NR 605 FINAL EXAM (DIAGNOSIS
MANAGEMENT IN PSYCHIATRIC)
2026/2027 QUESTIONS AND CORRECT
ANSWERS A+ GRADE
1. A 24-year-old male patient with a history of treatment-resistant schizophrenia is started on
Clozapine. Which of the following laboratory parameters is the most critical to monitor
according to the Risk Evaluation and Mitigation Strategy (REMS)?
A. Liver Function Tests (LFTs)
B. Absolute Neutrophil Count (ANC)
C. Serum Creatinine and BUN
D. Glycated Hemoglobin (HbA1c)
Answer: B
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis. REMS
monitoring requires regular Absolute Neutrophil Count (ANC) checks to manage the risk of
severe neutropenia.
2. Which brain region is primarily associated with the ‘negative symptoms’ of schizophrenia,
such as flat affect and alogia, due to dopaminergic hypoactivity?
A. Mesolimbic pathway
,B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: Negative symptoms of schizophrenia are hypothesized to be
caused by low dopamine levels in the mesocortical pathway, particularly the prefrontal
cortex.
3. A patient is diagnosed with Bipolar I Disorder. When initiating Lithium therapy, the PMHNP
knows that the therapeutic range for acute mania is generally:
A. 0.4 to 0.8 mEq/L
B. 0.8 to 1.2 mEq/L
C. 1.5 to 2.0 mEq/L
D. 2.0 to 2.5 mEq/L
Answer: B
Conceptual Explanation: For acute mania, the target lithium serum level is typically 0.8 to
1.2 mEq/L. Maintenance levels are slightly lower, usually 0.6 to 1.0 mEq/L.
, 4. A 45-year-old female presents with symptoms of Major Depressive Disorder. She also
reports chronic neuropathic pain. Which medication would be most appropriate to address
both conditions?
A. Escitalopram
B. Bupropion
C. Duloxetine
D. Fluoxetine
Answer: C
Conceptual Explanation: Duloxetine is an SNRI (Serotonin-Norepinephrine Reuptake
Inhibitor) FDA-approved for both Major Depressive Disorder and chronic pain conditions
like diabetic peripheral neuropathy.
5. In the treatment of Opioid Use Disorder, which medication acts as a partial mu-opioid
agonist and has a ‘ceiling effect’ that reduces the risk of respiratory depression?
A. Methadone
B. Buprenorphine
C. Naltrexone
D. Naloxone
Answer: B
MANAGEMENT IN PSYCHIATRIC)
2026/2027 QUESTIONS AND CORRECT
ANSWERS A+ GRADE
1. A 24-year-old male patient with a history of treatment-resistant schizophrenia is started on
Clozapine. Which of the following laboratory parameters is the most critical to monitor
according to the Risk Evaluation and Mitigation Strategy (REMS)?
A. Liver Function Tests (LFTs)
B. Absolute Neutrophil Count (ANC)
C. Serum Creatinine and BUN
D. Glycated Hemoglobin (HbA1c)
Answer: B
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis. REMS
monitoring requires regular Absolute Neutrophil Count (ANC) checks to manage the risk of
severe neutropenia.
2. Which brain region is primarily associated with the ‘negative symptoms’ of schizophrenia,
such as flat affect and alogia, due to dopaminergic hypoactivity?
A. Mesolimbic pathway
,B. Nigrostriatal pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: D
Conceptual Explanation: Negative symptoms of schizophrenia are hypothesized to be
caused by low dopamine levels in the mesocortical pathway, particularly the prefrontal
cortex.
3. A patient is diagnosed with Bipolar I Disorder. When initiating Lithium therapy, the PMHNP
knows that the therapeutic range for acute mania is generally:
A. 0.4 to 0.8 mEq/L
B. 0.8 to 1.2 mEq/L
C. 1.5 to 2.0 mEq/L
D. 2.0 to 2.5 mEq/L
Answer: B
Conceptual Explanation: For acute mania, the target lithium serum level is typically 0.8 to
1.2 mEq/L. Maintenance levels are slightly lower, usually 0.6 to 1.0 mEq/L.
, 4. A 45-year-old female presents with symptoms of Major Depressive Disorder. She also
reports chronic neuropathic pain. Which medication would be most appropriate to address
both conditions?
A. Escitalopram
B. Bupropion
C. Duloxetine
D. Fluoxetine
Answer: C
Conceptual Explanation: Duloxetine is an SNRI (Serotonin-Norepinephrine Reuptake
Inhibitor) FDA-approved for both Major Depressive Disorder and chronic pain conditions
like diabetic peripheral neuropathy.
5. In the treatment of Opioid Use Disorder, which medication acts as a partial mu-opioid
agonist and has a ‘ceiling effect’ that reduces the risk of respiratory depression?
A. Methadone
B. Buprenorphine
C. Naltrexone
D. Naloxone
Answer: B
