WGU D345 NURS 6438
Psychopharmacology Comprehensive
Final OA ACTUAL EXAM 2026/2027 |
Objective Assessment Guide with Verified
Questions and Correct Answers | A-Grade
| Pass Guaranteed
1. Question: A 25-year-old female with Bipolar I Disorder, currently
stable on lithium 900mg daily for 18 months, presents for routine follow-
up. She mentions she and her partner are planning to start a family in the
next year. Her lithium level is 0.9 mEq/L. What is the most critical next
step in management?
Answer: Provide immediate, comprehensive preconception counseling
regarding the significant teratogenic risks of lithium (especially cardiac
Ebstein's anomaly) and discuss alternative mood stabilizers.
Rationale: Lithium is a Category D drug with a well-established risk of
cardiac malformations, highest during the first trimester. Preconception
planning is essential. The goal is to maintain mood stability while
minimizing fetal risk, often by switching to a safer agent like lamotrigine
before pregnancy, if clinically appropriate.
2. Question: A patient started on clozapine for treatment-resistant
schizophrenia 4 weeks ago. At today's visit, their WBC count is 3.5 x
,10³/µL (down from 7.0 at baseline). What is the required action per
clozapine monitoring guidelines?
Answer: Continue clozapine but increase monitoring frequency to twice
weekly. This result indicates "benign leukopenia" or mild neutropenia,
triggering more frequent monitoring but not discontinuation.
Rationale: Per the Clozapine REMS Program:
• Normal: WBC ≥3500 and ANC ≥2000 (continue weekly).
• Mild Neutropenia: WBC 3000-3499 or ANC 1500-1999 (twice
weekly monitoring).
• Moderate/ Severe Neutropenia: WBC <3000 or ANC <1500
(requires interruption of clozapine and daily monitoring).
3. Question: A 45-year-old male with Major Depressive Disorder has
failed adequate trials of two SSRIs. You initiate a trial of venlafaxine XR
150mg daily. At his 2-week follow-up, he reports improved energy and
motivation but complains of a new, sustained elevation in blood
pressure. What is the likely mechanism?
Answer: Norepinephrine reuptake inhibition at the higher therapeutic
dose.
Rationale: Venlafaxine is a dose-dependent SNRI. At lower doses
(<150mg/day), it primarily inhibits serotonin reuptake. At higher doses,
norepinephrine reuptake inhibition becomes significant, which can lead
to increased blood pressure and heart rate. This requires routine BP
monitoring.
4. Question: A patient with Generalized Anxiety Disorder has been
successfully treated with paroxetine 40mg daily for 2 years. They now
wish to discontinue. What is the most appropriate strategy?
Answer: Initiate a very slow, gradual taper over several months (e.g.,
reduce by 10mg increments every 4-6 weeks).
Rationale: Paroxetine, due to its short half-life and anticholinergic
,properties, has one of the highest risks of severe
discontinuation/withdrawal syndrome (dizziness, paresthesias, nausea,
"brain zaps"). A hyperbolically slow taper minimizes these symptoms.
5. Question: What is the first-line pharmacotherapy for ADHD in a 10-
year-old child with no comorbid conditions?
Answer: Stimulant medications (methylphenidate or amphetamine-
based preparations).
Rationale: Based on decades of evidence and practice parameters from
the American Academy of Pediatrics, stimulant medications are the
most efficacious treatment for core ADHD symptoms. The choice
between methylphenidate and amphetamine classes is often based on
individual response, side effects, and duration needed.
6. Question: A 60-year-old male with a history of alcohol use disorder
(sober 5 years) presents with neuropathic pain. Which medication
should be avoided?
Answer: Pregabalin or gabapentin.
Rationale: While these are first-line for neuropathic pain, they have a
potential for misuse, dependence, and can produce euphoria,
particularly in individuals with a history of substance use disorders.
Duloxetine or venlafaxine may be safer alternatives in this population.
7. Question: For which condition is the alpha-2 agonist clonidine FDA-
approved?
Answer: Hypertension. Note: In psychiatry, it is used off-label for ADHD
(adjunct), PTSD nightmares, and opioid/nicotine withdrawal.
Rationale: It's crucial to distinguish between FDA-approved indications
and evidence-based off-label uses. Clonidine's primary mechanism is
central alpha-2 agonism, reducing sympathetic outflow, which explains
its utility across multiple conditions.
, 8. Question: A patient on fluoxetine 40mg daily for OCD needs surgery.
The anesthesiologist is concerned about serotonin syndrome risk with
certain anesthetics. How long before surgery should fluoxetine be
stopped?
Answer: It should not be routinely stopped. The long half-life of
fluoxetine (4-6 days) and its active metabolite norfluoxetine (7-15 days)
means it takes weeks to wash out. Abrupt discontinuation risks
depression/OCD relapse. The anesthesiologist should be informed of the
medication, and they will select safe agents.
Rationale: This question tests knowledge of pharmacokinetics
(fluoxetine's unique prolonged half-life) and risk-benefit analysis. The
risk of serotonin syndrome with modern anesthetics is low compared to
the high risk of psychiatric decompensation from stopping an SSRI
abruptly.
9. Question: Which antipsychotic carries the highest absolute risk for
causing weight gain and metabolic dysregulation?
Answer: Olanzapine, followed closely by clozapine.
Rationale: Multiple head-to-head trials (e.g., CATIE) have consistently
shown olanzapine causes the greatest weight gain and adverse
metabolic changes (increased triglycerides, insulin resistance). Baseline
and ongoing metabolic monitoring is mandatory with these agents.
10. Question: A patient taking valproic acid for bipolar disorder reports
easy bruising. Labs show a platelet count of 95,000/µL. What is the likely
cause and action?
Answer: Valproate-induced thrombocytopenia. Management involves
checking a valproate level (toxicity can cause this even within
"therapeutic" range) and considering dose reduction or alternative mood
stabilizer if clinically significant.
Rationale: Valproate can cause dose-related bone marrow suppression,
Psychopharmacology Comprehensive
Final OA ACTUAL EXAM 2026/2027 |
Objective Assessment Guide with Verified
Questions and Correct Answers | A-Grade
| Pass Guaranteed
1. Question: A 25-year-old female with Bipolar I Disorder, currently
stable on lithium 900mg daily for 18 months, presents for routine follow-
up. She mentions she and her partner are planning to start a family in the
next year. Her lithium level is 0.9 mEq/L. What is the most critical next
step in management?
Answer: Provide immediate, comprehensive preconception counseling
regarding the significant teratogenic risks of lithium (especially cardiac
Ebstein's anomaly) and discuss alternative mood stabilizers.
Rationale: Lithium is a Category D drug with a well-established risk of
cardiac malformations, highest during the first trimester. Preconception
planning is essential. The goal is to maintain mood stability while
minimizing fetal risk, often by switching to a safer agent like lamotrigine
before pregnancy, if clinically appropriate.
2. Question: A patient started on clozapine for treatment-resistant
schizophrenia 4 weeks ago. At today's visit, their WBC count is 3.5 x
,10³/µL (down from 7.0 at baseline). What is the required action per
clozapine monitoring guidelines?
Answer: Continue clozapine but increase monitoring frequency to twice
weekly. This result indicates "benign leukopenia" or mild neutropenia,
triggering more frequent monitoring but not discontinuation.
Rationale: Per the Clozapine REMS Program:
• Normal: WBC ≥3500 and ANC ≥2000 (continue weekly).
• Mild Neutropenia: WBC 3000-3499 or ANC 1500-1999 (twice
weekly monitoring).
• Moderate/ Severe Neutropenia: WBC <3000 or ANC <1500
(requires interruption of clozapine and daily monitoring).
3. Question: A 45-year-old male with Major Depressive Disorder has
failed adequate trials of two SSRIs. You initiate a trial of venlafaxine XR
150mg daily. At his 2-week follow-up, he reports improved energy and
motivation but complains of a new, sustained elevation in blood
pressure. What is the likely mechanism?
Answer: Norepinephrine reuptake inhibition at the higher therapeutic
dose.
Rationale: Venlafaxine is a dose-dependent SNRI. At lower doses
(<150mg/day), it primarily inhibits serotonin reuptake. At higher doses,
norepinephrine reuptake inhibition becomes significant, which can lead
to increased blood pressure and heart rate. This requires routine BP
monitoring.
4. Question: A patient with Generalized Anxiety Disorder has been
successfully treated with paroxetine 40mg daily for 2 years. They now
wish to discontinue. What is the most appropriate strategy?
Answer: Initiate a very slow, gradual taper over several months (e.g.,
reduce by 10mg increments every 4-6 weeks).
Rationale: Paroxetine, due to its short half-life and anticholinergic
,properties, has one of the highest risks of severe
discontinuation/withdrawal syndrome (dizziness, paresthesias, nausea,
"brain zaps"). A hyperbolically slow taper minimizes these symptoms.
5. Question: What is the first-line pharmacotherapy for ADHD in a 10-
year-old child with no comorbid conditions?
Answer: Stimulant medications (methylphenidate or amphetamine-
based preparations).
Rationale: Based on decades of evidence and practice parameters from
the American Academy of Pediatrics, stimulant medications are the
most efficacious treatment for core ADHD symptoms. The choice
between methylphenidate and amphetamine classes is often based on
individual response, side effects, and duration needed.
6. Question: A 60-year-old male with a history of alcohol use disorder
(sober 5 years) presents with neuropathic pain. Which medication
should be avoided?
Answer: Pregabalin or gabapentin.
Rationale: While these are first-line for neuropathic pain, they have a
potential for misuse, dependence, and can produce euphoria,
particularly in individuals with a history of substance use disorders.
Duloxetine or venlafaxine may be safer alternatives in this population.
7. Question: For which condition is the alpha-2 agonist clonidine FDA-
approved?
Answer: Hypertension. Note: In psychiatry, it is used off-label for ADHD
(adjunct), PTSD nightmares, and opioid/nicotine withdrawal.
Rationale: It's crucial to distinguish between FDA-approved indications
and evidence-based off-label uses. Clonidine's primary mechanism is
central alpha-2 agonism, reducing sympathetic outflow, which explains
its utility across multiple conditions.
, 8. Question: A patient on fluoxetine 40mg daily for OCD needs surgery.
The anesthesiologist is concerned about serotonin syndrome risk with
certain anesthetics. How long before surgery should fluoxetine be
stopped?
Answer: It should not be routinely stopped. The long half-life of
fluoxetine (4-6 days) and its active metabolite norfluoxetine (7-15 days)
means it takes weeks to wash out. Abrupt discontinuation risks
depression/OCD relapse. The anesthesiologist should be informed of the
medication, and they will select safe agents.
Rationale: This question tests knowledge of pharmacokinetics
(fluoxetine's unique prolonged half-life) and risk-benefit analysis. The
risk of serotonin syndrome with modern anesthetics is low compared to
the high risk of psychiatric decompensation from stopping an SSRI
abruptly.
9. Question: Which antipsychotic carries the highest absolute risk for
causing weight gain and metabolic dysregulation?
Answer: Olanzapine, followed closely by clozapine.
Rationale: Multiple head-to-head trials (e.g., CATIE) have consistently
shown olanzapine causes the greatest weight gain and adverse
metabolic changes (increased triglycerides, insulin resistance). Baseline
and ongoing metabolic monitoring is mandatory with these agents.
10. Question: A patient taking valproic acid for bipolar disorder reports
easy bruising. Labs show a platelet count of 95,000/µL. What is the likely
cause and action?
Answer: Valproate-induced thrombocytopenia. Management involves
checking a valproate level (toxicity can cause this even within
"therapeutic" range) and considering dose reduction or alternative mood
stabilizer if clinically significant.
Rationale: Valproate can cause dose-related bone marrow suppression,
