NR605 Exam 2 Actual Exam Style V3 | NR 605
Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan | Chamberlain
1. A 28-year-old female patient with treatment-resistant schizophrenia is being
started on Clozapine. Which of the following lab values must be monitored according
to the REMS protocol?
A. Absolute Neutrophil Count (ANC)
B. Platelet Count
C. Liver Function Tests (LFTs)
D. Serum Creatinine
Correct Answer: A
Expert Explanation: Clozapine carries a significant risk for severe neutropenia,
which can lead to life-threatening infections. The Clozapine REMS program requires
baseline and ongoing monitoring of the Absolute Neutrophil Count (ANC) to ensure
patient safety. If the ANC drops below 1500/mm3 in a non-benign ethnic
neutropenia patient, treatment must be interrupted or modified based on specific
protocols.
,2. A 34-year-old male patient with Bipolar I Disorder presents with coarse tremors,
ataxia, and confusion. His current medications include Lithium 600 mg BID. Which of
the following is the most likely cause?
A. Lithium Toxicity
B. Serotonin Syndrome
C. Neuroleptic Malignant Syndrome
D. Anticholinergic Toxicity
Correct Answer: A
Expert Explanation: Lithium has a narrow therapeutic index, typically between 0.6
and 1.2 mEq/L for maintenance. Symptoms of toxicity such as ataxia, coarse
tremors, and confusion usually occur when levels exceed 1.5 mEq/L. It is critical to
obtain a serum lithium level immediately and initiate supportive care or
hemodialysis depending on the severity.
3. A 19-year-old college student is prescribed Lamotrigine for Bipolar II depression.
Which education point is most critical regarding the risk of Stevens-Johnson Syndrome
(SJS)?
A. Stop the medication immediately if any new rash or skin peeling occurs.
B. Take the medication with a high-fat meal to increase absorption.
,C. Double the dose if a single day is missed to maintain blood levels.
D. Wait at least six months before checking any laboratory blood work.
Correct Answer: A
Expert Explanation: Lamotrigine is associated with a rare but life-threatening
dermatological reaction known as Stevens-Johnson Syndrome. Patients must be
educated to monitor for any new rash, especially during the first eight weeks of
titration. Immediate discontinuation and medical evaluation are necessary because
the rash can rapidly progress to toxic epidermal necrolysis.
4. A patient is taking Phenelzine (an MAOI) and mistakenly consumes aged cheese and
red wine. They present to the ER with a pounding headache and a BP of 210/120.
What is the diagnosis?
A. Hypertensive Crisis
B. Panic Attack
C. Serotonin Syndrome
D. Acute Ischemic Stroke
Correct Answer: A
Expert Explanation: MAOIs inhibit the breakdown of tyramine, which is found in
high quantities in aged and fermented foods. High levels of tyramine cause a
, massive release of norepinephrine, leading to severe vasoconstriction and
hypertensive crisis. Treatment typically involves the administration of an alpha-
adrenergic antagonist like phentolamine.
5. Which antidepressant is most likely to cause a seizure if prescribed to a patient with
a history of Bulimia Nervosa?
A. Fluoxetine
B. Bupropion
C. Sertraline
D. Venlafaxine
Correct Answer: B
Expert Explanation: Bupropion is contraindicated in patients with eating disorders
like Bulimia or Anorexia Nervosa. The medication lowers the seizure threshold
significantly in patients prone to electrolyte imbalances. Therefore, clinicians must
screen for eating disorders and seizure history before initiating Bupropion therapy.
6. A 72-year-old patient on Paroxetine presents with lethargy, confusion, and a serum
sodium level of 122 mEq/L. What is the likely cause?
A. Dehydration
B. SIADH
Diagnosis & Management in Psychiatric-Mental
Health across the Lifespan | Chamberlain
1. A 28-year-old female patient with treatment-resistant schizophrenia is being
started on Clozapine. Which of the following lab values must be monitored according
to the REMS protocol?
A. Absolute Neutrophil Count (ANC)
B. Platelet Count
C. Liver Function Tests (LFTs)
D. Serum Creatinine
Correct Answer: A
Expert Explanation: Clozapine carries a significant risk for severe neutropenia,
which can lead to life-threatening infections. The Clozapine REMS program requires
baseline and ongoing monitoring of the Absolute Neutrophil Count (ANC) to ensure
patient safety. If the ANC drops below 1500/mm3 in a non-benign ethnic
neutropenia patient, treatment must be interrupted or modified based on specific
protocols.
,2. A 34-year-old male patient with Bipolar I Disorder presents with coarse tremors,
ataxia, and confusion. His current medications include Lithium 600 mg BID. Which of
the following is the most likely cause?
A. Lithium Toxicity
B. Serotonin Syndrome
C. Neuroleptic Malignant Syndrome
D. Anticholinergic Toxicity
Correct Answer: A
Expert Explanation: Lithium has a narrow therapeutic index, typically between 0.6
and 1.2 mEq/L for maintenance. Symptoms of toxicity such as ataxia, coarse
tremors, and confusion usually occur when levels exceed 1.5 mEq/L. It is critical to
obtain a serum lithium level immediately and initiate supportive care or
hemodialysis depending on the severity.
3. A 19-year-old college student is prescribed Lamotrigine for Bipolar II depression.
Which education point is most critical regarding the risk of Stevens-Johnson Syndrome
(SJS)?
A. Stop the medication immediately if any new rash or skin peeling occurs.
B. Take the medication with a high-fat meal to increase absorption.
,C. Double the dose if a single day is missed to maintain blood levels.
D. Wait at least six months before checking any laboratory blood work.
Correct Answer: A
Expert Explanation: Lamotrigine is associated with a rare but life-threatening
dermatological reaction known as Stevens-Johnson Syndrome. Patients must be
educated to monitor for any new rash, especially during the first eight weeks of
titration. Immediate discontinuation and medical evaluation are necessary because
the rash can rapidly progress to toxic epidermal necrolysis.
4. A patient is taking Phenelzine (an MAOI) and mistakenly consumes aged cheese and
red wine. They present to the ER with a pounding headache and a BP of 210/120.
What is the diagnosis?
A. Hypertensive Crisis
B. Panic Attack
C. Serotonin Syndrome
D. Acute Ischemic Stroke
Correct Answer: A
Expert Explanation: MAOIs inhibit the breakdown of tyramine, which is found in
high quantities in aged and fermented foods. High levels of tyramine cause a
, massive release of norepinephrine, leading to severe vasoconstriction and
hypertensive crisis. Treatment typically involves the administration of an alpha-
adrenergic antagonist like phentolamine.
5. Which antidepressant is most likely to cause a seizure if prescribed to a patient with
a history of Bulimia Nervosa?
A. Fluoxetine
B. Bupropion
C. Sertraline
D. Venlafaxine
Correct Answer: B
Expert Explanation: Bupropion is contraindicated in patients with eating disorders
like Bulimia or Anorexia Nervosa. The medication lowers the seizure threshold
significantly in patients prone to electrolyte imbalances. Therefore, clinicians must
screen for eating disorders and seizure history before initiating Bupropion therapy.
6. A 72-year-old patient on Paroxetine presents with lethargy, confusion, and a serum
sodium level of 122 mEq/L. What is the likely cause?
A. Dehydration
B. SIADH
