NR546 Week 8 Final Exam Due 1st March 2026 Complete
Actual Exam Questions 1- 105 NR546 Advanced
Psychopharmacology for The PMHNP NR 546 Midterm and
Finals Examplify Online Proctored Exam Questions and
Answers | 100% Pass Guaranteed | Graded A+
Domain 1: Foundations of Psychopharmacology & Prescribing Principles
(Questions 1–15)
Question 1
A 28‑year‑old with major depressive disorder (MDD) has been taking sertraline
50 mg daily for 6 weeks and reports no change in mood. What is the most
appropriate next step?
A) Increase the dose to 100 mg daily.
B) Add trazodone 50 mg at bedtime.
C) Switch to fluoxetine 20 mg daily.
D) Obtain a serum drug level.
Correct ,,answer,,,,: A
Rationale: Sertraline’s typical therapeutic dose for MDD is 100–200 mg/day. A
6‑week trial at a subtherapeutic dose warrants a dose increase before considering a
switch. Serum drug levels are not routinely used for SSRIs, and adding trazodone
is not first‑line for nonresponse.
Question 2
A 45‑year‑old patient with chronic insomnia asks for medication. According to
current guidelines, which of the following is the preferred first‑line
pharmacological intervention?
,A) Zolpidem 10 mg at bedtime.
B) Trazodone 50 mg at bedtime.
C) Diphenhydramine 50 mg at bedtime.
D) Melatonin 5 mg at bedtime.
Correct ,,answer,,,,: B
Rationale: Trazodone at low doses (25‑100 mg) is commonly used off‑label for
sleep maintenance, with low abuse potential and minimal tolerance. Zolpidem is
generally reserved for second‑line use due to risks of dependence and next‑day
impairment. Antihistamines (e.g., diphenhydramine) and melatonin have weaker
evidence and may cause residual sedation.
Question 3
A PMHNP is prescribing a controlled substance for a patient with anxiety. Under
the Ryan Haight Act, what is required before an initial prescription of a Schedule II
medication via telemedicine?
A) A valid DEA registration and an in‑person evaluation (with limited exceptions).
B) A verbal consent from the patient recorded in the chart.
C) A written prescription mailed to the patient.
D) A concurrent prescription for naloxone.
Correct ,,answer,,,,: A
Rationale: The Ryan Haight Online Pharmacy Consumer Protection Act generally
requires an in‑person medical evaluation before prescribing controlled substances
via telemedicine, though some exceptions (e.g., public health emergencies) have
temporarily modified this rule. Naloxone is not universally required, and verbal
consent alone is insufficient.
,Question 4
A patient develops fever, muscle rigidity, altered mental status, and autonomic
instability 10 days after starting haloperidol. What is the most likely diagnosis?
A) Serotonin syndrome.
B) Neuroleptic malignant syndrome (NMS).
C) Acute dystonic reaction.
D) Tardive dyskinesia.
Correct ,,answer,,,,: B
Rationale: NMS presents with fever, rigidity, altered mental status, and autonomic
dysfunction, typically occurring within weeks of antipsychotic initiation. Serotonin
syndrome is associated with serotonergic agents and includes hyperreflexia and
clonus. Dystonia occurs earlier, while tardive dyskinesia appears after months to
years.
Question 5
Which of the following CYP450 enzymes is primarily responsible for the
metabolism of most SSRIs?
A) CYP2D6.
B) CYP3A4.
C) CYP1A2.
D) CYP2C19.
Correct ,,answer,,,,: A
, Rationale: CYP2D6 is a major pathway for many SSRIs (fluoxetine, paroxetine,
fluvoxamine) and other psychotropics. CYP3A4 metabolizes some
benzodiazepines and antipsychotics; CYP1A2 metabolizes clozapine; CYP2C19
metabolizes citalopram and escitalopram.
Question 6
A 32‑year‑old patient with bipolar I disorder and a history of substance use
disorder is prescribed a long‑acting injectable antipsychotic. What is the primary
advantage of this formulation?
A) Improved tolerability compared to oral agents.
B) Reduced risk of metabolic side effects.
C) Enhanced adherence and reduced relapse rates.
D) Faster onset of therapeutic action.
Correct ,,answer,,,,: C
Rationale: Long‑acting injectable antipsychotics are primarily used to improve
adherence, which is a critical issue in bipolar and schizophrenia, thereby reducing
hospitalizations and relapse rates. They do not offer improved tolerability or faster
onset; in fact, they may have similar side‑effect profiles.
Question 7
A 65‑year‑old with Parkinson’s disease develops visual hallucinations. The family
reports he is not agitated. What is the most appropriate antipsychotic?
A) Haloperidol.
B) Risperidone.
C) Quetiapine.
D) Olanzapine.
Actual Exam Questions 1- 105 NR546 Advanced
Psychopharmacology for The PMHNP NR 546 Midterm and
Finals Examplify Online Proctored Exam Questions and
Answers | 100% Pass Guaranteed | Graded A+
Domain 1: Foundations of Psychopharmacology & Prescribing Principles
(Questions 1–15)
Question 1
A 28‑year‑old with major depressive disorder (MDD) has been taking sertraline
50 mg daily for 6 weeks and reports no change in mood. What is the most
appropriate next step?
A) Increase the dose to 100 mg daily.
B) Add trazodone 50 mg at bedtime.
C) Switch to fluoxetine 20 mg daily.
D) Obtain a serum drug level.
Correct ,,answer,,,,: A
Rationale: Sertraline’s typical therapeutic dose for MDD is 100–200 mg/day. A
6‑week trial at a subtherapeutic dose warrants a dose increase before considering a
switch. Serum drug levels are not routinely used for SSRIs, and adding trazodone
is not first‑line for nonresponse.
Question 2
A 45‑year‑old patient with chronic insomnia asks for medication. According to
current guidelines, which of the following is the preferred first‑line
pharmacological intervention?
,A) Zolpidem 10 mg at bedtime.
B) Trazodone 50 mg at bedtime.
C) Diphenhydramine 50 mg at bedtime.
D) Melatonin 5 mg at bedtime.
Correct ,,answer,,,,: B
Rationale: Trazodone at low doses (25‑100 mg) is commonly used off‑label for
sleep maintenance, with low abuse potential and minimal tolerance. Zolpidem is
generally reserved for second‑line use due to risks of dependence and next‑day
impairment. Antihistamines (e.g., diphenhydramine) and melatonin have weaker
evidence and may cause residual sedation.
Question 3
A PMHNP is prescribing a controlled substance for a patient with anxiety. Under
the Ryan Haight Act, what is required before an initial prescription of a Schedule II
medication via telemedicine?
A) A valid DEA registration and an in‑person evaluation (with limited exceptions).
B) A verbal consent from the patient recorded in the chart.
C) A written prescription mailed to the patient.
D) A concurrent prescription for naloxone.
Correct ,,answer,,,,: A
Rationale: The Ryan Haight Online Pharmacy Consumer Protection Act generally
requires an in‑person medical evaluation before prescribing controlled substances
via telemedicine, though some exceptions (e.g., public health emergencies) have
temporarily modified this rule. Naloxone is not universally required, and verbal
consent alone is insufficient.
,Question 4
A patient develops fever, muscle rigidity, altered mental status, and autonomic
instability 10 days after starting haloperidol. What is the most likely diagnosis?
A) Serotonin syndrome.
B) Neuroleptic malignant syndrome (NMS).
C) Acute dystonic reaction.
D) Tardive dyskinesia.
Correct ,,answer,,,,: B
Rationale: NMS presents with fever, rigidity, altered mental status, and autonomic
dysfunction, typically occurring within weeks of antipsychotic initiation. Serotonin
syndrome is associated with serotonergic agents and includes hyperreflexia and
clonus. Dystonia occurs earlier, while tardive dyskinesia appears after months to
years.
Question 5
Which of the following CYP450 enzymes is primarily responsible for the
metabolism of most SSRIs?
A) CYP2D6.
B) CYP3A4.
C) CYP1A2.
D) CYP2C19.
Correct ,,answer,,,,: A
, Rationale: CYP2D6 is a major pathway for many SSRIs (fluoxetine, paroxetine,
fluvoxamine) and other psychotropics. CYP3A4 metabolizes some
benzodiazepines and antipsychotics; CYP1A2 metabolizes clozapine; CYP2C19
metabolizes citalopram and escitalopram.
Question 6
A 32‑year‑old patient with bipolar I disorder and a history of substance use
disorder is prescribed a long‑acting injectable antipsychotic. What is the primary
advantage of this formulation?
A) Improved tolerability compared to oral agents.
B) Reduced risk of metabolic side effects.
C) Enhanced adherence and reduced relapse rates.
D) Faster onset of therapeutic action.
Correct ,,answer,,,,: C
Rationale: Long‑acting injectable antipsychotics are primarily used to improve
adherence, which is a critical issue in bipolar and schizophrenia, thereby reducing
hospitalizations and relapse rates. They do not offer improved tolerability or faster
onset; in fact, they may have similar side‑effect profiles.
Question 7
A 65‑year‑old with Parkinson’s disease develops visual hallucinations. The family
reports he is not agitated. What is the most appropriate antipsychotic?
A) Haloperidol.
B) Risperidone.
C) Quetiapine.
D) Olanzapine.
