1
Wilkes NSG 526 Exams 1-3 Clinical Modalities
Advanced Psych with Explanations Actual Exam
2026/2027 – Complete Exam-Style Questions with
Detailed Rationales | Pass Guaranteed – A+
Graded
[EXAM 1: NEUROBIOLOGY, PSYCHOPHARMACOLOGY & MOOD DISORDERS —
QUESTIONS 1-50]
Q1: A PMHNP is teaching a nursing student about the neurobiology of schizophrenia. The
student asks which neurotransmitter is most commonly associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions. Which neurotransmitter should the PMHNP
identify?
A. Serotonin
B. GABA
C. Dopamine
D. Norepinephrine
Correct Answer: C
Rationale: The "dopamine hypothesis" suggests that hyperactivity of dopamine transmission in
the mesolimbic pathway contributes to positive symptoms like hallucinations and delusions.
While serotonin and glutamate also play roles in the pathophysiology, dopamine is the primary
target for antipsychotics which mitigate these symptoms. GABA is primarily inhibitory and
associated with anxiety disorders.
Q2: A patient diagnosed with Major Depressive Disorder (MDD) is prescribed an SSRI. What is
the primary mechanism of action (MOA) of this class of medications?
A. Inhibition of monoamine oxidase enzymes
B. Blockade of serotonin and norepinephrine reuptake pumps
C. Selective blockade of the serotonin reuptake pump
D. Antagonism of dopamine D2 receptors
,2
Correct Answer: C
Rationale: SSRIs (Selective Serotonin Reuptake Inhibitors) work by blocking the reabsorption
(reuptake) of serotonin into the presynaptic neuron, increasing its availability in the synaptic
cleft. This is distinct from SNRIs (which block norepinephrine too) and MAOIs (which block the
enzyme that breaks down neurotransmitters). Increasing synaptic serotonin is the cornerstone of
treating depression and anxiety.
Q3: A patient with depression is being treated with a TCA (Tricyclic Antidepressant). The
PMHNP monitors for anticholinergic side effects. Which of the following is a classic
anticholinergic side effect the patient might report?
A. Diarrhea
B. Dry mouth
C. Orthostatic hypotension
D. Weight loss
Correct Answer: B
Rationale: Dry mouth (xerostomia) is a classic anticholinergic effect caused by the blockade of
muscarinic acetylcholine receptors. Other anticholinergic effects include constipation, urinary
retention, blurred vision, and tachycardia. Orthostatic hypotension is also a side effect of TCAs,
but it is due to alpha-1 adrenergic blockade, not anticholinergic activity.
Q4: A patient with treatment-resistant depression is considering an MAOI (Monoamine Oxidase
Inhibitor). The PMHNP must educate the patient on dietary restrictions to prevent a hypertensive
crisis. Which food product contains high levels of tyramine and must be avoided?
A. Fresh citrus fruits
B. Aged cheeses and cured meats
C. Green leafy vegetables
D. Skim milk
Correct Answer: B
,3
Rationale: Aged cheeses, cured meats, tap beers, and fermented foods contain high levels of
tyramine. MAOIs inhibit the enzyme that breaks down tyramine; ingesting these foods can cause
a massive release of norepinephrine, leading to a hypertensive crisis which can be fatal. Fresh
fruits, vegetables, and fresh milk are generally safe.
Q5: A patient with Bipolar I Disorder is started on Lithium. The PMHNP orders a serum lithium
level. What is the generally accepted therapeutic range for lithium maintenance in bipolar
disorder?
A. 0.2 to 0.5 mEq/L
B. 0.6 to 1.2 mEq/L
C. 1.5 to 2.0 mEq/L
D. 2.5 to 3.0 mEq/L
Correct Answer: B
Rationale: The therapeutic range for lithium is generally 0.6 to 1.2 mEq/L. Levels below 0.6 are
often subtherapeutic, while levels above 1.2 mEq/L increase the risk of toxicity. Monitoring is
crucial because lithium has a narrow therapeutic index. Symptoms of toxicity include coarse
tremor, nausea, confusion, and seizures.
Q6: A patient with Bipolar Disorder cannot tolerate Lithium due to renal issues. The PMHNP
initiates Valproate (Depakote). In addition to monitoring liver function tests (LFTs), what other
serum level is critical to monitor for this medication?
A. Valproate level (50-125 mcg/mL)
B. Carbamazepine level
C. Ammonia level
D. Creatinine clearance
Correct Answer: A
Rationale: While ammonia levels should be monitored if hyperammonemia is suspected
(encephalopathy), the standard therapeutic monitoring for Valproate efficacy and safety is the
, 4
serum trough level, typically between 50-125 mcg/mL. Monitoring LFTs is required due to the
risk of hepatotoxicity. Valproate is a first-line agent for mania and mixed episodes.
Q7: A patient taking a First-Generation Antipsychotic (FGA) develops muscle spasms of the
neck and eyes (torticollis and oculogyric crisis) shortly after starting the medication. The
PMHNP recognizes this as acute dystonia. What is the appropriate treatment?
A. Beta-blocker
B. Benztropine (Cogentin) or Diphenhydramine (Benadryl)
C. Propranolol
D. Increase the antipsychotic dose
Correct Answer: B
Rationale: Acute dystonia is an extrapyramidal side effect (EPS) treated immediately with
anticholinergic medications such as Benztropine or antihistamines with anticholinergic properties
like Diphenhydramine. These agents counteract the dopamine blockade in the basal ganglia that
causes the muscle spasms. Increasing the antipsychotic dose would worsen the condition.
Q8: A patient with chronic schizophrenia has been on antipsychotics for years. During a routine
visit, the PMHNP notices involuntary, rhythmic movements of the tongue and lips (fly-catching
movements). The PMHNP suspects Tardive Dyskinesia (TD). What is the most appropriate
action?
A. Immediately discontinue all antipsychotics
B. Switch to a second-generation antipsychotic (SGA)
C. Increase the dose of the current antipsychotic to mask the symptoms
D. Prescribe a benztropine injection
Correct Answer: B
Rationale: Tardive Dyskinesia is often irreversible and is associated with long-term use of
antipsychotics (especially FGAs). The primary strategy is to prevent it by using the lowest
effective dose or SGAs. If TD occurs, switching to an SGA or using a VMAT2 inhibitor (like
Wilkes NSG 526 Exams 1-3 Clinical Modalities
Advanced Psych with Explanations Actual Exam
2026/2027 – Complete Exam-Style Questions with
Detailed Rationales | Pass Guaranteed – A+
Graded
[EXAM 1: NEUROBIOLOGY, PSYCHOPHARMACOLOGY & MOOD DISORDERS —
QUESTIONS 1-50]
Q1: A PMHNP is teaching a nursing student about the neurobiology of schizophrenia. The
student asks which neurotransmitter is most commonly associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions. Which neurotransmitter should the PMHNP
identify?
A. Serotonin
B. GABA
C. Dopamine
D. Norepinephrine
Correct Answer: C
Rationale: The "dopamine hypothesis" suggests that hyperactivity of dopamine transmission in
the mesolimbic pathway contributes to positive symptoms like hallucinations and delusions.
While serotonin and glutamate also play roles in the pathophysiology, dopamine is the primary
target for antipsychotics which mitigate these symptoms. GABA is primarily inhibitory and
associated with anxiety disorders.
Q2: A patient diagnosed with Major Depressive Disorder (MDD) is prescribed an SSRI. What is
the primary mechanism of action (MOA) of this class of medications?
A. Inhibition of monoamine oxidase enzymes
B. Blockade of serotonin and norepinephrine reuptake pumps
C. Selective blockade of the serotonin reuptake pump
D. Antagonism of dopamine D2 receptors
,2
Correct Answer: C
Rationale: SSRIs (Selective Serotonin Reuptake Inhibitors) work by blocking the reabsorption
(reuptake) of serotonin into the presynaptic neuron, increasing its availability in the synaptic
cleft. This is distinct from SNRIs (which block norepinephrine too) and MAOIs (which block the
enzyme that breaks down neurotransmitters). Increasing synaptic serotonin is the cornerstone of
treating depression and anxiety.
Q3: A patient with depression is being treated with a TCA (Tricyclic Antidepressant). The
PMHNP monitors for anticholinergic side effects. Which of the following is a classic
anticholinergic side effect the patient might report?
A. Diarrhea
B. Dry mouth
C. Orthostatic hypotension
D. Weight loss
Correct Answer: B
Rationale: Dry mouth (xerostomia) is a classic anticholinergic effect caused by the blockade of
muscarinic acetylcholine receptors. Other anticholinergic effects include constipation, urinary
retention, blurred vision, and tachycardia. Orthostatic hypotension is also a side effect of TCAs,
but it is due to alpha-1 adrenergic blockade, not anticholinergic activity.
Q4: A patient with treatment-resistant depression is considering an MAOI (Monoamine Oxidase
Inhibitor). The PMHNP must educate the patient on dietary restrictions to prevent a hypertensive
crisis. Which food product contains high levels of tyramine and must be avoided?
A. Fresh citrus fruits
B. Aged cheeses and cured meats
C. Green leafy vegetables
D. Skim milk
Correct Answer: B
,3
Rationale: Aged cheeses, cured meats, tap beers, and fermented foods contain high levels of
tyramine. MAOIs inhibit the enzyme that breaks down tyramine; ingesting these foods can cause
a massive release of norepinephrine, leading to a hypertensive crisis which can be fatal. Fresh
fruits, vegetables, and fresh milk are generally safe.
Q5: A patient with Bipolar I Disorder is started on Lithium. The PMHNP orders a serum lithium
level. What is the generally accepted therapeutic range for lithium maintenance in bipolar
disorder?
A. 0.2 to 0.5 mEq/L
B. 0.6 to 1.2 mEq/L
C. 1.5 to 2.0 mEq/L
D. 2.5 to 3.0 mEq/L
Correct Answer: B
Rationale: The therapeutic range for lithium is generally 0.6 to 1.2 mEq/L. Levels below 0.6 are
often subtherapeutic, while levels above 1.2 mEq/L increase the risk of toxicity. Monitoring is
crucial because lithium has a narrow therapeutic index. Symptoms of toxicity include coarse
tremor, nausea, confusion, and seizures.
Q6: A patient with Bipolar Disorder cannot tolerate Lithium due to renal issues. The PMHNP
initiates Valproate (Depakote). In addition to monitoring liver function tests (LFTs), what other
serum level is critical to monitor for this medication?
A. Valproate level (50-125 mcg/mL)
B. Carbamazepine level
C. Ammonia level
D. Creatinine clearance
Correct Answer: A
Rationale: While ammonia levels should be monitored if hyperammonemia is suspected
(encephalopathy), the standard therapeutic monitoring for Valproate efficacy and safety is the
, 4
serum trough level, typically between 50-125 mcg/mL. Monitoring LFTs is required due to the
risk of hepatotoxicity. Valproate is a first-line agent for mania and mixed episodes.
Q7: A patient taking a First-Generation Antipsychotic (FGA) develops muscle spasms of the
neck and eyes (torticollis and oculogyric crisis) shortly after starting the medication. The
PMHNP recognizes this as acute dystonia. What is the appropriate treatment?
A. Beta-blocker
B. Benztropine (Cogentin) or Diphenhydramine (Benadryl)
C. Propranolol
D. Increase the antipsychotic dose
Correct Answer: B
Rationale: Acute dystonia is an extrapyramidal side effect (EPS) treated immediately with
anticholinergic medications such as Benztropine or antihistamines with anticholinergic properties
like Diphenhydramine. These agents counteract the dopamine blockade in the basal ganglia that
causes the muscle spasms. Increasing the antipsychotic dose would worsen the condition.
Q8: A patient with chronic schizophrenia has been on antipsychotics for years. During a routine
visit, the PMHNP notices involuntary, rhythmic movements of the tongue and lips (fly-catching
movements). The PMHNP suspects Tardive Dyskinesia (TD). What is the most appropriate
action?
A. Immediately discontinue all antipsychotics
B. Switch to a second-generation antipsychotic (SGA)
C. Increase the dose of the current antipsychotic to mask the symptoms
D. Prescribe a benztropine injection
Correct Answer: B
Rationale: Tardive Dyskinesia is often irreversible and is associated with long-term use of
antipsychotics (especially FGAs). The primary strategy is to prevent it by using the lowest
effective dose or SGAs. If TD occurs, switching to an SGA or using a VMAT2 inhibitor (like
