PSYCHIATRIC NURSING
OBJECTIVE ASSESSMENT - EXAM
NR 546 / NR546 Final Exam
(Latest 2026/2027) Tested Questions
with Revised Answers, (A+ Guarantee)
NR546 - Advanced Psychopharmacology & Neuroscience 2026/2027
50 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Psychiatric Pharmacology & Drug Interactions Evidence-Based Psychotherapy Modalities
Neurobiology & Pathophysiology Advanced Practice Nursing Interventions
Psychiatric Assessment & DSM-5 Diagnosis Neurotransmitter Systems & Receptor Binding
COVER PAGE - 1
, 1 SECTION 1 | Pharmacology of Psychiatric Medications | Q1-Q10 | NR546 2026/2027
Q1 Question 1 of 50
A 34-year-old patient with treatment-resistant major depressive disorder is started on a
combination of fluoxetine 40 mg daily and olanzapine 5 mg daily. After 3 weeks, the patient
reports excessive daytime sedation, weight gain of 8 pounds, and new-onset orthostatic
dizziness. The nurse practitioner recognizes that the most likely contributing factor is the potent
antagonism of which receptor subtype?
A. 5-HT2A receptor antagonism
B. Histamine H1 receptor antagonism
C. Muscarinic acetylcholine receptor antagonism
D. Alpha-1 adrenergic receptor antagonism
Correct Answer: B
Rationale:
Olanzapine is a potent antagonist at histamine H1 receptors, which is the primary mechanism responsible for sedation
and weight gain. While alpha-1 antagonism causes orthostasis, the combination of sedation, significant weight gain, and
orthostasis in this short timeframe is most consistent with strong H1 blockade. 5-HT2A antagonism is associated with
metabolic effects but less directly with acute sedation.
Q2 Question 2 of 50
A 28-year-old patient with bipolar I disorder is prescribed lithium carbonate 900 mg twice daily.
At the 1-week follow-up, the patient complains of polyuria, polydipsia, and mild tremor.
Laboratory studies reveal a serum lithium level of 1.4 mEq/L. The nurse practitioner should
prioritize which immediate intervention?
A. Discontinue lithium and initiate hemodialysis
B. Reduce the lithium dose and recheck levels in 5 to 7 days
C. Add propranolol 20 mg twice daily for tremor management
D. Switch to valproic acid and taper lithium over 2 weeks
Correct Answer: B
Rationale:
A serum lithium level of 1.4 mEq/L is within the toxic range (therapeutic is 0.6-1.2 mEq/L for maintenance). The
appropriate first step is dose reduction with close monitoring. Hemodialysis is reserved for levels above 2.5 mEq/L or
severe neurotoxicity. Adding propranolol would mask tremor without addressing toxicity, and switching medications is
unnecessary when a simple dose adjustment resolves the issue.
NR546 - 2026/2027 | Passing Score: 80% | Page 2 of 28
, Q3 Question 3 of 50
A 45-year-old patient with generalized anxiety disorder has been taking lorazepam 2 mg three
times daily for 8 months. The patient expresses a desire to discontinue the medication due to
concerns about dependence. The nurse practitioner develops a tapering plan. Which tapering
strategy is most consistent with current evidence-based guidelines?
A. Reduce the dose by 50% every 3 days until discontinued
B. Taper by 10-25% of the daily dose every 1 to 2 weeks
C. Switch to diazepam 20 mg daily and taper over 4 weeks
D. Discontinue immediately and manage withdrawal symptoms as needed
Correct Answer: B
Rationale:
Benzodiazepine tapering should be gradual to minimize withdrawal symptoms and seizure risk. A reduction of 10-25%
every 1-2 weeks is the standard of care. Rapid tapers or abrupt discontinuation increase the risk of severe withdrawal,
including seizures. While diazepam has a longer half-life and may be used in some protocols, the most important
principle is the slow, gradual reduction rate regardless of the specific agent.
Q4 Question 4 of 50
A 52-year-old patient with schizophrenia has been stable on clozapine 400 mg daily for 2 years.
During a routine clinic visit, the patient reports fever of 101.2 degrees F, sore throat, and fatigue
for the past 2 days. The absolute neutrophil count from yesterday is 1,200/mm3. What is the
most appropriate immediate action by the nurse practitioner?
A. Continue clozapine and prescribe amoxicillin for presumed infection
B. Discontinue clozapine immediately and obtain a repeat CBC within 24 hours
C. Reduce clozapine to 200 mg daily and monitor symptoms for 48 hours
D. Continue clozapine and start granulocyte colony-stimulating factor therapy
Correct Answer: B
Rationale:
An absolute neutrophil count of 1,200/mm3 falls within the moderate neutropenia range (1,000-1,499/mm3) according to
the REMS program. Clozapine must be discontinued immediately, and a repeat CBC should be obtained within 24 hours
to rule out agranulocytosis. Continuing the medication risks progression to severe neutropenia. Antibiotics or dose
reduction are inappropriate when neutropenia is already documented.
NR546 - 2026/2027 | Passing Score: 80% | Page 3 of 28
OBJECTIVE ASSESSMENT - EXAM
NR 546 / NR546 Final Exam
(Latest 2026/2027) Tested Questions
with Revised Answers, (A+ Guarantee)
NR546 - Advanced Psychopharmacology & Neuroscience 2026/2027
50 100%
QUESTIONS VERIFIED ANSWERS EDITION
TOPICS COVERED
Psychiatric Pharmacology & Drug Interactions Evidence-Based Psychotherapy Modalities
Neurobiology & Pathophysiology Advanced Practice Nursing Interventions
Psychiatric Assessment & DSM-5 Diagnosis Neurotransmitter Systems & Receptor Binding
COVER PAGE - 1
, 1 SECTION 1 | Pharmacology of Psychiatric Medications | Q1-Q10 | NR546 2026/2027
Q1 Question 1 of 50
A 34-year-old patient with treatment-resistant major depressive disorder is started on a
combination of fluoxetine 40 mg daily and olanzapine 5 mg daily. After 3 weeks, the patient
reports excessive daytime sedation, weight gain of 8 pounds, and new-onset orthostatic
dizziness. The nurse practitioner recognizes that the most likely contributing factor is the potent
antagonism of which receptor subtype?
A. 5-HT2A receptor antagonism
B. Histamine H1 receptor antagonism
C. Muscarinic acetylcholine receptor antagonism
D. Alpha-1 adrenergic receptor antagonism
Correct Answer: B
Rationale:
Olanzapine is a potent antagonist at histamine H1 receptors, which is the primary mechanism responsible for sedation
and weight gain. While alpha-1 antagonism causes orthostasis, the combination of sedation, significant weight gain, and
orthostasis in this short timeframe is most consistent with strong H1 blockade. 5-HT2A antagonism is associated with
metabolic effects but less directly with acute sedation.
Q2 Question 2 of 50
A 28-year-old patient with bipolar I disorder is prescribed lithium carbonate 900 mg twice daily.
At the 1-week follow-up, the patient complains of polyuria, polydipsia, and mild tremor.
Laboratory studies reveal a serum lithium level of 1.4 mEq/L. The nurse practitioner should
prioritize which immediate intervention?
A. Discontinue lithium and initiate hemodialysis
B. Reduce the lithium dose and recheck levels in 5 to 7 days
C. Add propranolol 20 mg twice daily for tremor management
D. Switch to valproic acid and taper lithium over 2 weeks
Correct Answer: B
Rationale:
A serum lithium level of 1.4 mEq/L is within the toxic range (therapeutic is 0.6-1.2 mEq/L for maintenance). The
appropriate first step is dose reduction with close monitoring. Hemodialysis is reserved for levels above 2.5 mEq/L or
severe neurotoxicity. Adding propranolol would mask tremor without addressing toxicity, and switching medications is
unnecessary when a simple dose adjustment resolves the issue.
NR546 - 2026/2027 | Passing Score: 80% | Page 2 of 28
, Q3 Question 3 of 50
A 45-year-old patient with generalized anxiety disorder has been taking lorazepam 2 mg three
times daily for 8 months. The patient expresses a desire to discontinue the medication due to
concerns about dependence. The nurse practitioner develops a tapering plan. Which tapering
strategy is most consistent with current evidence-based guidelines?
A. Reduce the dose by 50% every 3 days until discontinued
B. Taper by 10-25% of the daily dose every 1 to 2 weeks
C. Switch to diazepam 20 mg daily and taper over 4 weeks
D. Discontinue immediately and manage withdrawal symptoms as needed
Correct Answer: B
Rationale:
Benzodiazepine tapering should be gradual to minimize withdrawal symptoms and seizure risk. A reduction of 10-25%
every 1-2 weeks is the standard of care. Rapid tapers or abrupt discontinuation increase the risk of severe withdrawal,
including seizures. While diazepam has a longer half-life and may be used in some protocols, the most important
principle is the slow, gradual reduction rate regardless of the specific agent.
Q4 Question 4 of 50
A 52-year-old patient with schizophrenia has been stable on clozapine 400 mg daily for 2 years.
During a routine clinic visit, the patient reports fever of 101.2 degrees F, sore throat, and fatigue
for the past 2 days. The absolute neutrophil count from yesterday is 1,200/mm3. What is the
most appropriate immediate action by the nurse practitioner?
A. Continue clozapine and prescribe amoxicillin for presumed infection
B. Discontinue clozapine immediately and obtain a repeat CBC within 24 hours
C. Reduce clozapine to 200 mg daily and monitor symptoms for 48 hours
D. Continue clozapine and start granulocyte colony-stimulating factor therapy
Correct Answer: B
Rationale:
An absolute neutrophil count of 1,200/mm3 falls within the moderate neutropenia range (1,000-1,499/mm3) according to
the REMS program. Clozapine must be discontinued immediately, and a repeat CBC should be obtained within 24 hours
to rule out agranulocytosis. Continuing the medication risks progression to severe neutropenia. Antibiotics or dose
reduction are inappropriate when neutropenia is already documented.
NR546 - 2026/2027 | Passing Score: 80% | Page 3 of 28
