NSG552 Psychopharmacology Exam 1 Review 2025/2026 -
100% Correct Questions & A Grade Verified Answers
A 28-year-old female is started on fluoxetine 20 mg daily for MDD. After 5 days she
reports nausea and loose stools. Which neurotransmitter receptor is most directly
responsible for these adverse effects?
A) Dopamine D₂ receptor
B) Serotonin 5-HT₃ receptor
C) Norepinephrine α₁ receptor
D) Histamine H₁ receptor
Answer: B
1. Rationale: 5-HT₃ stimulation in the gut and area postrema produces nausea and
increased GI motility—common early SSRI effects that usually abate.
A patient on sertraline 100 mg is switched to paroxetine 20 mg. Two days later she
develops myoclonus, diaphoresis, and hyper-reflexia. Which intervention is most
appropriate?
A) Increase paroxetine to 30 mg
B) Start lithium augmentation
C) Discontinue paroxetine and initiate cyproheptadine 4-8 mg q6h × 24 h
D) Add aripiprazole 5 mg
Answer: C
2. Rationale: Symptoms are consistent with serotonin syndrome; cyproheptadine
(5-HT₂A antagonist) blocks excess serotonergic activity.
A 45-year-old male with treatment-resistant depression is prescribed phenelzine 15 mg
TID. Which dietary choice requires urgent education?
A) Grilled chicken breast
B) Fresh apple slices
C) Aged cheddar cheese sandwich
D) White rice
Answer: C
3. Rationale: Aged cheeses are high in tyramine; MAO-A inhibition prevents
degradation, risking hypertensive crisis.
,A patient on venlafaxine 225 mg daily develops BP 165/100 mmHg. Which mechanism
best explains this finding?
A) 5-HT₂C antagonism
B) Dopamine reuptake inhibition
C) Norepinephrine reuptake inhibition at high dose
D) Muscarinic M₃ antagonism
Answer: C
4. Rationale: Venlafaxine blocks NE reuptake at doses ≥150 mg, increasing
sympathetic tone and BP.
A 19-year-old college student is started on atomoxetine 40 mg daily for ADHD. Which
laboratory test should be obtained before initiation?
A) Serum creatinine
B) Liver enzymes (ALT/AST)
C) TSH
D) Serum sodium
Answer: B
5. Rationale: Atomoxetine carries a boxed warning for hepatotoxicity; baseline LFTs
are recommended.
A patient on imipramine 150 mg hs presents with HR 115 bpm, dry mouth, and blurred
vision. Which receptor profile underlies these effects?
A) α₁ + H₁ + M₁ antagonism
B) 5-HT₁A agonism
C) D₂ antagonism
D) GABA-A agonism
Answer: A
6. Rationale: TCA anticholinergic (M₁), antihistaminic (H₁), and anti-adrenergic (α₁)
properties cause tachycardia, dry mouth, and accommodation issues.
A 60-year-old female on lithium 900 mg hs has Na⁺ 128 mEq/L. Which physiologic
mechanism is responsible?
A) Nephrogenic diabetes insipidus from lithium accumulation in collecting ducts
B) SIADH from serotonin excess
C) Osmotic diuresis from glucose loss
D) Mineralocorticoid receptor antagonism
Answer: A
, 7. Rationale: Lithium interferes with aquaporin insertion, causing polyuria,
polydipsia, and dilutional hyponatremia.
A patient on aripiprazole 10 mg reports restlessness and inability to sit still. Which term
best describes this adverse effect?
A) Acute dystonia
B) Akathisia
C) Tardive dyskinesia
D) Parkinsonism
Answer: B
8. Rationale: Akathisia is inner motor restlessness common with partial D₂ agonists
like aripiprazole at low doses.
A patient with bipolar I is prescribed quetiapine 400 mg hs. Which metabolic parameter
should be monitored at 3 months?
A) Hemoglobin A1C
B) Serum iron
C) Vitamin B12
D) Red-cell folate
Answer: A
9. Rationale: Quetiapine increases risk of hyperglycemia; A1C monitors long-term
glucose control.
A patient on clozapine 300 mg daily has WBC 2,900/mm³ with 45% neutrophils. Which
action is required?
A) Continue and recheck in 1 week
B) Hold clozapine and initiate filgrastim
C) Reduce dose to 150 mg
D) Switch to olanzapine without washout
Answer: B
10. Rationale: ANC <1,000 or WBC <3,000 mandates discontinuation and possible
G-CSF; monitor for infection.
A 70-year-old male with MDD is started on mirtazapine 15 mg hs. Which early effect is
expected?
A) Weight loss and insomnia
B) Increased appetite and sedation
C) Sexual dysfunction
100% Correct Questions & A Grade Verified Answers
A 28-year-old female is started on fluoxetine 20 mg daily for MDD. After 5 days she
reports nausea and loose stools. Which neurotransmitter receptor is most directly
responsible for these adverse effects?
A) Dopamine D₂ receptor
B) Serotonin 5-HT₃ receptor
C) Norepinephrine α₁ receptor
D) Histamine H₁ receptor
Answer: B
1. Rationale: 5-HT₃ stimulation in the gut and area postrema produces nausea and
increased GI motility—common early SSRI effects that usually abate.
A patient on sertraline 100 mg is switched to paroxetine 20 mg. Two days later she
develops myoclonus, diaphoresis, and hyper-reflexia. Which intervention is most
appropriate?
A) Increase paroxetine to 30 mg
B) Start lithium augmentation
C) Discontinue paroxetine and initiate cyproheptadine 4-8 mg q6h × 24 h
D) Add aripiprazole 5 mg
Answer: C
2. Rationale: Symptoms are consistent with serotonin syndrome; cyproheptadine
(5-HT₂A antagonist) blocks excess serotonergic activity.
A 45-year-old male with treatment-resistant depression is prescribed phenelzine 15 mg
TID. Which dietary choice requires urgent education?
A) Grilled chicken breast
B) Fresh apple slices
C) Aged cheddar cheese sandwich
D) White rice
Answer: C
3. Rationale: Aged cheeses are high in tyramine; MAO-A inhibition prevents
degradation, risking hypertensive crisis.
,A patient on venlafaxine 225 mg daily develops BP 165/100 mmHg. Which mechanism
best explains this finding?
A) 5-HT₂C antagonism
B) Dopamine reuptake inhibition
C) Norepinephrine reuptake inhibition at high dose
D) Muscarinic M₃ antagonism
Answer: C
4. Rationale: Venlafaxine blocks NE reuptake at doses ≥150 mg, increasing
sympathetic tone and BP.
A 19-year-old college student is started on atomoxetine 40 mg daily for ADHD. Which
laboratory test should be obtained before initiation?
A) Serum creatinine
B) Liver enzymes (ALT/AST)
C) TSH
D) Serum sodium
Answer: B
5. Rationale: Atomoxetine carries a boxed warning for hepatotoxicity; baseline LFTs
are recommended.
A patient on imipramine 150 mg hs presents with HR 115 bpm, dry mouth, and blurred
vision. Which receptor profile underlies these effects?
A) α₁ + H₁ + M₁ antagonism
B) 5-HT₁A agonism
C) D₂ antagonism
D) GABA-A agonism
Answer: A
6. Rationale: TCA anticholinergic (M₁), antihistaminic (H₁), and anti-adrenergic (α₁)
properties cause tachycardia, dry mouth, and accommodation issues.
A 60-year-old female on lithium 900 mg hs has Na⁺ 128 mEq/L. Which physiologic
mechanism is responsible?
A) Nephrogenic diabetes insipidus from lithium accumulation in collecting ducts
B) SIADH from serotonin excess
C) Osmotic diuresis from glucose loss
D) Mineralocorticoid receptor antagonism
Answer: A
, 7. Rationale: Lithium interferes with aquaporin insertion, causing polyuria,
polydipsia, and dilutional hyponatremia.
A patient on aripiprazole 10 mg reports restlessness and inability to sit still. Which term
best describes this adverse effect?
A) Acute dystonia
B) Akathisia
C) Tardive dyskinesia
D) Parkinsonism
Answer: B
8. Rationale: Akathisia is inner motor restlessness common with partial D₂ agonists
like aripiprazole at low doses.
A patient with bipolar I is prescribed quetiapine 400 mg hs. Which metabolic parameter
should be monitored at 3 months?
A) Hemoglobin A1C
B) Serum iron
C) Vitamin B12
D) Red-cell folate
Answer: A
9. Rationale: Quetiapine increases risk of hyperglycemia; A1C monitors long-term
glucose control.
A patient on clozapine 300 mg daily has WBC 2,900/mm³ with 45% neutrophils. Which
action is required?
A) Continue and recheck in 1 week
B) Hold clozapine and initiate filgrastim
C) Reduce dose to 150 mg
D) Switch to olanzapine without washout
Answer: B
10. Rationale: ANC <1,000 or WBC <3,000 mandates discontinuation and possible
G-CSF; monitor for infection.
A 70-year-old male with MDD is started on mirtazapine 15 mg hs. Which early effect is
expected?
A) Weight loss and insomnia
B) Increased appetite and sedation
C) Sexual dysfunction
