Psychopharmacology Exam 4 – NURS 752
(Liberty University, PMHNP) – 130
Practice Questions with Answers &
Rationales
SECTION 1: ANTIDEPRESSANTS (Questions 1-40)
Q1. A patient on an SSRI reports new-onset restlessness, pacing, and an
inability to sit still. What is the most likely cause?
A) Anxiety
B) Akathisia
C) Serotonin syndrome
D) Tardive dyskinesia
Answer: B) Akathisia
Rationale: Akathisia is a movement disorder characterized by an intense urge to
move and an inability to sit still. It is a known adverse effect of SSRIs and other
antidepressants, especially at higher doses. Unlike tardive dyskinesia (late-onset,
involuntary movements), akathisia can occur early in treatment.
,Q2. A patient with depression and a history of seizures is prescribed an
antidepressant. Which agent should be avoided due to its seizure-lowering
threshold effect?
A) Sertraline
B) Bupropion
C) Escitalopram
D) Mirtazapine
Answer: B) Bupropion
Rationale: Bupropion is known to lower the seizure threshold in a dose-dependent
manner. It is contraindicated in patients with known seizure disorders, eating
disorders (due to electrolyte imbalances that may lower seizure threshold), and
during abrupt withdrawal from alcohol or benzodiazepines.
Q3. A 55-year-old man with depression and neuropathic pain is started on
duloxetine. Which adverse effect is most important to monitor?
A) Weight gain
B) Hepatotoxicity
C) Sexual dysfunction
D) Hypertension
Answer: D) Hypertension
Rationale: Duloxetine (an SNRI) can cause dose-dependent increases in blood
pressure. Baseline and periodic blood pressure monitoring is recommended,
especially at higher doses. Sexual dysfunction and weight gain can occur but are
not the most serious. Hepatotoxicity is rare but has been reported.
,Q4. Which antidepressant is most likely to cause discontinuation syndrome
characterized by "brain zaps," dizziness, and nausea when stopped abruptly?
A) Fluoxetine
B) Escitalopram
C) Venlafaxine
D) Bupropion
Answer: C) Venlafaxine
Rationale: Venlafaxine has a short half-life and is associated with a high incidence
of discontinuation symptoms, including "brain zaps," dizziness, nausea, and
irritability. Fluoxetine has a long half-life and is less likely to cause withdrawal
symptoms. Bupropion can also cause withdrawal but the syndrome is less
characteristic.
Q5. Which antidepressant is least likely to cause sexual dysfunction?
A) Fluoxetine
B) Sertraline
C) Bupropion
D) Paroxetine
Answer: C) Bupropion
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI)
and has minimal sexual side effects compared to SSRIs, which are known to cause
sexual dysfunction in a significant percentage of patients (30-70%).
, Q6. A 68-year-old with depression is started on nortriptyline. What is the
primary concern?
A) Hepatic toxicity
B) Cardiotoxicity
C) Visual disturbances
D) Diarrhea
Answer: B) Cardiotoxicity
Rationale: Tricyclic antidepressants (TCAs) can lead to cardiotoxic effects,
especially in elderly patients. Nortriptyline, like other TCAs, can cause QT
prolongation, orthostatic hypotension, and arrhythmias. Elderly patients are
particularly vulnerable due to age-related cardiovascular changes and
polypharmacy.
Q7. Which antidepressant is associated with a black box warning for QT
prolongation and torsade de pointes, especially at doses above 40 mg/day?
A) Sertraline
B) Citalopram
C) Fluoxetine
D) Vortioxetine
Answer: B) Citalopram
Rationale: Citalopram (Celexa) carries a black box warning regarding dose-
dependent QT prolongation. The maximum recommended dose is 40 mg/day (20
mg/day for patients over 60, those with hepatic impairment, or CYP2C19 poor
metabolizers). Escitalopram also has QT prolongation risk but is less studied.
(Liberty University, PMHNP) – 130
Practice Questions with Answers &
Rationales
SECTION 1: ANTIDEPRESSANTS (Questions 1-40)
Q1. A patient on an SSRI reports new-onset restlessness, pacing, and an
inability to sit still. What is the most likely cause?
A) Anxiety
B) Akathisia
C) Serotonin syndrome
D) Tardive dyskinesia
Answer: B) Akathisia
Rationale: Akathisia is a movement disorder characterized by an intense urge to
move and an inability to sit still. It is a known adverse effect of SSRIs and other
antidepressants, especially at higher doses. Unlike tardive dyskinesia (late-onset,
involuntary movements), akathisia can occur early in treatment.
,Q2. A patient with depression and a history of seizures is prescribed an
antidepressant. Which agent should be avoided due to its seizure-lowering
threshold effect?
A) Sertraline
B) Bupropion
C) Escitalopram
D) Mirtazapine
Answer: B) Bupropion
Rationale: Bupropion is known to lower the seizure threshold in a dose-dependent
manner. It is contraindicated in patients with known seizure disorders, eating
disorders (due to electrolyte imbalances that may lower seizure threshold), and
during abrupt withdrawal from alcohol or benzodiazepines.
Q3. A 55-year-old man with depression and neuropathic pain is started on
duloxetine. Which adverse effect is most important to monitor?
A) Weight gain
B) Hepatotoxicity
C) Sexual dysfunction
D) Hypertension
Answer: D) Hypertension
Rationale: Duloxetine (an SNRI) can cause dose-dependent increases in blood
pressure. Baseline and periodic blood pressure monitoring is recommended,
especially at higher doses. Sexual dysfunction and weight gain can occur but are
not the most serious. Hepatotoxicity is rare but has been reported.
,Q4. Which antidepressant is most likely to cause discontinuation syndrome
characterized by "brain zaps," dizziness, and nausea when stopped abruptly?
A) Fluoxetine
B) Escitalopram
C) Venlafaxine
D) Bupropion
Answer: C) Venlafaxine
Rationale: Venlafaxine has a short half-life and is associated with a high incidence
of discontinuation symptoms, including "brain zaps," dizziness, nausea, and
irritability. Fluoxetine has a long half-life and is less likely to cause withdrawal
symptoms. Bupropion can also cause withdrawal but the syndrome is less
characteristic.
Q5. Which antidepressant is least likely to cause sexual dysfunction?
A) Fluoxetine
B) Sertraline
C) Bupropion
D) Paroxetine
Answer: C) Bupropion
Rationale: Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI)
and has minimal sexual side effects compared to SSRIs, which are known to cause
sexual dysfunction in a significant percentage of patients (30-70%).
, Q6. A 68-year-old with depression is started on nortriptyline. What is the
primary concern?
A) Hepatic toxicity
B) Cardiotoxicity
C) Visual disturbances
D) Diarrhea
Answer: B) Cardiotoxicity
Rationale: Tricyclic antidepressants (TCAs) can lead to cardiotoxic effects,
especially in elderly patients. Nortriptyline, like other TCAs, can cause QT
prolongation, orthostatic hypotension, and arrhythmias. Elderly patients are
particularly vulnerable due to age-related cardiovascular changes and
polypharmacy.
Q7. Which antidepressant is associated with a black box warning for QT
prolongation and torsade de pointes, especially at doses above 40 mg/day?
A) Sertraline
B) Citalopram
C) Fluoxetine
D) Vortioxetine
Answer: B) Citalopram
Rationale: Citalopram (Celexa) carries a black box warning regarding dose-
dependent QT prolongation. The maximum recommended dose is 40 mg/day (20
mg/day for patients over 60, those with hepatic impairment, or CYP2C19 poor
metabolizers). Escitalopram also has QT prolongation risk but is less studied.
