NR546 | NR546 Advanced Pharmacology
Psychopharmacology for the PMHNP Week 5 Exam
1 | Questions with Correct Answers and Expert
Explanation for Each Question | Chamberlain
1. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Correct Answer: C
Expert Explanation: The mesolimbic pathway projects from the ventral tegmental
area to the nucleus accumbens. Overactivity of dopamine in this specific pathway is
hypothesized to mediate positive psychotic symptoms. Antipsychotic medications
work by blocking D2 receptors in this pathway to reduce these symptoms.
2. A patient taking Haloperidol develops severe muscle rigidity, a high fever, and
autonomic instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
,C. Acute Dystonia
D. Anticholinergic Toxicity
Correct Answer: B
Expert Explanation: Neuroleptic Malignant Syndrome is a rare but life-threatening
reaction to dopamine antagonists. It is characterized by ‘lead-pipe’ rigidity,
hyperthermia, and mental status changes. Treatment involves immediate
discontinuation of the offending agent and supportive care.
3. Which antidepressant is known for its dual mechanism of inhibiting the reuptake of
both serotonin and norepinephrine?
A. Venlafaxine
B. Sertraline
C. Fluoxetine
D. Bupropion
Correct Answer: A
Expert Explanation: Venlafaxine is classified as a Serotonin-Norepinephrine
Reuptake Inhibitor (SNRI). At lower doses, it primarily affects serotonin, while at
higher doses, its norepinephrine effects become more prominent. This dual action is
often used for patients who do not respond to SSRIs alone.
,4. A patient is prescribed Lamotrigine for bipolar depression. What is the most critical
side effect the PMHNP must educate the patient about?
A. Severe skin rash (Stevens-Johnson Syndrome)
B. Weight gain
C. Agranulocytosis
D. Hyperprolactinemia
Correct Answer: A
Expert Explanation: Lamotrigine carries a black box warning for serious rashes,
including Stevens-Johnson Syndrome. To minimize this risk, the medication must be
titrated very slowly over several weeks. Patients must be instructed to seek
immediate medical attention if any skin changes or mucosal lesions occur.
5. Which enzyme system is primarily responsible for the metabolism of many
psychotropic medications, and is inhibited by fluoxetine?
A. CYP2D6
B. CYP1A2
C. MAO-A
D. COMT
Correct Answer: A
, Expert Explanation: Fluoxetine is a potent inhibitor of the CYP2D6 enzyme system.
This inhibition can lead to increased plasma levels of other drugs metabolized by
the same pathway, such as tricyclic antidepressants or beta-blockers. Understanding
these interactions is vital for safe prescribing practices.
6. A patient with a history of seizures and an eating disorder is seeking treatment for
depression. Which medication is contraindicated?
A. Bupropion
B. Mirtazapine
C. Escitalopram
D. Duloxetine
Correct Answer: A
Expert Explanation: Bupropion is associated with a dose-related risk of seizures,
which is significantly increased in patients with underlying seizure disorders. It is
also contraindicated in patients with anorexia or bulimia due to a higher incidence
of seizures in these populations. The PMHNP should select an alternative
antidepressant for this patient.
7. Which mood stabilizer requires regular monitoring of serum levels, renal function,
and thyroid function?
A. Valproate
Psychopharmacology for the PMHNP Week 5 Exam
1 | Questions with Correct Answers and Expert
Explanation for Each Question | Chamberlain
1. Which dopamine pathway is primarily responsible for the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Mesocortical pathway
B. Nigrostriatal pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Correct Answer: C
Expert Explanation: The mesolimbic pathway projects from the ventral tegmental
area to the nucleus accumbens. Overactivity of dopamine in this specific pathway is
hypothesized to mediate positive psychotic symptoms. Antipsychotic medications
work by blocking D2 receptors in this pathway to reduce these symptoms.
2. A patient taking Haloperidol develops severe muscle rigidity, a high fever, and
autonomic instability. What is the most likely diagnosis?
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
,C. Acute Dystonia
D. Anticholinergic Toxicity
Correct Answer: B
Expert Explanation: Neuroleptic Malignant Syndrome is a rare but life-threatening
reaction to dopamine antagonists. It is characterized by ‘lead-pipe’ rigidity,
hyperthermia, and mental status changes. Treatment involves immediate
discontinuation of the offending agent and supportive care.
3. Which antidepressant is known for its dual mechanism of inhibiting the reuptake of
both serotonin and norepinephrine?
A. Venlafaxine
B. Sertraline
C. Fluoxetine
D. Bupropion
Correct Answer: A
Expert Explanation: Venlafaxine is classified as a Serotonin-Norepinephrine
Reuptake Inhibitor (SNRI). At lower doses, it primarily affects serotonin, while at
higher doses, its norepinephrine effects become more prominent. This dual action is
often used for patients who do not respond to SSRIs alone.
,4. A patient is prescribed Lamotrigine for bipolar depression. What is the most critical
side effect the PMHNP must educate the patient about?
A. Severe skin rash (Stevens-Johnson Syndrome)
B. Weight gain
C. Agranulocytosis
D. Hyperprolactinemia
Correct Answer: A
Expert Explanation: Lamotrigine carries a black box warning for serious rashes,
including Stevens-Johnson Syndrome. To minimize this risk, the medication must be
titrated very slowly over several weeks. Patients must be instructed to seek
immediate medical attention if any skin changes or mucosal lesions occur.
5. Which enzyme system is primarily responsible for the metabolism of many
psychotropic medications, and is inhibited by fluoxetine?
A. CYP2D6
B. CYP1A2
C. MAO-A
D. COMT
Correct Answer: A
, Expert Explanation: Fluoxetine is a potent inhibitor of the CYP2D6 enzyme system.
This inhibition can lead to increased plasma levels of other drugs metabolized by
the same pathway, such as tricyclic antidepressants or beta-blockers. Understanding
these interactions is vital for safe prescribing practices.
6. A patient with a history of seizures and an eating disorder is seeking treatment for
depression. Which medication is contraindicated?
A. Bupropion
B. Mirtazapine
C. Escitalopram
D. Duloxetine
Correct Answer: A
Expert Explanation: Bupropion is associated with a dose-related risk of seizures,
which is significantly increased in patients with underlying seizure disorders. It is
also contraindicated in patients with anorexia or bulimia due to a higher incidence
of seizures in these populations. The PMHNP should select an alternative
antidepressant for this patient.
7. Which mood stabilizer requires regular monitoring of serum levels, renal function,
and thyroid function?
A. Valproate
