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

Reduce the clozapine dose by 50%

Answer

Continue clozapine and recheck WBC in 1 week

Answer

Add prophylactic G-CSF and continue clozapine

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

Amitriptyline

Answer

Paroxetine

Answer

Doxepin

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

Administer activated charcoal

Answer

Hold one dose and recheck in 6 hours

Answer

Reduce the lithium dose and add an antiemetic

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

Full D2 receptor antagonism

Answer

D1 receptor full agonism

Answer

Selective serotonin reuptake inhibition

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 safe during the first trimester only

Answer

Folate supplementation eliminates valproate's teratogenic risk

Answer

Valproate is preferred over lithium in pregnancy

Question 6

Which medication requires monitoring of fasting glucose and HbA1c due to its high risk of causing metabolic syndrome?

Accepted Answer

Olanzapine

Answer

Ziprasidone

Answer

Aripiprazole

Answer

Haloperidol

Question 7

A patient taking phenelzine eats a meal containing aged cheese and develops a severe hypertensive crisis. What is the pharmacological explanation?

Accepted Answer

MAO inhibition prevents tyramine breakdown, causing massive norepinephrine release

Answer

Phenelzine inhibits dopamine beta-hydroxylase, concentrating dopamine

Answer

Phenelzine blocks alpha-2 receptors, enhancing norepinephrine release

Answer

Cheese directly inhibits MAO-B, potentiating phenelzine's effects