP should suspect lithium toxicity at what serum level?
A. 2.0 mEq/L
B. 1.0 mEq/L
,C. 1.2 mEq/L
D. 0.6 mEq/L
Correct Answer: A
Explanation: Lithium levels above 1.5 mEq/L are generally considered toxic, with severe
symptoms like coarse tremors and ataxia typically appearing at 2.0 mEq/L or higher.
Therapeutic levels for acute mania are usually between 0.8 and 1.2 mEq/L. Monitoring for
these symptoms is vital as lithium has a very narrow therapeutic index.
3. When prescribing Valproic Acid (Depakote), which Black Box Warning must the PMHNP
discuss with the patient?
A. Agranulocytosis
B. Stevens-Johnson Syndrome
C. Hepatotoxicity
D. Prolonged QT interval
Correct Answer: C
Explanation: Valproic acid carries a Black Box Warning for hepatotoxicity, which can be
fatal and usually occurs within the first six months of treatment. It also carries warnings for
pancreatitis and fetal neural tube defects. Regular monitoring of liver function tests is
necessary to mitigate this risk during the early stages of therapy.
, 4. Which mood stabilizer is specifically known to cause a life-threatening rash known as
Stevens-Johnson Syndrome (SJS) if titrated too quickly?
A. Lithium
B. Valproic Acid
C. Gabapentin
D. Lamotrigine
Correct Answer: D
Explanation: Lamotrigine requires a very slow titration schedule to minimize the risk of
serious, potentially life-threatening rashes like SJS. The risk is significantly increased if the
starting dose is too high or if the dose is escalated faster than recommended. Patients must
be educated to stop the medication and seek immediate care if any skin changes occur.
5. A patient with Bipolar I Disorder is started on Carbamazepine. Which genetic screening is
recommended by the FDA for patients of Asian descent before starting this medication?
A. CYP2D6
B. MTHFR
C. HLA-B*1502
D. APOE4
Correct Answer: C
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
6 Exam) | Chamberlain University
1. A 28-year-old female patient diagnosed with Bipolar I Disorder is being considered for
lithium therapy. Which of the following baseline laboratory tests is the most essential prior to
starting this medication?
A. Liver function tests (LFTs)
B. Serum creatinine and Bun
C. Amylase and lipase
D. Hemoglobin A1c
Correct Answer: B
Explanation: Lithium is excreted almost exclusively by the kidneys, making renal function
assessment critical before initiation. Abnormal renal function can lead to lithium
accumulation and toxicity even at standard doses. Therefore, baseline serum creatinine and
BUN are mandatory to ensure safe clearance of the drug.
2. A patient taking lithium for Bipolar Disorder reports a new onset of coarse hand tremors,
nausea, and slurred speech. The PMHNP should suspect lithium toxicity at what serum level?
A. 2.0 mEq/L
B. 1.0 mEq/L
,C. 1.2 mEq/L
D. 0.6 mEq/L
Correct Answer: A
Explanation: Lithium levels above 1.5 mEq/L are generally considered toxic, with severe
symptoms like coarse tremors and ataxia typically appearing at 2.0 mEq/L or higher.
Therapeutic levels for acute mania are usually between 0.8 and 1.2 mEq/L. Monitoring for
these symptoms is vital as lithium has a very narrow therapeutic index.
3. When prescribing Valproic Acid (Depakote), which Black Box Warning must the PMHNP
discuss with the patient?
A. Agranulocytosis
B. Stevens-Johnson Syndrome
C. Hepatotoxicity
D. Prolonged QT interval
Correct Answer: C
Explanation: Valproic acid carries a Black Box Warning for hepatotoxicity, which can be
fatal and usually occurs within the first six months of treatment. It also carries warnings for
pancreatitis and fetal neural tube defects. Regular monitoring of liver function tests is
necessary to mitigate this risk during the early stages of therapy.
, 4. Which mood stabilizer is specifically known to cause a life-threatening rash known as
Stevens-Johnson Syndrome (SJS) if titrated too quickly?
A. Lithium
B. Valproic Acid
C. Gabapentin
D. Lamotrigine
Correct Answer: D
Explanation: Lamotrigine requires a very slow titration schedule to minimize the risk of
serious, potentially life-threatening rashes like SJS. The risk is significantly increased if the
starting dose is too high or if the dose is escalated faster than recommended. Patients must
be educated to stop the medication and seek immediate care if any skin changes occur.
5. A patient with Bipolar I Disorder is started on Carbamazepine. Which genetic screening is
recommended by the FDA for patients of Asian descent before starting this medication?
A. CYP2D6
B. MTHFR
C. HLA-B*1502
D. APOE4
Correct Answer: C
