NRNP 6675 Final Exam Latest
2026/2027: 100 Qs & Ans [Verified
Answers] Plus Rationales | Instant
PDF Download
Domain 1: Advanced Psychopharmacology & Medical Monitoring
(Qs 1-20)
1. Which of the following neurotransmitters is most directly involved in regulating
mood, sleep, and appetite?
• A. Dopamine
• B. Acetylcholine
• C. Serotonin
• D. Glutamate
Rationale: Serotonin plays a significant role in mood regulation, sleep cycles, and
appetite control. Dopamine is more related to reward and motivation, acetylcholine to
memory and muscle activation, and glutamate to excitatory signaling .
2. A 35-year-old with major depressive disorder fails to respond to two SSRIs. What
is the next reasonable pharmacologic option?
• A. Switch to a monoamine oxidase inhibitor (MAOI)
• B. Try a serotonin-norepinephrine reuptake inhibitor (SNRI)
• C. Add a benzodiazepine
• D. Add a stimulant
Rationale: SNRIs are appropriate after SSRI failure as they target both serotonin and
norepinephrine. MAOIs are reserved for treatment-resistant cases due to dietary
restrictions. Benzodiazepines and stimulants do not address core depressive symptoms .
3. Which antidepressant is most likely to cause significant weight gain?
,• A. Bupropion
• B. Fluoxetine
• C. Mirtazapine
• D. Venlafaxine
*Rationale: Mirtazapine commonly causes increased appetite and weight gain due to
histamine H1 receptor blockade. Bupropion often causes weight loss, while fluoxetine
and venlafaxine are weight-neutral .*
4. A patient on lithium therapy has a level of 25 mEq/L. What presentation is
expected?
• A. Mild nausea and tremor
• B. Sedation and ataxia
• C. Confusion and coarse tremor
• D. Convulsions, oliguria, and renal failure
*Rationale: A lithium level of 25 mEq/L indicates severe, life-threatening toxicity
requiring immediate medical intervention. Symptoms include seizures, decreased
urine output, and kidney failure .*
5. A patient with history of schizophrenia on haloperidol presents with hyperthermia,
muscle rigidity, autonomic instability, and elevated creatine kinase. The ARNP
recognizes these symptoms as:
• A. Serotonin syndrome
• B. Neuroleptic malignant syndrome (NMS)
• C. Anticholinergic toxicity
• D. Malignant hyperthermia
Rationale: NMS is a life-threatening reaction to antipsychotics characterized by the
classic triad of rigidity, hyperthermia, and autonomic instability. Risk factors include
rapid dose escalation, parenteral administration, and use of high-potency typical
antipsychotics .
6. The half-life of lithium is approximately:
• A. 24 hours
• B. 12 hours
• C. 36 hours
• D. 48 hours
*Rationale: Lithium has a half-life of approximately 24 hours in young adults, though
it may be prolonged in elderly patients or those with renal impairment .*
7. Which laboratory test should be ordered before initiating valproic acid therapy?
• A. Complete blood count (CBC)
• B. Thyroid-stimulating hormone (TSH)
, • C. Serum creatinine
• D. Fasting glucose
Rationale: Valproic acid can cause thrombocytopenia and hepatotoxicity; a baseline
CBC and liver function tests are essential before initiation .
8. Which medication requires regular white blood cell count monitoring due to risk
of agranulocytosis?
• A. Risperidone
• B. Clozapine
• C. Aripiprazole
• D. Ziprasidone
Rationale: Clozapine uniquely requires serial CBC monitoring (weekly or biweekly)
because of its risk for agranulocytosis, a potentially fatal drop in neutrophils .
9. A patient on long-term benzodiazepine therapy is most at risk for which adverse
effect?
• A. Weight loss
• B. Cognitive impairment
• C. Bradycardia
• D. Tinnitus
Rationale: Chronic benzodiazepine use can lead to dependence, memory deficits, and
cognitive slowing, particularly in elderly patients .
10. The mechanism of action of benzodiazepines primarily involves:
• A. Blocking sodium channels
• B. Enhancing GABA-A receptor activity
• C. Inhibiting dopamine reuptake
• D. Stimulating serotonin release
Rationale: Benzodiazepines potentiate GABA-A receptor-mediated chloride channel
opening, causing neuronal inhibition and anxiolytic, sedative, and anticonvulsant
effects .
11. Which medication class is most associated with extrapyramidal side effects (EPS)?
• A. Typical antipsychotics
• B. Atypical antipsychotics
• C. SSRIs
• D. SNRIs
*Rationale: Typical (first-generation) antipsychotics, particularly high-potency agents
like haloperidol, commonly cause EPS due to D2 receptor blockade in the
nigrostriatal pathway .*
2026/2027: 100 Qs & Ans [Verified
Answers] Plus Rationales | Instant
PDF Download
Domain 1: Advanced Psychopharmacology & Medical Monitoring
(Qs 1-20)
1. Which of the following neurotransmitters is most directly involved in regulating
mood, sleep, and appetite?
• A. Dopamine
• B. Acetylcholine
• C. Serotonin
• D. Glutamate
Rationale: Serotonin plays a significant role in mood regulation, sleep cycles, and
appetite control. Dopamine is more related to reward and motivation, acetylcholine to
memory and muscle activation, and glutamate to excitatory signaling .
2. A 35-year-old with major depressive disorder fails to respond to two SSRIs. What
is the next reasonable pharmacologic option?
• A. Switch to a monoamine oxidase inhibitor (MAOI)
• B. Try a serotonin-norepinephrine reuptake inhibitor (SNRI)
• C. Add a benzodiazepine
• D. Add a stimulant
Rationale: SNRIs are appropriate after SSRI failure as they target both serotonin and
norepinephrine. MAOIs are reserved for treatment-resistant cases due to dietary
restrictions. Benzodiazepines and stimulants do not address core depressive symptoms .
3. Which antidepressant is most likely to cause significant weight gain?
,• A. Bupropion
• B. Fluoxetine
• C. Mirtazapine
• D. Venlafaxine
*Rationale: Mirtazapine commonly causes increased appetite and weight gain due to
histamine H1 receptor blockade. Bupropion often causes weight loss, while fluoxetine
and venlafaxine are weight-neutral .*
4. A patient on lithium therapy has a level of 25 mEq/L. What presentation is
expected?
• A. Mild nausea and tremor
• B. Sedation and ataxia
• C. Confusion and coarse tremor
• D. Convulsions, oliguria, and renal failure
*Rationale: A lithium level of 25 mEq/L indicates severe, life-threatening toxicity
requiring immediate medical intervention. Symptoms include seizures, decreased
urine output, and kidney failure .*
5. A patient with history of schizophrenia on haloperidol presents with hyperthermia,
muscle rigidity, autonomic instability, and elevated creatine kinase. The ARNP
recognizes these symptoms as:
• A. Serotonin syndrome
• B. Neuroleptic malignant syndrome (NMS)
• C. Anticholinergic toxicity
• D. Malignant hyperthermia
Rationale: NMS is a life-threatening reaction to antipsychotics characterized by the
classic triad of rigidity, hyperthermia, and autonomic instability. Risk factors include
rapid dose escalation, parenteral administration, and use of high-potency typical
antipsychotics .
6. The half-life of lithium is approximately:
• A. 24 hours
• B. 12 hours
• C. 36 hours
• D. 48 hours
*Rationale: Lithium has a half-life of approximately 24 hours in young adults, though
it may be prolonged in elderly patients or those with renal impairment .*
7. Which laboratory test should be ordered before initiating valproic acid therapy?
• A. Complete blood count (CBC)
• B. Thyroid-stimulating hormone (TSH)
, • C. Serum creatinine
• D. Fasting glucose
Rationale: Valproic acid can cause thrombocytopenia and hepatotoxicity; a baseline
CBC and liver function tests are essential before initiation .
8. Which medication requires regular white blood cell count monitoring due to risk
of agranulocytosis?
• A. Risperidone
• B. Clozapine
• C. Aripiprazole
• D. Ziprasidone
Rationale: Clozapine uniquely requires serial CBC monitoring (weekly or biweekly)
because of its risk for agranulocytosis, a potentially fatal drop in neutrophils .
9. A patient on long-term benzodiazepine therapy is most at risk for which adverse
effect?
• A. Weight loss
• B. Cognitive impairment
• C. Bradycardia
• D. Tinnitus
Rationale: Chronic benzodiazepine use can lead to dependence, memory deficits, and
cognitive slowing, particularly in elderly patients .
10. The mechanism of action of benzodiazepines primarily involves:
• A. Blocking sodium channels
• B. Enhancing GABA-A receptor activity
• C. Inhibiting dopamine reuptake
• D. Stimulating serotonin release
Rationale: Benzodiazepines potentiate GABA-A receptor-mediated chloride channel
opening, causing neuronal inhibition and anxiolytic, sedative, and anticonvulsant
effects .
11. Which medication class is most associated with extrapyramidal side effects (EPS)?
• A. Typical antipsychotics
• B. Atypical antipsychotics
• C. SSRIs
• D. SNRIs
*Rationale: Typical (first-generation) antipsychotics, particularly high-potency agents
like haloperidol, commonly cause EPS due to D2 receptor blockade in the
nigrostriatal pathway .*
