NURS 660 Exam 2 V3 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 2 2026)
1. A 32-year-old female patient with Bipolar I Disorder is being started on Lithium. Which
laboratory test is most critical to obtain before initiating this medication?
A. Liver function tests
B. Serum creatinine and BUN
C. Complete blood count with differential
D. Lipid panel
Answer: B
Rationale: Lithium is primarily excreted by the kidneys and can be nephrotoxic. Baseline
renal function including serum creatinine and BUN is essential to determine safe dosing.
Ongoing monitoring is required to prevent renal impairment over long-term use.
2. Which of the following describes the mechanism of action of Lamotrigine in the treatment
of Bipolar Disorder?
A. Blockade of D2 receptors
B. Potentiation of GABA-A receptors
,C. Inhibition of voltage-sensitive sodium channels
D. Agonism of 5HT-1A receptors
Answer: C
Rationale: Lamotrigine stabilizes neuronal membranes by inhibiting voltage-sensitive
sodium channels. This action reduces the release of excitatory neurotransmitters like
glutamate. It is particularly effective for the maintenance phase of Bipolar Disorder to
prevent depressive episodes.
3. A patient taking Clozapine presents with a sore throat and fever. What is the most
appropriate immediate action for the PMHNP?
A. Prescribe a broad-spectrum antibiotic
B. Switch the patient to Olanzapine
C. Advise the patient to take acetaminophen
D. Obtain an immediate Absolute Neutrophil Count (ANC)
Answer: D
Rationale: Clozapine carries a black box warning for agranulocytosis, which can manifest
as signs of infection. An immediate ANC is required to ensure the patient’s white blood cell
count is within safe limits. Treatment must be suspended if the ANC falls below specific
REMS thresholds.
, 4. Which antipsychotic medication is most likely to cause significant weight gain and
metabolic syndrome?
A. Olanzapine
B. Aripiprazole
C. Ziprasidone
D. Lurasidone
Answer: A
Rationale: Olanzapine is associated with the highest risk of metabolic side effects among
the second-generation antipsychotics. Patients frequently experience significant weight
gain, dyslipidemia, and insulin resistance. Monitoring of BMI, waist circumference, and
blood glucose is mandatory.
5. A patient is prescribed Valproic Acid for mood stabilization. Which side effect is a primary
concern for a female of childbearing age?
A. Stevens-Johnson Syndrome
B. Polycystic Ovary Syndrome (PCOS)
C. Agranulocytosis
D. Nephrogenic diabetes insipidus
Answer: B
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 2 2026)
1. A 32-year-old female patient with Bipolar I Disorder is being started on Lithium. Which
laboratory test is most critical to obtain before initiating this medication?
A. Liver function tests
B. Serum creatinine and BUN
C. Complete blood count with differential
D. Lipid panel
Answer: B
Rationale: Lithium is primarily excreted by the kidneys and can be nephrotoxic. Baseline
renal function including serum creatinine and BUN is essential to determine safe dosing.
Ongoing monitoring is required to prevent renal impairment over long-term use.
2. Which of the following describes the mechanism of action of Lamotrigine in the treatment
of Bipolar Disorder?
A. Blockade of D2 receptors
B. Potentiation of GABA-A receptors
,C. Inhibition of voltage-sensitive sodium channels
D. Agonism of 5HT-1A receptors
Answer: C
Rationale: Lamotrigine stabilizes neuronal membranes by inhibiting voltage-sensitive
sodium channels. This action reduces the release of excitatory neurotransmitters like
glutamate. It is particularly effective for the maintenance phase of Bipolar Disorder to
prevent depressive episodes.
3. A patient taking Clozapine presents with a sore throat and fever. What is the most
appropriate immediate action for the PMHNP?
A. Prescribe a broad-spectrum antibiotic
B. Switch the patient to Olanzapine
C. Advise the patient to take acetaminophen
D. Obtain an immediate Absolute Neutrophil Count (ANC)
Answer: D
Rationale: Clozapine carries a black box warning for agranulocytosis, which can manifest
as signs of infection. An immediate ANC is required to ensure the patient’s white blood cell
count is within safe limits. Treatment must be suspended if the ANC falls below specific
REMS thresholds.
, 4. Which antipsychotic medication is most likely to cause significant weight gain and
metabolic syndrome?
A. Olanzapine
B. Aripiprazole
C. Ziprasidone
D. Lurasidone
Answer: A
Rationale: Olanzapine is associated with the highest risk of metabolic side effects among
the second-generation antipsychotics. Patients frequently experience significant weight
gain, dyslipidemia, and insulin resistance. Monitoring of BMI, waist circumference, and
blood glucose is mandatory.
5. A patient is prescribed Valproic Acid for mood stabilization. Which side effect is a primary
concern for a female of childbearing age?
A. Stevens-Johnson Syndrome
B. Polycystic Ovary Syndrome (PCOS)
C. Agranulocytosis
D. Nephrogenic diabetes insipidus
Answer: B
