NR 546 Week 4 Exam V3 | NR 546 Advanced
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
4 Exam) | Chamberlain University
1. A patient taking Lithium Carbonate for Bipolar I Disorder reports for a routine follow-up.
The PMHNP notes the latest serum lithium level is 1.4 mEq/L. What is the most appropriate
clinical action?
A. Hold the dose and assess the patient for signs of toxicity such as ataxia or coarse
tremors.
B. Maintain the current dose as the level is within the standard therapeutic range.
C. Increase the dose to reach the therapeutic ceiling of 1.5 mEq/L.
D. Immediately order hemodialysis to prevent permanent renal damage.
Correct Answer: A
Explanation: The therapeutic range for lithium is generally considered 0.6 to 1.2 mEq/L
for maintenance. A level of 1.4 mEq/L is approaching the toxic threshold, which typically
begins at 1.5 mEq/L. The PMHNP should hold the medication and carefully assess the
patient for clinical symptoms of toxicity like confusion or slurred speech.
2. When initiating Lamotrigine (Lamictal) for a patient with Bipolar Depression, why is it
critical to follow a slow titration schedule?
A. To ensure the patient does not develop acute dystonia.
,B. To avoid the rapid onset of hypertensive crisis.
C. To minimize the risk of weight gain and metabolic syndrome.
D. To prevent the development of Stevens-Johnson Syndrome (SJS).
Correct Answer: D
Explanation: Lamotrigine carries a black box warning for serious rashes, including
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Rapid titration significantly
increases the risk of these life-threatening dermatological reactions. A standard titration
usually starts at 25mg daily for two weeks to allow for immune system tolerance.
3. A patient is prescribed Valproic Acid (Depakote). Which laboratory tests must be
monitored regularly due to the drug’s safety profile?
A. Serum creatinine and blood urea nitrogen.
B. Hemoglobin A1c and lipid panel only.
C. Thyroid stimulating hormone and serum calcium.
D. Liver function tests (LFTs) and Complete Blood Count (CBC) with platelets.
Correct Answer: D
Explanation: Valproic Acid is associated with risks of hepatotoxicity and
thrombocytopenia. The PMHNP must monitor LFTs to detect potential liver failure and CBC
to monitor for low platelet counts. These labs are typically checked at baseline and then at
regular intervals throughout treatment.
, 4. Which of the following antidepressants is most likely to cause a hypertensive crisis if the
patient consumes foods rich in tyramine?
A. Fluoxetine (Prozac)
B. Venlafaxine (Effexor)
C. Phenelzine (Nardil)
D. Bupropion (Wellbutrin)
Correct Answer: C
Explanation: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI). MAOIs inhibit the
breakdown of tyramine, which can lead to excessive norepinephrine release and a
dangerous spike in blood pressure. Patients must strictly follow a low-tyramine diet,
avoiding aged cheeses, cured meats, and fermented products.
5. A patient presents with hyperreflexia, shivering, diaphoresis, and diarrhea after increasing
their dosage of Sertraline and starting an over-the-counter cough suppressant. What is the
suspected condition?
A. Neuroleptic Malignant Syndrome
B. Discontinuation Syndrome
C. Anticholinergic Toxicity
D. Serotonin Syndrome
Correct Answer: D
Pharmacology Psychopharmacology for the
PMHNP | Actual Q&A with Rationale (NR546 Week
4 Exam) | Chamberlain University
1. A patient taking Lithium Carbonate for Bipolar I Disorder reports for a routine follow-up.
The PMHNP notes the latest serum lithium level is 1.4 mEq/L. What is the most appropriate
clinical action?
A. Hold the dose and assess the patient for signs of toxicity such as ataxia or coarse
tremors.
B. Maintain the current dose as the level is within the standard therapeutic range.
C. Increase the dose to reach the therapeutic ceiling of 1.5 mEq/L.
D. Immediately order hemodialysis to prevent permanent renal damage.
Correct Answer: A
Explanation: The therapeutic range for lithium is generally considered 0.6 to 1.2 mEq/L
for maintenance. A level of 1.4 mEq/L is approaching the toxic threshold, which typically
begins at 1.5 mEq/L. The PMHNP should hold the medication and carefully assess the
patient for clinical symptoms of toxicity like confusion or slurred speech.
2. When initiating Lamotrigine (Lamictal) for a patient with Bipolar Depression, why is it
critical to follow a slow titration schedule?
A. To ensure the patient does not develop acute dystonia.
,B. To avoid the rapid onset of hypertensive crisis.
C. To minimize the risk of weight gain and metabolic syndrome.
D. To prevent the development of Stevens-Johnson Syndrome (SJS).
Correct Answer: D
Explanation: Lamotrigine carries a black box warning for serious rashes, including
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Rapid titration significantly
increases the risk of these life-threatening dermatological reactions. A standard titration
usually starts at 25mg daily for two weeks to allow for immune system tolerance.
3. A patient is prescribed Valproic Acid (Depakote). Which laboratory tests must be
monitored regularly due to the drug’s safety profile?
A. Serum creatinine and blood urea nitrogen.
B. Hemoglobin A1c and lipid panel only.
C. Thyroid stimulating hormone and serum calcium.
D. Liver function tests (LFTs) and Complete Blood Count (CBC) with platelets.
Correct Answer: D
Explanation: Valproic Acid is associated with risks of hepatotoxicity and
thrombocytopenia. The PMHNP must monitor LFTs to detect potential liver failure and CBC
to monitor for low platelet counts. These labs are typically checked at baseline and then at
regular intervals throughout treatment.
, 4. Which of the following antidepressants is most likely to cause a hypertensive crisis if the
patient consumes foods rich in tyramine?
A. Fluoxetine (Prozac)
B. Venlafaxine (Effexor)
C. Phenelzine (Nardil)
D. Bupropion (Wellbutrin)
Correct Answer: C
Explanation: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI). MAOIs inhibit the
breakdown of tyramine, which can lead to excessive norepinephrine release and a
dangerous spike in blood pressure. Patients must strictly follow a low-tyramine diet,
avoiding aged cheeses, cured meats, and fermented products.
5. A patient presents with hyperreflexia, shivering, diaphoresis, and diarrhea after increasing
their dosage of Sertraline and starting an over-the-counter cough suppressant. What is the
suspected condition?
A. Neuroleptic Malignant Syndrome
B. Discontinuation Syndrome
C. Anticholinergic Toxicity
D. Serotonin Syndrome
Correct Answer: D
