NSG 552 Exam 2 V2 | NSG 552
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 2) | Wilkes
1. What is the recommended therapeutic serum level for Lithium during the maintenance
phase of treatment?
A. 0.4 to 0.8 mEq/L
B. 1.5 to 2.0 mEq/L
C. 1.0 to 1.5 mEq/L
D. 0.6 to 1.2 mEq/L
Correct Answer: D
Explanation: The therapeutic range for lithium is narrow, typically 0.6 to 1.2 mEq/L for
maintenance therapy. Levels exceeding 1.5 mEq/L are generally considered toxic and
require immediate clinical assessment. Regular blood monitoring is essential to ensure
efficacy while avoiding severe side effects such as renal impairment.
2. Which mechanism of action is primarily responsible for the antidepressant effects of
Bupropion?
A. Selective serotonin reuptake inhibition
B. Serotonin and norepinephrine reuptake inhibition
C. Monoamine oxidase inhibition
,D. Norepinephrine and dopamine reuptake inhibition
Correct Answer: D
Explanation: Bupropion works as a Norepinephrine-Dopamine Reuptake Inhibitor (NDRI),
which distinguishes it from SSRIs and SNRIs. This unique mechanism makes it a preferred
choice for patients experiencing sexual dysfunction or weight gain on other
antidepressants. However, it should be avoided in patients with a history of seizures or
eating disorders due to the increased risk of seizure activity.
3. A patient starting Lamotrigine should be educated about which life-threatening side effect?
A. Agranulocytosis
B. Stevens-Johnson Syndrome (SJS)
C. Hepatic failure
D. Serotonin Syndrome
Correct Answer: B
Explanation: Stevens-Johnson Syndrome is a rare but severe skin reaction associated with
Lamotrigine, especially during the initiation phase. Patients must be instructed to report
any new rash immediately and to follow a very slow titration schedule. This titration is
critical because rapid dose increases significantly elevate the risk of dermatological
emergencies.
,4. Which antidepressant is known for its exceptionally long half-life, requiring a washout
period of at least 5 weeks before starting an MAOI?
A. Sertraline
B. Paroxetine
C. Fluoxetine
D. Escitalopram
Correct Answer: C
Explanation: Fluoxetine has a very long half-life due to its active metabolite, norfluoxetine,
which can stay in the system for weeks. This necessitates a 5-week washout period when
switching to a Monoamine Oxidase Inhibitor (MAOI) to prevent serotonin syndrome. Other
SSRIs typically only require a 2-week washout period because they are cleared more
quickly from the body.
5. Which of the following dietary items must be avoided by a patient taking a non-selective
Monoamine Oxidase Inhibitor (MAOI)?
A. Fresh chicken and fish
B. Aged cheeses and cured meats
C. Green leafy vegetables
D. Citrus fruits and berries
Correct Answer: B
, Explanation: Aged cheeses and cured meats contain high levels of tyramine, which can
trigger a hypertensive crisis in patients taking MAOIs. MAOIs prevent the breakdown of
tyramine, leading to excessive norepinephrine release and dangerous spikes in blood
pressure. Patients must strictly adhere to a low-tyramine diet to ensure safety while on
these medications.
6. Which mood stabilizer is most closely associated with the development of Polycystic Ovary
Syndrome (PCOS) in young women?
A. Lithium
B. Valproate (Depakote)
C. Oxcarbazepine
D. Lamotrigine
Correct Answer: B
Explanation: Valproate use has been linked to an increased risk of PCOS, particularly in
women who start the medication before the age of 20. This risk involves symptoms such as
weight gain, hirsutism, and irregular menses, necessitating regular endocrine monitoring.
Clinicians should consider alternative mood stabilizers for young female patients whenever
clinically appropriate.
7. The addition of which medication class is most likely to increase serum Lithium levels to
toxic concentrations?
A. Acetaminophen
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 2) | Wilkes
1. What is the recommended therapeutic serum level for Lithium during the maintenance
phase of treatment?
A. 0.4 to 0.8 mEq/L
B. 1.5 to 2.0 mEq/L
C. 1.0 to 1.5 mEq/L
D. 0.6 to 1.2 mEq/L
Correct Answer: D
Explanation: The therapeutic range for lithium is narrow, typically 0.6 to 1.2 mEq/L for
maintenance therapy. Levels exceeding 1.5 mEq/L are generally considered toxic and
require immediate clinical assessment. Regular blood monitoring is essential to ensure
efficacy while avoiding severe side effects such as renal impairment.
2. Which mechanism of action is primarily responsible for the antidepressant effects of
Bupropion?
A. Selective serotonin reuptake inhibition
B. Serotonin and norepinephrine reuptake inhibition
C. Monoamine oxidase inhibition
,D. Norepinephrine and dopamine reuptake inhibition
Correct Answer: D
Explanation: Bupropion works as a Norepinephrine-Dopamine Reuptake Inhibitor (NDRI),
which distinguishes it from SSRIs and SNRIs. This unique mechanism makes it a preferred
choice for patients experiencing sexual dysfunction or weight gain on other
antidepressants. However, it should be avoided in patients with a history of seizures or
eating disorders due to the increased risk of seizure activity.
3. A patient starting Lamotrigine should be educated about which life-threatening side effect?
A. Agranulocytosis
B. Stevens-Johnson Syndrome (SJS)
C. Hepatic failure
D. Serotonin Syndrome
Correct Answer: B
Explanation: Stevens-Johnson Syndrome is a rare but severe skin reaction associated with
Lamotrigine, especially during the initiation phase. Patients must be instructed to report
any new rash immediately and to follow a very slow titration schedule. This titration is
critical because rapid dose increases significantly elevate the risk of dermatological
emergencies.
,4. Which antidepressant is known for its exceptionally long half-life, requiring a washout
period of at least 5 weeks before starting an MAOI?
A. Sertraline
B. Paroxetine
C. Fluoxetine
D. Escitalopram
Correct Answer: C
Explanation: Fluoxetine has a very long half-life due to its active metabolite, norfluoxetine,
which can stay in the system for weeks. This necessitates a 5-week washout period when
switching to a Monoamine Oxidase Inhibitor (MAOI) to prevent serotonin syndrome. Other
SSRIs typically only require a 2-week washout period because they are cleared more
quickly from the body.
5. Which of the following dietary items must be avoided by a patient taking a non-selective
Monoamine Oxidase Inhibitor (MAOI)?
A. Fresh chicken and fish
B. Aged cheeses and cured meats
C. Green leafy vegetables
D. Citrus fruits and berries
Correct Answer: B
, Explanation: Aged cheeses and cured meats contain high levels of tyramine, which can
trigger a hypertensive crisis in patients taking MAOIs. MAOIs prevent the breakdown of
tyramine, leading to excessive norepinephrine release and dangerous spikes in blood
pressure. Patients must strictly adhere to a low-tyramine diet to ensure safety while on
these medications.
6. Which mood stabilizer is most closely associated with the development of Polycystic Ovary
Syndrome (PCOS) in young women?
A. Lithium
B. Valproate (Depakote)
C. Oxcarbazepine
D. Lamotrigine
Correct Answer: B
Explanation: Valproate use has been linked to an increased risk of PCOS, particularly in
women who start the medication before the age of 20. This risk involves symptoms such as
weight gain, hirsutism, and irregular menses, necessitating regular endocrine monitoring.
Clinicians should consider alternative mood stabilizers for young female patients whenever
clinically appropriate.
7. The addition of which medication class is most likely to increase serum Lithium levels to
toxic concentrations?
A. Acetaminophen
