NURS 660 Exam 1 V3 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 1 2026)
1. A patient is prescribed a medication that is a potent inhibitor of the Cytochrome P450 2D6
enzyme. Which of the following consequences should the PMHNP anticipate if the patient is
also taking a substrate of this enzyme?
A. Increased risk of toxicity from the substrate
B. Decreased plasma levels of the substrate
C. Accelerated metabolism of the substrate
D. Increased renal clearance of the drug
Answer: A
Rationale: Inhibition of the CYP450 2D6 enzyme slows down the metabolism of its
substrates, leading to higher plasma concentrations. This accumulation significantly
increases the risk of side effects and clinical toxicity for the patient. Monitoring for adverse
reactions is essential when adding an inhibitor to a stable drug regimen.
2. Which brain region is primarily associated with the ‘fear circuit’ and is often overactive in
patients with Panic Disorder?
A. Amygdala
,B. Prefrontal Cortex
C. Hippocampus
D. Basal Ganglia
Answer: A
Rationale: The amygdala is the primary processing center for emotions and the fear
response in the brain. Overactivity in this region is a hallmark of anxiety disorders,
particularly panic disorder and PTSD. Treatments often aim to modulate the amygdala’s
output through serotonergic or GABAergic pathways.
3. A 24-year-old female patient with a history of Bulimia Nervosa presents with Major
Depressive Disorder. Which antidepressant is strictly contraindicated for this patient?
A. Fluoxetine
B. Sertraline
C. Bupropion
D. Escitalopram
Answer: C
Rationale: Bupropion is contraindicated in patients with eating disorders due to an
increased risk of seizures. Patients with bulimia or anorexia often have electrolyte
imbalances that lower the seizure threshold. Other antidepressants like SSRIs are generally
safer alternatives for this population.
, 4. During the initiation of Lithium therapy, which laboratory value is most critical to monitor
to prevent toxicity?
A. Liver Function Tests (LFTs)
B. Serum Creatinine and GFR
C. Complete Blood Count (CBC)
D. Amylase levels
Answer: B
Rationale: Lithium is almost exclusively excreted by the kidneys, making renal function
the most important factor in its clearance. Elevations in serum creatinine or a decrease in
GFR can lead to Lithium accumulation and subsequent toxicity. Providers must monitor
kidney function regularly to ensure safe dosing and prevent long-term damage.
5. A patient taking Haloperidol develops severe muscle rigidity, a temperature of 103°F, and
autonomic instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Crisis
C. Extrapyramidal Symptoms (EPS)
D. Neuroleptic Malignant Syndrome (NMS)
Answer: D
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 1 2026)
1. A patient is prescribed a medication that is a potent inhibitor of the Cytochrome P450 2D6
enzyme. Which of the following consequences should the PMHNP anticipate if the patient is
also taking a substrate of this enzyme?
A. Increased risk of toxicity from the substrate
B. Decreased plasma levels of the substrate
C. Accelerated metabolism of the substrate
D. Increased renal clearance of the drug
Answer: A
Rationale: Inhibition of the CYP450 2D6 enzyme slows down the metabolism of its
substrates, leading to higher plasma concentrations. This accumulation significantly
increases the risk of side effects and clinical toxicity for the patient. Monitoring for adverse
reactions is essential when adding an inhibitor to a stable drug regimen.
2. Which brain region is primarily associated with the ‘fear circuit’ and is often overactive in
patients with Panic Disorder?
A. Amygdala
,B. Prefrontal Cortex
C. Hippocampus
D. Basal Ganglia
Answer: A
Rationale: The amygdala is the primary processing center for emotions and the fear
response in the brain. Overactivity in this region is a hallmark of anxiety disorders,
particularly panic disorder and PTSD. Treatments often aim to modulate the amygdala’s
output through serotonergic or GABAergic pathways.
3. A 24-year-old female patient with a history of Bulimia Nervosa presents with Major
Depressive Disorder. Which antidepressant is strictly contraindicated for this patient?
A. Fluoxetine
B. Sertraline
C. Bupropion
D. Escitalopram
Answer: C
Rationale: Bupropion is contraindicated in patients with eating disorders due to an
increased risk of seizures. Patients with bulimia or anorexia often have electrolyte
imbalances that lower the seizure threshold. Other antidepressants like SSRIs are generally
safer alternatives for this population.
, 4. During the initiation of Lithium therapy, which laboratory value is most critical to monitor
to prevent toxicity?
A. Liver Function Tests (LFTs)
B. Serum Creatinine and GFR
C. Complete Blood Count (CBC)
D. Amylase levels
Answer: B
Rationale: Lithium is almost exclusively excreted by the kidneys, making renal function
the most important factor in its clearance. Elevations in serum creatinine or a decrease in
GFR can lead to Lithium accumulation and subsequent toxicity. Providers must monitor
kidney function regularly to ensure safe dosing and prevent long-term damage.
5. A patient taking Haloperidol develops severe muscle rigidity, a temperature of 103°F, and
autonomic instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Crisis
C. Extrapyramidal Symptoms (EPS)
D. Neuroleptic Malignant Syndrome (NMS)
Answer: D
