D345 NURS 6348
Psychopharmacology for Advanced
Psychiatric Mental Health Practice
Proctored Final Assessment Review
(With Solutions)
2026
1
,Multiple Choice (15 Questions)
1. A 32-year-old patient with treatment-resistant depression is
prescribed ketamine infusion therapy. Which of the following
best explains ketamine’s rapid antidepressant effect? A)
Blockade of dopamine receptors B) NMDA receptor antagonism
leading to increased glutamate release C) Serotonin reuptake
inhibition D) Monoamine oxidase inhibition
Answer: B Rationale: Ketamine blocks NMDA receptors, which
increases glutamate release, stimulating AMPA receptors and
promoting synaptic plasticity, leading to rapid antidepressant effects.
2. In managing a patient on clozapine presenting with high fever
and muscle rigidity, what is the most critical immediate
intervention? A) Discontinue clozapine and initiate supportive care
B) Increase clozapine dose gradually C) Add a benzodiazepine for
agitation D) Administer lithium
Answer: A Rationale: Symptoms suggest neuroleptic malignant
syndrome, a life-threatening reaction; immediate cessation of
clozapine and supportive medical treatment are essential.
3. Which cytochrome P450 enzyme is primarily responsible for
metabolizing most SSRIs, leading to numerous drug-drug
interactions? A) CYP2D6 B) CYP3A4 C) CYP1A2 D) CYP2C19
Answer: A Rationale: CYP2D6 metabolizes many SSRIs like
fluoxetine and paroxetine, causing possible interactions with other
drugs metabolized by this enzyme.
4. A patient treated with lithium develops confusion, ataxia, and
vomiting. What level of lithium toxicity is most consistent with
these symptoms? A) 0.6-1.2 mEq/L B) 1.5-2.0 mEq/L C) >2.5 mEq/L
D) 0.3-0.6 mEq/L
Answer: B Rationale: Symptoms such as confusion and ataxia
suggest moderate lithium toxicity often seen at serum levels between
1.5-2.0 mEq/L.
5. Which of the following antipsychotics has the highest risk of
causing QTc prolongation? A) Olanzapine B) Ziprasidone C)
2
, Aripiprazole D) Risperidone
Answer: B Rationale: Ziprasidone is associated with significant QTc
prolongation compared to other second-generation antipsychotics.
6. True/False: Benzodiazepines exert their anxiolytic effect by
directly binding to GABA-A receptors and opening chloride
channels.
Answer: False Rationale: Benzodiazepines do not directly open
chloride channels but modulate GABA-A receptor activity to enhance
the effect of GABA, increasing chloride influx.
7. Which medication requires regular monitoring of white blood
cell count due to the risk of agranulocytosis? A) Haloperidol B)
Clozapine C) Quetiapine D) Risperidone
Answer: B Rationale: Clozapine has a significant risk of
agranulocytosis, requiring frequent blood monitoring.
8. Fill in the blank: The antidepressant _______ is a norepinephrine-
dopamine reuptake inhibitor that can also lower seizure
threshold.
Answer: Bupropion Rationale: Bupropion inhibits norepinephrine
and dopamine reuptake but can increase seizure risk, especially at
higher doses.
9. A 45-year-old patient with schizophrenia is started on
haloperidol. After 3 weeks, he develops involuntary movements of
his tongue and face. This most likely represents: A) Acute dystonia
B) Tardive dyskinesia C) Neuroleptic malignant syndrome D) Akathisia
Answer: B Rationale: Tardive dyskinesia is characterized by
repetitive involuntary movements, often emerging after weeks to
months of antipsychotic treatment.
10. Which mood stabilizer is also FDA-approved for migraine
prophylaxis? A) Lithium B) Carbamazepine C) Valproic acid D)
Lamotrigine
Answer: C Rationale: Valproic acid is approved for both bipolar
disorder and migraine prophylaxis.
True/False (7 Questions)
3
Psychopharmacology for Advanced
Psychiatric Mental Health Practice
Proctored Final Assessment Review
(With Solutions)
2026
1
,Multiple Choice (15 Questions)
1. A 32-year-old patient with treatment-resistant depression is
prescribed ketamine infusion therapy. Which of the following
best explains ketamine’s rapid antidepressant effect? A)
Blockade of dopamine receptors B) NMDA receptor antagonism
leading to increased glutamate release C) Serotonin reuptake
inhibition D) Monoamine oxidase inhibition
Answer: B Rationale: Ketamine blocks NMDA receptors, which
increases glutamate release, stimulating AMPA receptors and
promoting synaptic plasticity, leading to rapid antidepressant effects.
2. In managing a patient on clozapine presenting with high fever
and muscle rigidity, what is the most critical immediate
intervention? A) Discontinue clozapine and initiate supportive care
B) Increase clozapine dose gradually C) Add a benzodiazepine for
agitation D) Administer lithium
Answer: A Rationale: Symptoms suggest neuroleptic malignant
syndrome, a life-threatening reaction; immediate cessation of
clozapine and supportive medical treatment are essential.
3. Which cytochrome P450 enzyme is primarily responsible for
metabolizing most SSRIs, leading to numerous drug-drug
interactions? A) CYP2D6 B) CYP3A4 C) CYP1A2 D) CYP2C19
Answer: A Rationale: CYP2D6 metabolizes many SSRIs like
fluoxetine and paroxetine, causing possible interactions with other
drugs metabolized by this enzyme.
4. A patient treated with lithium develops confusion, ataxia, and
vomiting. What level of lithium toxicity is most consistent with
these symptoms? A) 0.6-1.2 mEq/L B) 1.5-2.0 mEq/L C) >2.5 mEq/L
D) 0.3-0.6 mEq/L
Answer: B Rationale: Symptoms such as confusion and ataxia
suggest moderate lithium toxicity often seen at serum levels between
1.5-2.0 mEq/L.
5. Which of the following antipsychotics has the highest risk of
causing QTc prolongation? A) Olanzapine B) Ziprasidone C)
2
, Aripiprazole D) Risperidone
Answer: B Rationale: Ziprasidone is associated with significant QTc
prolongation compared to other second-generation antipsychotics.
6. True/False: Benzodiazepines exert their anxiolytic effect by
directly binding to GABA-A receptors and opening chloride
channels.
Answer: False Rationale: Benzodiazepines do not directly open
chloride channels but modulate GABA-A receptor activity to enhance
the effect of GABA, increasing chloride influx.
7. Which medication requires regular monitoring of white blood
cell count due to the risk of agranulocytosis? A) Haloperidol B)
Clozapine C) Quetiapine D) Risperidone
Answer: B Rationale: Clozapine has a significant risk of
agranulocytosis, requiring frequent blood monitoring.
8. Fill in the blank: The antidepressant _______ is a norepinephrine-
dopamine reuptake inhibitor that can also lower seizure
threshold.
Answer: Bupropion Rationale: Bupropion inhibits norepinephrine
and dopamine reuptake but can increase seizure risk, especially at
higher doses.
9. A 45-year-old patient with schizophrenia is started on
haloperidol. After 3 weeks, he develops involuntary movements of
his tongue and face. This most likely represents: A) Acute dystonia
B) Tardive dyskinesia C) Neuroleptic malignant syndrome D) Akathisia
Answer: B Rationale: Tardive dyskinesia is characterized by
repetitive involuntary movements, often emerging after weeks to
months of antipsychotic treatment.
10. Which mood stabilizer is also FDA-approved for migraine
prophylaxis? A) Lithium B) Carbamazepine C) Valproic acid D)
Lamotrigine
Answer: C Rationale: Valproic acid is approved for both bipolar
disorder and migraine prophylaxis.
True/False (7 Questions)
3
