NR 546 PSYCHOPHARMACOLOGY MIDTERM 2026–2027 | VERIFIED
QUESTIONS & ANSWERS | PMHNP STUDY GUIDE,100% CORRECT
ALREADY GRADED A+
1.
Which neurotransmitter pathway is most implicated in the therapeutic action of
SSRIs for depression, particularly improving mood and emotional regulation?
A) Serotonin reuptake inhibition in the limbic and prefrontal cortex
B) Dopamine stimulation in the mesolimbic system
C) Norepinephrine blockade in the amygdala
D) GABA activation in the basal ganglia
Correct Answer: A) Serotonin reuptake inhibition in the limbic and prefrontal
cortex
2.
A patient starting on fluoxetine reports insomnia and agitation after one week.
What mechanism best explains this early side effect?
A) Increased serotonergic activation before receptor desensitization occurs
B) Sudden dopamine depletion in the mesocortical pathway
C) Blockade of muscarinic receptors
D) GABA receptor downregulation
Correct Answer: A) Increased serotonergic activation before receptor
desensitization occurs
3.
When initiating sertraline for major depressive disorder, what education should be
provided regarding therapeutic onset?
,A) Symptom improvement may take 4–6 weeks despite early side effects
B) Full effects occur within 48 hours of the first dose
C) It should be stopped after 1 week if no response is seen
D) Combining with alcohol improves sleep quality
Correct Answer: A) Symptom improvement may take 4–6 weeks despite early
side effects
4.
Which SSRI is most associated with QT prolongation, requiring caution in
patients with cardiac disease?
A) Citalopram
B) Paroxetine
C) Sertraline
D) Escitalopram
Correct Answer: A) Citalopram
5.
A 35-year-old on venlafaxine reports elevated blood pressure during follow-up.
What is the most likely mechanism?
A) Norepinephrine reuptake inhibition at higher doses
B) Serotonin blockade
C) Dopamine stimulation
D) Anticholinergic effects
Correct Answer: A) Norepinephrine reuptake inhibition at higher doses
6.
What differentiates duloxetine from SSRIs in terms of its pharmacologic action?
A) It inhibits both serotonin and norepinephrine reuptake
B) It acts solely on dopamine receptors
,C) It blocks histamine and alpha-adrenergic receptors
D) It increases GABA activity in the CNS
Correct Answer: A) It inhibits both serotonin and norepinephrine reuptake
7.
Which antidepressant is most effective for a patient with depression and
comorbid neuropathic pain?
A) Duloxetine
B) Fluoxetine
C) Escitalopram
D) Sertraline
Correct Answer: A) Duloxetine
8.
A 42-year-old patient on paroxetine complains of sexual dysfunction. What is the
most appropriate alternative antidepressant?
A) Bupropion
B) Citalopram
C) Venlafaxine
D) Fluoxetine
Correct Answer: A) Bupropion
9.
Which antidepressant poses the highest risk for seizures, especially in patients
with eating disorders?
A) Bupropion
B) Sertraline
C) Fluoxetine
, D) Duloxetine
Correct Answer: A) Bupropion
10.
Which monoamine oxidase inhibitor (MAOI) requires a strict tyramine-restricted
diet to prevent hypertensive crisis?
A) Phenelzine
B) Selegiline (transdermal)
C) Trazodone
D) Nortriptyline
Correct Answer: A) Phenelzine
11.
A patient on MAOIs consumes aged cheese and develops severe headache and
hypertension. What is the immediate treatment?
A) Administer phentolamine (alpha-adrenergic blocker)
B) Give benzodiazepines
C) Provide beta-blockers immediately
D) Induce emesis
Correct Answer: A) Administer phentolamine (alpha-adrenergic blocker)
12.
Which tricyclic antidepressant (TCA) is most likely to cause orthostatic
hypotension and anticholinergic effects?
A) Amitriptyline
B) Nortriptyline
C) Desipramine
D) Clomipramine
Correct Answer: A) Amitriptyline
QUESTIONS & ANSWERS | PMHNP STUDY GUIDE,100% CORRECT
ALREADY GRADED A+
1.
Which neurotransmitter pathway is most implicated in the therapeutic action of
SSRIs for depression, particularly improving mood and emotional regulation?
A) Serotonin reuptake inhibition in the limbic and prefrontal cortex
B) Dopamine stimulation in the mesolimbic system
C) Norepinephrine blockade in the amygdala
D) GABA activation in the basal ganglia
Correct Answer: A) Serotonin reuptake inhibition in the limbic and prefrontal
cortex
2.
A patient starting on fluoxetine reports insomnia and agitation after one week.
What mechanism best explains this early side effect?
A) Increased serotonergic activation before receptor desensitization occurs
B) Sudden dopamine depletion in the mesocortical pathway
C) Blockade of muscarinic receptors
D) GABA receptor downregulation
Correct Answer: A) Increased serotonergic activation before receptor
desensitization occurs
3.
When initiating sertraline for major depressive disorder, what education should be
provided regarding therapeutic onset?
,A) Symptom improvement may take 4–6 weeks despite early side effects
B) Full effects occur within 48 hours of the first dose
C) It should be stopped after 1 week if no response is seen
D) Combining with alcohol improves sleep quality
Correct Answer: A) Symptom improvement may take 4–6 weeks despite early
side effects
4.
Which SSRI is most associated with QT prolongation, requiring caution in
patients with cardiac disease?
A) Citalopram
B) Paroxetine
C) Sertraline
D) Escitalopram
Correct Answer: A) Citalopram
5.
A 35-year-old on venlafaxine reports elevated blood pressure during follow-up.
What is the most likely mechanism?
A) Norepinephrine reuptake inhibition at higher doses
B) Serotonin blockade
C) Dopamine stimulation
D) Anticholinergic effects
Correct Answer: A) Norepinephrine reuptake inhibition at higher doses
6.
What differentiates duloxetine from SSRIs in terms of its pharmacologic action?
A) It inhibits both serotonin and norepinephrine reuptake
B) It acts solely on dopamine receptors
,C) It blocks histamine and alpha-adrenergic receptors
D) It increases GABA activity in the CNS
Correct Answer: A) It inhibits both serotonin and norepinephrine reuptake
7.
Which antidepressant is most effective for a patient with depression and
comorbid neuropathic pain?
A) Duloxetine
B) Fluoxetine
C) Escitalopram
D) Sertraline
Correct Answer: A) Duloxetine
8.
A 42-year-old patient on paroxetine complains of sexual dysfunction. What is the
most appropriate alternative antidepressant?
A) Bupropion
B) Citalopram
C) Venlafaxine
D) Fluoxetine
Correct Answer: A) Bupropion
9.
Which antidepressant poses the highest risk for seizures, especially in patients
with eating disorders?
A) Bupropion
B) Sertraline
C) Fluoxetine
, D) Duloxetine
Correct Answer: A) Bupropion
10.
Which monoamine oxidase inhibitor (MAOI) requires a strict tyramine-restricted
diet to prevent hypertensive crisis?
A) Phenelzine
B) Selegiline (transdermal)
C) Trazodone
D) Nortriptyline
Correct Answer: A) Phenelzine
11.
A patient on MAOIs consumes aged cheese and develops severe headache and
hypertension. What is the immediate treatment?
A) Administer phentolamine (alpha-adrenergic blocker)
B) Give benzodiazepines
C) Provide beta-blockers immediately
D) Induce emesis
Correct Answer: A) Administer phentolamine (alpha-adrenergic blocker)
12.
Which tricyclic antidepressant (TCA) is most likely to cause orthostatic
hypotension and anticholinergic effects?
A) Amitriptyline
B) Nortriptyline
C) Desipramine
D) Clomipramine
Correct Answer: A) Amitriptyline
