NR 546 Week 8 Final Exam Complete Questions 1-75 Actual Exam Screenshots 29 August 2025 Examplify Proctored NR546 Advanced Psychopharmacology for The PMHNP Exam Questions and Answers

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NR 546 Week 8 Final Exam Complete Questions 1-75 Actual
Exam Screenshots 29 August 2025 Examplify Proctored NR546
Advanced Psychopharmacology for The PMHNP Exam
Questions and Answers


NR 546 Week 8 Final Exam – Advanced Psychopharmacology
75 Questions with Verified Answers & Rationales


1. A PMHNP is prescribing an SSRI for a patient with major depressive
disorder. The patient asks, “How long will it take before I feel better?”
The most accurate response is:
o A) You will notice improvement within 24 to 48 hours.
o B) Significant improvement in mood typically occurs within 1 to 2
weeks.
o C) It may take 2 to 4 weeks for initial effects, with full therapeutic
benefit at 6 to 8 weeks.
o D) If you do not respond in 4 weeks, the medication will never work.
Answer: C) It may take 2 to 4 weeks for initial effects, with full therapeutic
benefit at 6 to 8 weeks.
*Rationale: SSRIs require downregulation of postsynaptic receptors, which takes
time. Patients often see some improvement in sleep, appetite, or energy within 1-
2 weeks, but mood improvement takes 2-4 weeks; full remission may take up to 8
weeks.*
2. Which of the following antidepressants is most likely to cause sexual
dysfunction?
o A) Bupropion
o B) Mirtazapine



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o C) Paroxetine
o D) Vortioxetine
Answer: C) Paroxetine
Rationale: Paroxetine (an SSRI) has the highest rate of sexual side effects among
SSRIs due to strong serotonin reuptake inhibition and some anticholinergic
activity. Bupropion and mirtazapine are less likely to cause sexual dysfunction;
vortioxetine has a lower risk.
3. A 65-year-old patient with depression also has significant insomnia and
weight loss. Which antidepressant might provide the most appropriate
coverage for both depression and these target symptoms?
o A) Fluoxetine
o B) Mirtazapine
o C) Bupropion
o D) Sertraline
Answer: B) Mirtazapine
*Rationale: Mirtazapine, an alpha-2 antagonist, enhances noradrenergic and
serotonergic transmission. It is associated with sedation (useful for insomnia) and
increased appetite/weight gain, making it suitable for patients with these
symptoms.*
4. A patient taking phenelzine (an MAOI) asks if they can eat pepperoni
pizza. The PMHNP should instruct the patient to:
o A) Eat the pizza as they normally would.
o B) Avoid the pizza entirely because pepperoni is a cured meat high in
tyramine.
o C) Only eat pizza with extra cheese to bind the tyramine.
o D) Take an extra dose of phenelzine before eating the pizza.
Answer: B) Avoid the pizza entirely because pepperoni is a cured meat high in
tyramine.
Rationale: MAOIs prevent the breakdown of tyramine; high-tyramine foods (aged

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cheeses, cured meats, tap beer) can cause a hypertensive crisis. Patients must
adhere to a strict low-tyramine diet.
5. The PMHNP is managing a patient with bipolar I disorder in an acute
manic episode. Which medication is FDA-approved as monotherapy for
acute mania?
o A) Lamotrigine
o B) Lithium
o C) Fluoxetine
o D) Gabapentin
Answer: B) Lithium
Rationale: Lithium is a first-line mood stabilizer approved for acute mania and
maintenance. Lamotrigine is more effective for bipolar depression and
maintenance, not acute mania. Gabapentin lacks strong evidence; fluoxetine is an
antidepressant and can induce mania.
6. A patient on lithium develops coarse tremor, confusion, and severe
diarrhea. A stat lithium level is 2.3 mEq/L. The PMHNP's priority action is
to:
o A) Increase fluid intake and reassess in 24 hours.
o B) Hold lithium, assess airway, and arrange emergency medical
evaluation.
o C) Administer oral sodium polystyrene sulfonate.
o D) Reduce the lithium dose by half.
Answer: B) Hold lithium, assess airway, and arrange emergency medical
evaluation.
*Rationale: Lithium levels above 1.5 mEq/L indicate toxicity; >2.0 mEq/L is severe
and can be life-threatening (seizures, coma, renal failure). Immediate
discontinuation and emergency care are required. Hemodialysis may be
indicated.*




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7. Which anticonvulsant mood stabilizer requires monitoring of serum levels
and has a therapeutic window of 50–125 µg/mL?
o A) Carbamazepine
o B) Valproic acid
o C) Lamotrigine
o D) Topiramate
Answer: B) Valproic acid
*Rationale: Valproic acid therapeutic range for mood stabilization is usually 50–
125 µg/mL. Carbamazepine range is 4–12 µg/mL. Lamotrigine does not have a
well-defined serum level for mood stabilization, but levels guide compliance.*
8. A patient is started on clozapine for treatment-resistant schizophrenia.
Which lab monitoring is essential due to a boxed warning?
o A) Liver function tests
o B) Absolute neutrophil count (ANC)
o C) Serum prolactin
o D) Thyroid stimulating hormone
Answer: B) Absolute neutrophil count (ANC)
Rationale: Clozapine carries a risk of agranulocytosis (severe neutropenia). ANC
must be monitored at baseline, weekly for the first 6 months, every 2 weeks for
the next 6 months, and then every 4 weeks.
9. A patient on haloperidol develops sustained contraction of the neck
muscles (torticollis) and eyes (oculogyric crisis). This is classified as:
o A) Akathisia
o B) Tardive dyskinesia
o C) Acute dystonia
o D) Parkinsonism




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