Psychiatric-Mental Health Nurse Practitioner Exam Medications 2

Question 1

A patient on clozapine develops a WBC of 2,800/mm³. What is the most appropriate action?

Accepted Answer

Discontinue clozapine immediately and do not rechallenge

Answer

A WBC below 3,000/mm³ indicates agranulocytosis risk; clozapine must be stopped immediately and is permanently contraindicated for that patient.

Question 2

Which antidepressant is most appropriate for a patient with major depressive disorder who also has significant insomnia but cannot tolerate anticholinergic side effects?

Accepted Answer

Mirtazapine

Answer

Mirtazapine is highly sedating via H1 antagonism and has minimal anticholinergic activity, making it suitable for patients needing sleep aid without anticholinergic burden.

Question 3

A patient prescribed lithium develops nausea, vomiting, coarse tremor, and confusion. Serum lithium level is 2.1 mEq/L. What is the priority intervention?

Accepted Answer

Initiate hemodialysis

Answer

A lithium level above 2.0 mEq/L with severe neurological symptoms requires hemodialysis to rapidly remove lithium, as lithium is not bound to activated charcoal.

Question 4

Which of the following is the mechanism of action of aripiprazole that differentiates it from most other second-generation antipsychotics?

Accepted Answer

D2 receptor partial agonism

Answer

Aripiprazole acts as a partial agonist at D2 and D3 receptors, stabilizing dopamine activity rather than fully blocking it, which reduces EPS risk.

Question 5

A woman of childbearing potential is being started on valproate for bipolar disorder. What is the most critical counseling point?

Accepted Answer

Valproate carries a high risk of neural tube defects and requires reliable contraception

Answer

Valproate is a major teratogen associated with neural tube defects (spina bifida), cognitive impairment in offspring, and requires a REMS program with mandatory contraception.

Psychiatric-Mental Health Nurse Practitioner Exam Practice Test

Psychiatric-Mental Health Nurse Practitioner Exam Practice Test

Psychiatric-Mental Health Nurse Practitioner Exam Medications 2