NRNP 6665 WEEK 11 FINAL EXAM
UPDATED 2026 QUESTIONS AND VERIFIED
ANSWERS
SECTION ONE: ADVANCED PSYCHOPHARMACOLOGY AND NOVEL AGENTS
Question 1
A patient with treatment-resistant major depressive disorder is prescribed
dextromethorphan/bupropion (Auvelity). What is the primary mechanism of action that
makes this combination effective for treatment-resistant depression?
A. It acts as a potent serotonin and norepinephrine reuptake inhibitor.
B. It blocks NMDA receptors and sigma-1 receptors while inhibiting the reuptake of
dopamine and norepinephrine.
C. It acts as a reversible inhibitor of monoamine oxidase type A.
D. It provides rapid glutamate surge similar to intravenous ketamine without the
dissociative side effects.
Answer: B
Rationale: Auvelity is the first FDA-approved oral NMDA receptor antagonist for
depression. Dextromethorphan acts as an NMDA antagonist and sigma-1 receptor
agonist (promoting neuroplasticity), while bupropion serves to inhibit CYP2D6 (boosting
dextromethorphan levels) and provides norepinephrine-dopamine reuptake inhibition
, (NDRI). It does not cause the profound dissociation or require REMS monitoring
associated with esketamine.
Question 2
A patient with Bipolar I disorder is in the acute depressive phase. The PMHNP chooses
lurasidone (Latuda). What is a critical instruction the PMHNP must provide regarding
the administration of this specific medication?
A. It must be taken on an empty stomach to prevent severe nausea.
B. It must be taken with at least 350 calories of food to ensure adequate absorption;
taking it without food significantly decreases its bioavailability.
C. It must be taken at bedtime due to its severe sedative properties.
D. It must be taken with an antacid to prevent esophageal ulceration.
Answer: B
Rationale: Lurasidone's absorption is highly dependent on food. If taken on an empty
stomach, its bioavailability is drastically reduced, rendering the medication ineffective.
It must be taken with at least 350 calories. While it can be sedating, taking it at night is
less critical than the food requirement, though it is often dosed in the evening.
Question 3
A patient with schizophrenia is switched from risperidone to cariprazine (Vraylar).
What unique clinical advantage does cariprazine offer over other atypical
antipsychotics for this patient population?
A. It has a lower risk of metabolic syndrome than all other atypical antipsychotics.
B. It preferentially binds to D3 receptors, making it highly effective for treating the
negative symptoms of schizophrenia (e.g., avolition, alogia, flat affect).
C. It acts as a fast-dissolving tablet that absorbs sublingually for rapid onset in
agitation.
D. It does not require any baseline metabolic or cardiac monitoring.
Answer: B
UPDATED 2026 QUESTIONS AND VERIFIED
ANSWERS
SECTION ONE: ADVANCED PSYCHOPHARMACOLOGY AND NOVEL AGENTS
Question 1
A patient with treatment-resistant major depressive disorder is prescribed
dextromethorphan/bupropion (Auvelity). What is the primary mechanism of action that
makes this combination effective for treatment-resistant depression?
A. It acts as a potent serotonin and norepinephrine reuptake inhibitor.
B. It blocks NMDA receptors and sigma-1 receptors while inhibiting the reuptake of
dopamine and norepinephrine.
C. It acts as a reversible inhibitor of monoamine oxidase type A.
D. It provides rapid glutamate surge similar to intravenous ketamine without the
dissociative side effects.
Answer: B
Rationale: Auvelity is the first FDA-approved oral NMDA receptor antagonist for
depression. Dextromethorphan acts as an NMDA antagonist and sigma-1 receptor
agonist (promoting neuroplasticity), while bupropion serves to inhibit CYP2D6 (boosting
dextromethorphan levels) and provides norepinephrine-dopamine reuptake inhibition
, (NDRI). It does not cause the profound dissociation or require REMS monitoring
associated with esketamine.
Question 2
A patient with Bipolar I disorder is in the acute depressive phase. The PMHNP chooses
lurasidone (Latuda). What is a critical instruction the PMHNP must provide regarding
the administration of this specific medication?
A. It must be taken on an empty stomach to prevent severe nausea.
B. It must be taken with at least 350 calories of food to ensure adequate absorption;
taking it without food significantly decreases its bioavailability.
C. It must be taken at bedtime due to its severe sedative properties.
D. It must be taken with an antacid to prevent esophageal ulceration.
Answer: B
Rationale: Lurasidone's absorption is highly dependent on food. If taken on an empty
stomach, its bioavailability is drastically reduced, rendering the medication ineffective.
It must be taken with at least 350 calories. While it can be sedating, taking it at night is
less critical than the food requirement, though it is often dosed in the evening.
Question 3
A patient with schizophrenia is switched from risperidone to cariprazine (Vraylar).
What unique clinical advantage does cariprazine offer over other atypical
antipsychotics for this patient population?
A. It has a lower risk of metabolic syndrome than all other atypical antipsychotics.
B. It preferentially binds to D3 receptors, making it highly effective for treating the
negative symptoms of schizophrenia (e.g., avolition, alogia, flat affect).
C. It acts as a fast-dissolving tablet that absorbs sublingually for rapid onset in
agitation.
D. It does not require any baseline metabolic or cardiac monitoring.
Answer: B
