NSG 552 Final Exam V3 | NSG 552
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Final Exam) | Wilkes
1. A patient is prescribed Clozapine for treatment-resistant schizophrenia. Which laboratory
value must be monitored most closely to prevent life-threatening complications?
A. Absolute Neutrophil Count (ANC)
B. Blood Urea Nitrogen (BUN)
C. Serum Potassium
D. Thyroid Stimulating Hormone (TSH)
Correct Answer: A
Explanation: Clozapine carries a black box warning for agranulocytosis, a severe drop in
white blood cell counts. The Absolute Neutrophil Count (ANC) must be monitored weekly
for the first six months of treatment to ensure patient safety. This monitoring is mandated
by the Clozapine REMS program to mitigate the risk of severe infection.
2. Which mechanism of action is primarily responsible for the therapeutic effects of Selective
Serotonin Reuptake Inhibitors (SSRIs)?
A. Inhibition of the Serotonin Transporter (SERT)
B. Antagonism of the Alpha-2 adrenergic receptor
C. Agonism of the GABA-A receptor complex
,D. Inhibition of Monoamine Oxidase B
Correct Answer: A
Explanation: SSRIs work by binding to the serotonin transporter (SERT) and preventing
the reuptake of serotonin into the presynaptic neuron. This leads to an increased
concentration of serotonin in the synaptic cleft, which enhances neurotransmission. Over
time, this leads to downstream changes in receptor sensitivity that correlate with
antidepressant effects.
3. A 24-year-old female patient diagnosed with Bipolar Disorder is being started on
Lamotrigine. What is the most critical education point regarding the titration of this
medication?
A. Report any new rashes immediately due to risk of Stevens-Johnson Syndrome
B. Increase the dose rapidly to achieve therapeutic levels
C. Take the medication only on an empty stomach
D. Stop the medication immediately if you experience dry mouth
Correct Answer: A
Explanation: Lamotrigine must be titrated slowly to minimize the risk of Stevens-Johnson
Syndrome (SJS), a potentially fatal skin reaction. Patients must be educated to monitor for
any new rash, especially during the first 8 weeks of treatment. If a rash occurs, the
medication should generally be discontinued and evaluated by a provider immediately.
, 4. Which of the following antidepressants is contraindicated in patients with a history of
seizure disorders or bulimia nervosa?
A. Sertraline
B. Fluoxetine
C. Paroxetine
D. Bupropion
Correct Answer: D
Explanation: Bupropion is known to lower the seizure threshold, especially at higher
doses or in vulnerable populations. It is specifically contraindicated in patients with eating
disorders like bulimia or anorexia due to a higher incidence of seizures in these groups.
Clinicians should screen for these conditions before initiating treatment with bupropion.
5. Lithium is considered a gold standard for Bipolar Disorder, but it has a narrow therapeutic
index. What is the standard therapeutic serum level for maintenance therapy?
A. 0.1 - 0.5 mEq/L
B. 0.6 - 1.2 mEq/L
C. 1.5 - 2.0 mEq/L
D. 2.5 - 3.0 mEq/L
Correct Answer: B
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Final Exam) | Wilkes
1. A patient is prescribed Clozapine for treatment-resistant schizophrenia. Which laboratory
value must be monitored most closely to prevent life-threatening complications?
A. Absolute Neutrophil Count (ANC)
B. Blood Urea Nitrogen (BUN)
C. Serum Potassium
D. Thyroid Stimulating Hormone (TSH)
Correct Answer: A
Explanation: Clozapine carries a black box warning for agranulocytosis, a severe drop in
white blood cell counts. The Absolute Neutrophil Count (ANC) must be monitored weekly
for the first six months of treatment to ensure patient safety. This monitoring is mandated
by the Clozapine REMS program to mitigate the risk of severe infection.
2. Which mechanism of action is primarily responsible for the therapeutic effects of Selective
Serotonin Reuptake Inhibitors (SSRIs)?
A. Inhibition of the Serotonin Transporter (SERT)
B. Antagonism of the Alpha-2 adrenergic receptor
C. Agonism of the GABA-A receptor complex
,D. Inhibition of Monoamine Oxidase B
Correct Answer: A
Explanation: SSRIs work by binding to the serotonin transporter (SERT) and preventing
the reuptake of serotonin into the presynaptic neuron. This leads to an increased
concentration of serotonin in the synaptic cleft, which enhances neurotransmission. Over
time, this leads to downstream changes in receptor sensitivity that correlate with
antidepressant effects.
3. A 24-year-old female patient diagnosed with Bipolar Disorder is being started on
Lamotrigine. What is the most critical education point regarding the titration of this
medication?
A. Report any new rashes immediately due to risk of Stevens-Johnson Syndrome
B. Increase the dose rapidly to achieve therapeutic levels
C. Take the medication only on an empty stomach
D. Stop the medication immediately if you experience dry mouth
Correct Answer: A
Explanation: Lamotrigine must be titrated slowly to minimize the risk of Stevens-Johnson
Syndrome (SJS), a potentially fatal skin reaction. Patients must be educated to monitor for
any new rash, especially during the first 8 weeks of treatment. If a rash occurs, the
medication should generally be discontinued and evaluated by a provider immediately.
, 4. Which of the following antidepressants is contraindicated in patients with a history of
seizure disorders or bulimia nervosa?
A. Sertraline
B. Fluoxetine
C. Paroxetine
D. Bupropion
Correct Answer: D
Explanation: Bupropion is known to lower the seizure threshold, especially at higher
doses or in vulnerable populations. It is specifically contraindicated in patients with eating
disorders like bulimia or anorexia due to a higher incidence of seizures in these groups.
Clinicians should screen for these conditions before initiating treatment with bupropion.
5. Lithium is considered a gold standard for Bipolar Disorder, but it has a narrow therapeutic
index. What is the standard therapeutic serum level for maintenance therapy?
A. 0.1 - 0.5 mEq/L
B. 0.6 - 1.2 mEq/L
C. 1.5 - 2.0 mEq/L
D. 2.5 - 3.0 mEq/L
Correct Answer: B
