1
NU 673 Midterm Exam Actual Exam
2026/2027 – Complete Exam-Style Questions
with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
[SECTION 1: Neurobiology & Psychopharmacology — Questions 1-20]
Q1: Which dopamine pathway is primarily implicated in the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
B. Mesolimbic pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Correct Answer: B
Rationale: The mesolimbic pathway is associated with the positive symptoms of schizophrenia
due to hyperactivity of dopamine transmission. The nigrostriatal pathway (A) is involved in
motor control and is associated with extrapyramidal symptoms (EPS). The mesocortical pathway
(C) is linked to negative symptoms and cognitive deficits, often associated with
hypodopaminergia. The tuberoinfundibular pathway (D) regulates prolactin secretion.
Q2: A patient prescribed an SSRI reports sexual dysfunction, including delayed ejaculation and
anorgasmia. This side effect is most directly caused by the medication's effect on which
neurotransmitter?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. GABA
Correct Answer: C
,2
Rationale: SSRIs increase synaptic serotonin by inhibiting the serotonin transporter (SERT).
While effective for mood and anxiety, increased serotonin activity, specifically at 5-HT2 and 5-
HT3 receptors, is strongly linked to sexual dysfunction. Dopamine (A) and Norepinephrine (B)
generally have pro-sexual effects. GABA (D) is inhibitory and not the primary target of SSRIs.
Q3: Which of the following neurobiological mechanisms is associated with the pathophysiology
of Alzheimer's disease?
A. Degeneration of dopaminergic neurons in the substantia nigra
B. Serotonin deficiency in the prefrontal cortex
C. Deficiency of acetylcholine and beta-amyloid plaques
D. Hyperactivity of the nigrostriatal dopamine pathway
Correct Answer: C
Rationale: Alzheimer's disease is characterized by a deficit in acetylcholine due to the
degeneration of cholinergic neurons in the basal forebrain, alongside the accumulation of beta-
amyloid plaques and tau tangles. Dopaminergic degeneration (A) is seen in Parkinson's.
Serotonin deficiency (B) is linked to depression. Dopaminergic hyperactivity (D) is linked to
psychosis.
Q4: A PMHNP is considering prescribing Carbamazepine for a patient with Bipolar Disorder.
Which of the following is a critical baseline laboratory test required before initiation?
A. Complete Blood Count (CBC) with differential
B. Serum Sodium
C. Thyroid Stimulating Hormone (TSH)
D. Prolactin level
Correct Answer: A
Rationale: Carbamazepine carries a risk of aplastic anemia and agranulocytosis; therefore, a
baseline CBC is mandatory to monitor for bone marrow suppression. Serum Sodium (B) is
monitored for carbamazepine-induced hyponatremia, but CBC is the critical safety test for
,3
hematologic toxicity. TSH (C) is monitored for Lithium. Prolactin (D) is monitored for
antipsychotics.
Q5: A patient taking Fluoxetine complains of "brain zaps," dizziness, and flu-like symptoms after
abruptly stopping the medication. The PMHNP recognizes this as:
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
C. Antidepressant Discontinuation Syndrome
D. Extrapyramidal Symptoms (EPS)
Correct Answer: C
Rationale: Antidepressant Discontinuation Syndrome occurs after abrupt cessation of
antidepressants, particularly those with short half-lives (like paroxetine or venlafaxine), but also
fluoxetine due to its active metabolite. Symptoms include sensory disturbances ("brain zaps"),
dizziness, and gastrointestinal upset. Serotonin Syndrome (A) involves hyperthermia and
rigidity. NMS (B) is a reaction to antipsychotics. EPS (D) involves movement disorders.
Q6: Which of the following mood stabilizers requires specific monitoring for a potentially life-
threatening rash (Stevens-Johnson Syndrome) necessitating a slow titration schedule?
A. Lithium
B. Valproate (Divalproex)
C. Lamotrigine
D. Carbamazepine
Correct Answer: C
Rationale: Lamotrigine carries a significant risk of Stevens-Johnson Syndrome (SJS) and Toxic
Epidermal Necrolysis (TEN). To mitigate this, it requires a very slow titration schedule (e.g.,
starting at 25 mg daily and increasing slowly). While Carbamazepine (D) also carries an SJS
risk, Lamotrigine's titration protocol is particularly distinct and emphasized in NP curricula.
Lithium (A) and Valproate (B) do not require slow titration specifically for SJS risk.
, 4
Q7: A patient with Major Depressive Disorder who has not responded to two adequate trials of
SSRIs is prescribed Venlafaxine. What is a unique side effect risk associated with Venlafaxine at
higher doses?
A. Weight gain
B. Dry mouth
C. Dose-dependent sustained hypertension
D. Sedation
Correct Answer: C
Rationale: Venlafaxine is an SNRI that affects serotonin at low doses and norepinephrine at
higher doses (>150 mg). The increased noradrenergic activity can lead to dose-dependent
sustained hypertension. Weight gain (A), dry mouth (B), and sedation (D) are common side
effects of many antidepressants but hypertension is the distinct cardiovascular risk for
venlafaxine.
Q8: A patient is prescribed Phenelzine, an MAOI. The PMHNP educates the patient about the
risk of hypertensive crisis. Which food item should be strictly avoided?
A. Fresh apples
B. Aged cheddar cheese
C. White rice
D. Coffee
Correct Answer: B
Rationale: MAOIs inhibit the breakdown of tyramine. Ingesting tyramine-rich foods (aged
cheeses, cured meats, tap beer, soy sauce) can cause a hypertensive crisis. Fresh fruits (A), white
rice (C), and coffee (D) are not significant sources of tyramine and are generally safe.
Q9: Which second-generation antipsychotic is considered a partial D2 agonist and is often used
as an adjunct in Major Depressive Disorder due to its lower risk of metabolic side effects?
A. Olanzapine
NU 673 Midterm Exam Actual Exam
2026/2027 – Complete Exam-Style Questions
with Detailed Rationales | 100% Verified |
Pass Guaranteed – A+ Graded
[SECTION 1: Neurobiology & Psychopharmacology — Questions 1-20]
Q1: Which dopamine pathway is primarily implicated in the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
B. Mesolimbic pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Correct Answer: B
Rationale: The mesolimbic pathway is associated with the positive symptoms of schizophrenia
due to hyperactivity of dopamine transmission. The nigrostriatal pathway (A) is involved in
motor control and is associated with extrapyramidal symptoms (EPS). The mesocortical pathway
(C) is linked to negative symptoms and cognitive deficits, often associated with
hypodopaminergia. The tuberoinfundibular pathway (D) regulates prolactin secretion.
Q2: A patient prescribed an SSRI reports sexual dysfunction, including delayed ejaculation and
anorgasmia. This side effect is most directly caused by the medication's effect on which
neurotransmitter?
A. Dopamine
B. Norepinephrine
C. Serotonin
D. GABA
Correct Answer: C
,2
Rationale: SSRIs increase synaptic serotonin by inhibiting the serotonin transporter (SERT).
While effective for mood and anxiety, increased serotonin activity, specifically at 5-HT2 and 5-
HT3 receptors, is strongly linked to sexual dysfunction. Dopamine (A) and Norepinephrine (B)
generally have pro-sexual effects. GABA (D) is inhibitory and not the primary target of SSRIs.
Q3: Which of the following neurobiological mechanisms is associated with the pathophysiology
of Alzheimer's disease?
A. Degeneration of dopaminergic neurons in the substantia nigra
B. Serotonin deficiency in the prefrontal cortex
C. Deficiency of acetylcholine and beta-amyloid plaques
D. Hyperactivity of the nigrostriatal dopamine pathway
Correct Answer: C
Rationale: Alzheimer's disease is characterized by a deficit in acetylcholine due to the
degeneration of cholinergic neurons in the basal forebrain, alongside the accumulation of beta-
amyloid plaques and tau tangles. Dopaminergic degeneration (A) is seen in Parkinson's.
Serotonin deficiency (B) is linked to depression. Dopaminergic hyperactivity (D) is linked to
psychosis.
Q4: A PMHNP is considering prescribing Carbamazepine for a patient with Bipolar Disorder.
Which of the following is a critical baseline laboratory test required before initiation?
A. Complete Blood Count (CBC) with differential
B. Serum Sodium
C. Thyroid Stimulating Hormone (TSH)
D. Prolactin level
Correct Answer: A
Rationale: Carbamazepine carries a risk of aplastic anemia and agranulocytosis; therefore, a
baseline CBC is mandatory to monitor for bone marrow suppression. Serum Sodium (B) is
monitored for carbamazepine-induced hyponatremia, but CBC is the critical safety test for
,3
hematologic toxicity. TSH (C) is monitored for Lithium. Prolactin (D) is monitored for
antipsychotics.
Q5: A patient taking Fluoxetine complains of "brain zaps," dizziness, and flu-like symptoms after
abruptly stopping the medication. The PMHNP recognizes this as:
A. Serotonin Syndrome
B. Neuroleptic Malignant Syndrome (NMS)
C. Antidepressant Discontinuation Syndrome
D. Extrapyramidal Symptoms (EPS)
Correct Answer: C
Rationale: Antidepressant Discontinuation Syndrome occurs after abrupt cessation of
antidepressants, particularly those with short half-lives (like paroxetine or venlafaxine), but also
fluoxetine due to its active metabolite. Symptoms include sensory disturbances ("brain zaps"),
dizziness, and gastrointestinal upset. Serotonin Syndrome (A) involves hyperthermia and
rigidity. NMS (B) is a reaction to antipsychotics. EPS (D) involves movement disorders.
Q6: Which of the following mood stabilizers requires specific monitoring for a potentially life-
threatening rash (Stevens-Johnson Syndrome) necessitating a slow titration schedule?
A. Lithium
B. Valproate (Divalproex)
C. Lamotrigine
D. Carbamazepine
Correct Answer: C
Rationale: Lamotrigine carries a significant risk of Stevens-Johnson Syndrome (SJS) and Toxic
Epidermal Necrolysis (TEN). To mitigate this, it requires a very slow titration schedule (e.g.,
starting at 25 mg daily and increasing slowly). While Carbamazepine (D) also carries an SJS
risk, Lamotrigine's titration protocol is particularly distinct and emphasized in NP curricula.
Lithium (A) and Valproate (B) do not require slow titration specifically for SJS risk.
, 4
Q7: A patient with Major Depressive Disorder who has not responded to two adequate trials of
SSRIs is prescribed Venlafaxine. What is a unique side effect risk associated with Venlafaxine at
higher doses?
A. Weight gain
B. Dry mouth
C. Dose-dependent sustained hypertension
D. Sedation
Correct Answer: C
Rationale: Venlafaxine is an SNRI that affects serotonin at low doses and norepinephrine at
higher doses (>150 mg). The increased noradrenergic activity can lead to dose-dependent
sustained hypertension. Weight gain (A), dry mouth (B), and sedation (D) are common side
effects of many antidepressants but hypertension is the distinct cardiovascular risk for
venlafaxine.
Q8: A patient is prescribed Phenelzine, an MAOI. The PMHNP educates the patient about the
risk of hypertensive crisis. Which food item should be strictly avoided?
A. Fresh apples
B. Aged cheddar cheese
C. White rice
D. Coffee
Correct Answer: B
Rationale: MAOIs inhibit the breakdown of tyramine. Ingesting tyramine-rich foods (aged
cheeses, cured meats, tap beer, soy sauce) can cause a hypertensive crisis. Fresh fruits (A), white
rice (C), and coffee (D) are not significant sources of tyramine and are generally safe.
Q9: Which second-generation antipsychotic is considered a partial D2 agonist and is often used
as an adjunct in Major Depressive Disorder due to its lower risk of metabolic side effects?
A. Olanzapine
