NSG 552 Exam 3 V2 | NSG 552
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 3) | Wilkes
1. A 28-year-old female patient with Bipolar I disorder is being started on Lithium. Which of
the following baseline laboratory tests is the most critical before initiating therapy?
A. Liver function tests (LFTs) and Prothrombin time
B. Lipid panel and Hemoglobin A1c
C. Complete blood count (CBC) with differential
D. Serum creatinine, BUN, and Thyroid Stimulating Hormone (TSH)
Correct Answer: D
Explanation: Lithium is primarily excreted by the kidneys and can significantly impact
renal function over time. Additionally, lithium frequently causes hypothyroidism by
interfering with iodine uptake and thyroid hormone release. Baseline assessment of serum
creatinine and TSH is essential for long-term safety monitoring.
2. When initiating Lamotrigine therapy, what is the most important clinical teaching point to
prevent life-threatening adverse reactions?
A. The medication should be taken with a high-fat meal to increase absorption.
B. Blood levels must be drawn every 2 weeks to ensure therapeutic efficacy.
C. The dosage must be titrated slowly to reduce the risk of Stevens-Johnson Syndrome.
,D. Avoid grapefruit juice as it inhibits the metabolism of the drug.
Correct Answer: C
Explanation: Stevens-Johnson Syndrome (SJS) is a rare but potentially fatal skin reaction
associated with Lamotrigine. The risk of SJS is significantly higher if the medication is
started at a high dose or titrated too rapidly. Patients must be educated to report any new
rash immediately to their provider.
3. A patient taking Clozapine presents with a fever, sore throat, and an Absolute Neutrophil
Count (ANC) of 800/mm³. Which action should the PMHNP take immediately?
A. Continue Clozapine but monitor the ANC daily until it rises above 1500.
B. Discontinue Clozapine immediately due to severe neutropenia.
C. Reduce the Clozapine dose by 50% and reassess in three days.
D. Administer a dose of Benztropine to counteract potential extrapyramidal symptoms.
Correct Answer: B
Explanation: Clozapine carries a Black Box Warning for agranulocytosis, which can lead to
life-threatening infections. An ANC below 1000/mm³ is classified as severe neutropenia
and requires immediate cessation of the drug according to FDA REMS guidelines. The
clinical presentation of fever and sore throat further suggests an active infection secondary
to immunosuppression.
,4. Which second-generation antipsychotic (SGA) is most associated with significant weight
gain, dyslipidemia, and elevated blood glucose levels?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Lurasidone
Correct Answer: C
Explanation: Olanzapine is notorious for having the highest metabolic risk profile among
second-generation antipsychotics. It significantly increases the risk of obesity, type 2
diabetes, and metabolic syndrome. Clinicians should prioritize monitoring BMI, waist
circumference, and metabolic labs throughout treatment.
5. A 45-year-old male with a history of alcohol use disorder is prescribed Naltrexone to assist
with maintaining abstinence. How does Naltrexone work in this context?
A. It causes a disulfiram-like reaction (nausea/vomiting) if alcohol is consumed.
B. It acts as a GABA-A receptor agonist to reduce withdrawal tremors.
C. It blocks mu-opioid receptors, thereby reducing the reward and craving for alcohol.
D. It increases dopamine levels in the nucleus accumbens to stabilize mood.
Correct Answer: C
, Explanation: Naltrexone is an opioid receptor antagonist that interferes with the
endogenous opioid system involved in the reinforcing effects of alcohol. By blocking these
receptors, the patient experiences less euphoria from drinking, which helps reduce
cravings. It is not an aversive therapy like Disulfiram, which relies on making the patient
physically ill.
6. Which medication is considered the first-line treatment for a patient experiencing acute
dystonia following a dose of Haloperidol?
A. Benztropine
B. Propranolol
C. Lorazepam
D. Bromocriptine
Correct Answer: A
Explanation: Acute dystonia is caused by a sudden blockade of dopamine receptors in the
basal ganglia, leading to an imbalance with acetylcholine. Anticholinergic agents like
Benztropine or Diphenhydramine are the treatments of choice to restore this balance.
Propranolol is typically reserved for akathisia, while Bromocriptine is used in Neuroleptic
Malignant Syndrome.
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 3) | Wilkes
1. A 28-year-old female patient with Bipolar I disorder is being started on Lithium. Which of
the following baseline laboratory tests is the most critical before initiating therapy?
A. Liver function tests (LFTs) and Prothrombin time
B. Lipid panel and Hemoglobin A1c
C. Complete blood count (CBC) with differential
D. Serum creatinine, BUN, and Thyroid Stimulating Hormone (TSH)
Correct Answer: D
Explanation: Lithium is primarily excreted by the kidneys and can significantly impact
renal function over time. Additionally, lithium frequently causes hypothyroidism by
interfering with iodine uptake and thyroid hormone release. Baseline assessment of serum
creatinine and TSH is essential for long-term safety monitoring.
2. When initiating Lamotrigine therapy, what is the most important clinical teaching point to
prevent life-threatening adverse reactions?
A. The medication should be taken with a high-fat meal to increase absorption.
B. Blood levels must be drawn every 2 weeks to ensure therapeutic efficacy.
C. The dosage must be titrated slowly to reduce the risk of Stevens-Johnson Syndrome.
,D. Avoid grapefruit juice as it inhibits the metabolism of the drug.
Correct Answer: C
Explanation: Stevens-Johnson Syndrome (SJS) is a rare but potentially fatal skin reaction
associated with Lamotrigine. The risk of SJS is significantly higher if the medication is
started at a high dose or titrated too rapidly. Patients must be educated to report any new
rash immediately to their provider.
3. A patient taking Clozapine presents with a fever, sore throat, and an Absolute Neutrophil
Count (ANC) of 800/mm³. Which action should the PMHNP take immediately?
A. Continue Clozapine but monitor the ANC daily until it rises above 1500.
B. Discontinue Clozapine immediately due to severe neutropenia.
C. Reduce the Clozapine dose by 50% and reassess in three days.
D. Administer a dose of Benztropine to counteract potential extrapyramidal symptoms.
Correct Answer: B
Explanation: Clozapine carries a Black Box Warning for agranulocytosis, which can lead to
life-threatening infections. An ANC below 1000/mm³ is classified as severe neutropenia
and requires immediate cessation of the drug according to FDA REMS guidelines. The
clinical presentation of fever and sore throat further suggests an active infection secondary
to immunosuppression.
,4. Which second-generation antipsychotic (SGA) is most associated with significant weight
gain, dyslipidemia, and elevated blood glucose levels?
A. Ziprasidone
B. Aripiprazole
C. Olanzapine
D. Lurasidone
Correct Answer: C
Explanation: Olanzapine is notorious for having the highest metabolic risk profile among
second-generation antipsychotics. It significantly increases the risk of obesity, type 2
diabetes, and metabolic syndrome. Clinicians should prioritize monitoring BMI, waist
circumference, and metabolic labs throughout treatment.
5. A 45-year-old male with a history of alcohol use disorder is prescribed Naltrexone to assist
with maintaining abstinence. How does Naltrexone work in this context?
A. It causes a disulfiram-like reaction (nausea/vomiting) if alcohol is consumed.
B. It acts as a GABA-A receptor agonist to reduce withdrawal tremors.
C. It blocks mu-opioid receptors, thereby reducing the reward and craving for alcohol.
D. It increases dopamine levels in the nucleus accumbens to stabilize mood.
Correct Answer: C
, Explanation: Naltrexone is an opioid receptor antagonist that interferes with the
endogenous opioid system involved in the reinforcing effects of alcohol. By blocking these
receptors, the patient experiences less euphoria from drinking, which helps reduce
cravings. It is not an aversive therapy like Disulfiram, which relies on making the patient
physically ill.
6. Which medication is considered the first-line treatment for a patient experiencing acute
dystonia following a dose of Haloperidol?
A. Benztropine
B. Propranolol
C. Lorazepam
D. Bromocriptine
Correct Answer: A
Explanation: Acute dystonia is caused by a sudden blockade of dopamine receptors in the
basal ganglia, leading to an imbalance with acetylcholine. Anticholinergic agents like
Benztropine or Diphenhydramine are the treatments of choice to restore this balance.
Propranolol is typically reserved for akathisia, while Bromocriptine is used in Neuroleptic
Malignant Syndrome.
