NR 546 Exam 1 Actual Exam V3 | NR 546 Advanced
Psychopharmacology for the PMHNP (NR546 Exam 1) [PDF] |
Chamberlain University
1. A patient with treatment-resistant schizophrenia is being started on Clozapine. Which
baseline laboratory value is most critical for the PMHNP to obtain before initiating therapy?
A. Thyroid Stimulating Hormone (TSH)
B. Liver Function Tests (LFTs)
C. Serum Creatinine
D. Absolute Neutrophil Count (ANC)
Answer: D
Rationale: Clozapine is associated with a risk of severe neutropenia and agranulocytosis.
Baseline ANC must be at least 1500/mm3 for the general population and 1000/mm3 for
patients with documented Benign Ethnic Neutropenia. Monitoring continues weekly for the
first six months to ensure patient safety.
2. A 30-year-old male smoker is stabilized on Clozapine 300mg daily. If he suddenly stops
smoking, what is the expected effect on his Clozapine levels?
A. Levels will increase significantly.
B. Levels will remain the same.
C. Levels will decrease significantly.
D. Levels will become undetectable.
Answer: A
Rationale: Polycyclic aromatic hydrocarbons in cigarette smoke induce the CYP1A2
enzyme, which metabolizes Clozapine. When a patient stops smoking, the induction stops,
leading to a decrease in metabolism and a subsequent rise in drug serum levels. The
PMHNP must monitor for toxicity and potentially reduce the dosage.
3. When prescribing a medication that is a substrate of CYP2D6 to a patient who is identified
as a ‘poor metabolizer’ via pharmacogenetic testing, what should the PMHNP anticipate?
A. A need for a higher than average dose.
B. No change in the standard dosing regimen.
C. Rapid clearance of the medication from the system.
D. Increased risk of adverse drug reactions at standard doses.
,Answer: D
Rationale: Poor metabolizers lack functional enzymes to break down medications
processed by the CYP2D6 pathway. This leads to higher plasma concentrations of the drug
even at standard doses. The PMHNP should consider lower starting doses and slower
titration to minimize side effects.
4. A patient taking an MAOI for depression attends a party and consumes aged cheeses and
red wine. She arrives at the ER with a severe headache and BP of 210/120. What is the most
likely cause?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome
C. Anticholinergic Toxicity
D. Hypertensive Crisis
Answer: D
Rationale: MAOIs inhibit the breakdown of tyramine, which is found in aged and
fermented foods. High levels of tyramine cause a massive release of norepinephrine,
leading to dangerous vasoconstriction and hypertensive crisis. This is a medical emergency
requiring immediate intervention and education on dietary restrictions.
5. Which receptor mechanism is primarily responsible for the reduced risk of Extrapyramidal
Symptoms (EPS) in atypical antipsychotics compared to typical antipsychotics?
A. D2 Receptor Antagonism
B. 5-HT2A Receptor Antagonism
C. H1 Receptor Agonism
D. Alpha-1 Receptor Blockade
Answer: B
Rationale: Atypical antipsychotics combine D2 antagonism with 5-HT2A antagonism.
Serotonin antagonism in the nigrostriatal pathway increases dopamine release, which
competes with the D2 blockade. This ‘fine-tuning’ reduces the occurrence of movement
disorders like dystonia and parkinsonism.
6. A PMHNP is treating a 22-year-old female for bipolar disorder with Lithium. Which of the
following lab combinations is essential for long-term monitoring?
A. BMI and Lipid Panel
B. CBC with differential and LFTs
C. TSH and Serum Creatinine
, D. Vitamin B12 and Folate
Answer: C
Rationale: Lithium is known to cause hypothyroidism and can impair renal function over
time. Regular monitoring of Thyroid Stimulating Hormone (TSH) and Serum Creatinine is
required to detect these side effects early. Assessing renal clearance is also vital because
lithium is excreted almost entirely by the kidneys.
7. An elderly patient is prescribed a benzodiazepine for insomnia. Why is the PMHNP
concerned about the half-life of medications in this population?
A. Increased renal clearance makes the drug less effective.
B. Elderly patients have more stomach acid, increasing absorption.
C. Decreased hepatic metabolism and increased body fat prolong drug half-life.
D. Benzodiazepines work faster in older adults due to high protein binding.
Answer: C
Rationale: Aging is associated with physiological changes such as reduced hepatic blood
flow and an increase in the proportion of body fat. Fat-soluble drugs like many
benzodiazepines have a larger volume of distribution and take longer to clear. This
increases the risk of accumulation, sedation, and falls in the geriatric population.
8. A patient is prescribed Lamotrigine for bipolar depression. The PMHNP emphasizes the
need to report any skin rash immediately. What is the primary concern?
A. Psoriasis flare-up
B. Contact dermatitis
C. Stevens-Johnson Syndrome (SJS)
D. Acneiform eruption
Answer: C
Rationale: Stevens-Johnson Syndrome is a rare but life-threatening dermatological
emergency associated with Lamotrigine. The risk is minimized by a very slow titration
schedule of the medication. Any new rash must be evaluated immediately to rule out toxic
epidermal necrolysis or SJS.
9. A PMHNP is performing medication reconciliation and notes the patient is taking St. John’s
Wort and Paroxetine. What is the most significant risk of this combination?
A. Serotonin Syndrome
B. Hypertensive Crisis
C. Hyperglycemia
Psychopharmacology for the PMHNP (NR546 Exam 1) [PDF] |
Chamberlain University
1. A patient with treatment-resistant schizophrenia is being started on Clozapine. Which
baseline laboratory value is most critical for the PMHNP to obtain before initiating therapy?
A. Thyroid Stimulating Hormone (TSH)
B. Liver Function Tests (LFTs)
C. Serum Creatinine
D. Absolute Neutrophil Count (ANC)
Answer: D
Rationale: Clozapine is associated with a risk of severe neutropenia and agranulocytosis.
Baseline ANC must be at least 1500/mm3 for the general population and 1000/mm3 for
patients with documented Benign Ethnic Neutropenia. Monitoring continues weekly for the
first six months to ensure patient safety.
2. A 30-year-old male smoker is stabilized on Clozapine 300mg daily. If he suddenly stops
smoking, what is the expected effect on his Clozapine levels?
A. Levels will increase significantly.
B. Levels will remain the same.
C. Levels will decrease significantly.
D. Levels will become undetectable.
Answer: A
Rationale: Polycyclic aromatic hydrocarbons in cigarette smoke induce the CYP1A2
enzyme, which metabolizes Clozapine. When a patient stops smoking, the induction stops,
leading to a decrease in metabolism and a subsequent rise in drug serum levels. The
PMHNP must monitor for toxicity and potentially reduce the dosage.
3. When prescribing a medication that is a substrate of CYP2D6 to a patient who is identified
as a ‘poor metabolizer’ via pharmacogenetic testing, what should the PMHNP anticipate?
A. A need for a higher than average dose.
B. No change in the standard dosing regimen.
C. Rapid clearance of the medication from the system.
D. Increased risk of adverse drug reactions at standard doses.
,Answer: D
Rationale: Poor metabolizers lack functional enzymes to break down medications
processed by the CYP2D6 pathway. This leads to higher plasma concentrations of the drug
even at standard doses. The PMHNP should consider lower starting doses and slower
titration to minimize side effects.
4. A patient taking an MAOI for depression attends a party and consumes aged cheeses and
red wine. She arrives at the ER with a severe headache and BP of 210/120. What is the most
likely cause?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome
C. Anticholinergic Toxicity
D. Hypertensive Crisis
Answer: D
Rationale: MAOIs inhibit the breakdown of tyramine, which is found in aged and
fermented foods. High levels of tyramine cause a massive release of norepinephrine,
leading to dangerous vasoconstriction and hypertensive crisis. This is a medical emergency
requiring immediate intervention and education on dietary restrictions.
5. Which receptor mechanism is primarily responsible for the reduced risk of Extrapyramidal
Symptoms (EPS) in atypical antipsychotics compared to typical antipsychotics?
A. D2 Receptor Antagonism
B. 5-HT2A Receptor Antagonism
C. H1 Receptor Agonism
D. Alpha-1 Receptor Blockade
Answer: B
Rationale: Atypical antipsychotics combine D2 antagonism with 5-HT2A antagonism.
Serotonin antagonism in the nigrostriatal pathway increases dopamine release, which
competes with the D2 blockade. This ‘fine-tuning’ reduces the occurrence of movement
disorders like dystonia and parkinsonism.
6. A PMHNP is treating a 22-year-old female for bipolar disorder with Lithium. Which of the
following lab combinations is essential for long-term monitoring?
A. BMI and Lipid Panel
B. CBC with differential and LFTs
C. TSH and Serum Creatinine
, D. Vitamin B12 and Folate
Answer: C
Rationale: Lithium is known to cause hypothyroidism and can impair renal function over
time. Regular monitoring of Thyroid Stimulating Hormone (TSH) and Serum Creatinine is
required to detect these side effects early. Assessing renal clearance is also vital because
lithium is excreted almost entirely by the kidneys.
7. An elderly patient is prescribed a benzodiazepine for insomnia. Why is the PMHNP
concerned about the half-life of medications in this population?
A. Increased renal clearance makes the drug less effective.
B. Elderly patients have more stomach acid, increasing absorption.
C. Decreased hepatic metabolism and increased body fat prolong drug half-life.
D. Benzodiazepines work faster in older adults due to high protein binding.
Answer: C
Rationale: Aging is associated with physiological changes such as reduced hepatic blood
flow and an increase in the proportion of body fat. Fat-soluble drugs like many
benzodiazepines have a larger volume of distribution and take longer to clear. This
increases the risk of accumulation, sedation, and falls in the geriatric population.
8. A patient is prescribed Lamotrigine for bipolar depression. The PMHNP emphasizes the
need to report any skin rash immediately. What is the primary concern?
A. Psoriasis flare-up
B. Contact dermatitis
C. Stevens-Johnson Syndrome (SJS)
D. Acneiform eruption
Answer: C
Rationale: Stevens-Johnson Syndrome is a rare but life-threatening dermatological
emergency associated with Lamotrigine. The risk is minimized by a very slow titration
schedule of the medication. Any new rash must be evaluated immediately to rule out toxic
epidermal necrolysis or SJS.
9. A PMHNP is performing medication reconciliation and notes the patient is taking St. John’s
Wort and Paroxetine. What is the most significant risk of this combination?
A. Serotonin Syndrome
B. Hypertensive Crisis
C. Hyperglycemia
