NURS 660 Exam 3 V3 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 3 2026)
1. A patient initiated on Clozapine (Clozaril) must have their Absolute Neutrophil Count (ANC)
monitored regularly. What is the minimum ANC level required to continue treatment in a
non-benign ethnic neutropenia (BEN) patient?
A. 1,000/µL
B. 500/µL
C. 2,000/µL
D. 1,500/µL
Answer: D
Rationale: The FDA Clozapine REMS program requires an ANC of at least 1,500/µL to
initiate and continue treatment in general populations. If the ANC falls below this
threshold, the clinician must follow specific protocols for interruption or frequent
monitoring. This monitoring is critical due to the risk of life-threatening agranulocytosis
associated with clozapine therapy.
,2. Which antidepressant is most likely to cause a dose-dependent increase in blood pressure
due to its mechanism as a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)?
A. Sertraline
B. Fluoxetine
C. Venlafaxine
D. Paroxetine
Answer: C
Rationale: Venlafaxine inhibits norepinephrine reuptake more significantly at higher
doses, which can lead to increased diastolic blood pressure. Clinical guidelines recommend
monitoring blood pressure regularly for all patients on venlafaxine therapy. If hypertension
develops, the dose may need to be reduced or the medication switched to an SSRI.
3. A 24-year-old female patient prescribed Valproate (Depakote) for bipolar disorder presents
with concerns about reproductive health. What is a primary concern regarding Valproate use
in women of childbearing age?
A. Increased risk of Stevens-Johnson Syndrome
B. Polycystic Ovary Syndrome (PCOS) and teratogenicity
C. Permanent hair loss
D. Hyperthyroidism
Answer: B
, Rationale: Valproate is associated with a high risk of neural tube defects in the fetus,
making it a poor choice for women planning pregnancy. Additionally, it has been linked to
the development of Polycystic Ovary Syndrome (PCOS) in younger female patients.
Clinicians should consider alternative mood stabilizers like Lamotrigine for women of
childbearing age when possible.
4. Lithium toxicity is a medical emergency. Which of the following serum levels is typically
considered the threshold for moderate to severe toxicity?
A. 0.8 mEq/L
B. 1.5 mEq/L
C. 1.2 mEq/L
D. 0.4 mEq/L
Answer: B
Rationale: While the therapeutic range for lithium is generally 0.6 to 1.2 mEq/L, levels
exceeding 1.5 mEq/L are typically associated with toxicity. Symptoms of moderate toxicity
include coarse tremors, GI distress, and ataxia. Severe toxicity can lead to seizures, coma,
and permanent neurological damage.
5. When switching a patient from an MAOI like Phenelzine to an SSRI like Fluoxetine, what is
the required washout period?
A. 14 days
B. 7 days
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 3 2026)
1. A patient initiated on Clozapine (Clozaril) must have their Absolute Neutrophil Count (ANC)
monitored regularly. What is the minimum ANC level required to continue treatment in a
non-benign ethnic neutropenia (BEN) patient?
A. 1,000/µL
B. 500/µL
C. 2,000/µL
D. 1,500/µL
Answer: D
Rationale: The FDA Clozapine REMS program requires an ANC of at least 1,500/µL to
initiate and continue treatment in general populations. If the ANC falls below this
threshold, the clinician must follow specific protocols for interruption or frequent
monitoring. This monitoring is critical due to the risk of life-threatening agranulocytosis
associated with clozapine therapy.
,2. Which antidepressant is most likely to cause a dose-dependent increase in blood pressure
due to its mechanism as a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI)?
A. Sertraline
B. Fluoxetine
C. Venlafaxine
D. Paroxetine
Answer: C
Rationale: Venlafaxine inhibits norepinephrine reuptake more significantly at higher
doses, which can lead to increased diastolic blood pressure. Clinical guidelines recommend
monitoring blood pressure regularly for all patients on venlafaxine therapy. If hypertension
develops, the dose may need to be reduced or the medication switched to an SSRI.
3. A 24-year-old female patient prescribed Valproate (Depakote) for bipolar disorder presents
with concerns about reproductive health. What is a primary concern regarding Valproate use
in women of childbearing age?
A. Increased risk of Stevens-Johnson Syndrome
B. Polycystic Ovary Syndrome (PCOS) and teratogenicity
C. Permanent hair loss
D. Hyperthyroidism
Answer: B
, Rationale: Valproate is associated with a high risk of neural tube defects in the fetus,
making it a poor choice for women planning pregnancy. Additionally, it has been linked to
the development of Polycystic Ovary Syndrome (PCOS) in younger female patients.
Clinicians should consider alternative mood stabilizers like Lamotrigine for women of
childbearing age when possible.
4. Lithium toxicity is a medical emergency. Which of the following serum levels is typically
considered the threshold for moderate to severe toxicity?
A. 0.8 mEq/L
B. 1.5 mEq/L
C. 1.2 mEq/L
D. 0.4 mEq/L
Answer: B
Rationale: While the therapeutic range for lithium is generally 0.6 to 1.2 mEq/L, levels
exceeding 1.5 mEq/L are typically associated with toxicity. Symptoms of moderate toxicity
include coarse tremors, GI distress, and ataxia. Severe toxicity can lead to seizures, coma,
and permanent neurological damage.
5. When switching a patient from an MAOI like Phenelzine to an SSRI like Fluoxetine, what is
the required washout period?
A. 14 days
B. 7 days
