NR 546 Final Exam Actual Exam V2 | NR 546 Advanced
Psychopharmacology for the PMHNP (NR546 Final Exam) [PDF] |
Chamberlain University
1. A 32-year-old patient with treatment-resistant schizophrenia is starting Clozapine. The
PMHNP notes the Absolute Neutrophil Count (ANC) is 1,600/mm³. What is the most
appropriate action?
A. Delay initiation until ANC is above 2,000/mm³.
B. Initiate Clozapine and monitor ANC weekly.
C. Initiate Clozapine and monitor ANC every other day.
D. Refer to hematology for a bone marrow biopsy before starting.
Answer: B
Rationale: According to Clozapine REMS guidelines, a patient with a baseline ANC of
1,500/mm³ or greater can safely initiate treatment. Weekly monitoring is required for the
first six months of therapy to detect potential agranulocytosis. This evidence-based
strategy balances the need for effective treatment in resistant cases with patient safety
protocols.
2. A 65-year-old patient on Lithium for Bipolar I Disorder presents with worsening tremors
and confusion after being prescribed Ibuprofen for arthritis. What is the most likely
pharmacological explanation?
A. Ibuprofen reduces renal clearance of Lithium, increasing serum levels.
B. Ibuprofen increases Lithium’s renal excretion.
C. Lithium increases the metabolism of Ibuprofen.
D. The combination causes a synergistic pharmacodynamic effect on GABA.
Answer: A
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen reduce
prostaglandin synthesis, which can lead to decreased renal blood flow and Lithium
clearance. This interaction frequently results in Lithium toxicity, manifested here by
tremors and cognitive changes. PMHNPs should advise patients to use acetaminophen or
monitor lithium levels closely if NSAIDs are necessary.
3. When adding Valproic Acid to a regimen that includes Lamotrigine, what must the PMHNP
do regarding the Lamotrigine dosage?
A. Increase the Lamotrigine dose by 50%.
B. Maintain the current Lamotrigine dose.
,C. Decrease the Lamotrigine dose by 50%.
D. Discontinue Lamotrigine immediately due to toxicity risk.
Answer: C
Rationale: Valproic acid inhibits the glucuronidation pathway, which is the primary route
of metabolism for Lamotrigine. This inhibition effectively doubles the serum concentration
of Lamotrigine, significantly increasing the risk of Stevens-Johnson Syndrome (SJS). A 50%
dose reduction and a slower titration schedule are required when these two medications
are used together.
4. A patient presents with hyperthermia, muscle rigidity, and autonomic instability after a
recent increase in Haloperidol. What is the priority intervention?
A. Administer Cyproheptadine.
B. Discontinue Haloperidol and provide supportive cooling and hydration.
C. Switch to a Second-Generation Antipsychotic immediately.
D. Administer a high-dose benzodiazepine to stop seizures.
Answer: B
Rationale: These symptoms are classic indicators of Neuroleptic Malignant Syndrome
(NMS), a life-threatening complication of dopamine antagonists. The first step in
management is the immediate cessation of the causative antipsychotic agent. Supportive
care, including temperature regulation and fluid management, is critical for survival and
stabilization.
5. A 24-year-old of Han Chinese descent is being considered for Carbamazepine therapy.
Which genetic test is mandatory before starting?
A. CYP2D6 polymorphism
B. MTHFR mutation
C. Factor V Leiden
D. HLA-B*1502 allele
Answer: D
Rationale: The HLA-B*1502 allele is strongly associated with an increased risk of
Carbamazepine-induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in
Asian populations. Testing is mandated by the FDA for patients with this genetic
background before initiating treatment. This pharmacogenomic approach prevents severe,
potentially fatal cutaneous reactions.
, 6. Which antidepressant is considered a potent inhibitor of CYP2D6 and should be used with
caution in patients taking Tamoxifen?
A. Escitalopram
B. Venlafaxine
C. Mirtazapine
D. Fluoxetine
Answer: D
Rationale: Fluoxetine is a strong CYP2D6 inhibitor, which can prevent the conversion of
Tamoxifen to its active metabolite, endoxifen. This drug-drug interaction may reduce the
efficacy of breast cancer treatment. In patients on Tamoxifen, antidepressants with less
CYP2D6 inhibition, such as Venlafaxine, are generally preferred.
7. An 8-year-old child with ADHD and a family history of sudden cardiac death is being
evaluated for stimulant therapy. What is the recommended baseline assessment?
A. Baseline serum electrolytes only.
B. Mandatory 24-hour Holter monitoring for all patients.
C. Genetic testing for catecholaminergic polymorphic ventricular tachycardia.
D. Standard physical exam and detailed cardiac history.
Answer: D
Rationale: While routine ECGs are not mandatory for all healthy children starting
stimulants, a thorough physical exam and family cardiac history are essential. If a family
history of sudden death or cardiac disease is present, a cardiology consultation and ECG are
indicated before prescribing stimulants. This strategy ensures medication safety in a high-
risk pediatric population.
8. A pregnant patient in her first trimester requires treatment for Bipolar Disorder. Which
medication carries the highest risk for Ebstein’s Anomaly?
A. Valproate
B. Lamotrigine
C. Quetiapine
D. Lithium
Answer: D
Rationale: Lithium exposure during the first trimester is specifically associated with
Ebstein’s anomaly, a rare cardiac malformation of the tricuspid valve. While the absolute
risk is lower than previously thought, it remains a significant consideration in
Psychopharmacology for the PMHNP (NR546 Final Exam) [PDF] |
Chamberlain University
1. A 32-year-old patient with treatment-resistant schizophrenia is starting Clozapine. The
PMHNP notes the Absolute Neutrophil Count (ANC) is 1,600/mm³. What is the most
appropriate action?
A. Delay initiation until ANC is above 2,000/mm³.
B. Initiate Clozapine and monitor ANC weekly.
C. Initiate Clozapine and monitor ANC every other day.
D. Refer to hematology for a bone marrow biopsy before starting.
Answer: B
Rationale: According to Clozapine REMS guidelines, a patient with a baseline ANC of
1,500/mm³ or greater can safely initiate treatment. Weekly monitoring is required for the
first six months of therapy to detect potential agranulocytosis. This evidence-based
strategy balances the need for effective treatment in resistant cases with patient safety
protocols.
2. A 65-year-old patient on Lithium for Bipolar I Disorder presents with worsening tremors
and confusion after being prescribed Ibuprofen for arthritis. What is the most likely
pharmacological explanation?
A. Ibuprofen reduces renal clearance of Lithium, increasing serum levels.
B. Ibuprofen increases Lithium’s renal excretion.
C. Lithium increases the metabolism of Ibuprofen.
D. The combination causes a synergistic pharmacodynamic effect on GABA.
Answer: A
Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen reduce
prostaglandin synthesis, which can lead to decreased renal blood flow and Lithium
clearance. This interaction frequently results in Lithium toxicity, manifested here by
tremors and cognitive changes. PMHNPs should advise patients to use acetaminophen or
monitor lithium levels closely if NSAIDs are necessary.
3. When adding Valproic Acid to a regimen that includes Lamotrigine, what must the PMHNP
do regarding the Lamotrigine dosage?
A. Increase the Lamotrigine dose by 50%.
B. Maintain the current Lamotrigine dose.
,C. Decrease the Lamotrigine dose by 50%.
D. Discontinue Lamotrigine immediately due to toxicity risk.
Answer: C
Rationale: Valproic acid inhibits the glucuronidation pathway, which is the primary route
of metabolism for Lamotrigine. This inhibition effectively doubles the serum concentration
of Lamotrigine, significantly increasing the risk of Stevens-Johnson Syndrome (SJS). A 50%
dose reduction and a slower titration schedule are required when these two medications
are used together.
4. A patient presents with hyperthermia, muscle rigidity, and autonomic instability after a
recent increase in Haloperidol. What is the priority intervention?
A. Administer Cyproheptadine.
B. Discontinue Haloperidol and provide supportive cooling and hydration.
C. Switch to a Second-Generation Antipsychotic immediately.
D. Administer a high-dose benzodiazepine to stop seizures.
Answer: B
Rationale: These symptoms are classic indicators of Neuroleptic Malignant Syndrome
(NMS), a life-threatening complication of dopamine antagonists. The first step in
management is the immediate cessation of the causative antipsychotic agent. Supportive
care, including temperature regulation and fluid management, is critical for survival and
stabilization.
5. A 24-year-old of Han Chinese descent is being considered for Carbamazepine therapy.
Which genetic test is mandatory before starting?
A. CYP2D6 polymorphism
B. MTHFR mutation
C. Factor V Leiden
D. HLA-B*1502 allele
Answer: D
Rationale: The HLA-B*1502 allele is strongly associated with an increased risk of
Carbamazepine-induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in
Asian populations. Testing is mandated by the FDA for patients with this genetic
background before initiating treatment. This pharmacogenomic approach prevents severe,
potentially fatal cutaneous reactions.
, 6. Which antidepressant is considered a potent inhibitor of CYP2D6 and should be used with
caution in patients taking Tamoxifen?
A. Escitalopram
B. Venlafaxine
C. Mirtazapine
D. Fluoxetine
Answer: D
Rationale: Fluoxetine is a strong CYP2D6 inhibitor, which can prevent the conversion of
Tamoxifen to its active metabolite, endoxifen. This drug-drug interaction may reduce the
efficacy of breast cancer treatment. In patients on Tamoxifen, antidepressants with less
CYP2D6 inhibition, such as Venlafaxine, are generally preferred.
7. An 8-year-old child with ADHD and a family history of sudden cardiac death is being
evaluated for stimulant therapy. What is the recommended baseline assessment?
A. Baseline serum electrolytes only.
B. Mandatory 24-hour Holter monitoring for all patients.
C. Genetic testing for catecholaminergic polymorphic ventricular tachycardia.
D. Standard physical exam and detailed cardiac history.
Answer: D
Rationale: While routine ECGs are not mandatory for all healthy children starting
stimulants, a thorough physical exam and family cardiac history are essential. If a family
history of sudden death or cardiac disease is present, a cardiology consultation and ECG are
indicated before prescribing stimulants. This strategy ensures medication safety in a high-
risk pediatric population.
8. A pregnant patient in her first trimester requires treatment for Bipolar Disorder. Which
medication carries the highest risk for Ebstein’s Anomaly?
A. Valproate
B. Lamotrigine
C. Quetiapine
D. Lithium
Answer: D
Rationale: Lithium exposure during the first trimester is specifically associated with
Ebstein’s anomaly, a rare cardiac malformation of the tricuspid valve. While the absolute
risk is lower than previously thought, it remains a significant consideration in
