NURS 660 Final Exam V3 | 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 is prescribed Lithium for the management of Bipolar I Disorder. Which of the
following laboratory values is the primary concern for the PMHNP when assessing for
potential toxicity?
A. Serum lithium level of 1.6 mEq/L
B. Serum sodium level of 135 mEq/L
C. Creatinine level of 0.9 mg/dL
D. White blood cell count of 8,000/mm3
Answer: A
Rationale: The therapeutic window for Lithium is narrow, typically ranging from 0.6 to 1.2
mEq/L for maintenance. A level of 1.6 mEq/L indicates mild to moderate toxicity, which
requires immediate clinical intervention and dose adjustment. Toxic levels can lead to
severe neurological and renal complications if not addressed promptly.
2. When initiating Clozapine therapy, which laboratory monitoring schedule is strictly
mandated by the REMS program during the first six months?
A. Monthly CBC with differential
,B. Bi-weekly ANC (Absolute Neutrophil Count)
C. Weekly ANC (Absolute Neutrophil Count)
D. Baseline ANC only if the patient has no history of infection
Answer: C
Rationale: Clozapine carries a significant risk for agranulocytosis, necessitating strict
hematological monitoring. The REMS program requires weekly Absolute Neutrophil Count
(ANC) monitoring for the first six months of treatment. After six months of stable counts,
the frequency may be reduced to every two weeks, and eventually monthly.
3. A patient taking Phenelzine (an MAOI) is admitted to the ER with a severe headache,
palpitations, and a blood pressure of 210/120 mmHg. Which dietary indiscretion is the most
likely cause?
A. Consuming fresh green leafy vegetables
B. Eating a high-protein diet consisting of chicken and fish
C. Consuming aged cheeses and red wine
D. Consuming excessive amounts of caffeine
Answer: C
Rationale: MAOIs inhibit the breakdown of tyramine, which is found in high
concentrations in aged, fermented, or cured foods. Consuming aged cheeses and red wine
causes a massive release of norepinephrine, leading to a hypertensive crisis. This condition
,is a medical emergency that requires immediate treatment with alpha-adrenergic
antagonists.
4. A patient presents with ‘lead-pipe’ muscle rigidity, a temperature of 104°F, and altered
mental status shortly after starting 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, hyperthermia, and autonomic
instability. It is distinguished from Serotonin Syndrome by the presence of ‘lead-pipe’
rigidity rather than hyperreflexia and myoclonus. Management involves immediate
discontinuation of the antipsychotic and supportive care in an ICU setting.
5. Which of the following antidepressants is contraindicated in patients with a history of
seizure disorders or eating disorders?
A. Fluoxetine
B. Sertraline
C. Bupropion
, D. Mirtazapine
Answer: C
Rationale: Bupropion is known to lower the seizure threshold, particularly in patients
with electrolyte imbalances such as those seen in bulimia or anorexia nervosa. Its use is
strictly contraindicated in individuals with these conditions due to the high risk of grand
mal seizures. Clinicians should screen for these risk factors before initiating therapy with
this norepinephrine-dopamine reuptake inhibitor.
6. A PMHNP is treating a patient with Chronic Obstructive Pulmonary Disease (COPD) and
Generalized Anxiety Disorder. Which medication class should be avoided if possible due to
the risk of respiratory depression?
A. SSRIs
B. Buspirone
C. Benzodiazepines
D. Beta-blockers
Answer: C
Rationale: Benzodiazepines can suppress the respiratory drive, which is particularly
dangerous in patients with compromised pulmonary function like COPD. They also carry a
risk of physical dependence and cognitive impairment in older adults. Alternative
treatments like SSRIs or Buspirone are generally preferred for long-term anxiety
management in this population.
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Final Exam 2026)
1. A patient is prescribed Lithium for the management of Bipolar I Disorder. Which of the
following laboratory values is the primary concern for the PMHNP when assessing for
potential toxicity?
A. Serum lithium level of 1.6 mEq/L
B. Serum sodium level of 135 mEq/L
C. Creatinine level of 0.9 mg/dL
D. White blood cell count of 8,000/mm3
Answer: A
Rationale: The therapeutic window for Lithium is narrow, typically ranging from 0.6 to 1.2
mEq/L for maintenance. A level of 1.6 mEq/L indicates mild to moderate toxicity, which
requires immediate clinical intervention and dose adjustment. Toxic levels can lead to
severe neurological and renal complications if not addressed promptly.
2. When initiating Clozapine therapy, which laboratory monitoring schedule is strictly
mandated by the REMS program during the first six months?
A. Monthly CBC with differential
,B. Bi-weekly ANC (Absolute Neutrophil Count)
C. Weekly ANC (Absolute Neutrophil Count)
D. Baseline ANC only if the patient has no history of infection
Answer: C
Rationale: Clozapine carries a significant risk for agranulocytosis, necessitating strict
hematological monitoring. The REMS program requires weekly Absolute Neutrophil Count
(ANC) monitoring for the first six months of treatment. After six months of stable counts,
the frequency may be reduced to every two weeks, and eventually monthly.
3. A patient taking Phenelzine (an MAOI) is admitted to the ER with a severe headache,
palpitations, and a blood pressure of 210/120 mmHg. Which dietary indiscretion is the most
likely cause?
A. Consuming fresh green leafy vegetables
B. Eating a high-protein diet consisting of chicken and fish
C. Consuming aged cheeses and red wine
D. Consuming excessive amounts of caffeine
Answer: C
Rationale: MAOIs inhibit the breakdown of tyramine, which is found in high
concentrations in aged, fermented, or cured foods. Consuming aged cheeses and red wine
causes a massive release of norepinephrine, leading to a hypertensive crisis. This condition
,is a medical emergency that requires immediate treatment with alpha-adrenergic
antagonists.
4. A patient presents with ‘lead-pipe’ muscle rigidity, a temperature of 104°F, and altered
mental status shortly after starting 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, hyperthermia, and autonomic
instability. It is distinguished from Serotonin Syndrome by the presence of ‘lead-pipe’
rigidity rather than hyperreflexia and myoclonus. Management involves immediate
discontinuation of the antipsychotic and supportive care in an ICU setting.
5. Which of the following antidepressants is contraindicated in patients with a history of
seizure disorders or eating disorders?
A. Fluoxetine
B. Sertraline
C. Bupropion
, D. Mirtazapine
Answer: C
Rationale: Bupropion is known to lower the seizure threshold, particularly in patients
with electrolyte imbalances such as those seen in bulimia or anorexia nervosa. Its use is
strictly contraindicated in individuals with these conditions due to the high risk of grand
mal seizures. Clinicians should screen for these risk factors before initiating therapy with
this norepinephrine-dopamine reuptake inhibitor.
6. A PMHNP is treating a patient with Chronic Obstructive Pulmonary Disease (COPD) and
Generalized Anxiety Disorder. Which medication class should be avoided if possible due to
the risk of respiratory depression?
A. SSRIs
B. Buspirone
C. Benzodiazepines
D. Beta-blockers
Answer: C
Rationale: Benzodiazepines can suppress the respiratory drive, which is particularly
dangerous in patients with compromised pulmonary function like COPD. They also carry a
risk of physical dependence and cognitive impairment in older adults. Alternative
treatments like SSRIs or Buspirone are generally preferred for long-term anxiety
management in this population.
