NSG 552 Exam 3 Psychopharmacology
(2026/2027) PDF | Nursing | Wilkes University
1. A patient’s genetic testing reveals a CYP2D6 poor
metabolizer phenotype. Which medication would require
the most significant dose reduction?
A) Lamotrigine
B) Fluoxetine
C) Aripiprazole
D) Lithium
Correct Answer: C
Rationale: Aripiprazole is partially metabolized by
CYP2D6. Poor metabolizers have 2× higher drug
exposure, requiring dose reduction. Lamotrigine is
primarily glucuronidated; fluoxetine inhibits CYP2D6 but
is not a substrate; lithium is renally excreted.
2. The concept of “therapeutic drug monitoring” is most
critical for which medication due to its narrow therapeutic
index?
1
,A) Sertraline
B) Quetiapine
C) Valproate
D) Bupropion
Correct Answer: C
Rationale: Valproate has a narrow therapeutic index
(50–100 µg/mL); toxicity risk increases above 125
µg/mL. Sertraline, quetiapine, and bupropion have wider
safety margins and routine monitoring is less critical.
3. A patient on fluoxetine 40 mg daily reports new-onset
bruising after starting ibuprofen. This interaction is best
explained by:
A) Additive serotonergic effect
B) Inhibition of platelet aggregation
C) Induction of CYP450 enzymes
D) Displacement from protein binding sites
Correct Answer: B
Rationale: SSRIs like fluoxetine deplete platelet serotonin,
2
,reducing aggregation. NSAIDs further inhibit platelet
function via cyclooxygenase inhibition, increasing
bleeding risk.
4. Which statement best describes pharmacodynamics?
A) How the body absorbs, distributes, metabolizes, and
excretes a drug
B) How a drug binds to receptors and produces a
physiological effect
C) The genetic variation in drug-metabolizing enzymes
D) The time required for half of the drug to be eliminated
Correct Answer: B
Rationale: Pharmacodynamics is “what the drug does to
the body” – receptor binding and effect.
Pharmacokinetics (A) is “what the body does to the drug.”
CYP450 variation (C) is pharmacogenetics. Half-life (D) is
a pharmacokinetic parameter.
5. A patient starting sertraline asks, “How long until I feel
better?” The PMHNP explains that symptomatic
3
, improvement typically begins in:
A) 24–48 hours
B) 2–4 weeks
C) 6–8 weeks
D) 10–12 weeks
Correct Answer: B
Rationale: SSRIs typically show initial response by 2–4
weeks, with full therapeutic effect by 6–8 weeks. 24–48
hours is too soon; 6–8 weeks is full effect, not initial.
6. The PMHNP understands that the primary reason for
starting a new psychotropic at a low dose and titrating
slowly is to:
A) Achieve steady state faster
B) Minimize adverse effects and improve adherence
C) Reduce the need for therapeutic drug monitoring
D) Avoid drug-drug interactions with OTC medications
Correct Answer: B
Rationale: Slow titration minimizes initial side effects (e.g.,
4
(2026/2027) PDF | Nursing | Wilkes University
1. A patient’s genetic testing reveals a CYP2D6 poor
metabolizer phenotype. Which medication would require
the most significant dose reduction?
A) Lamotrigine
B) Fluoxetine
C) Aripiprazole
D) Lithium
Correct Answer: C
Rationale: Aripiprazole is partially metabolized by
CYP2D6. Poor metabolizers have 2× higher drug
exposure, requiring dose reduction. Lamotrigine is
primarily glucuronidated; fluoxetine inhibits CYP2D6 but
is not a substrate; lithium is renally excreted.
2. The concept of “therapeutic drug monitoring” is most
critical for which medication due to its narrow therapeutic
index?
1
,A) Sertraline
B) Quetiapine
C) Valproate
D) Bupropion
Correct Answer: C
Rationale: Valproate has a narrow therapeutic index
(50–100 µg/mL); toxicity risk increases above 125
µg/mL. Sertraline, quetiapine, and bupropion have wider
safety margins and routine monitoring is less critical.
3. A patient on fluoxetine 40 mg daily reports new-onset
bruising after starting ibuprofen. This interaction is best
explained by:
A) Additive serotonergic effect
B) Inhibition of platelet aggregation
C) Induction of CYP450 enzymes
D) Displacement from protein binding sites
Correct Answer: B
Rationale: SSRIs like fluoxetine deplete platelet serotonin,
2
,reducing aggregation. NSAIDs further inhibit platelet
function via cyclooxygenase inhibition, increasing
bleeding risk.
4. Which statement best describes pharmacodynamics?
A) How the body absorbs, distributes, metabolizes, and
excretes a drug
B) How a drug binds to receptors and produces a
physiological effect
C) The genetic variation in drug-metabolizing enzymes
D) The time required for half of the drug to be eliminated
Correct Answer: B
Rationale: Pharmacodynamics is “what the drug does to
the body” – receptor binding and effect.
Pharmacokinetics (A) is “what the body does to the drug.”
CYP450 variation (C) is pharmacogenetics. Half-life (D) is
a pharmacokinetic parameter.
5. A patient starting sertraline asks, “How long until I feel
better?” The PMHNP explains that symptomatic
3
, improvement typically begins in:
A) 24–48 hours
B) 2–4 weeks
C) 6–8 weeks
D) 10–12 weeks
Correct Answer: B
Rationale: SSRIs typically show initial response by 2–4
weeks, with full therapeutic effect by 6–8 weeks. 24–48
hours is too soon; 6–8 weeks is full effect, not initial.
6. The PMHNP understands that the primary reason for
starting a new psychotropic at a low dose and titrating
slowly is to:
A) Achieve steady state faster
B) Minimize adverse effects and improve adherence
C) Reduce the need for therapeutic drug monitoring
D) Avoid drug-drug interactions with OTC medications
Correct Answer: B
Rationale: Slow titration minimizes initial side effects (e.g.,
4
