NSG552 EXAM 2 Actual Exam 2026/2027
Complete Questions and Verified Answers
with Detailed Rationales
Psychopharmacology Grade A 100% Correct
Pass Guaranteed - A+ Graded
SECTION 1: ANTIDEPRESSANTS (Questions 1-20)
Q1: A patient with major depressive disorder is started on sertraline. The patient calls the office 3
days later reporting nausea and headache. What is the most appropriate nursing response? A.
Discontinue the medication immediately
B. Reassure the patient that these side effects are often temporary and may improve with time.
[CORRECT]
C. Double the dose to overcome the side effects
D. Switch to a different antidepressant
Rationale: SSRIs commonly cause GI side effects (nausea) and headache initially, but these
often improve within 1-2 weeks. Reassuring the patient and encouraging them to continue is
appropriate (B). Discontinuing (A) or switching (D) is premature. Doubling the dose (C) may
worsen side effects.
Q2: A patient has been taking fluoxetine 20 mg daily for 6 weeks with minimal improvement in
depression. The prescriber increases the dose to 40 mg. How long should the patient wait to
evaluate the full therapeutic effect at this new dose? A. 1 week
B. 2-4 weeks. [CORRECT]
C. 6 months
D. 24 hours
Rationale: After a dose increase, patients should wait an additional 2-4 weeks to assess full
therapeutic response (B). Antidepressants typically require 2-4 weeks at therapeutic doses for
clinical effect, and this timeline resets with dose adjustments.
Q3: A patient taking paroxetine for 8 months wants to discontinue the medication. What is the
most appropriate tapering strategy? A. Stop immediately
B. Reduce by 10 mg every 1-2 weeks. [CORRECT]
C. Reduce by 20 mg every 3 days
D. Switch to fluoxetine for 1 week then stop
Rationale: Paroxetine has a short half-life and high affinity for the serotonin transporter, causing
,significant discontinuation syndrome. Gradual tapering by 10 mg every 1-2 weeks (B) minimizes
withdrawal symptoms. Immediate discontinuation (A) or rapid taper (C) causes severe
discontinuation syndrome.
Q4: A patient with depression and chronic neuropathic pain is started on duloxetine. What
important monitoring parameter should be included in the plan of care? A. Complete blood count
monthly
B. Blood pressure monitoring. [CORRECT]
C. Liver function tests weekly
D. Thyroid function tests quarterly
Rationale: Duloxetine (an SNRI) can cause dose-dependent increases in blood pressure (B).
Baseline and periodic BP monitoring is recommended, especially at doses >60 mg/day. Routine
CBC (A), weekly LFTs (C), or thyroid tests (D) are not standard for duloxetine.
Q5: A patient presents with depression characterized by hypersomnia, weight gain, and mood
reactivity. Which antidepressant would be most appropriate? A. Fluoxetine
B. Phenelzine. [CORRECT]
C. Bupropion
D. Desipramine
Rationale: Atypical depression features (hypersomnia, weight gain, mood reactivity) respond
preferentially to MAOIs such as phenelzine (B). MAOIs are often effective when SSRIs fail in
atypical depression, though dietary restrictions are required.
Q6: A patient taking amitriptyline for depression reports dry mouth, constipation, and blurred
vision. These side effects are best explained by: A. Alpha-1 blockade
B. Histamine H1 blockade
C. Muscarinic cholinergic blockade. [CORRECT]
D. Dopamine D2 blockade
Rationale: TCAs like amitriptyline cause anticholinergic side effects (dry mouth, constipation,
blurred vision, urinary retention) through muscarinic cholinergic receptor blockade (C).
Histamine blockade (B) causes sedation and weight gain.
Q7: A patient with depression and smoking cessation goals is started on bupropion XL. What
critical counseling point must be included? A. Take at bedtime due to sedation
B. Avoid in patients with seizure disorders or eating disorders due to lowered seizure threshold.
[CORRECT]
C. Expect sexual side effects
D. Avoid tyramine-containing foods
Rationale: Bupropion lowers the seizure threshold and is contraindicated in seizure disorders,
anorexia nervosa, or bulimia due to increased seizure risk (B). It is activating (take in morning),
does not cause sexual side effects, and has no dietary restrictions.
, Q8: A patient taking venlafaxine XR 225 mg daily develops sustained hypertension (BP 165/95).
What is the most appropriate intervention? A. Add lisinopril
B. Reduce venlafaxine dose or switch to SSRI. [CORRECT]
C. Add propranolol
D. Increase venlafaxine to 300 mg
Rationale: Venlafaxine causes dose-dependent norepinephrine reuptake inhibition leading to
hypertension at higher doses (>150 mg). The best approach is dose reduction or switching to an
SSRI without significant NE effects (B). Adding antihypertensives (A, C) treats symptoms but
not the cause.
Q9: A patient with depression and insomnia is prescribed trazodone 50 mg at bedtime. What rare
but serious side effect should be included in patient education? A. Serotonin syndrome
B. Priapism (prolonged erection). [CORRECT]
C. Agranulocytosis
D. Stevens-Johnson syndrome
Rationale: Trazodone carries a rare but serious risk of priapism (prolonged, painful erection)
requiring immediate medical attention (B). While serotonin syndrome (A) is possible with any
serotonergic agent, priapism is specific to trazodone among antidepressants.
Q10: A patient taking phenelzine eats aged cheese and develops severe headache, neck stiffness,
and BP 190/110. What is the most likely diagnosis? A. Serotonin syndrome
B. Hypertensive crisis from tyramine. [CORRECT]
C. Neuroleptic malignant syndrome
D. Malignant hyperthermia
Rationale: MAOIs inhibit breakdown of tyramine in food, leading to norepinephrine release and
hypertensive crisis (B). Aged cheeses are high in tyramine. This requires immediate BP
management with agents like nifedipine or phentolamine.
Q11: A patient with depression and sexual dysfunction on sertraline is switched to mirtazapine.
What side effect should be anticipated and discussed? A. Insomnia
B. Weight gain and sedation. [CORRECT]
C. Sexual dysfunction
D. Hypertension
Rationale: Mirtazapine is associated with significant weight gain and sedation (take at bedtime)
(B). It has minimal sexual side effects (unlike SSRIs/SNRIs), does not cause insomnia (may
improve sleep), and does not cause hypertension.
Q12: A patient taking citalopram 40 mg daily has QTc prolongation to 520 ms on ECG. What is
the appropriate intervention? A. Continue current dose
B. Reduce dose to maximum 20 mg or switch antidepressant. [CORRECT]
C. Add metoprolol
D. Increase to 60 mg
Complete Questions and Verified Answers
with Detailed Rationales
Psychopharmacology Grade A 100% Correct
Pass Guaranteed - A+ Graded
SECTION 1: ANTIDEPRESSANTS (Questions 1-20)
Q1: A patient with major depressive disorder is started on sertraline. The patient calls the office 3
days later reporting nausea and headache. What is the most appropriate nursing response? A.
Discontinue the medication immediately
B. Reassure the patient that these side effects are often temporary and may improve with time.
[CORRECT]
C. Double the dose to overcome the side effects
D. Switch to a different antidepressant
Rationale: SSRIs commonly cause GI side effects (nausea) and headache initially, but these
often improve within 1-2 weeks. Reassuring the patient and encouraging them to continue is
appropriate (B). Discontinuing (A) or switching (D) is premature. Doubling the dose (C) may
worsen side effects.
Q2: A patient has been taking fluoxetine 20 mg daily for 6 weeks with minimal improvement in
depression. The prescriber increases the dose to 40 mg. How long should the patient wait to
evaluate the full therapeutic effect at this new dose? A. 1 week
B. 2-4 weeks. [CORRECT]
C. 6 months
D. 24 hours
Rationale: After a dose increase, patients should wait an additional 2-4 weeks to assess full
therapeutic response (B). Antidepressants typically require 2-4 weeks at therapeutic doses for
clinical effect, and this timeline resets with dose adjustments.
Q3: A patient taking paroxetine for 8 months wants to discontinue the medication. What is the
most appropriate tapering strategy? A. Stop immediately
B. Reduce by 10 mg every 1-2 weeks. [CORRECT]
C. Reduce by 20 mg every 3 days
D. Switch to fluoxetine for 1 week then stop
Rationale: Paroxetine has a short half-life and high affinity for the serotonin transporter, causing
,significant discontinuation syndrome. Gradual tapering by 10 mg every 1-2 weeks (B) minimizes
withdrawal symptoms. Immediate discontinuation (A) or rapid taper (C) causes severe
discontinuation syndrome.
Q4: A patient with depression and chronic neuropathic pain is started on duloxetine. What
important monitoring parameter should be included in the plan of care? A. Complete blood count
monthly
B. Blood pressure monitoring. [CORRECT]
C. Liver function tests weekly
D. Thyroid function tests quarterly
Rationale: Duloxetine (an SNRI) can cause dose-dependent increases in blood pressure (B).
Baseline and periodic BP monitoring is recommended, especially at doses >60 mg/day. Routine
CBC (A), weekly LFTs (C), or thyroid tests (D) are not standard for duloxetine.
Q5: A patient presents with depression characterized by hypersomnia, weight gain, and mood
reactivity. Which antidepressant would be most appropriate? A. Fluoxetine
B. Phenelzine. [CORRECT]
C. Bupropion
D. Desipramine
Rationale: Atypical depression features (hypersomnia, weight gain, mood reactivity) respond
preferentially to MAOIs such as phenelzine (B). MAOIs are often effective when SSRIs fail in
atypical depression, though dietary restrictions are required.
Q6: A patient taking amitriptyline for depression reports dry mouth, constipation, and blurred
vision. These side effects are best explained by: A. Alpha-1 blockade
B. Histamine H1 blockade
C. Muscarinic cholinergic blockade. [CORRECT]
D. Dopamine D2 blockade
Rationale: TCAs like amitriptyline cause anticholinergic side effects (dry mouth, constipation,
blurred vision, urinary retention) through muscarinic cholinergic receptor blockade (C).
Histamine blockade (B) causes sedation and weight gain.
Q7: A patient with depression and smoking cessation goals is started on bupropion XL. What
critical counseling point must be included? A. Take at bedtime due to sedation
B. Avoid in patients with seizure disorders or eating disorders due to lowered seizure threshold.
[CORRECT]
C. Expect sexual side effects
D. Avoid tyramine-containing foods
Rationale: Bupropion lowers the seizure threshold and is contraindicated in seizure disorders,
anorexia nervosa, or bulimia due to increased seizure risk (B). It is activating (take in morning),
does not cause sexual side effects, and has no dietary restrictions.
, Q8: A patient taking venlafaxine XR 225 mg daily develops sustained hypertension (BP 165/95).
What is the most appropriate intervention? A. Add lisinopril
B. Reduce venlafaxine dose or switch to SSRI. [CORRECT]
C. Add propranolol
D. Increase venlafaxine to 300 mg
Rationale: Venlafaxine causes dose-dependent norepinephrine reuptake inhibition leading to
hypertension at higher doses (>150 mg). The best approach is dose reduction or switching to an
SSRI without significant NE effects (B). Adding antihypertensives (A, C) treats symptoms but
not the cause.
Q9: A patient with depression and insomnia is prescribed trazodone 50 mg at bedtime. What rare
but serious side effect should be included in patient education? A. Serotonin syndrome
B. Priapism (prolonged erection). [CORRECT]
C. Agranulocytosis
D. Stevens-Johnson syndrome
Rationale: Trazodone carries a rare but serious risk of priapism (prolonged, painful erection)
requiring immediate medical attention (B). While serotonin syndrome (A) is possible with any
serotonergic agent, priapism is specific to trazodone among antidepressants.
Q10: A patient taking phenelzine eats aged cheese and develops severe headache, neck stiffness,
and BP 190/110. What is the most likely diagnosis? A. Serotonin syndrome
B. Hypertensive crisis from tyramine. [CORRECT]
C. Neuroleptic malignant syndrome
D. Malignant hyperthermia
Rationale: MAOIs inhibit breakdown of tyramine in food, leading to norepinephrine release and
hypertensive crisis (B). Aged cheeses are high in tyramine. This requires immediate BP
management with agents like nifedipine or phentolamine.
Q11: A patient with depression and sexual dysfunction on sertraline is switched to mirtazapine.
What side effect should be anticipated and discussed? A. Insomnia
B. Weight gain and sedation. [CORRECT]
C. Sexual dysfunction
D. Hypertension
Rationale: Mirtazapine is associated with significant weight gain and sedation (take at bedtime)
(B). It has minimal sexual side effects (unlike SSRIs/SNRIs), does not cause insomnia (may
improve sleep), and does not cause hypertension.
Q12: A patient taking citalopram 40 mg daily has QTc prolongation to 520 ms on ECG. What is
the appropriate intervention? A. Continue current dose
B. Reduce dose to maximum 20 mg or switch antidepressant. [CORRECT]
C. Add metoprolol
D. Increase to 60 mg
