NR605 Exam 2 Actual Exam Style V2 | NR 605
Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan | Chamberlain
1. A 28-year-old female patient is being started on Lamotrigine for Bipolar II disorder.
What is the most important education to provide regarding potential skin reactions?
A. A mild rash is expected and will resolve on its own within a week.
B. The risk of rash is only present if the medication is taken on an empty stomach.
C. Apply hydrocortisone cream to any red areas that appear during the first month.
D. Stop the medication immediately and seek emergency care if any rash or mucosal
involvement occurs.
Correct Answer: D
Expert Explanation: Lamotrigine is associated with a risk of Stevens-Johnson
Syndrome, which is a life-threatening dermatological emergency. Patients must be
taught to identify the early signs of a serious rash, including blistering or
involvement of the mouth and eyes. Immediate discontinuation and medical
evaluation are necessary to prevent progression to toxic epidermal necrolysis.
2. When monitoring a patient on Lithium carbonate, which of the following lab values
should the PMHNP prioritize to assess for potential toxicity?
A. Alanine aminotransferase (ALT)
,B. Fasted blood glucose levels
C. Complete blood count with differential
D. Serum sodium and creatinine
Correct Answer: D
Expert Explanation: Lithium is primarily excreted by the kidneys, making renal
function monitoring essential for safety. Changes in serum sodium levels can
significantly impact lithium clearance, leading to potential toxicity or subtherapeutic
levels. Regular monitoring of creatinine and electrolytes helps ensure the patient
remains within the narrow therapeutic index of the drug.
3. A 45-year-old male complains of sexual dysfunction after starting Sertraline for
Major Depressive Disorder. Which strategy is most appropriate to manage this side
effect?
A. Consider adding Bupropion as an adjunctive treatment or switching to it.
B. Switch the patient to a different SSRI like Paroxetine.
C. Advise the patient to stop the medication immediately without tapering.
D. Instruct the patient that the side effect will likely disappear within 48 hours.
Correct Answer: A
,Expert Explanation: Sexual dysfunction is a common reason for non-adherence
with SSRI therapy in patients with depression. Bupropion is often used because it
does not have significant serotonergic activity and may even improve sexual
function. This approach allows for continued antidepressant coverage while
addressing the patient’s quality-of-life concerns.
4. Which neurotransmitter is primarily targeted by First-Generation Antipsychotics
(FGAs) to reduce positive symptoms of schizophrenia?
A. Serotonin (5-HT2A)
B. Dopamine (D2)
C. Norepinephrine
D. GABA
Correct Answer: B
Expert Explanation: First-Generation Antipsychotics work primarily by blocking
D2 receptors in the mesolimbic pathway of the brain. While this effectively reduces
hallucinations and delusions, it also leads to blockade in the nigrostriatal pathway.
This lack of selectivity is what causes the high incidence of extrapyramidal
symptoms seen with these older medications.
, 5. A patient is experiencing severe muscle rigidity, high fever, and autonomic
instability after an increase in Haloperidol dosage. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Toxicity
C. Neuroleptic Malignant Syndrome (NMS)
D. Acute Dystonic Reaction
Correct Answer: C
Expert Explanation: Neuroleptic Malignant Syndrome is a rare but life-threatening
reaction to antipsychotic medications. It is characterized by the ‘lead-pipe’ muscle
rigidity and hyperthermia mentioned in the clinical presentation. Immediate
treatment involves stopping the causative agent, providing supportive care, and
potentially administering dantrolene or bromocriptine.
6. Which medication is considered a first-line treatment for a patient diagnosed with
Generalized Anxiety Disorder (GAD)?
A. Alprazolam
B. Escitalopram
C. Quetiapine
D. Diphenhydramine
Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan | Chamberlain
1. A 28-year-old female patient is being started on Lamotrigine for Bipolar II disorder.
What is the most important education to provide regarding potential skin reactions?
A. A mild rash is expected and will resolve on its own within a week.
B. The risk of rash is only present if the medication is taken on an empty stomach.
C. Apply hydrocortisone cream to any red areas that appear during the first month.
D. Stop the medication immediately and seek emergency care if any rash or mucosal
involvement occurs.
Correct Answer: D
Expert Explanation: Lamotrigine is associated with a risk of Stevens-Johnson
Syndrome, which is a life-threatening dermatological emergency. Patients must be
taught to identify the early signs of a serious rash, including blistering or
involvement of the mouth and eyes. Immediate discontinuation and medical
evaluation are necessary to prevent progression to toxic epidermal necrolysis.
2. When monitoring a patient on Lithium carbonate, which of the following lab values
should the PMHNP prioritize to assess for potential toxicity?
A. Alanine aminotransferase (ALT)
,B. Fasted blood glucose levels
C. Complete blood count with differential
D. Serum sodium and creatinine
Correct Answer: D
Expert Explanation: Lithium is primarily excreted by the kidneys, making renal
function monitoring essential for safety. Changes in serum sodium levels can
significantly impact lithium clearance, leading to potential toxicity or subtherapeutic
levels. Regular monitoring of creatinine and electrolytes helps ensure the patient
remains within the narrow therapeutic index of the drug.
3. A 45-year-old male complains of sexual dysfunction after starting Sertraline for
Major Depressive Disorder. Which strategy is most appropriate to manage this side
effect?
A. Consider adding Bupropion as an adjunctive treatment or switching to it.
B. Switch the patient to a different SSRI like Paroxetine.
C. Advise the patient to stop the medication immediately without tapering.
D. Instruct the patient that the side effect will likely disappear within 48 hours.
Correct Answer: A
,Expert Explanation: Sexual dysfunction is a common reason for non-adherence
with SSRI therapy in patients with depression. Bupropion is often used because it
does not have significant serotonergic activity and may even improve sexual
function. This approach allows for continued antidepressant coverage while
addressing the patient’s quality-of-life concerns.
4. Which neurotransmitter is primarily targeted by First-Generation Antipsychotics
(FGAs) to reduce positive symptoms of schizophrenia?
A. Serotonin (5-HT2A)
B. Dopamine (D2)
C. Norepinephrine
D. GABA
Correct Answer: B
Expert Explanation: First-Generation Antipsychotics work primarily by blocking
D2 receptors in the mesolimbic pathway of the brain. While this effectively reduces
hallucinations and delusions, it also leads to blockade in the nigrostriatal pathway.
This lack of selectivity is what causes the high incidence of extrapyramidal
symptoms seen with these older medications.
, 5. A patient is experiencing severe muscle rigidity, high fever, and autonomic
instability after an increase in Haloperidol dosage. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Anticholinergic Toxicity
C. Neuroleptic Malignant Syndrome (NMS)
D. Acute Dystonic Reaction
Correct Answer: C
Expert Explanation: Neuroleptic Malignant Syndrome is a rare but life-threatening
reaction to antipsychotic medications. It is characterized by the ‘lead-pipe’ muscle
rigidity and hyperthermia mentioned in the clinical presentation. Immediate
treatment involves stopping the causative agent, providing supportive care, and
potentially administering dantrolene or bromocriptine.
6. Which medication is considered a first-line treatment for a patient diagnosed with
Generalized Anxiety Disorder (GAD)?
A. Alprazolam
B. Escitalopram
C. Quetiapine
D. Diphenhydramine
