NU 643 Exam 2 V2 | NU 643 Advanced
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 2) | Regis University
1. A 24-year-old male diagnosed with schizophrenia is being treated with Haloperidol. He
presents with acute muscle spasms of the neck and back. Which dopamine pathway is
primarily involved in this side effect?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesocortical pathway
Correct Answer: C
Explanation: The nigrostriatal pathway controls motor function and movement. Blockade
of D2 receptors in this pathway by first-generation antipsychotics like Haloperidol leads to
extrapyramidal symptoms (EPS) such as acute dystonia. This specific pathway project from
the substantia nigra to the striatum, and its disruption is responsible for the movement
disorders observed in these patients.
2. Which of the following monitoring parameters is most critical for a patient initiated on
Clozapine (Clozaril)?
A. Absolute Neutrophil Count (ANC)
B. Serum potassium levels
,C. Liver function tests (LFTs)
D. Thyroid stimulating hormone (TSH)
Correct Answer: A
Explanation: Clozapine carries a significant risk of agranulocytosis, a life-threatening
decrease in white blood cell count. Due to this risk, the FDA mandates a strict Risk
Evaluation and Mitigation Strategy (REMS) program requiring regular ANC monitoring.
Providers must ensure the ANC is within a safe range before dispensing the medication to
prevent severe infections or death.
3. A patient taking Lithium for Bipolar I Disorder reports coarse hand tremors, nausea, and
blurred vision. What is the most appropriate next step for the clinician?
A. Increase the dose to stabilize mood
B. Add a benzodiazepine for tremors
C. Obtain an immediate serum lithium level
D. Switch the patient to Valproic Acid
Correct Answer: C
Explanation: Symptoms such as coarse hand tremors, nausea, and ataxia are classic signs
of lithium toxicity. Lithium has a narrow therapeutic index, meaning the difference
between a therapeutic and toxic dose is very small. Immediate serum level testing is
required to assess for toxicity and guide emergency management or dose adjustment.
, 4. According to the mechanism of action, why does Aripiprazole (Abilify) have a lower risk of
extrapyramidal symptoms compared to Haloperidol?
A. It is a potent D2 antagonist
B. It acts as a D2 partial agonist
C. It exclusively targets 5HT2A receptors
D. It lacks affinity for dopamine receptors
Correct Answer: B
Explanation: Aripiprazole is a dopamine D2 partial agonist, which allows it to modulate
dopamine activity depending on the endogenous levels. In areas of high dopamine, it acts as
an antagonist, while in areas of low dopamine, it provides enough stimulation to prevent
total blockade. This ‘dopamine stabilizer’ effect significantly reduces the incidence of
movement disorders and hyperprolactinemia compared to full D2 antagonists.
5. A 32-year-old female patient is starting Lamotrigine (Lamictal) for Bipolar II depression.
What instruction is vital to include in the patient education?
A. Restrict intake of tyramine-rich foods
B. Take the medication only as needed for mood
C. Report any new skin rashes immediately
D. Expect significant weight gain within weeks
Correct Answer: C
Psychopharmacology | Actual Q&A with Rationale
(NU643 Exam 2) | Regis University
1. A 24-year-old male diagnosed with schizophrenia is being treated with Haloperidol. He
presents with acute muscle spasms of the neck and back. Which dopamine pathway is
primarily involved in this side effect?
A. Mesolimbic pathway
B. Tuberoinfundibular pathway
C. Nigrostriatal pathway
D. Mesocortical pathway
Correct Answer: C
Explanation: The nigrostriatal pathway controls motor function and movement. Blockade
of D2 receptors in this pathway by first-generation antipsychotics like Haloperidol leads to
extrapyramidal symptoms (EPS) such as acute dystonia. This specific pathway project from
the substantia nigra to the striatum, and its disruption is responsible for the movement
disorders observed in these patients.
2. Which of the following monitoring parameters is most critical for a patient initiated on
Clozapine (Clozaril)?
A. Absolute Neutrophil Count (ANC)
B. Serum potassium levels
,C. Liver function tests (LFTs)
D. Thyroid stimulating hormone (TSH)
Correct Answer: A
Explanation: Clozapine carries a significant risk of agranulocytosis, a life-threatening
decrease in white blood cell count. Due to this risk, the FDA mandates a strict Risk
Evaluation and Mitigation Strategy (REMS) program requiring regular ANC monitoring.
Providers must ensure the ANC is within a safe range before dispensing the medication to
prevent severe infections or death.
3. A patient taking Lithium for Bipolar I Disorder reports coarse hand tremors, nausea, and
blurred vision. What is the most appropriate next step for the clinician?
A. Increase the dose to stabilize mood
B. Add a benzodiazepine for tremors
C. Obtain an immediate serum lithium level
D. Switch the patient to Valproic Acid
Correct Answer: C
Explanation: Symptoms such as coarse hand tremors, nausea, and ataxia are classic signs
of lithium toxicity. Lithium has a narrow therapeutic index, meaning the difference
between a therapeutic and toxic dose is very small. Immediate serum level testing is
required to assess for toxicity and guide emergency management or dose adjustment.
, 4. According to the mechanism of action, why does Aripiprazole (Abilify) have a lower risk of
extrapyramidal symptoms compared to Haloperidol?
A. It is a potent D2 antagonist
B. It acts as a D2 partial agonist
C. It exclusively targets 5HT2A receptors
D. It lacks affinity for dopamine receptors
Correct Answer: B
Explanation: Aripiprazole is a dopamine D2 partial agonist, which allows it to modulate
dopamine activity depending on the endogenous levels. In areas of high dopamine, it acts as
an antagonist, while in areas of low dopamine, it provides enough stimulation to prevent
total blockade. This ‘dopamine stabilizer’ effect significantly reduces the incidence of
movement disorders and hyperprolactinemia compared to full D2 antagonists.
5. A 32-year-old female patient is starting Lamotrigine (Lamictal) for Bipolar II depression.
What instruction is vital to include in the patient education?
A. Restrict intake of tyramine-rich foods
B. Take the medication only as needed for mood
C. Report any new skin rashes immediately
D. Expect significant weight gain within weeks
Correct Answer: C
