NURS 660 Final Exam V2 | NURS 660
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Final Exam 2026)
1. A patient diagnosed with Schizophrenia has failed two trials of atypical antipsychotics and
is now starting Clozapine. Which laboratory value must be monitored most stringently
throughout treatment?
A. Serum glucose levels
B. Serum Creatinine
C. Thyroid Stimulating Hormone (TSH)
D. Absolute Neutrophil Count (ANC)
E. Liver function tests
Answer: D
Rationale: Clozapine carries a high risk of life-threatening agranulocytosis, necessitating
frequent monitoring of the Absolute Neutrophil Count. Patients must be registered in the
REMS program to ensure compliance with blood work schedules. If the ANC falls below a
specific threshold, the medication must be discontinued immediately to prevent severe
infection.
,2. Which neurotransmitter is primarily targeted by Benzodiazepines to produce their
anxiolytic and sedative effects?
A. Gamma-aminobutyric acid (GABA)
B. Dopamine
C. Serotonin
D. Glutamate
Answer: A
Rationale: Benzodiazepines act as positive allosteric modulators at the GABA-A receptor
complex. By enhancing the inhibitory effects of GABA, they increase chloride ion influx,
which hyperpolarizes the neuron. This mechanism effectively reduces neuronal
excitability, leading to the clinical effects of sedation and anxiety reduction.
3. A 24-year-old male is prescribed Lithium for Bipolar I Disorder. Which of the following sets
of symptoms would most likely indicate early Lithium toxicity?
A. Hyperreflexia, clonus, and high fever
B. Severe muscle rigidity, autonomic instability, and diaphoresis
C. Coarse hand tremors, persistent diarrhea, and ataxia
D. Weight gain, polyuria, and fine hand tremors
Answer: C
,Rationale: Early signs of Lithium toxicity often include gastrointestinal distress and
neurological symptoms like ataxia and coarse tremors. It is critical to distinguish these
from common side effects such as fine tremors or mild polyuria. Serum levels should be
checked immediately if these symptoms develop to avoid progression to seizures or coma.
4. In the treatment of ADHD, how does the mechanism of action of Methylphenidate differ
from that of Amphetamines?
A. There is no clinical or mechanistic difference between the two.
B. Methylphenidate is a partial agonist, while Amphetamines are full agonists.
C. Methylphenidate primarily affects Serotonin, while Amphetamines affect Dopamine.
D. Methylphenidate blocks the reuptake of Dopamine and Norepinephrine, while
Amphetamines both block reuptake and stimulate release.
Answer: D
Rationale: Methylphenidate primarily functions as a reuptake inhibitor for dopamine and
norepinephrine. Amphetamines go a step further by also inducing the release of these
catecholamines from presynaptic storage vesicles. This dual action often makes
amphetamines more potent in their clinical effect on focus and arousal.
5. A patient taking Phenelzine (an MAOI) presents to the emergency department with a
severe headache, palpitations, and a blood pressure of 210/120 mmHg. Which dietary
indiscretion is most likely the cause?
A. Eating excess refined sugar
, B. Consuming grapefruit juice
C. A high-sodium diet
D. Consuming foods high in Tyramine like aged cheese
Answer: D
Rationale: MAOIs inhibit the breakdown of tyramine in the gut, which can lead to a
massive release of norepinephrine if tyramine-rich foods are consumed. This reaction
causes a hypertensive crisis characterized by severe headache and dangerously high blood
pressure. Patients on these medications must adhere to strict low-tyramine diets to ensure
safety.
6. Which antipsychotic medication is most associated with a high risk of metabolic syndrome,
including weight gain and dyslipidemia?
A. Aripiprazole
B. Ziprasidone
C. Lurasidone
D. Olanzapine
Answer: D
Rationale: Olanzapine is well-documented for its significant impact on weight, glucose
metabolism, and lipid profiles. Clinical guidelines recommend frequent monitoring of BMI
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Final Exam 2026)
1. A patient diagnosed with Schizophrenia has failed two trials of atypical antipsychotics and
is now starting Clozapine. Which laboratory value must be monitored most stringently
throughout treatment?
A. Serum glucose levels
B. Serum Creatinine
C. Thyroid Stimulating Hormone (TSH)
D. Absolute Neutrophil Count (ANC)
E. Liver function tests
Answer: D
Rationale: Clozapine carries a high risk of life-threatening agranulocytosis, necessitating
frequent monitoring of the Absolute Neutrophil Count. Patients must be registered in the
REMS program to ensure compliance with blood work schedules. If the ANC falls below a
specific threshold, the medication must be discontinued immediately to prevent severe
infection.
,2. Which neurotransmitter is primarily targeted by Benzodiazepines to produce their
anxiolytic and sedative effects?
A. Gamma-aminobutyric acid (GABA)
B. Dopamine
C. Serotonin
D. Glutamate
Answer: A
Rationale: Benzodiazepines act as positive allosteric modulators at the GABA-A receptor
complex. By enhancing the inhibitory effects of GABA, they increase chloride ion influx,
which hyperpolarizes the neuron. This mechanism effectively reduces neuronal
excitability, leading to the clinical effects of sedation and anxiety reduction.
3. A 24-year-old male is prescribed Lithium for Bipolar I Disorder. Which of the following sets
of symptoms would most likely indicate early Lithium toxicity?
A. Hyperreflexia, clonus, and high fever
B. Severe muscle rigidity, autonomic instability, and diaphoresis
C. Coarse hand tremors, persistent diarrhea, and ataxia
D. Weight gain, polyuria, and fine hand tremors
Answer: C
,Rationale: Early signs of Lithium toxicity often include gastrointestinal distress and
neurological symptoms like ataxia and coarse tremors. It is critical to distinguish these
from common side effects such as fine tremors or mild polyuria. Serum levels should be
checked immediately if these symptoms develop to avoid progression to seizures or coma.
4. In the treatment of ADHD, how does the mechanism of action of Methylphenidate differ
from that of Amphetamines?
A. There is no clinical or mechanistic difference between the two.
B. Methylphenidate is a partial agonist, while Amphetamines are full agonists.
C. Methylphenidate primarily affects Serotonin, while Amphetamines affect Dopamine.
D. Methylphenidate blocks the reuptake of Dopamine and Norepinephrine, while
Amphetamines both block reuptake and stimulate release.
Answer: D
Rationale: Methylphenidate primarily functions as a reuptake inhibitor for dopamine and
norepinephrine. Amphetamines go a step further by also inducing the release of these
catecholamines from presynaptic storage vesicles. This dual action often makes
amphetamines more potent in their clinical effect on focus and arousal.
5. A patient taking Phenelzine (an MAOI) presents to the emergency department with a
severe headache, palpitations, and a blood pressure of 210/120 mmHg. Which dietary
indiscretion is most likely the cause?
A. Eating excess refined sugar
, B. Consuming grapefruit juice
C. A high-sodium diet
D. Consuming foods high in Tyramine like aged cheese
Answer: D
Rationale: MAOIs inhibit the breakdown of tyramine in the gut, which can lead to a
massive release of norepinephrine if tyramine-rich foods are consumed. This reaction
causes a hypertensive crisis characterized by severe headache and dangerously high blood
pressure. Patients on these medications must adhere to strict low-tyramine diets to ensure
safety.
6. Which antipsychotic medication is most associated with a high risk of metabolic syndrome,
including weight gain and dyslipidemia?
A. Aripiprazole
B. Ziprasidone
C. Lurasidone
D. Olanzapine
Answer: D
Rationale: Olanzapine is well-documented for its significant impact on weight, glucose
metabolism, and lipid profiles. Clinical guidelines recommend frequent monitoring of BMI
