NRNP 6675 Final Exam 2026 Psychiatric Mental Health Nurse Practitioner
Questions & Verified Answers.
Domain 1: Foundational Neuroscience & Psychopharmacology (Questions 1-30)
1. A 34-year-old with major depressive disorder (MDD) has failed two SSRIs. You
consider adding aripiprazole. Its primary mechanism of action is:
A) Full antagonism at D2 receptors
B) MAO-A inhibition
C) Partial agonism at D2 and 5-HT1A receptors
D) Selective norepinephrine reuptake inhibition
Answer: C
*Rationale: Aripiprazole is a dopamine (D2) and serotonin (5-HT1A) partial agonist
and a 5-HT2A antagonist. This "dopamine system stabilizer" mechanism is FDA-
approved as adjunctive treatment for MDD. Full agonists or antagonists do not
explain its unique profile. *
2. A patient on clozapine reports drooling, constipation, and sedation. These are
most attributable to:
A) D2 receptor blockade
B) Norepinephrine reuptake inhibition
,C) 5-HT2C inverse agonism
D) Histamine H1 and muscarinic M1 antagonism
Answer: D
*Rationale: Clozapine has high affinity for H1 (causing sedation, weight gain) and
M1 (causing constipation, dry mouth, drooling) receptors. Alpha-1 antagonism
causes orthostasis; D2 blockade causes EPS, but clozapine has low D2 affinity. *
3. Which anticonvulsant requires baseline and serial LFTs, CBC with differential,
and serum drug levels due to risk of hepatotoxicity and hematologic effects?
A) Lamotrigine
B) Gabapentin
C) Valproate (valproic acid)
D) Levetiracetam
Answer: C
*Rationale: Valproate carries black box warnings for hepatotoxicity (especially
children <2 years) and pancreatitis. It also causes thrombocytopenia and requires
level monitoring (50–100 mcg/mL). *
,4. A patient on phenelzine (MAOI) presents with occipital headache, palpitations,
and dilated pupils 30 minutes after eating aged cheese. The most likely cause is:
A) Serotonin syndrome
B) Hypertensive crisis from reduced tyramine metabolism
C) Cholinergic crisis
D) Neuroleptic malignant syndrome (NMS)
Answer: B
Rationale: MAOIs irreversibly inhibit MAO-A and MAO-B, preventing dietary
tyramine breakdown. Tyramine displaces norepinephrine from vesicles, causing a
surge in blood pressure. Aged cheese is high in tyramine.
5. The half-life of lithium is approximately:
A) 12 hours
B) 24 hours
C) 36 hours
D) 48 hours
Answer: B
, *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. *
6. Which long-acting injectable (LAI) antipsychotic is a partial D2 agonist and can
be given every 4 weeks?
A) Haloperidol decanoate
B) Risperidone microspheres
C) Aripiprazole monohydrate
D) Paliperidone palmitate
Answer: C
*Rationale: Aripiprazole LAI (400 mg IM q4weeks) is a D2/5-HT1A partial agonist.
Use requires oral aripiprazole lead-in to ensure tolerability. *
7. A patient on valproate develops tremor, ataxia, and confusion. Her ammonia
level is 120 mcg/dL (normal 10-50). The next step is:
A) Increase valproate dose
B) Add oral lactulose
C) Discontinue valproate and consider alternative mood stabilizer
D) Order STAT CT head
Questions & Verified Answers.
Domain 1: Foundational Neuroscience & Psychopharmacology (Questions 1-30)
1. A 34-year-old with major depressive disorder (MDD) has failed two SSRIs. You
consider adding aripiprazole. Its primary mechanism of action is:
A) Full antagonism at D2 receptors
B) MAO-A inhibition
C) Partial agonism at D2 and 5-HT1A receptors
D) Selective norepinephrine reuptake inhibition
Answer: C
*Rationale: Aripiprazole is a dopamine (D2) and serotonin (5-HT1A) partial agonist
and a 5-HT2A antagonist. This "dopamine system stabilizer" mechanism is FDA-
approved as adjunctive treatment for MDD. Full agonists or antagonists do not
explain its unique profile. *
2. A patient on clozapine reports drooling, constipation, and sedation. These are
most attributable to:
A) D2 receptor blockade
B) Norepinephrine reuptake inhibition
,C) 5-HT2C inverse agonism
D) Histamine H1 and muscarinic M1 antagonism
Answer: D
*Rationale: Clozapine has high affinity for H1 (causing sedation, weight gain) and
M1 (causing constipation, dry mouth, drooling) receptors. Alpha-1 antagonism
causes orthostasis; D2 blockade causes EPS, but clozapine has low D2 affinity. *
3. Which anticonvulsant requires baseline and serial LFTs, CBC with differential,
and serum drug levels due to risk of hepatotoxicity and hematologic effects?
A) Lamotrigine
B) Gabapentin
C) Valproate (valproic acid)
D) Levetiracetam
Answer: C
*Rationale: Valproate carries black box warnings for hepatotoxicity (especially
children <2 years) and pancreatitis. It also causes thrombocytopenia and requires
level monitoring (50–100 mcg/mL). *
,4. A patient on phenelzine (MAOI) presents with occipital headache, palpitations,
and dilated pupils 30 minutes after eating aged cheese. The most likely cause is:
A) Serotonin syndrome
B) Hypertensive crisis from reduced tyramine metabolism
C) Cholinergic crisis
D) Neuroleptic malignant syndrome (NMS)
Answer: B
Rationale: MAOIs irreversibly inhibit MAO-A and MAO-B, preventing dietary
tyramine breakdown. Tyramine displaces norepinephrine from vesicles, causing a
surge in blood pressure. Aged cheese is high in tyramine.
5. The half-life of lithium is approximately:
A) 12 hours
B) 24 hours
C) 36 hours
D) 48 hours
Answer: B
, *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. *
6. Which long-acting injectable (LAI) antipsychotic is a partial D2 agonist and can
be given every 4 weeks?
A) Haloperidol decanoate
B) Risperidone microspheres
C) Aripiprazole monohydrate
D) Paliperidone palmitate
Answer: C
*Rationale: Aripiprazole LAI (400 mg IM q4weeks) is a D2/5-HT1A partial agonist.
Use requires oral aripiprazole lead-in to ensure tolerability. *
7. A patient on valproate develops tremor, ataxia, and confusion. Her ammonia
level is 120 mcg/dL (normal 10-50). The next step is:
A) Increase valproate dose
B) Add oral lactulose
C) Discontinue valproate and consider alternative mood stabilizer
D) Order STAT CT head
