NR-607 Final Examination – Diagnosis & Management in Psychiatric Mental
Health III
Total Questions: 100
Passing Score: 80% (80 correct)
1. A patient with schizophrenia has been stable on clozapine for 2 years. Routine
monitoring should include:
A. CBC with differential every 4 weeks
B. Liver function tests monthly
C. ECG every 6 months
D. Thyroid panel annually
Correct Answer: A
Rationale: Clozapine carries a 0.5–2% risk of agranulocytosis; absolute neutrophil count
(ANC) must be monitored every 4 weeks (or weekly for first 6 months, then every 4
weeks).
2. A 32-year-old with bipolar I disorder presents with rapid speech, decreased need for
sleep, and grandiosity for 5 days. Which medication is most appropriate acutely?
A. Fluoxetine
B. Lithium
C. Quetiapine
D. Lamotrigine
Correct Answer: C
Rationale: Acute mania requires an antipsychotic (e.g., quetiapine) or mood stabilizer;
lithium takes longer. Fluoxetine may worsen mania. Lamotrigine is for maintenance, not
acute.
,3. Which lab value is most critical to check before starting lithium?
A. TSH, BUN, creatinine, pregnancy test
B. CBC, LFTs, vitamin B12
C. ESR, CRP, ANA
D. Hemoglobin A1c, lipid panel
Correct Answer: A
Rationale: Lithium affects thyroid and kidney function; baseline TSH, creatinine, BUN,
and pregnancy test (teratogenic risk) are essential.
4. A 45-year-old with panic disorder has been on alprazolam 2 mg TID for 2 years. You
plan to taper. The safest next step is:
A. Switch to clonazepam and taper over 12 weeks
B. Discontinue alprazolam immediately
C. Reduce alprazolam by 0.5 mg every 2 days
D. Add buspirone and stop alprazolam in 1 week
Correct Answer: A
Rationale: Long-acting benzodiazepine (clonazepam) facilitates smoother taper; abrupt
withdrawal risks seizures. Slow taper over weeks to months.
5. A patient with PTSD reports nightmares and hypervigilance. Which medication has
FDA approval for PTSD?
A. Paroxetine
B. Propranolol
C. Prazosin
D. Clonidine
Correct Answer: A
Rationale: Paroxetine and sertraline are FDA-approved for PTSD. Prazosin is used off-
label for nightmares but not FDA-approved as monotherapy.
,6. Which finding is most suggestive of neuroleptic malignant syndrome (NMS)?
A. Dry mouth, urinary retention, constipation
B. Lead-pipe rigidity, fever, elevated CK, altered mental status
C. Involuntary lip smacking and tongue protrusion
D. Akathisia and restlessness
Correct Answer: B
Rationale: NMS triad: rigidity, hyperthermia, autonomic instability + elevated CK.
Tardive dyskinesia (C) is different.
7. A patient on valproate for bipolar disorder has a level of 120 mcg/mL. What is the
most likely adverse effect at this level?
A. Thrombocytopenia
B. Alopecia
C. Tremor and confusion
D. Weight gain
Correct Answer: C
Rationale: Valproate therapeutic range 50–125 mcg/mL; levels >100 increase risk of
tremor, ataxia, confusion. Thrombocytopenia can occur but is less dose-predictable.
8. Which of the following is a first-line treatment for bulimia nervosa?
A. Fluoxetine 60 mg daily
B. Olanzapine 10 mg daily
C. Topiramate 100 mg BID
D. Cognitive behavioral therapy (CBT) alone
Correct Answer: A
Rationale: Fluoxetine (60 mg) is FDA-approved for bulimia. CBT is effective but
medication is first-line when psychotherapy unavailable.
, 9. A 22-year-old with ADHD has hypertension (140/90). Which medication is preferred?
A. Mixed amphetamine salts
B. Methylphenidate
C. Lisdexamfetamine
D. Guanfacine
Correct Answer: D
Rationale: Guanfacine (alpha-2 agonist) is non-stimulant, less effect on BP, approved
for ADHD. Stimulants may worsen hypertension.
10. A patient with major depression and ECT referral has a history of increased
intracranial pressure. ECT is:
A. Contraindicated
B. Safe with pretreatment mannitol
C. Safe with lower stimulus dose
D. Safe only if unilateral
Correct Answer: A
Rationale: Increased ICP is an absolute contraindication to ECT due to risk of
herniation.
11. Which lab abnormality is associated with long-term lithium use?
A. Hypernatremia
B. Hypothyroidism
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale: Lithium inhibits thyroid hormone release and synthesis; 5–15% develop
hypothyroidism.
Health III
Total Questions: 100
Passing Score: 80% (80 correct)
1. A patient with schizophrenia has been stable on clozapine for 2 years. Routine
monitoring should include:
A. CBC with differential every 4 weeks
B. Liver function tests monthly
C. ECG every 6 months
D. Thyroid panel annually
Correct Answer: A
Rationale: Clozapine carries a 0.5–2% risk of agranulocytosis; absolute neutrophil count
(ANC) must be monitored every 4 weeks (or weekly for first 6 months, then every 4
weeks).
2. A 32-year-old with bipolar I disorder presents with rapid speech, decreased need for
sleep, and grandiosity for 5 days. Which medication is most appropriate acutely?
A. Fluoxetine
B. Lithium
C. Quetiapine
D. Lamotrigine
Correct Answer: C
Rationale: Acute mania requires an antipsychotic (e.g., quetiapine) or mood stabilizer;
lithium takes longer. Fluoxetine may worsen mania. Lamotrigine is for maintenance, not
acute.
,3. Which lab value is most critical to check before starting lithium?
A. TSH, BUN, creatinine, pregnancy test
B. CBC, LFTs, vitamin B12
C. ESR, CRP, ANA
D. Hemoglobin A1c, lipid panel
Correct Answer: A
Rationale: Lithium affects thyroid and kidney function; baseline TSH, creatinine, BUN,
and pregnancy test (teratogenic risk) are essential.
4. A 45-year-old with panic disorder has been on alprazolam 2 mg TID for 2 years. You
plan to taper. The safest next step is:
A. Switch to clonazepam and taper over 12 weeks
B. Discontinue alprazolam immediately
C. Reduce alprazolam by 0.5 mg every 2 days
D. Add buspirone and stop alprazolam in 1 week
Correct Answer: A
Rationale: Long-acting benzodiazepine (clonazepam) facilitates smoother taper; abrupt
withdrawal risks seizures. Slow taper over weeks to months.
5. A patient with PTSD reports nightmares and hypervigilance. Which medication has
FDA approval for PTSD?
A. Paroxetine
B. Propranolol
C. Prazosin
D. Clonidine
Correct Answer: A
Rationale: Paroxetine and sertraline are FDA-approved for PTSD. Prazosin is used off-
label for nightmares but not FDA-approved as monotherapy.
,6. Which finding is most suggestive of neuroleptic malignant syndrome (NMS)?
A. Dry mouth, urinary retention, constipation
B. Lead-pipe rigidity, fever, elevated CK, altered mental status
C. Involuntary lip smacking and tongue protrusion
D. Akathisia and restlessness
Correct Answer: B
Rationale: NMS triad: rigidity, hyperthermia, autonomic instability + elevated CK.
Tardive dyskinesia (C) is different.
7. A patient on valproate for bipolar disorder has a level of 120 mcg/mL. What is the
most likely adverse effect at this level?
A. Thrombocytopenia
B. Alopecia
C. Tremor and confusion
D. Weight gain
Correct Answer: C
Rationale: Valproate therapeutic range 50–125 mcg/mL; levels >100 increase risk of
tremor, ataxia, confusion. Thrombocytopenia can occur but is less dose-predictable.
8. Which of the following is a first-line treatment for bulimia nervosa?
A. Fluoxetine 60 mg daily
B. Olanzapine 10 mg daily
C. Topiramate 100 mg BID
D. Cognitive behavioral therapy (CBT) alone
Correct Answer: A
Rationale: Fluoxetine (60 mg) is FDA-approved for bulimia. CBT is effective but
medication is first-line when psychotherapy unavailable.
, 9. A 22-year-old with ADHD has hypertension (140/90). Which medication is preferred?
A. Mixed amphetamine salts
B. Methylphenidate
C. Lisdexamfetamine
D. Guanfacine
Correct Answer: D
Rationale: Guanfacine (alpha-2 agonist) is non-stimulant, less effect on BP, approved
for ADHD. Stimulants may worsen hypertension.
10. A patient with major depression and ECT referral has a history of increased
intracranial pressure. ECT is:
A. Contraindicated
B. Safe with pretreatment mannitol
C. Safe with lower stimulus dose
D. Safe only if unilateral
Correct Answer: A
Rationale: Increased ICP is an absolute contraindication to ECT due to risk of
herniation.
11. Which lab abnormality is associated with long-term lithium use?
A. Hypernatremia
B. Hypothyroidism
C. Hypercalcemia
D. Hypomagnesemia
Correct Answer: B
Rationale: Lithium inhibits thyroid hormone release and synthesis; 5–15% develop
hypothyroidism.
