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
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 Correct Answer: B Rationale: SSRIs commonly cause
GI side effects (nausea, diarrhea) and headache during the first 1-2 weeks of treatment, but these
typically improve with continued use. Reassuring the patient, suggesting taking with food, and
encouraging adherence is appropriate initial management (B). Discontinuing (A) or switching
(D) is premature. Doubling the dose (C) would likely worsen side effects.
Q2: A patient taking fluoxetine for depression reports sexual dysfunction including decreased
libido and delayed ejaculation. The PMHNP should explain that:
A. These side effects are permanent and will not resolve
B. Sexual dysfunction occurs in 30-70% of patients taking SSRIs and may be managed with dose
adjustment, switching, or adjunctive medications [CORRECT]
C. These side effects indicate the medication is not working
D. The patient should stop the medication immediately Correct Answer: B Rationale: Sexual
dysfunction (decreased libido, delayed ejaculation/orgasm, erectile dysfunction) affects 30-70%
of SSRI users due to increased serotonin inhibiting dopamine and nitric oxide pathways.
Management options include waiting for tolerance, dose reduction, switching to bupropion or
,mirtazapine, or adding bupropion, sildenafil, or buspirone (B). These effects are not permanent
(A) and do not indicate treatment failure (C).
Q3: A patient taking phenelzine (an MAOI) asks about dietary restrictions. The nurse should
instruct the patient to avoid:
A. Fresh fruits and vegetables
B. Aged cheeses, cured meats, fermented foods, and tap beer [CORRECT]
C. All dairy products
D. All carbohydrates Correct Answer: B Rationale: MAOIs inhibit MAO-A, preventing
breakdown of tyramine in the gut. Tyramine-rich foods (aged cheeses, cured/smoked meats,
fermented products, fava beans, tap/draft beers, wine, soy sauce) can cause hypertensive crisis
(sudden severe hypertension, headache, stroke) due to release of stored catecholamines (B).
Fresh foods (A) are safe. Fresh dairy (C) and carbs (D) are not restricted.
Q4: A patient with neuropathic pain and depression is prescribed duloxetine. The mechanism of
action involves:
A. Selective serotonin reuptake inhibition only
B. Serotonin and norepinephrine reuptake inhibition [CORRECT]
C. Dopamine and norepinephrine reuptake inhibition
D. Monoamine oxidase inhibition Correct Answer: B Rationale: Duloxetine is an SNRI that
inhibits both serotonin and norepinephrine reuptake. The norepinephrine component provides
analgesic effects for neuropathic pain, fibromyalgia, and chronic musculoskeletal pain, making it
useful for patients with comorbid depression and pain conditions (B).
Q5: A patient taking amitriptyline reports dry mouth, constipation, and blurred vision. These side
effects are due to:
A. Serotonin reuptake inhibition
B. Anticholinergic (muscarinic receptor antagonism) effects [CORRECT]
C. Alpha-1 adrenergic blockade
D. Histamine H1 antagonism Correct Answer: B Rationale: TCAs like amitriptyline have
potent anticholinergic effects (muscarinic receptor antagonism) causing dry mouth, constipation,
urinary retention, blurred vision, and cognitive impairment. These side effects limit tolerability,
particularly in older adults who are more sensitive to anticholinergic burden (B).
Q6: A patient with treatment-resistant depression and seasonal affective disorder is started on
bupropion. Important patient education includes:
, A. The medication should be taken at bedtime due to sedation
B. The medication may cause insomnia and should be taken in the morning; avoid if history of
seizures or eating disorders [CORRECT]
C. The medication commonly causes sexual dysfunction
D. The medication requires dietary tyramine restriction Correct Answer: B Rationale:
Bupropion is an NDRI (norepinephrine-dopamine reuptake inhibitor) that is activating and may
cause insomnia, agitation, and headache. It should be taken in the morning and avoided in
patients with seizure disorders, eating disorders (lowers seizure threshold), or those undergoing
alcohol/benzodiazepine withdrawal (B). It has low sexual side effects (C) and no tyramine
restriction (D).
Q7: A patient taking venlafaxine XR at 225 mg/day has blood pressure of 158/92 mmHg. This is
likely due to:
A. Serotonin reuptake inhibition only
B. Norepinephrine reuptake inhibition at higher doses causing increased sympathetic tone
[CORRECT]
C. Alpha-2 adrenergic agonism
D. Histamine H1 antagonism Correct Answer: B Rationale: Venlafaxine has dose-dependent
effects: at lower doses primarily SSRI, at higher doses (≥150-225 mg) significant norepinephrine
reuptake inhibition occurs, potentially causing increased blood pressure due to enhanced
sympathetic tone. BP monitoring is essential at higher doses (B).
Q8: A patient abruptly discontinues paroxetine after 6 months of treatment and experiences
dizziness, nausea, paresthesias, irritability, and "electric shock" sensations. This represents:
A. Serotonin syndrome
B. SSRI discontinuation syndrome [CORRECT]
C. Neuroleptic malignant syndrome
D. Hypertensive crisis Correct Answer: B Rationale: SSRI discontinuation syndrome occurs
with abrupt cessation, especially with short half-life agents like paroxetine and venlafaxine.
Symptoms include dizziness, nausea, fatigue, headache, paresthesias, and sensory disturbances
("brain zaps"). Tapering over several weeks prevents this (B). Serotonin syndrome (A) is from
excess serotonin. NMS (C) is from antipsychotics. Hypertensive crisis (D) is from MAOIs.
Q9: A patient with depression and insomnia is prescribed trazodone 50 mg at bedtime. The
mechanism for its sedating effect is:
A. Selective serotonin reuptake inhibition
Complete Questions and Verified Answers
with Detailed Rationales
Psychopharmacology Grade A 100% Correct
Pass Guaranteed - A+ Graded
SECTION 1: ANTIDEPRESSANTS
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 Correct Answer: B Rationale: SSRIs commonly cause
GI side effects (nausea, diarrhea) and headache during the first 1-2 weeks of treatment, but these
typically improve with continued use. Reassuring the patient, suggesting taking with food, and
encouraging adherence is appropriate initial management (B). Discontinuing (A) or switching
(D) is premature. Doubling the dose (C) would likely worsen side effects.
Q2: A patient taking fluoxetine for depression reports sexual dysfunction including decreased
libido and delayed ejaculation. The PMHNP should explain that:
A. These side effects are permanent and will not resolve
B. Sexual dysfunction occurs in 30-70% of patients taking SSRIs and may be managed with dose
adjustment, switching, or adjunctive medications [CORRECT]
C. These side effects indicate the medication is not working
D. The patient should stop the medication immediately Correct Answer: B Rationale: Sexual
dysfunction (decreased libido, delayed ejaculation/orgasm, erectile dysfunction) affects 30-70%
of SSRI users due to increased serotonin inhibiting dopamine and nitric oxide pathways.
Management options include waiting for tolerance, dose reduction, switching to bupropion or
,mirtazapine, or adding bupropion, sildenafil, or buspirone (B). These effects are not permanent
(A) and do not indicate treatment failure (C).
Q3: A patient taking phenelzine (an MAOI) asks about dietary restrictions. The nurse should
instruct the patient to avoid:
A. Fresh fruits and vegetables
B. Aged cheeses, cured meats, fermented foods, and tap beer [CORRECT]
C. All dairy products
D. All carbohydrates Correct Answer: B Rationale: MAOIs inhibit MAO-A, preventing
breakdown of tyramine in the gut. Tyramine-rich foods (aged cheeses, cured/smoked meats,
fermented products, fava beans, tap/draft beers, wine, soy sauce) can cause hypertensive crisis
(sudden severe hypertension, headache, stroke) due to release of stored catecholamines (B).
Fresh foods (A) are safe. Fresh dairy (C) and carbs (D) are not restricted.
Q4: A patient with neuropathic pain and depression is prescribed duloxetine. The mechanism of
action involves:
A. Selective serotonin reuptake inhibition only
B. Serotonin and norepinephrine reuptake inhibition [CORRECT]
C. Dopamine and norepinephrine reuptake inhibition
D. Monoamine oxidase inhibition Correct Answer: B Rationale: Duloxetine is an SNRI that
inhibits both serotonin and norepinephrine reuptake. The norepinephrine component provides
analgesic effects for neuropathic pain, fibromyalgia, and chronic musculoskeletal pain, making it
useful for patients with comorbid depression and pain conditions (B).
Q5: A patient taking amitriptyline reports dry mouth, constipation, and blurred vision. These side
effects are due to:
A. Serotonin reuptake inhibition
B. Anticholinergic (muscarinic receptor antagonism) effects [CORRECT]
C. Alpha-1 adrenergic blockade
D. Histamine H1 antagonism Correct Answer: B Rationale: TCAs like amitriptyline have
potent anticholinergic effects (muscarinic receptor antagonism) causing dry mouth, constipation,
urinary retention, blurred vision, and cognitive impairment. These side effects limit tolerability,
particularly in older adults who are more sensitive to anticholinergic burden (B).
Q6: A patient with treatment-resistant depression and seasonal affective disorder is started on
bupropion. Important patient education includes:
, A. The medication should be taken at bedtime due to sedation
B. The medication may cause insomnia and should be taken in the morning; avoid if history of
seizures or eating disorders [CORRECT]
C. The medication commonly causes sexual dysfunction
D. The medication requires dietary tyramine restriction Correct Answer: B Rationale:
Bupropion is an NDRI (norepinephrine-dopamine reuptake inhibitor) that is activating and may
cause insomnia, agitation, and headache. It should be taken in the morning and avoided in
patients with seizure disorders, eating disorders (lowers seizure threshold), or those undergoing
alcohol/benzodiazepine withdrawal (B). It has low sexual side effects (C) and no tyramine
restriction (D).
Q7: A patient taking venlafaxine XR at 225 mg/day has blood pressure of 158/92 mmHg. This is
likely due to:
A. Serotonin reuptake inhibition only
B. Norepinephrine reuptake inhibition at higher doses causing increased sympathetic tone
[CORRECT]
C. Alpha-2 adrenergic agonism
D. Histamine H1 antagonism Correct Answer: B Rationale: Venlafaxine has dose-dependent
effects: at lower doses primarily SSRI, at higher doses (≥150-225 mg) significant norepinephrine
reuptake inhibition occurs, potentially causing increased blood pressure due to enhanced
sympathetic tone. BP monitoring is essential at higher doses (B).
Q8: A patient abruptly discontinues paroxetine after 6 months of treatment and experiences
dizziness, nausea, paresthesias, irritability, and "electric shock" sensations. This represents:
A. Serotonin syndrome
B. SSRI discontinuation syndrome [CORRECT]
C. Neuroleptic malignant syndrome
D. Hypertensive crisis Correct Answer: B Rationale: SSRI discontinuation syndrome occurs
with abrupt cessation, especially with short half-life agents like paroxetine and venlafaxine.
Symptoms include dizziness, nausea, fatigue, headache, paresthesias, and sensory disturbances
("brain zaps"). Tapering over several weeks prevents this (B). Serotonin syndrome (A) is from
excess serotonin. NMS (C) is from antipsychotics. Hypertensive crisis (D) is from MAOIs.
Q9: A patient with depression and insomnia is prescribed trazodone 50 mg at bedtime. The
mechanism for its sedating effect is:
A. Selective serotonin reuptake inhibition
