NURS 660 Exam 2 V1 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 2 2026)
1. A 28-year-old female patient is starting Lithium for Bipolar I Disorder. Which of the
following baseline laboratory tests is required due to the risk of Ebstein’s anomaly in women
of childbearing age?
A. Liver Function Tests (LFTs)
B. Complete Blood Count (CBC)
C. Serum HCG
D. Blood Urea Nitrogen (BUN)
Answer: C
Rationale: Lithium is a known teratogen associated with Ebstein’s anomaly, a cardiac
defect, especially during the first trimester. It is imperative to obtain a serum HCG to rule
out pregnancy before initiation of therapy. Documentation of birth control use and
counseling on the risks of lithium during pregnancy are essential components of the
treatment plan.
,2. A patient taking Sertraline (Zoloft) reports significant sexual dysfunction. Which medication
could be added as an adjunct or switched to to help alleviate this side effect while still
treating depressive symptoms?
A. Bupropion
B. Paroxetine
C. Venlafaxine
D. Escitalopram
Answer: A
Rationale: Bupropion is an NDRI that lacks serotonergic activity, which is the primary
cause of sexual dysfunction in SSRIs. It is frequently used as an adjunct to counteract SSRI-
induced sexual side effects or as a monotherapy. Switching to other SSRIs like Paroxetine
or SNRIs like Venlafaxine usually does not resolve the issue as they both affect serotonin
levels.
3. Which mood stabilizer requires specific HLA-B*1502 genetic testing in patients of Asian
descent due to the risk of Stevens-Johnson Syndrome?
A. Valproic Acid
B. Lithium
C. Lamotrigine
D. Carbamazepine
,Answer: D
Rationale: Carbamazepine is associated with a high risk of Stevens-Johnson Syndrome and
Toxic Epidermal Necrolysis in individuals carrying the HLA-B*1502 allele. This allele is
most common in populations of Asian ancestry, making genetic screening mandatory prior
to starting the drug in these groups. While Lamotrigine also carries a risk of SJS, the specific
genetic test requirement is most strictly tied to Carbamazepine.
4. A patient presents with high fever, ‘lead pipe’ muscle rigidity, autonomic instability, and
altered mental status after increasing their dose of Haloperidol. What is the most likely
diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Toxicity
C. Acute Dystonic Reaction
D. Neuroleptic Malignant Syndrome (NMS)
Answer: D
Rationale: Neuroleptic Malignant Syndrome (NMS) is a life-threatening reaction to
dopamine antagonists characterized by muscle rigidity and hyperthermia. Serotonin
syndrome is distinguished by hyperreflexia and myoclonus, whereas NMS features ‘lead
pipe’ rigidity. Immediate cessation of the antipsychotic and supportive care in an ICU
setting are required.
, 5. Which of the following antidepressants has a half-life of nearly one week, reducing the risk
of discontinuation syndrome if a dose is missed?
A. Venlafaxine
B. Fluoxetine
C. Paroxetine
D. Duloxetine
Answer: B
Rationale: Fluoxetine and its active metabolite norfluoxetine have an exceptionally long
half-life, which provides a ‘self-tapering’ effect. This makes it a preferred choice for patients
who are frequently non-compliant with their daily regimen. In contrast, medications like
Venlafaxine and Paroxetine have short half-lives and are associated with severe
discontinuation symptoms.
6. Clozapine therapy requires frequent monitoring of which lab value due to the risk of severe
neutropenia?
A. Serum Creatinine
B. Platelet Count
C. Absolute Neutrophil Count (ANC)
D. Liver Enzymes
Answer: C
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 2 2026)
1. A 28-year-old female patient is starting Lithium for Bipolar I Disorder. Which of the
following baseline laboratory tests is required due to the risk of Ebstein’s anomaly in women
of childbearing age?
A. Liver Function Tests (LFTs)
B. Complete Blood Count (CBC)
C. Serum HCG
D. Blood Urea Nitrogen (BUN)
Answer: C
Rationale: Lithium is a known teratogen associated with Ebstein’s anomaly, a cardiac
defect, especially during the first trimester. It is imperative to obtain a serum HCG to rule
out pregnancy before initiation of therapy. Documentation of birth control use and
counseling on the risks of lithium during pregnancy are essential components of the
treatment plan.
,2. A patient taking Sertraline (Zoloft) reports significant sexual dysfunction. Which medication
could be added as an adjunct or switched to to help alleviate this side effect while still
treating depressive symptoms?
A. Bupropion
B. Paroxetine
C. Venlafaxine
D. Escitalopram
Answer: A
Rationale: Bupropion is an NDRI that lacks serotonergic activity, which is the primary
cause of sexual dysfunction in SSRIs. It is frequently used as an adjunct to counteract SSRI-
induced sexual side effects or as a monotherapy. Switching to other SSRIs like Paroxetine
or SNRIs like Venlafaxine usually does not resolve the issue as they both affect serotonin
levels.
3. Which mood stabilizer requires specific HLA-B*1502 genetic testing in patients of Asian
descent due to the risk of Stevens-Johnson Syndrome?
A. Valproic Acid
B. Lithium
C. Lamotrigine
D. Carbamazepine
,Answer: D
Rationale: Carbamazepine is associated with a high risk of Stevens-Johnson Syndrome and
Toxic Epidermal Necrolysis in individuals carrying the HLA-B*1502 allele. This allele is
most common in populations of Asian ancestry, making genetic screening mandatory prior
to starting the drug in these groups. While Lamotrigine also carries a risk of SJS, the specific
genetic test requirement is most strictly tied to Carbamazepine.
4. A patient presents with high fever, ‘lead pipe’ muscle rigidity, autonomic instability, and
altered mental status after increasing their dose of Haloperidol. What is the most likely
diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Toxicity
C. Acute Dystonic Reaction
D. Neuroleptic Malignant Syndrome (NMS)
Answer: D
Rationale: Neuroleptic Malignant Syndrome (NMS) is a life-threatening reaction to
dopamine antagonists characterized by muscle rigidity and hyperthermia. Serotonin
syndrome is distinguished by hyperreflexia and myoclonus, whereas NMS features ‘lead
pipe’ rigidity. Immediate cessation of the antipsychotic and supportive care in an ICU
setting are required.
, 5. Which of the following antidepressants has a half-life of nearly one week, reducing the risk
of discontinuation syndrome if a dose is missed?
A. Venlafaxine
B. Fluoxetine
C. Paroxetine
D. Duloxetine
Answer: B
Rationale: Fluoxetine and its active metabolite norfluoxetine have an exceptionally long
half-life, which provides a ‘self-tapering’ effect. This makes it a preferred choice for patients
who are frequently non-compliant with their daily regimen. In contrast, medications like
Venlafaxine and Paroxetine have short half-lives and are associated with severe
discontinuation symptoms.
6. Clozapine therapy requires frequent monitoring of which lab value due to the risk of severe
neutropenia?
A. Serum Creatinine
B. Platelet Count
C. Absolute Neutrophil Count (ANC)
D. Liver Enzymes
Answer: C
