NU 673 Midterm Exam ACTUAL
EXAM 2026/2027 | NU 673
Psychopharmacology | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1 – Foundational Neurobiology & Psychopharmacology (Questions 1–15)
Q1: A PMHNP is prescribing an SSRI for a patient with major depressive disorder. Which statement best
explains the mechanism of action of SSRIs?
A. Blockade of norepinephrine reuptake at the synaptic cleft
B. Inhibition of monoamine oxidase (MAO) in the presynaptic terminal
C. Selective blockade of serotonin reuptake, increasing synaptic serotonin [CORRECT]
D. Antagonism of postsynaptic dopamine D2 receptors
Correct Answer: C
Rationale: SSRIs selectively block the serotonin transporter (SERT), preventing reuptake of serotonin into
the presynaptic neuron and increasing available serotonin in the synaptic cleft.
Q2: A 45-year-old male with MDD has failed two SSRIs at adequate doses. He reports a normal appetite,
low energy, and anhedonia but no weight gain or hypersomnia. Which medication is the most
appropriate next step?
A. Mirtazapine
B. Bupropion [CORRECT]
C. Paroxetine
D. Trazodone
Correct Answer: B
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that is activating, weight-
neutral, and effective for anhedonia/lack of energy without sedation or weight gain.
,Q3: A patient with bipolar I disorder is currently manic with aggressive behavior and insomnia. The
patient is not taking any mood stabilizer. Which medication should be initiated first?
A. Fluoxetine
B. Lithium [CORRECT]
C. Lamotrigine
D. Buspirone
Correct Answer: B
Rationale: Lithium is first-line for acute mania with demonstrated anti-manic, mood-stabilizing, and anti-
suicidal effects; it reduces manic symptoms within 1-2 weeks.
Q4: Which neurotransmitter is primarily responsible for the positive symptoms of schizophrenia
(hallucinations, delusions)?
A. Serotonin
B. Dopamine [CORRECT]
C. GABA
D. Acetylcholine
Correct Answer: B
Rationale: The dopamine hypothesis of schizophrenia posits that hyperactivity in mesolimbic dopamine
pathways causes positive symptoms; antipsychotics work primarily through D2 receptor antagonism.
Q5: A patient is prescribed clozapine for treatment-resistant schizophrenia. Which receptor antagonism
is most responsible for its unique efficacy?
A. D2 receptor antagonism only
B. D4 receptor antagonism and 5-HT2A receptor antagonism [CORRECT]
C. Alpha-1 receptor antagonism only
D. Muscarinic receptor agonism
Correct Answer: B
Rationale: Clozapine's unique efficacy in treatment-resistant schizophrenia is attributed to its relatively
weak D2 antagonism combined with potent 5-HT2A antagonism and D4 antagonism; this atypical
receptor profile distinguishes it from typical antipsychotics.
, Q6: Which medication acts as an antagonist at the NMDA receptor and is used for treatment-resistant
depression?
A. Fluoxetine
B. Ketamine [CORRECT]
C. Lithium
D. Risperidone
Correct Answer: B
Rationale: Ketamine is an NMDA receptor antagonist that produces rapid antidepressant effects (within
hours) through glutamate surge and synaptogenesis; it is FDA-approved as esketamine (Spravato) for
treatment-resistant depression.
Q7: A patient with GAD is started on buspirone. What is its mechanism of action?
A. GABA-A receptor agonism
B. 5-HT1A partial agonism [CORRECT]
C. Dopamine reuptake inhibition
D. Norepinephrine reuptake inhibition
Correct Answer: B
Rationale: Buspirone is a 5-HT1A receptor partial agonist that reduces serotonin neuron firing and
increases dopamine release in prefrontal cortex; it is non-sedating and non-addictive for generalized
anxiety disorder.
Q8: Which antidepressant has the highest affinity for the histamine H1 receptor, causing significant
sedation and weight gain?
A. Sertraline
B. Mirtazapine [CORRECT]
C. Venlafaxine
D. Bupropion
Correct Answer: B
Rationale: Mirtazapine is a potent H1 receptor antagonist (inverse agonist), producing marked sedation
and appetite stimulation; this makes it useful for insomnia and anorexia but problematic for weight-
conscious patients.
EXAM 2026/2027 | NU 673
Psychopharmacology | Verified Q&A |
Pass Guaranteed - A+ Graded
Section 1 – Foundational Neurobiology & Psychopharmacology (Questions 1–15)
Q1: A PMHNP is prescribing an SSRI for a patient with major depressive disorder. Which statement best
explains the mechanism of action of SSRIs?
A. Blockade of norepinephrine reuptake at the synaptic cleft
B. Inhibition of monoamine oxidase (MAO) in the presynaptic terminal
C. Selective blockade of serotonin reuptake, increasing synaptic serotonin [CORRECT]
D. Antagonism of postsynaptic dopamine D2 receptors
Correct Answer: C
Rationale: SSRIs selectively block the serotonin transporter (SERT), preventing reuptake of serotonin into
the presynaptic neuron and increasing available serotonin in the synaptic cleft.
Q2: A 45-year-old male with MDD has failed two SSRIs at adequate doses. He reports a normal appetite,
low energy, and anhedonia but no weight gain or hypersomnia. Which medication is the most
appropriate next step?
A. Mirtazapine
B. Bupropion [CORRECT]
C. Paroxetine
D. Trazodone
Correct Answer: B
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) that is activating, weight-
neutral, and effective for anhedonia/lack of energy without sedation or weight gain.
,Q3: A patient with bipolar I disorder is currently manic with aggressive behavior and insomnia. The
patient is not taking any mood stabilizer. Which medication should be initiated first?
A. Fluoxetine
B. Lithium [CORRECT]
C. Lamotrigine
D. Buspirone
Correct Answer: B
Rationale: Lithium is first-line for acute mania with demonstrated anti-manic, mood-stabilizing, and anti-
suicidal effects; it reduces manic symptoms within 1-2 weeks.
Q4: Which neurotransmitter is primarily responsible for the positive symptoms of schizophrenia
(hallucinations, delusions)?
A. Serotonin
B. Dopamine [CORRECT]
C. GABA
D. Acetylcholine
Correct Answer: B
Rationale: The dopamine hypothesis of schizophrenia posits that hyperactivity in mesolimbic dopamine
pathways causes positive symptoms; antipsychotics work primarily through D2 receptor antagonism.
Q5: A patient is prescribed clozapine for treatment-resistant schizophrenia. Which receptor antagonism
is most responsible for its unique efficacy?
A. D2 receptor antagonism only
B. D4 receptor antagonism and 5-HT2A receptor antagonism [CORRECT]
C. Alpha-1 receptor antagonism only
D. Muscarinic receptor agonism
Correct Answer: B
Rationale: Clozapine's unique efficacy in treatment-resistant schizophrenia is attributed to its relatively
weak D2 antagonism combined with potent 5-HT2A antagonism and D4 antagonism; this atypical
receptor profile distinguishes it from typical antipsychotics.
, Q6: Which medication acts as an antagonist at the NMDA receptor and is used for treatment-resistant
depression?
A. Fluoxetine
B. Ketamine [CORRECT]
C. Lithium
D. Risperidone
Correct Answer: B
Rationale: Ketamine is an NMDA receptor antagonist that produces rapid antidepressant effects (within
hours) through glutamate surge and synaptogenesis; it is FDA-approved as esketamine (Spravato) for
treatment-resistant depression.
Q7: A patient with GAD is started on buspirone. What is its mechanism of action?
A. GABA-A receptor agonism
B. 5-HT1A partial agonism [CORRECT]
C. Dopamine reuptake inhibition
D. Norepinephrine reuptake inhibition
Correct Answer: B
Rationale: Buspirone is a 5-HT1A receptor partial agonist that reduces serotonin neuron firing and
increases dopamine release in prefrontal cortex; it is non-sedating and non-addictive for generalized
anxiety disorder.
Q8: Which antidepressant has the highest affinity for the histamine H1 receptor, causing significant
sedation and weight gain?
A. Sertraline
B. Mirtazapine [CORRECT]
C. Venlafaxine
D. Bupropion
Correct Answer: B
Rationale: Mirtazapine is a potent H1 receptor antagonist (inverse agonist), producing marked sedation
and appetite stimulation; this makes it useful for insomnia and anorexia but problematic for weight-
conscious patients.
