NSG 552 EXAM 3 – WILKES
PSYCHOPHARMACOLOGY
COMPREHENSIVE QUESTIONS AND
ANSWERS
1. A 28-year-old female patient with Bipolar I Disorder is planning to become pregnant.
Which of the following mood stabilizers is associated with the highest risk of neural tube
defects?
A. Valproate
B. Lithium
C. Lamotrigine
D. Carbamazepine
Answer: A
Conceptual Explanation: Valproate carries a significant risk of teratogenicity, specifically
neural tube defects like spina bifida, estimated at 1-2%. Lithium is associated with
Ebstein’s anomaly, but the risk is lower than previously thought.
,2. When initiating Lamotrigine in a patient already taking Valproate, how should the PMHNP
adjust the titration schedule?
A. Start at 50 mg every other day
B. Start at 25 mg daily
C. Start at 25 mg every other day
D. Double the standard starting dose
Answer: C
Conceptual Explanation: Valproate inhibits the metabolism of Lamotrigine, doubling its
blood levels. Therefore, the starting dose of Lamotrigine must be reduced by half (25 mg
every other day) to decrease the risk of Stevens-Johnson Syndrome.
3. Which of the following laboratory parameters is most critical to monitor for a patient
prescribed Carbamazepine?
A. Thyroid Stimulating Hormone (TSH)
B. Serum Creatinine
C. Absolute Neutrophil Count (ANC)
D. Hemoglobin A1c
Answer: C
, Conceptual Explanation: Carbamazepine is associated with rare but serious blood
dyscrasias, including agranulocytosis and aplastic anemia. Frequent monitoring of CBC and
ANC is essential.
4. A patient taking Lithium presents with a fine tremor, polyuria, and mild nausea. Their
serum lithium level is 0.9 mEq/L. What is the most appropriate next step?
A. Discontinue Lithium immediately
B. Reassure the patient these are common side effects within the therapeutic range
C. Decrease the dose and reassess
D. Administer activated charcoal
Answer: B
Conceptual Explanation: A level of 0.9 mEq/L is within the standard therapeutic range
(0.6-1.2 mEq/L). Fine tremors, polyuria, and nausea are common side effects that often
occur even at therapeutic levels.
5. Which antidepressant mechanism of action involves the antagonism of Alpha-2 adrenergic
receptors?
A. Venlafaxine
B. Mirtazapine
C. Bupropion
D. Fluoxetine
PSYCHOPHARMACOLOGY
COMPREHENSIVE QUESTIONS AND
ANSWERS
1. A 28-year-old female patient with Bipolar I Disorder is planning to become pregnant.
Which of the following mood stabilizers is associated with the highest risk of neural tube
defects?
A. Valproate
B. Lithium
C. Lamotrigine
D. Carbamazepine
Answer: A
Conceptual Explanation: Valproate carries a significant risk of teratogenicity, specifically
neural tube defects like spina bifida, estimated at 1-2%. Lithium is associated with
Ebstein’s anomaly, but the risk is lower than previously thought.
,2. When initiating Lamotrigine in a patient already taking Valproate, how should the PMHNP
adjust the titration schedule?
A. Start at 50 mg every other day
B. Start at 25 mg daily
C. Start at 25 mg every other day
D. Double the standard starting dose
Answer: C
Conceptual Explanation: Valproate inhibits the metabolism of Lamotrigine, doubling its
blood levels. Therefore, the starting dose of Lamotrigine must be reduced by half (25 mg
every other day) to decrease the risk of Stevens-Johnson Syndrome.
3. Which of the following laboratory parameters is most critical to monitor for a patient
prescribed Carbamazepine?
A. Thyroid Stimulating Hormone (TSH)
B. Serum Creatinine
C. Absolute Neutrophil Count (ANC)
D. Hemoglobin A1c
Answer: C
, Conceptual Explanation: Carbamazepine is associated with rare but serious blood
dyscrasias, including agranulocytosis and aplastic anemia. Frequent monitoring of CBC and
ANC is essential.
4. A patient taking Lithium presents with a fine tremor, polyuria, and mild nausea. Their
serum lithium level is 0.9 mEq/L. What is the most appropriate next step?
A. Discontinue Lithium immediately
B. Reassure the patient these are common side effects within the therapeutic range
C. Decrease the dose and reassess
D. Administer activated charcoal
Answer: B
Conceptual Explanation: A level of 0.9 mEq/L is within the standard therapeutic range
(0.6-1.2 mEq/L). Fine tremors, polyuria, and nausea are common side effects that often
occur even at therapeutic levels.
5. Which antidepressant mechanism of action involves the antagonism of Alpha-2 adrenergic
receptors?
A. Venlafaxine
B. Mirtazapine
C. Bupropion
D. Fluoxetine
