MIDTERM EXAM: NR546/ NR 546
PSYCHOPHARMACOLOGY FOR THE
PSYCHIATRIC-MENTAL HEALTH NURSE
PRACTITIONER | QUESTIONS AND
VERIFIED ANSWERS| NEW!! 2026 UPDATE–
CHAMBERLAIN
1. Is nicotine an inducer or an inhibitor of the CYP1A2 enzyme?
A. Inhibitor
B. Inducer
C. Neutral
D. Substrate
Answer: B. Inducer
Rationale: Nicotine is an inducer of the CYP1A2 enzyme. This means it increases the
activity of the enzyme, which can accelerate the metabolism of drugs metabolized by
CYP1A2, such as olanzapine. Clinicians must be aware of this interaction to adjust
medication dosages appropriately to maintain therapeutic effects.
2. Nicotine is an inducer of CYP1A2. Does the PMHNP anticipate Joshua may
need a higher or lower dose of olanzapine to achieve a therapeutic
response?
A. Lower dose
B. Higher dose
C. Same dose
D. Discontinue olanzapine
Answer: B. Higher dose
Rationale: Because nicotine induces CYP1A2, it lowers plasma concentrations of
olanzapine by increasing its metabolism. To achieve a therapeutic effect, the clinician
may need to increase the dose while monitoring for side effects. Adjustments should
be gradual and patient-specific.
,3. Ernesto, a 60-year-old, reports anxiety, feeling frozen, palpitations, and
difficulty sleeping. Which neurotransmitter is likely elevated?
A. Dopamine
B. Serotonin
C. Norepinephrine
D. GABA
Answer: C. Norepinephrine
Rationale: Norepinephrine mediates the fight-or-flight response and is associated
with anxiety, hyperarousal, and somatic symptoms such as palpitations. Elevated
norepinephrine can contribute to difficulty sleeping and feelings of panic. Targeting
systems that reduce sympathetic activity can alleviate these symptoms.
4. Which medication class is best for Ernesto to address elevated
norepinephrine levels?
A. SSRI
B. SNRI
C. Benzodiazepine
D. MAOI
Answer: A. SSRI
Rationale: SSRIs increase serotonin levels, which indirectly reduces norepinephrine
release by stabilizing mood and anxiety. SNRIs, while effective for some, directly
increase norepinephrine and may worsen hyperarousal. Benzodiazepines increase
GABA but do not target norepinephrine. MAOIs increase norepinephrine, which would
exacerbate symptoms.
5. During a 4-week follow-up after starting an SSRI, which medication might
need to be added?
,A. Phosphodiesterase inhibitor (e.g., sildenafil)
B. Beta-blocker
C. Short-acting benzodiazepine
D. St. John’s Wort
Answer: A. Phosphodiesterase inhibitor (e.g., sildenafil)
Rationale: SSRIs can cause sexual dysfunction in both men and women due to
increased serotonin. After 4–6 weeks, if sexual side effects persist, a
phosphodiesterase inhibitor may be considered. Beta-blockers and benzodiazepines
are not standard for this issue, and St. John’s Wort may precipitate serotonin
syndrome.
6. Glutamate is a:
A. Inhibitory neurotransmitter
B. Excitatory neurotransmitter
C. Monoamine neurotransmitter
D. Hormone
Answer: B. Excitatory neurotransmitter
Rationale: Glutamate is the brain’s primary excitatory neurotransmitter, affecting
nearly every neuron. It plays a key role in learning, memory, neural plasticity, and
sensory processing. Excessive glutamate can contribute to excitotoxicity and disorders
like schizophrenia or epilepsy.
7. GABA primarily functions as a:
A. Stimulant
B. Inhibitory neurotransmitter
C. Excitatory neurotransmitter
D. Hormone
Answer: B. Inhibitory neurotransmitter
Rationale: GABA decreases neuronal excitability and has a calming effect on the CNS.
Low levels are associated with anxiety and seizure disorders, whereas excessive GABA
, can impair motor coordination and executive function. Drugs that increase GABA (e.g.,
benzodiazepines) enhance its inhibitory effect.
8. Serotonin (5HT) helps regulate:
A. Mood, sleep, arousal, and aggression
B. Motor coordination only
C. Reward and addiction
D. Muscle contraction
Answer: A. Mood, sleep, arousal, and aggression
Rationale: Serotonin is crucial for mood stabilization, anxiety regulation, sleep-wake
cycles, and social behavior. Dysregulation can contribute to depression, anxiety
disorders, and sleep disturbances.
9. Norepinephrine (NE) is responsible for:
A. Reward and addiction
B. Fight-or-flight responses, focus, and productivity
C. Learning and memory
D. Inhibitory signaling
Answer: B. Fight-or-flight responses, focus, and productivity
Rationale: NE is a monoamine neurotransmitter that enhances alertness, arousal,
and attention. Excessive NE, due to stress or stimulant use, can cause nervousness,
restlessness, and poor concentration. Medications often aim to normalize its levels.
10. Dopamine (DA) is associated with:
A. Mood, executive function, movement, and reward
PSYCHOPHARMACOLOGY FOR THE
PSYCHIATRIC-MENTAL HEALTH NURSE
PRACTITIONER | QUESTIONS AND
VERIFIED ANSWERS| NEW!! 2026 UPDATE–
CHAMBERLAIN
1. Is nicotine an inducer or an inhibitor of the CYP1A2 enzyme?
A. Inhibitor
B. Inducer
C. Neutral
D. Substrate
Answer: B. Inducer
Rationale: Nicotine is an inducer of the CYP1A2 enzyme. This means it increases the
activity of the enzyme, which can accelerate the metabolism of drugs metabolized by
CYP1A2, such as olanzapine. Clinicians must be aware of this interaction to adjust
medication dosages appropriately to maintain therapeutic effects.
2. Nicotine is an inducer of CYP1A2. Does the PMHNP anticipate Joshua may
need a higher or lower dose of olanzapine to achieve a therapeutic
response?
A. Lower dose
B. Higher dose
C. Same dose
D. Discontinue olanzapine
Answer: B. Higher dose
Rationale: Because nicotine induces CYP1A2, it lowers plasma concentrations of
olanzapine by increasing its metabolism. To achieve a therapeutic effect, the clinician
may need to increase the dose while monitoring for side effects. Adjustments should
be gradual and patient-specific.
,3. Ernesto, a 60-year-old, reports anxiety, feeling frozen, palpitations, and
difficulty sleeping. Which neurotransmitter is likely elevated?
A. Dopamine
B. Serotonin
C. Norepinephrine
D. GABA
Answer: C. Norepinephrine
Rationale: Norepinephrine mediates the fight-or-flight response and is associated
with anxiety, hyperarousal, and somatic symptoms such as palpitations. Elevated
norepinephrine can contribute to difficulty sleeping and feelings of panic. Targeting
systems that reduce sympathetic activity can alleviate these symptoms.
4. Which medication class is best for Ernesto to address elevated
norepinephrine levels?
A. SSRI
B. SNRI
C. Benzodiazepine
D. MAOI
Answer: A. SSRI
Rationale: SSRIs increase serotonin levels, which indirectly reduces norepinephrine
release by stabilizing mood and anxiety. SNRIs, while effective for some, directly
increase norepinephrine and may worsen hyperarousal. Benzodiazepines increase
GABA but do not target norepinephrine. MAOIs increase norepinephrine, which would
exacerbate symptoms.
5. During a 4-week follow-up after starting an SSRI, which medication might
need to be added?
,A. Phosphodiesterase inhibitor (e.g., sildenafil)
B. Beta-blocker
C. Short-acting benzodiazepine
D. St. John’s Wort
Answer: A. Phosphodiesterase inhibitor (e.g., sildenafil)
Rationale: SSRIs can cause sexual dysfunction in both men and women due to
increased serotonin. After 4–6 weeks, if sexual side effects persist, a
phosphodiesterase inhibitor may be considered. Beta-blockers and benzodiazepines
are not standard for this issue, and St. John’s Wort may precipitate serotonin
syndrome.
6. Glutamate is a:
A. Inhibitory neurotransmitter
B. Excitatory neurotransmitter
C. Monoamine neurotransmitter
D. Hormone
Answer: B. Excitatory neurotransmitter
Rationale: Glutamate is the brain’s primary excitatory neurotransmitter, affecting
nearly every neuron. It plays a key role in learning, memory, neural plasticity, and
sensory processing. Excessive glutamate can contribute to excitotoxicity and disorders
like schizophrenia or epilepsy.
7. GABA primarily functions as a:
A. Stimulant
B. Inhibitory neurotransmitter
C. Excitatory neurotransmitter
D. Hormone
Answer: B. Inhibitory neurotransmitter
Rationale: GABA decreases neuronal excitability and has a calming effect on the CNS.
Low levels are associated with anxiety and seizure disorders, whereas excessive GABA
, can impair motor coordination and executive function. Drugs that increase GABA (e.g.,
benzodiazepines) enhance its inhibitory effect.
8. Serotonin (5HT) helps regulate:
A. Mood, sleep, arousal, and aggression
B. Motor coordination only
C. Reward and addiction
D. Muscle contraction
Answer: A. Mood, sleep, arousal, and aggression
Rationale: Serotonin is crucial for mood stabilization, anxiety regulation, sleep-wake
cycles, and social behavior. Dysregulation can contribute to depression, anxiety
disorders, and sleep disturbances.
9. Norepinephrine (NE) is responsible for:
A. Reward and addiction
B. Fight-or-flight responses, focus, and productivity
C. Learning and memory
D. Inhibitory signaling
Answer: B. Fight-or-flight responses, focus, and productivity
Rationale: NE is a monoamine neurotransmitter that enhances alertness, arousal,
and attention. Excessive NE, due to stress or stimulant use, can cause nervousness,
restlessness, and poor concentration. Medications often aim to normalize its levels.
10. Dopamine (DA) is associated with:
A. Mood, executive function, movement, and reward
