NR607 Final Exam Review for Diagnosis & Management in Psychiatric-
Mental Health III Practicum Questions and Verified Answers
Question 1
A 51-year-old male stable on lithium carbonate develops osteoarthritis and is prescribed
a high-dose NSAID. Two weeks later, he presents with coarse resting tremors, ataxia,
and dysarthria. His serum lithium level is 2.2 mEq/L. Which pharmacokinetic
mechanism explains this toxicity?
A. Hepatic induction of CYP3A4 accelerating drug breakdown.
B. Competitive displacement from plasma protein binding sites.
C. Inhibition of renal prostaglandins reducing GFR and increasing proximal tubule
reabsorption.
D. Increased intracellular mobilization of elemental ions.
Answer: C
Question 2
, A clozapine patient's weekly routine complete blood count reveals an Absolute
Neutrophil Count (ANC) of 1,200/mcL. The patient is entirely asymptomatic. According
to Clozapine REMS guidelines, what is the correct action?
A. Stop clozapine immediately and permanently.
B. Continue clozapine and increase ANC monitoring to three times weekly.
C. Hold clozapine for 48 hours, then resume regular weekly draws.
D. Switch immediately to a low-dose typical antipsychotic.
Answer: B
Question 3
A patient taking an MAOI is mistakenly prescribed an SSRI. He presents with severe
agitation, hyperthermia, myoclonus, and lower-extremity hyperreflexia with inducible
clonus. Which feature best differentiates this from Neuroleptic Malignant Syndrome
(NMS)?
A. Lead-pipe rigidity.
B. Severe autonomic instability.
C. Hyperreflexia and myoclonus.
D. Elevated creatine kinase levels.
Answer: C
Question 4
A patient started on haloperidol reports an intense, overwhelming sense of inner
restlessness and a constant urge to pace. Which medication is the first-line choice to
manage this akathisia?
A. Benztropine
B. Propranolol
C. Diphenhydramine
D. Lorazepam
Answer: B
Question 5
, An outpatient is taking citalopram 60 mg daily and ziprasidone 80 mg twice daily. Why
does this specific combination require urgent modification?
A. High risk of bone marrow suppression.
B. Additive QTc interval prolongation leading to Torsades de Pointes.
C. Risk of profound hepatic necrosis.
D. Severe hypernatremia.
Answer: B
Question 6
A patient presents with severe lithium toxicity (serum level 3.1 mEq/L), altered mental
status, and anuria. He is refractory to saline resuscitation. What is the definitive
treatment?
A. Activated charcoal
B. Sodium polystyrene sulfonate
C. Urgent hemodialysis
D. Intravenous sodium bicarbonate
Answer: C
Question 7
Which neuromuscular finding is classically present in Neuroleptic Malignant Syndrome
(NMS) but absent in Serotonin Syndrome?
A. Ocular clonus
B. Hyperreflexia
C. Generalized lead-pipe rigidity
D. Spontaneous myoclonus
Answer: C
Question 8
Aside from stopping all causative agents and initiating cooling measures, which specific
pharmacological 5-HT2 antagonist is used to treat severe Serotonin Syndrome?
A. Dantrolene
, B. Cyproheptadine
C. Bromocriptine
D. Flumazenil
Answer: B
Question 9
Within 4 hours of receiving intramuscular haloperidol, a patient develops torticollis and
an oculogyric crisis. Which acute treatment is most appropriate?
A. Oral propranolol
B. Parenteral benztropine or diphenhydramine
C. Intravenous flumazenil
D. Increasing the haloperidol dose
Answer: B
Question 10
A patient on long-term lithium therapy develops severe nephrogenic diabetes insipidus
(NDI). If lithium cannot be discontinued, which diuretic is the treatment of choice to
block lithium entry into the collecting ducts?
A. Furosemide
B. Hydrochlorothiazide
C. Amiloride
D. Spironolactone
Answer: C
Question 11
What is the mandatory minimum washout period required when switching a patient from
a standard SSRI like sertraline to an MAOI?
A. 24 hours
B. 72 hours
C. 2 weeks
D. 5 half-lives of the MAOI
Answer: C
Mental Health III Practicum Questions and Verified Answers
Question 1
A 51-year-old male stable on lithium carbonate develops osteoarthritis and is prescribed
a high-dose NSAID. Two weeks later, he presents with coarse resting tremors, ataxia,
and dysarthria. His serum lithium level is 2.2 mEq/L. Which pharmacokinetic
mechanism explains this toxicity?
A. Hepatic induction of CYP3A4 accelerating drug breakdown.
B. Competitive displacement from plasma protein binding sites.
C. Inhibition of renal prostaglandins reducing GFR and increasing proximal tubule
reabsorption.
D. Increased intracellular mobilization of elemental ions.
Answer: C
Question 2
, A clozapine patient's weekly routine complete blood count reveals an Absolute
Neutrophil Count (ANC) of 1,200/mcL. The patient is entirely asymptomatic. According
to Clozapine REMS guidelines, what is the correct action?
A. Stop clozapine immediately and permanently.
B. Continue clozapine and increase ANC monitoring to three times weekly.
C. Hold clozapine for 48 hours, then resume regular weekly draws.
D. Switch immediately to a low-dose typical antipsychotic.
Answer: B
Question 3
A patient taking an MAOI is mistakenly prescribed an SSRI. He presents with severe
agitation, hyperthermia, myoclonus, and lower-extremity hyperreflexia with inducible
clonus. Which feature best differentiates this from Neuroleptic Malignant Syndrome
(NMS)?
A. Lead-pipe rigidity.
B. Severe autonomic instability.
C. Hyperreflexia and myoclonus.
D. Elevated creatine kinase levels.
Answer: C
Question 4
A patient started on haloperidol reports an intense, overwhelming sense of inner
restlessness and a constant urge to pace. Which medication is the first-line choice to
manage this akathisia?
A. Benztropine
B. Propranolol
C. Diphenhydramine
D. Lorazepam
Answer: B
Question 5
, An outpatient is taking citalopram 60 mg daily and ziprasidone 80 mg twice daily. Why
does this specific combination require urgent modification?
A. High risk of bone marrow suppression.
B. Additive QTc interval prolongation leading to Torsades de Pointes.
C. Risk of profound hepatic necrosis.
D. Severe hypernatremia.
Answer: B
Question 6
A patient presents with severe lithium toxicity (serum level 3.1 mEq/L), altered mental
status, and anuria. He is refractory to saline resuscitation. What is the definitive
treatment?
A. Activated charcoal
B. Sodium polystyrene sulfonate
C. Urgent hemodialysis
D. Intravenous sodium bicarbonate
Answer: C
Question 7
Which neuromuscular finding is classically present in Neuroleptic Malignant Syndrome
(NMS) but absent in Serotonin Syndrome?
A. Ocular clonus
B. Hyperreflexia
C. Generalized lead-pipe rigidity
D. Spontaneous myoclonus
Answer: C
Question 8
Aside from stopping all causative agents and initiating cooling measures, which specific
pharmacological 5-HT2 antagonist is used to treat severe Serotonin Syndrome?
A. Dantrolene
, B. Cyproheptadine
C. Bromocriptine
D. Flumazenil
Answer: B
Question 9
Within 4 hours of receiving intramuscular haloperidol, a patient develops torticollis and
an oculogyric crisis. Which acute treatment is most appropriate?
A. Oral propranolol
B. Parenteral benztropine or diphenhydramine
C. Intravenous flumazenil
D. Increasing the haloperidol dose
Answer: B
Question 10
A patient on long-term lithium therapy develops severe nephrogenic diabetes insipidus
(NDI). If lithium cannot be discontinued, which diuretic is the treatment of choice to
block lithium entry into the collecting ducts?
A. Furosemide
B. Hydrochlorothiazide
C. Amiloride
D. Spironolactone
Answer: C
Question 11
What is the mandatory minimum washout period required when switching a patient from
a standard SSRI like sertraline to an MAOI?
A. 24 hours
B. 72 hours
C. 2 weeks
D. 5 half-lives of the MAOI
Answer: C
