NURS 660 Exam 2 V2 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 2 2026)
1. A patient is being initiated on Lithium for the treatment of Bipolar I Disorder. Which of the
following lab values is most critical to monitor due to the narrow therapeutic index of this
medication?
A. Liver function tests (ALT/AST) and Platelets
B. Serum Lithium level, BUN/Creatinine, and TSH
C. Serum glucose and Lipid profile
D. Complete Blood Count (CBC) with differential
Answer: B
Rationale: Lithium is excreted almost entirely by the kidneys, making renal function tests
like BUN and Creatinine essential for safety. It also has a known inhibitory effect on the
thyroid gland, necessitating baseline and periodic TSH monitoring. Maintaining a
therapeutic serum level between 0.6 and 1.2 mEq/L is vital to avoid toxicity while ensuring
efficacy.
,2. When prescribing Clozapine (Clozaril) for treatment-resistant schizophrenia, the clinician
must educate the patient on the mandatory monitoring of which parameter?
A. Urinary output and protein levels
B. Serum potassium and magnesium
C. Absolute Neutrophil Count (ANC)
D. Visual acuity and intraocular pressure
Answer: C
Rationale: Clozapine carries a significant risk of life-threatening agranulocytosis, requiring
strict adherence to the Risk Evaluation and Mitigation Strategy (REMS) program. The
Absolute Neutrophil Count (ANC) must be monitored weekly for the first six months of
treatment. Treatment must be interrupted or discontinued if the ANC falls below specific
thresholds to prevent severe infection.
3. A 24-year-old female patient started on Lamotrigine (Lamictal) for mood stabilization. She
calls the clinic reporting a new, blistering rash on her torso. What is the appropriate clinical
intervention?
A. Instruct the patient to take diphenhydramine and continue the medication.
B. Tell the patient to reduce the dose by half and monitor for 24 hours.
C. Advise the patient to stop the medication immediately and seek emergency care.
D. Reassure the patient that this is a common, benign side effect of the drug.
,Answer: C
Rationale: Lamotrigine is associated with a rare but potentially fatal condition known as
Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis. Any new rash, particularly
one involving blisters or mucosal membranes, must be treated as a medical emergency. The
medication should be discontinued immediately to prevent further systemic progression.
4. Which mechanism of action explains why Second-Generation Antipsychotics (SGAs) are
associated with a lower risk of Extrapyramidal Symptoms (EPS) compared to First-Generation
Antipsychotics?
A. Potent blockade of Alpha-1 adrenergic receptors
B. Selective antagonism of Muscarinic M1 receptors
C. Irreversible binding to D2 receptors in the nigrostriatal pathway
D. Rapid dissociation from D2 receptors and 5HT-2A antagonism
Answer: D
Rationale: SGAs generally have a lower affinity for D2 receptors and dissociate more
quickly than first-generation agents, which reduces the duration of dopamine blockade.
Additionally, 5HT-2A receptor antagonism increases dopamine release in the nigrostriatal
pathway, further mitigating the risk of movement disorders. This ‘hit-and-run’ mechanism
allows for antipsychotic efficacy with fewer motor side effects.
, 5. A patient diagnosed with Major Depressive Disorder is prescribed Phenelzine (Nardil).
Which dietary choice indicates the patient needs further teaching?
A. A glass of red wine and aged salami
B. Fresh apple and a slice of cheddar cheese
C. Grilled chicken breast and steamed broccoli
D. Scrambled eggs and whole-wheat toast
Answer: A
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that inhibits the
breakdown of tyramine in the gut. Consuming high-tyramine foods like aged meats,
fermented products, and certain alcohols can trigger a hypertensive crisis. The clinician
must ensure the patient understands the strict dietary restrictions required to avoid life-
threatening elevations in blood pressure.
6. Which antidepressant is uniquely contraindicated in patients with a history of seizure
disorders or eating disorders such as Bulimia or Anorexia Nervosa?
A. Fluoxetine (Prozac)
B. Bupropion (Wellbutrin)
C. Sertraline (Zoloft)
D. Venlafaxine (Effexor)
Answer: B
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 2 2026)
1. A patient is being initiated on Lithium for the treatment of Bipolar I Disorder. Which of the
following lab values is most critical to monitor due to the narrow therapeutic index of this
medication?
A. Liver function tests (ALT/AST) and Platelets
B. Serum Lithium level, BUN/Creatinine, and TSH
C. Serum glucose and Lipid profile
D. Complete Blood Count (CBC) with differential
Answer: B
Rationale: Lithium is excreted almost entirely by the kidneys, making renal function tests
like BUN and Creatinine essential for safety. It also has a known inhibitory effect on the
thyroid gland, necessitating baseline and periodic TSH monitoring. Maintaining a
therapeutic serum level between 0.6 and 1.2 mEq/L is vital to avoid toxicity while ensuring
efficacy.
,2. When prescribing Clozapine (Clozaril) for treatment-resistant schizophrenia, the clinician
must educate the patient on the mandatory monitoring of which parameter?
A. Urinary output and protein levels
B. Serum potassium and magnesium
C. Absolute Neutrophil Count (ANC)
D. Visual acuity and intraocular pressure
Answer: C
Rationale: Clozapine carries a significant risk of life-threatening agranulocytosis, requiring
strict adherence to the Risk Evaluation and Mitigation Strategy (REMS) program. The
Absolute Neutrophil Count (ANC) must be monitored weekly for the first six months of
treatment. Treatment must be interrupted or discontinued if the ANC falls below specific
thresholds to prevent severe infection.
3. A 24-year-old female patient started on Lamotrigine (Lamictal) for mood stabilization. She
calls the clinic reporting a new, blistering rash on her torso. What is the appropriate clinical
intervention?
A. Instruct the patient to take diphenhydramine and continue the medication.
B. Tell the patient to reduce the dose by half and monitor for 24 hours.
C. Advise the patient to stop the medication immediately and seek emergency care.
D. Reassure the patient that this is a common, benign side effect of the drug.
,Answer: C
Rationale: Lamotrigine is associated with a rare but potentially fatal condition known as
Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis. Any new rash, particularly
one involving blisters or mucosal membranes, must be treated as a medical emergency. The
medication should be discontinued immediately to prevent further systemic progression.
4. Which mechanism of action explains why Second-Generation Antipsychotics (SGAs) are
associated with a lower risk of Extrapyramidal Symptoms (EPS) compared to First-Generation
Antipsychotics?
A. Potent blockade of Alpha-1 adrenergic receptors
B. Selective antagonism of Muscarinic M1 receptors
C. Irreversible binding to D2 receptors in the nigrostriatal pathway
D. Rapid dissociation from D2 receptors and 5HT-2A antagonism
Answer: D
Rationale: SGAs generally have a lower affinity for D2 receptors and dissociate more
quickly than first-generation agents, which reduces the duration of dopamine blockade.
Additionally, 5HT-2A receptor antagonism increases dopamine release in the nigrostriatal
pathway, further mitigating the risk of movement disorders. This ‘hit-and-run’ mechanism
allows for antipsychotic efficacy with fewer motor side effects.
, 5. A patient diagnosed with Major Depressive Disorder is prescribed Phenelzine (Nardil).
Which dietary choice indicates the patient needs further teaching?
A. A glass of red wine and aged salami
B. Fresh apple and a slice of cheddar cheese
C. Grilled chicken breast and steamed broccoli
D. Scrambled eggs and whole-wheat toast
Answer: A
Rationale: Phenelzine is a Monoamine Oxidase Inhibitor (MAOI) that inhibits the
breakdown of tyramine in the gut. Consuming high-tyramine foods like aged meats,
fermented products, and certain alcohols can trigger a hypertensive crisis. The clinician
must ensure the patient understands the strict dietary restrictions required to avoid life-
threatening elevations in blood pressure.
6. Which antidepressant is uniquely contraindicated in patients with a history of seizure
disorders or eating disorders such as Bulimia or Anorexia Nervosa?
A. Fluoxetine (Prozac)
B. Bupropion (Wellbutrin)
C. Sertraline (Zoloft)
D. Venlafaxine (Effexor)
Answer: B
