NR605 Exam 3 Actual Exam Style V3 | NR 605
Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan | Chamberlain
1. A 24-year-old female patient is being treated for schizophrenia. She presents with
significant muscle rigidity, a temperature of 103.5°F, and autonomic instability. Which
of the following is the most likely diagnosis?
A. Serotonin Syndrome
B. Acute Dystonia
C. Neuroleptic Malignant Syndrome
D. Anticholinergic Toxicity
Correct Answer: C
Expert Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening
reaction to antipsychotic medication characterized by high fever, rigidity, and
autonomic instability. Unlike serotonin syndrome, NMS typically presents with
‘lead-pipe’ rigidity rather than hyperreflexia or myoclonus. Immediate cessation of
the causative agent and supportive care are the primary treatments for this
psychiatric emergency.
,2. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Correct Answer: A
Expert Explanation: The mesolimbic pathway involves the projection of dopamine
from the ventral tegmental area to the nucleus accumbens. Hyperactivity in this
specific pathway is strongly associated with the positive symptoms of
schizophrenia. Modern antipsychotics aim to reduce dopamine activity in this area
to alleviate these psychotic symptoms.
3. A PMHNP is considering starting Clozapine for a patient with treatment-resistant
schizophrenia. What is the absolute neutrophil count (ANC) threshold required to
initiate treatment?
A. At least 1,500/mm³
B. At least 1,000/mm³
C. At least 2,000/mm³
,D. At least 500/mm³
Correct Answer: A
Expert Explanation: For the general population, the ANC must be at least
1,500/mm³ to initiate Clozapine therapy according to FDA safety protocols. This
stringent monitoring is necessary due to the risk of severe neutropenia and
agranulocytosis. Regular blood monitoring continues throughout the duration of
treatment to ensure patient safety.
4. In the treatment of Bipolar I Disorder, which medication is specifically FDA-
approved for the prevention of depressive episodes rather than acute mania?
A. Lamotrigine
B. Valproate
C. Lithium
D. Quetiapine
Correct Answer: A
Expert Explanation: Lamotrigine is primarily used as maintenance therapy for
Bipolar I Disorder to delay the time to occurrence of mood episodes, specifically
depression. It is not indicated for the treatment of acute mania due to the required
slow titration to avoid Stevens-Johnson Syndrome. Clinicians must educate patients
on the signs of a rash during the initial weeks of therapy.
, 5. A 65-year-old patient presents with symptoms of Major Depressive Disorder. Which
class of antidepressants is generally avoided as a first-line treatment in the elderly due
to significant anticholinergic side effects?
A. Selective Serotonin Reuptake Inhibitors (SSRIs)
B. Tricyclic Antidepressants (TCAs)
C. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
D. Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)
Correct Answer: B
Expert Explanation: Tricyclic antidepressants are often avoided in the elderly
because they pose a high risk of sedation, orthostatic hypotension, and
anticholinergic effects like urinary retention. These side effects can lead to an
increased risk of falls and cognitive impairment in older populations. SSRIs or SNRIs
are typically preferred first-line options for geriatric depression.
6. A patient taking Lithium for Bipolar Disorder presents with coarse tremors, ataxia,
and confusion. Their serum lithium level is 2.2 mEq/L. What is the most appropriate
next step?
A. Hold the dose and initiate hydration
B. Reduce the dose and recheck in one week
Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan | Chamberlain
1. A 24-year-old female patient is being treated for schizophrenia. She presents with
significant muscle rigidity, a temperature of 103.5°F, and autonomic instability. Which
of the following is the most likely diagnosis?
A. Serotonin Syndrome
B. Acute Dystonia
C. Neuroleptic Malignant Syndrome
D. Anticholinergic Toxicity
Correct Answer: C
Expert Explanation: Neuroleptic Malignant Syndrome (NMS) is a life-threatening
reaction to antipsychotic medication characterized by high fever, rigidity, and
autonomic instability. Unlike serotonin syndrome, NMS typically presents with
‘lead-pipe’ rigidity rather than hyperreflexia or myoclonus. Immediate cessation of
the causative agent and supportive care are the primary treatments for this
psychiatric emergency.
,2. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Correct Answer: A
Expert Explanation: The mesolimbic pathway involves the projection of dopamine
from the ventral tegmental area to the nucleus accumbens. Hyperactivity in this
specific pathway is strongly associated with the positive symptoms of
schizophrenia. Modern antipsychotics aim to reduce dopamine activity in this area
to alleviate these psychotic symptoms.
3. A PMHNP is considering starting Clozapine for a patient with treatment-resistant
schizophrenia. What is the absolute neutrophil count (ANC) threshold required to
initiate treatment?
A. At least 1,500/mm³
B. At least 1,000/mm³
C. At least 2,000/mm³
,D. At least 500/mm³
Correct Answer: A
Expert Explanation: For the general population, the ANC must be at least
1,500/mm³ to initiate Clozapine therapy according to FDA safety protocols. This
stringent monitoring is necessary due to the risk of severe neutropenia and
agranulocytosis. Regular blood monitoring continues throughout the duration of
treatment to ensure patient safety.
4. In the treatment of Bipolar I Disorder, which medication is specifically FDA-
approved for the prevention of depressive episodes rather than acute mania?
A. Lamotrigine
B. Valproate
C. Lithium
D. Quetiapine
Correct Answer: A
Expert Explanation: Lamotrigine is primarily used as maintenance therapy for
Bipolar I Disorder to delay the time to occurrence of mood episodes, specifically
depression. It is not indicated for the treatment of acute mania due to the required
slow titration to avoid Stevens-Johnson Syndrome. Clinicians must educate patients
on the signs of a rash during the initial weeks of therapy.
, 5. A 65-year-old patient presents with symptoms of Major Depressive Disorder. Which
class of antidepressants is generally avoided as a first-line treatment in the elderly due
to significant anticholinergic side effects?
A. Selective Serotonin Reuptake Inhibitors (SSRIs)
B. Tricyclic Antidepressants (TCAs)
C. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
D. Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)
Correct Answer: B
Expert Explanation: Tricyclic antidepressants are often avoided in the elderly
because they pose a high risk of sedation, orthostatic hypotension, and
anticholinergic effects like urinary retention. These side effects can lead to an
increased risk of falls and cognitive impairment in older populations. SSRIs or SNRIs
are typically preferred first-line options for geriatric depression.
6. A patient taking Lithium for Bipolar Disorder presents with coarse tremors, ataxia,
and confusion. Their serum lithium level is 2.2 mEq/L. What is the most appropriate
next step?
A. Hold the dose and initiate hydration
B. Reduce the dose and recheck in one week
