NURS 660 Exam 3 V1 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 3 2026)
1. A 28-year-old female patient with Bipolar I Disorder expresses a desire to become
pregnant. She is currently stable on Lithium. What is the most significant congenital risk
associated with Lithium use during the first trimester?
A. Neural tube defects
B. Cleft palate
C. Ebstein’s anomaly
D. Fetal hydantoin syndrome
Answer: C
Rationale: Ebstein’s anomaly is a rare cardiovascular defect specifically associated with
Lithium exposure in utero. While the absolute risk is relatively low, it remains a primary
concern for providers managing Bipolar Disorder during pregnancy. Clinical guidelines
often suggest tapering Lithium before conception if the patient is stable enough to
minimize this risk.
,2. A patient taking Clozapine presents for their routine blood work. Which laboratory value
would require immediate discontinuation of the medication and consultation with a
hematologist?
A. Absolute Neutrophil Count (ANC) of 1,600/mm³
B. White Blood Cell (WBC) count of 4,500/mm³
C. Platelet count of 150,000/mm³
D. Absolute Neutrophil Count (ANC) of 900/mm³
Answer: D
Rationale: Clozapine carries a boxed warning for severe neutropenia, formerly referred to
as agranulocytosis. According to the Clozapine REMS program, an ANC below 1000/mm³ is
considered severe neutropenia and necessitates stopping the drug. Monitoring the ANC is
the only reliable way to manage this life-threatening risk during treatment.
3. Which of the following atypical antipsychotics is considered the most ‘weight-neutral’ and
has the lowest risk for metabolic syndrome?
A. Olanzapine
B. Ziprasidone
C. Quetiapine
D. Risperidone
Answer: B
,Rationale: Ziprasidone is well-known for being weight-neutral compared to other Second-
Generation Antipsychotics (SGAs). Olanzapine and Quetiapine are associated with
significant weight gain and metabolic disturbances. Patients on Ziprasidone must be
counseled to take the medication with a meal of at least 500 calories for proper absorption.
4. A 10-year-old male is prescribed Methylphenidate for ADHD. The parents are concerned
about the side effects. Which of the following should the PMHNP monitor most closely during
follow-up visits?
A. Liver enzymes and jaundice
B. White blood cell count
C. Height, weight, and blood pressure
D. Serum glucose levels
Answer: C
Rationale: Stimulants like Methylphenidate can cause appetite suppression, which may
lead to growth deceleration in pediatric patients. Additionally, these medications can
increase heart rate and blood pressure due to their sympathomimetic effects. Regular
charting on a growth curve is essential for long-term management of children on
stimulants.
5. A patient with Alcohol Use Disorder is prescribed Disulfiram. What is the primary
mechanism of action that causes the ‘disulfiram reaction’ when alcohol is consumed?
A. Inhibition of Alcohol Dehydrogenase
, B. Inhibition of Aldehyde Dehydrogenase
C. Antagonism of NMDA receptors
D. Activation of GABA-A receptors
Answer: B
Rationale: Disulfiram irreversibly inhibits the enzyme aldehyde dehydrogenase,
preventing the breakdown of acetaldehyde. Acetaldehyde buildup in the bloodstream leads
to flushing, nausea, tachycardia, and hypotension if the patient drinks alcohol. This serves
as a psychological deterrent for patients committed to abstinence.
6. Which mood stabilizer is most strongly associated with the rare but life-threatening side
effect of Stevens-Johnson Syndrome (SJS), particularly during the initiation phase?
A. Lamotrigine
B. Valproate
C. Lithium
D. Gabapentin
Answer: A
Rationale: Lamotrigine requires a very slow titration schedule to minimize the risk of a
serious rash or Stevens-Johnson Syndrome. If the patient misses more than five days of the
medication, the titration process must be restarted from the beginning. It is critical to
educate patients to seek immediate medical attention if any skin changes occur.
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Exam 3 2026)
1. A 28-year-old female patient with Bipolar I Disorder expresses a desire to become
pregnant. She is currently stable on Lithium. What is the most significant congenital risk
associated with Lithium use during the first trimester?
A. Neural tube defects
B. Cleft palate
C. Ebstein’s anomaly
D. Fetal hydantoin syndrome
Answer: C
Rationale: Ebstein’s anomaly is a rare cardiovascular defect specifically associated with
Lithium exposure in utero. While the absolute risk is relatively low, it remains a primary
concern for providers managing Bipolar Disorder during pregnancy. Clinical guidelines
often suggest tapering Lithium before conception if the patient is stable enough to
minimize this risk.
,2. A patient taking Clozapine presents for their routine blood work. Which laboratory value
would require immediate discontinuation of the medication and consultation with a
hematologist?
A. Absolute Neutrophil Count (ANC) of 1,600/mm³
B. White Blood Cell (WBC) count of 4,500/mm³
C. Platelet count of 150,000/mm³
D. Absolute Neutrophil Count (ANC) of 900/mm³
Answer: D
Rationale: Clozapine carries a boxed warning for severe neutropenia, formerly referred to
as agranulocytosis. According to the Clozapine REMS program, an ANC below 1000/mm³ is
considered severe neutropenia and necessitates stopping the drug. Monitoring the ANC is
the only reliable way to manage this life-threatening risk during treatment.
3. Which of the following atypical antipsychotics is considered the most ‘weight-neutral’ and
has the lowest risk for metabolic syndrome?
A. Olanzapine
B. Ziprasidone
C. Quetiapine
D. Risperidone
Answer: B
,Rationale: Ziprasidone is well-known for being weight-neutral compared to other Second-
Generation Antipsychotics (SGAs). Olanzapine and Quetiapine are associated with
significant weight gain and metabolic disturbances. Patients on Ziprasidone must be
counseled to take the medication with a meal of at least 500 calories for proper absorption.
4. A 10-year-old male is prescribed Methylphenidate for ADHD. The parents are concerned
about the side effects. Which of the following should the PMHNP monitor most closely during
follow-up visits?
A. Liver enzymes and jaundice
B. White blood cell count
C. Height, weight, and blood pressure
D. Serum glucose levels
Answer: C
Rationale: Stimulants like Methylphenidate can cause appetite suppression, which may
lead to growth deceleration in pediatric patients. Additionally, these medications can
increase heart rate and blood pressure due to their sympathomimetic effects. Regular
charting on a growth curve is essential for long-term management of children on
stimulants.
5. A patient with Alcohol Use Disorder is prescribed Disulfiram. What is the primary
mechanism of action that causes the ‘disulfiram reaction’ when alcohol is consumed?
A. Inhibition of Alcohol Dehydrogenase
, B. Inhibition of Aldehyde Dehydrogenase
C. Antagonism of NMDA receptors
D. Activation of GABA-A receptors
Answer: B
Rationale: Disulfiram irreversibly inhibits the enzyme aldehyde dehydrogenase,
preventing the breakdown of acetaldehyde. Acetaldehyde buildup in the bloodstream leads
to flushing, nausea, tachycardia, and hypotension if the patient drinks alcohol. This serves
as a psychological deterrent for patients committed to abstinence.
6. Which mood stabilizer is most strongly associated with the rare but life-threatening side
effect of Stevens-Johnson Syndrome (SJS), particularly during the initiation phase?
A. Lamotrigine
B. Valproate
C. Lithium
D. Gabapentin
Answer: A
Rationale: Lamotrigine requires a very slow titration schedule to minimize the risk of a
serious rash or Stevens-Johnson Syndrome. If the patient misses more than five days of the
medication, the titration process must be restarted from the beginning. It is critical to
educate patients to seek immediate medical attention if any skin changes occur.
