NSG 552 Exam 3 V1 | NSG 552
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 3) | Wilkes
1. A patient is being initiated on Lithium for the treatment of Bipolar I Disorder. Which of the
following is the narrow therapeutic serum range recommended for maintenance therapy?
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 standard therapeutic range for lithium maintenance is generally 0.6 to
1.2 mEq/L to balance efficacy and safety. Acute mania may require slightly higher levels,
often up to 1.5 mEq/L, but maintenance levels are lower to prevent toxicity. Monitoring is
crucial because lithium has a very narrow therapeutic index.
2. When prescribing Clozapine (Clozaril), the psychiatric nurse practitioner must monitor the
Absolute Neutrophil Count (ANC). What is the minimum ANC required to initiate treatment?
A. 500/mm³
B. 1500/mm³
C. 1000/mm³
,D. 2000/mm³
Correct Answer: B
Explanation: For the general population, the ANC must be at least 1500/mm³ before
clozapine therapy can be started. This requirement is part of the Clozapine REMS program
to mitigate the risk of severe neutropenia and agranulocytosis. If the ANC falls below
certain thresholds during treatment, the medication must be interrupted or discontinued.
3. A patient taking an MAOI for treatment-resistant depression is admitted for a hypertensive
crisis. Which of the following dietary choices most likely triggered this event?
A. Fresh green salad with vinaigrette
B. Grilled chicken breast and white rice
C. Aged cheddar cheese and cured meats
D. Whole grain bread and honey
Correct Answer: C
Explanation: Aged cheeses and cured meats are high in tyramine, which can lead to a
hypertensive crisis when consumed by patients on MAOIs. Tyramine acts as a
sympathomimetic amine that is normally broken down by monoamine oxidase. Inhibiting
this enzyme leads to excessive norepinephrine release, causing dangerous spikes in blood
pressure.
, 4. Which mood stabilizer is most closely associated with the risk of Stevens-Johnson
Syndrome (SJS), particularly if the dose is titrated too quickly?
A. Lithium
B. Valproate
C. Lamotrigine
D. Carbamazepine
Correct Answer: C
Explanation: Lamotrigine carries a black box warning for serious rashes, including
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. To minimize this risk, the
medication must be titrated very slowly according to a specific schedule. The risk is
significantly increased if it is used concurrently with valproate, which doubles lamotrigine
levels.
5. A patient on Valproate (Depakote) for Bipolar Disorder reports new-onset abdominal pain,
nausea, and anorexia. Which laboratory test is the most urgent to order?
A. Serum Creatinine
B. Thyroid Stimulating Hormone
C. Amylase and Lipase
D. Serum Sodium
Correct Answer: C
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 3) | Wilkes
1. A patient is being initiated on Lithium for the treatment of Bipolar I Disorder. Which of the
following is the narrow therapeutic serum range recommended for maintenance therapy?
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 standard therapeutic range for lithium maintenance is generally 0.6 to
1.2 mEq/L to balance efficacy and safety. Acute mania may require slightly higher levels,
often up to 1.5 mEq/L, but maintenance levels are lower to prevent toxicity. Monitoring is
crucial because lithium has a very narrow therapeutic index.
2. When prescribing Clozapine (Clozaril), the psychiatric nurse practitioner must monitor the
Absolute Neutrophil Count (ANC). What is the minimum ANC required to initiate treatment?
A. 500/mm³
B. 1500/mm³
C. 1000/mm³
,D. 2000/mm³
Correct Answer: B
Explanation: For the general population, the ANC must be at least 1500/mm³ before
clozapine therapy can be started. This requirement is part of the Clozapine REMS program
to mitigate the risk of severe neutropenia and agranulocytosis. If the ANC falls below
certain thresholds during treatment, the medication must be interrupted or discontinued.
3. A patient taking an MAOI for treatment-resistant depression is admitted for a hypertensive
crisis. Which of the following dietary choices most likely triggered this event?
A. Fresh green salad with vinaigrette
B. Grilled chicken breast and white rice
C. Aged cheddar cheese and cured meats
D. Whole grain bread and honey
Correct Answer: C
Explanation: Aged cheeses and cured meats are high in tyramine, which can lead to a
hypertensive crisis when consumed by patients on MAOIs. Tyramine acts as a
sympathomimetic amine that is normally broken down by monoamine oxidase. Inhibiting
this enzyme leads to excessive norepinephrine release, causing dangerous spikes in blood
pressure.
, 4. Which mood stabilizer is most closely associated with the risk of Stevens-Johnson
Syndrome (SJS), particularly if the dose is titrated too quickly?
A. Lithium
B. Valproate
C. Lamotrigine
D. Carbamazepine
Correct Answer: C
Explanation: Lamotrigine carries a black box warning for serious rashes, including
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. To minimize this risk, the
medication must be titrated very slowly according to a specific schedule. The risk is
significantly increased if it is used concurrently with valproate, which doubles lamotrigine
levels.
5. A patient on Valproate (Depakote) for Bipolar Disorder reports new-onset abdominal pain,
nausea, and anorexia. Which laboratory test is the most urgent to order?
A. Serum Creatinine
B. Thyroid Stimulating Hormone
C. Amylase and Lipase
D. Serum Sodium
Correct Answer: C
