NURS 660 Final Exam V1 | 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 initiated on Clozapine (Clozaril) must have their Absolute Neutrophil Count (ANC)
monitored regularly. Which ANC level requires immediate discontinuation of the medication
according to the Clozapine REMS program?
A. ANC < 2000/mm³
B. ANC < 1500/mm³
C. ANC < 1000/mm³
D. ANC < 500/mm³
Answer: C
Rationale: The Clozapine REMS program specifies that for the general population,
treatment must be interrupted if the ANC falls below 1000/mm³. This threshold is critical
to prevent severe neutropenia and potential life-threatening infections. Healthcare
providers must follow strict monitoring protocols to ensure patient safety while on this
second-generation antipsychotic.
,2. Which antidepressant is most likely to cause a significant increase in blood pressure,
particularly at higher doses?
A. Venlafaxine
B. Escitalopram
C. Mirtazapine
D. Bupropion
Answer: A
Rationale: Venlafaxine is a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) that can
increase blood pressure due to its noradrenergic effects. This effect is dose-dependent and
more common at doses exceeding 225 mg per day. Monitoring blood pressure is essential
for all patients prescribed SNRIs to mitigate cardiovascular risks.
3. A 24-year-old female patient with Bipolar I Disorder is being treated with Valproate. What
is the most significant concern regarding the use of this medication in a patient of
childbearing age?
A. Risk of Stevens-Johnson Syndrome
B. High risk of neural tube defects (teratogenicity)
C. Risk of polycystic ovary syndrome (PCOS)
D. Increased risk of agranulocytosis
Answer: B
, Rationale: Valproate is associated with a high risk of teratogenicity, specifically neural
tube defects like spina bifida. The risk is significantly higher compared to other mood
stabilizers, making it a last-resort option for women of childbearing potential. Education on
effective contraception and folic acid supplementation is mandatory for this demographic.
4. Lithium toxicity is a medical emergency. At what serum level do symptoms typically
become severe, including seizures and coma?
A. 0.8 - 1.2 mEq/L
B. > 2.5 mEq/L
C. 2.0 - 2.5 mEq/L
D. 1.5 - 2.0 mEq/L
Answer: B
Rationale: Lithium levels above 2.5 mEq/L are considered severe toxicity and may require
hemodialysis. Symptoms at this level include complex neurological impairment, cardiac
arrhythmias, and multi-organ failure. Close monitoring of renal function and hydration
status is necessary to prevent these dangerous peaks.
5. A patient is experiencing ‘wet’ side effects (excessive salivation) while taking Clozapine.
Which medication is commonly used to treat this specific side effect?
A. Benztropine
B. Propranolol
C. Atropine drops (ophthalmic solution used sublingually)
Psychopharmacology and Advanced
Mental Health | Maryville University of
St. Louis | 2026 Q&A with Rationale
(Maryville NURS660 Final Exam 2026)
1. A patient initiated on Clozapine (Clozaril) must have their Absolute Neutrophil Count (ANC)
monitored regularly. Which ANC level requires immediate discontinuation of the medication
according to the Clozapine REMS program?
A. ANC < 2000/mm³
B. ANC < 1500/mm³
C. ANC < 1000/mm³
D. ANC < 500/mm³
Answer: C
Rationale: The Clozapine REMS program specifies that for the general population,
treatment must be interrupted if the ANC falls below 1000/mm³. This threshold is critical
to prevent severe neutropenia and potential life-threatening infections. Healthcare
providers must follow strict monitoring protocols to ensure patient safety while on this
second-generation antipsychotic.
,2. Which antidepressant is most likely to cause a significant increase in blood pressure,
particularly at higher doses?
A. Venlafaxine
B. Escitalopram
C. Mirtazapine
D. Bupropion
Answer: A
Rationale: Venlafaxine is a Serotonin-Norepinephrine Reuptake Inhibitor (SNRI) that can
increase blood pressure due to its noradrenergic effects. This effect is dose-dependent and
more common at doses exceeding 225 mg per day. Monitoring blood pressure is essential
for all patients prescribed SNRIs to mitigate cardiovascular risks.
3. A 24-year-old female patient with Bipolar I Disorder is being treated with Valproate. What
is the most significant concern regarding the use of this medication in a patient of
childbearing age?
A. Risk of Stevens-Johnson Syndrome
B. High risk of neural tube defects (teratogenicity)
C. Risk of polycystic ovary syndrome (PCOS)
D. Increased risk of agranulocytosis
Answer: B
, Rationale: Valproate is associated with a high risk of teratogenicity, specifically neural
tube defects like spina bifida. The risk is significantly higher compared to other mood
stabilizers, making it a last-resort option for women of childbearing potential. Education on
effective contraception and folic acid supplementation is mandatory for this demographic.
4. Lithium toxicity is a medical emergency. At what serum level do symptoms typically
become severe, including seizures and coma?
A. 0.8 - 1.2 mEq/L
B. > 2.5 mEq/L
C. 2.0 - 2.5 mEq/L
D. 1.5 - 2.0 mEq/L
Answer: B
Rationale: Lithium levels above 2.5 mEq/L are considered severe toxicity and may require
hemodialysis. Symptoms at this level include complex neurological impairment, cardiac
arrhythmias, and multi-organ failure. Close monitoring of renal function and hydration
status is necessary to prevent these dangerous peaks.
5. A patient is experiencing ‘wet’ side effects (excessive salivation) while taking Clozapine.
Which medication is commonly used to treat this specific side effect?
A. Benztropine
B. Propranolol
C. Atropine drops (ophthalmic solution used sublingually)
