NSG 552 Exam 4 V3 | NSG 552
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 4) | Wilkes
1. A 45-year-old male with bipolar I disorder is prescribed Lithium. Which of the following
laboratory panels is most critical to monitor periodically to prevent long-term toxicity?
A. Serum creatinine, thyroid-stimulating hormone (TSH), and lithium levels.
B. Serum electrolyte levels and liver function tests.
C. Complete blood count and lipid profile.
D. Urinalysis and fasting blood glucose.
Correct Answer: A
Explanation: Lithium is primarily excreted by the kidneys and can significantly impact
renal function over time. It is also known to interfere with thyroid hormone synthesis,
potentially leading to hypothyroidism. Routine monitoring of serum creatinine, TSH, and
therapeutic lithium levels is essential to ensure patient safety and drug efficacy.
2. A patient experiencing treatment-resistant schizophrenia is being considered for Clozapine
(Clozaril). What is the absolute neutrophil count (ANC) threshold required to initiate this
medication?
A. Greater than or equal to 500/mm³
B. Greater than or equal to 2,000/mm³
,C. Greater than or equal to 1,000/mm³
D. Greater than or equal to 1,500/mm³
Correct Answer: D
Explanation: Clozapine initiation requires an ANC of at least 1,500/mm³ for the general
population to mitigate the risk of agranulocytosis. This life-threatening side effect
necessitates strict adherence to the Clozapine REMS program for ongoing monitoring.
Patients with Benign Ethnic Neutropenia (BEN) may have different thresholds, but
1,500/mm³ remains the standard baseline for most.
3. When prescribing Valproic Acid (Depakote) to a female patient of childbearing age, which
risk factor is of greatest concern regarding reproductive health?
A. Significant weight loss and decreased fertility.
B. Increased risk of Polycystic Ovarian Syndrome (PCOS).
C. Premature ovarian failure.
D. Hyperprolactinemia leading to galactorrhea.
Correct Answer: B
Explanation: Valproic acid has been associated with an increased risk of developing PCOS
in young women treated for epilepsy or bipolar disorder. This condition can lead to
irregular menstrual cycles and hyperandrogenism, impacting overall health. Providers
should monitor for symptoms and discuss the risks of teratogenicity and hormonal changes
before initiation.
, 4. A geriatric patient is being treated for depression. According to the Beers Criteria, which
antidepressant should be avoided due to its high anticholinergic activity?
A. Amitriptyline (Elavil)
B. Sertraline (Zoloft)
C. Escitalopram (Lexapro)
D. Bupropion (Wellbutrin)
Correct Answer: A
Explanation: Amitriptyline is a tricyclic antidepressant with significant anticholinergic
properties that can cause confusion and sedation in the elderly. The Beers Criteria
specifically list it as potentially inappropriate because it increases the risk of falls and
cognitive impairment. Safer alternatives like SSRIs are generally preferred for this
demographic.
5. In the treatment of pediatric ADHD, what is the primary mechanism of action for stimulant
medications like Methylphenidate?
A. Antagonism of the D2 dopamine receptors in the limbic system.
B. Blockade of serotonin transporters in the prefrontal cortex.
C. Activation of GABA receptors to reduce neuronal excitability.
D. Inhibition of the reuptake of dopamine and norepinephrine.
Correct Answer: D
Psychopharmacology | Actual Q&A with Rationale
(NSG 552 Exam 4) | Wilkes
1. A 45-year-old male with bipolar I disorder is prescribed Lithium. Which of the following
laboratory panels is most critical to monitor periodically to prevent long-term toxicity?
A. Serum creatinine, thyroid-stimulating hormone (TSH), and lithium levels.
B. Serum electrolyte levels and liver function tests.
C. Complete blood count and lipid profile.
D. Urinalysis and fasting blood glucose.
Correct Answer: A
Explanation: Lithium is primarily excreted by the kidneys and can significantly impact
renal function over time. It is also known to interfere with thyroid hormone synthesis,
potentially leading to hypothyroidism. Routine monitoring of serum creatinine, TSH, and
therapeutic lithium levels is essential to ensure patient safety and drug efficacy.
2. A patient experiencing treatment-resistant schizophrenia is being considered for Clozapine
(Clozaril). What is the absolute neutrophil count (ANC) threshold required to initiate this
medication?
A. Greater than or equal to 500/mm³
B. Greater than or equal to 2,000/mm³
,C. Greater than or equal to 1,000/mm³
D. Greater than or equal to 1,500/mm³
Correct Answer: D
Explanation: Clozapine initiation requires an ANC of at least 1,500/mm³ for the general
population to mitigate the risk of agranulocytosis. This life-threatening side effect
necessitates strict adherence to the Clozapine REMS program for ongoing monitoring.
Patients with Benign Ethnic Neutropenia (BEN) may have different thresholds, but
1,500/mm³ remains the standard baseline for most.
3. When prescribing Valproic Acid (Depakote) to a female patient of childbearing age, which
risk factor is of greatest concern regarding reproductive health?
A. Significant weight loss and decreased fertility.
B. Increased risk of Polycystic Ovarian Syndrome (PCOS).
C. Premature ovarian failure.
D. Hyperprolactinemia leading to galactorrhea.
Correct Answer: B
Explanation: Valproic acid has been associated with an increased risk of developing PCOS
in young women treated for epilepsy or bipolar disorder. This condition can lead to
irregular menstrual cycles and hyperandrogenism, impacting overall health. Providers
should monitor for symptoms and discuss the risks of teratogenicity and hormonal changes
before initiation.
, 4. A geriatric patient is being treated for depression. According to the Beers Criteria, which
antidepressant should be avoided due to its high anticholinergic activity?
A. Amitriptyline (Elavil)
B. Sertraline (Zoloft)
C. Escitalopram (Lexapro)
D. Bupropion (Wellbutrin)
Correct Answer: A
Explanation: Amitriptyline is a tricyclic antidepressant with significant anticholinergic
properties that can cause confusion and sedation in the elderly. The Beers Criteria
specifically list it as potentially inappropriate because it increases the risk of falls and
cognitive impairment. Safer alternatives like SSRIs are generally preferred for this
demographic.
5. In the treatment of pediatric ADHD, what is the primary mechanism of action for stimulant
medications like Methylphenidate?
A. Antagonism of the D2 dopamine receptors in the limbic system.
B. Blockade of serotonin transporters in the prefrontal cortex.
C. Activation of GABA receptors to reduce neuronal excitability.
D. Inhibition of the reuptake of dopamine and norepinephrine.
Correct Answer: D
