NSG 552 Final Exam V1 | NSG 552
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Final Exam) | Wilkes
1. A patient initiated on Clozapine (Clozaril) reports a sudden onset of high fever, sore throat,
and lethargy. Which action is the priority for the PMHNP?
A. Order an immediate Absolute Neutrophil Count (ANC)
B. Advise the patient to take acetaminophen and monitor symptoms
C. Increase the Clozapine dose to treat potential inflammatory response
D. Refer the patient to an ENT specialist for possible tonsillitis
Correct Answer: A
Explanation: Clozapine is associated with a risk of life-threatening agranulocytosis, which
necessitates strict monitoring of the Absolute Neutrophil Count (ANC). Fever and sore
throat are common clinical signs of a severely compromised immune system in patients
taking this medication. The PMHNP must immediately verify the ANC to determine if the
medication must be discontinued according to REMS protocols.
2. When prescribing Lithium for a patient with Bipolar I Disorder, which baseline laboratory
test is most critical due to the drug’s potential for causing nephrogenic diabetes insipidus?
A. Liver Function Tests (LFTs)
B. Electrocardiogram (ECG)
,C. Complete Blood Count (CBC) with differential
D. Serum Creatinine and Blood Urea Nitrogen (BUN)
Correct Answer: D
Explanation: Lithium is primarily excreted by the kidneys and has a very narrow
therapeutic index. Long-term use can lead to renal impairment and decreased glomerular
filtration rates. Monitoring renal function through Creatinine and BUN is essential to
prevent toxicity and ensure patient safety.
3. Which antidepressant is most likely to cause a hypertensive crisis if the patient consumes
foods high in tyramine, such as aged cheeses or red wine?
A. Phenelzine (Nardil)
B. Sertraline (Zoloft)
C. Bupropion (Wellbutrin)
D. Venlafaxine (Effexor)
Correct Answer: A
Explanation: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that inhibits the
enzyme responsible for breaking down tyramine. Elevated levels of tyramine can lead to a
massive release of norepinephrine, causing a dangerous spike in blood pressure. Patients
must strictly follow a low-tyramine diet to avoid this life-threatening interaction.
, 4. A PMHNP is treating a patient with history of seizures who now requires treatment for
Major Depressive Disorder. Which medication is contraindicated in this patient?
A. Fluoxetine (Prozac)
B. Bupropion (Wellbutrin)
C. Escitalopram (Lexapro)
D. Mirtazapine (Remeron)
Correct Answer: B
Explanation: Bupropion is known to lower the seizure threshold, particularly at higher
doses or in patients with pre-existing seizure disorders. It is also contraindicated in
patients with eating disorders like bulimia or anorexia nervosa due to increased seizure
risk. The PMHNP should select an alternative antidepressant to maintain neurological
stability.
5. Which mechanism of action best describes how Benzodiazepines exert their anxiolytic
effects?
A. Inhibition of serotonin reuptake
B. Antagonism of Dopamine D2 receptors
C. Positive allosteric modulation of GABA-A receptors
D. Stimulation of Alpha-2 adrenergic receptors
Correct Answer: C
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Final Exam) | Wilkes
1. A patient initiated on Clozapine (Clozaril) reports a sudden onset of high fever, sore throat,
and lethargy. Which action is the priority for the PMHNP?
A. Order an immediate Absolute Neutrophil Count (ANC)
B. Advise the patient to take acetaminophen and monitor symptoms
C. Increase the Clozapine dose to treat potential inflammatory response
D. Refer the patient to an ENT specialist for possible tonsillitis
Correct Answer: A
Explanation: Clozapine is associated with a risk of life-threatening agranulocytosis, which
necessitates strict monitoring of the Absolute Neutrophil Count (ANC). Fever and sore
throat are common clinical signs of a severely compromised immune system in patients
taking this medication. The PMHNP must immediately verify the ANC to determine if the
medication must be discontinued according to REMS protocols.
2. When prescribing Lithium for a patient with Bipolar I Disorder, which baseline laboratory
test is most critical due to the drug’s potential for causing nephrogenic diabetes insipidus?
A. Liver Function Tests (LFTs)
B. Electrocardiogram (ECG)
,C. Complete Blood Count (CBC) with differential
D. Serum Creatinine and Blood Urea Nitrogen (BUN)
Correct Answer: D
Explanation: Lithium is primarily excreted by the kidneys and has a very narrow
therapeutic index. Long-term use can lead to renal impairment and decreased glomerular
filtration rates. Monitoring renal function through Creatinine and BUN is essential to
prevent toxicity and ensure patient safety.
3. Which antidepressant is most likely to cause a hypertensive crisis if the patient consumes
foods high in tyramine, such as aged cheeses or red wine?
A. Phenelzine (Nardil)
B. Sertraline (Zoloft)
C. Bupropion (Wellbutrin)
D. Venlafaxine (Effexor)
Correct Answer: A
Explanation: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that inhibits the
enzyme responsible for breaking down tyramine. Elevated levels of tyramine can lead to a
massive release of norepinephrine, causing a dangerous spike in blood pressure. Patients
must strictly follow a low-tyramine diet to avoid this life-threatening interaction.
, 4. A PMHNP is treating a patient with history of seizures who now requires treatment for
Major Depressive Disorder. Which medication is contraindicated in this patient?
A. Fluoxetine (Prozac)
B. Bupropion (Wellbutrin)
C. Escitalopram (Lexapro)
D. Mirtazapine (Remeron)
Correct Answer: B
Explanation: Bupropion is known to lower the seizure threshold, particularly at higher
doses or in patients with pre-existing seizure disorders. It is also contraindicated in
patients with eating disorders like bulimia or anorexia nervosa due to increased seizure
risk. The PMHNP should select an alternative antidepressant to maintain neurological
stability.
5. Which mechanism of action best describes how Benzodiazepines exert their anxiolytic
effects?
A. Inhibition of serotonin reuptake
B. Antagonism of Dopamine D2 receptors
C. Positive allosteric modulation of GABA-A receptors
D. Stimulation of Alpha-2 adrenergic receptors
Correct Answer: C
