NSG 533 — Advanced
1 TSET · 335 GSN
NSG
533
Pharmacology
Test 1 — Week 4: Psychopharmacology & Sleep Disorders
PHARM
EVIDENCE-BASED PRESCRIBING · CLINICAL EXCELLENCE
NSG 533 Advanced Pharmacology Test 1 — Week 4
CO M P L E T E Q U E ST I O N S & V E R I F I E D A N S W E RS | PSYC H O P H A R M ACO LO G Y, A N X I E TY &
S L E E P D I S O R D E RS
INSTITUTION Graduate Nursing Program — NSG COURSE CODE NSG 533 — Advanced
533 Pharmacology
PROGRAM Master of Science in Nursing / DNP ACADEMIC YEAR
EXAM TITLE NSG 533 Advanced Pharmacology TOTAL QUESTIONS 42 Questions
Test 1 Week 4 | Verified Answers
COURSE TITLE Advanced Psychopharmacology & FORMAT Multiple Choice — Select the
Sleep Medicine Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover SSRIs, MAOIs, TCAs, SNRIs, anxiety disorders (GAD, panic, SAD), sleep disorders
(insomnia, RLS, narcolepsy, OSA), and CBT.
▸ Correct answers and detailed clinical rationales appear below each question.
▸ Content aligned with advanced pharmacology curriculum and evidence-based prescribing guidelines.
, SECTION I — ADVANCED PHARMACOLOGY TEST 1 (WEEK
Questions 1 – 42
4) EXAMINATION
1. Which of the following SSRIs requires up to a 5-week washout period because of the long
half-life of its potent active metabolite?
A. Escitalopram
B. Fluvoxamine
C. Fluoxetine
D. Sertraline
CORRECT ANSWER C — Fluoxetine
RATIONALE Fluoxetine has the longest half-life of all SSRIs (4-6 days for the parent drug) and
its active metabolite norfluoxetine has an even longer half-life (up to 16 days).
When switching from fluoxetine to an MAOI, a minimum 5-week washout is
required to prevent serotonin syndrome — the extended time needed for
complete clearance of both fluoxetine and norfluoxetine. Other SSRIs
(escitalopram, fluvoxamine, sertraline) have much shorter half-lives and require
only a 2-week washout before starting an MAOI. This pharmacokinetic property
makes fluoxetine the safest SSRI for patients with adherence concerns (self-
tapering) but the most dangerous when transitioning to MAOIs.
,2. Which of the following symptoms is most likely to improve within approximately 1 week
of starting treatment?
A. Depressed mood
B. Suicidal thoughts
C. Anhedonia
D. Sleep
CORRECT ANSWER D — Sleep
RATIONALE Sleep disturbance (insomnia or hypersomnia) is often the first symptom to
improve with antidepressant treatment — sometimes within the first week. This
is because the sedating effects of many antidepressants (particularly those with
histamine H1 antagonism like mirtazapine, trazodone, or sedating TCAs) are
immediate pharmacological effects, not requiring the neuroplastic changes that
mediate mood improvement. Depressed mood, anhedonia, and suicidal
thoughts typically require 2-4 weeks (or longer) to improve, as these depend on
downstream neuroplastic changes (BDNF, neurogenesis). Early sleep
improvement can provide hope and encourage adherence, but patients must be
warned that mood improvement takes longer.
, 3. Of the following combinations of medications, which one would you want to avoid?
A. Fluoxetine-lithium
B. Fluoxetine-phenelzine
C. Citalopram-valproic acid
D. Citalopram-aripiprazole
CORRECT ANSWER B — Fluoxetine-phenelzine
RATIONALE Combining an SSRI (fluoxetine) with an MAOI (phenelzine) is absolutely
contraindicated due to the high risk of serotonin syndrome — a potentially fatal
condition characterized by hyperthermia, autonomic instability, neuromuscular
hyperactivity (myoclonus, hyperreflexia), and altered mental status. Both
medications increase serotonin — SSRIs block reuptake, MAOIs prevent
degradation. The combination produces excessive serotonergic activity. A
minimum 5-week washout from fluoxetine is required before starting an MAOI.
Fluoxetine-lithium, citalopram-valproic acid, and citalopram-aripiprazole are
commonly used combinations without this life-threatening interaction.
1 TSET · 335 GSN
NSG
533
Pharmacology
Test 1 — Week 4: Psychopharmacology & Sleep Disorders
PHARM
EVIDENCE-BASED PRESCRIBING · CLINICAL EXCELLENCE
NSG 533 Advanced Pharmacology Test 1 — Week 4
CO M P L E T E Q U E ST I O N S & V E R I F I E D A N S W E RS | PSYC H O P H A R M ACO LO G Y, A N X I E TY &
S L E E P D I S O R D E RS
INSTITUTION Graduate Nursing Program — NSG COURSE CODE NSG 533 — Advanced
533 Pharmacology
PROGRAM Master of Science in Nursing / DNP ACADEMIC YEAR
EXAM TITLE NSG 533 Advanced Pharmacology TOTAL QUESTIONS 42 Questions
Test 1 Week 4 | Verified Answers
COURSE TITLE Advanced Psychopharmacology & FORMAT Multiple Choice — Select the
Sleep Medicine Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question.
▸ Questions cover SSRIs, MAOIs, TCAs, SNRIs, anxiety disorders (GAD, panic, SAD), sleep disorders
(insomnia, RLS, narcolepsy, OSA), and CBT.
▸ Correct answers and detailed clinical rationales appear below each question.
▸ Content aligned with advanced pharmacology curriculum and evidence-based prescribing guidelines.
, SECTION I — ADVANCED PHARMACOLOGY TEST 1 (WEEK
Questions 1 – 42
4) EXAMINATION
1. Which of the following SSRIs requires up to a 5-week washout period because of the long
half-life of its potent active metabolite?
A. Escitalopram
B. Fluvoxamine
C. Fluoxetine
D. Sertraline
CORRECT ANSWER C — Fluoxetine
RATIONALE Fluoxetine has the longest half-life of all SSRIs (4-6 days for the parent drug) and
its active metabolite norfluoxetine has an even longer half-life (up to 16 days).
When switching from fluoxetine to an MAOI, a minimum 5-week washout is
required to prevent serotonin syndrome — the extended time needed for
complete clearance of both fluoxetine and norfluoxetine. Other SSRIs
(escitalopram, fluvoxamine, sertraline) have much shorter half-lives and require
only a 2-week washout before starting an MAOI. This pharmacokinetic property
makes fluoxetine the safest SSRI for patients with adherence concerns (self-
tapering) but the most dangerous when transitioning to MAOIs.
,2. Which of the following symptoms is most likely to improve within approximately 1 week
of starting treatment?
A. Depressed mood
B. Suicidal thoughts
C. Anhedonia
D. Sleep
CORRECT ANSWER D — Sleep
RATIONALE Sleep disturbance (insomnia or hypersomnia) is often the first symptom to
improve with antidepressant treatment — sometimes within the first week. This
is because the sedating effects of many antidepressants (particularly those with
histamine H1 antagonism like mirtazapine, trazodone, or sedating TCAs) are
immediate pharmacological effects, not requiring the neuroplastic changes that
mediate mood improvement. Depressed mood, anhedonia, and suicidal
thoughts typically require 2-4 weeks (or longer) to improve, as these depend on
downstream neuroplastic changes (BDNF, neurogenesis). Early sleep
improvement can provide hope and encourage adherence, but patients must be
warned that mood improvement takes longer.
, 3. Of the following combinations of medications, which one would you want to avoid?
A. Fluoxetine-lithium
B. Fluoxetine-phenelzine
C. Citalopram-valproic acid
D. Citalopram-aripiprazole
CORRECT ANSWER B — Fluoxetine-phenelzine
RATIONALE Combining an SSRI (fluoxetine) with an MAOI (phenelzine) is absolutely
contraindicated due to the high risk of serotonin syndrome — a potentially fatal
condition characterized by hyperthermia, autonomic instability, neuromuscular
hyperactivity (myoclonus, hyperreflexia), and altered mental status. Both
medications increase serotonin — SSRIs block reuptake, MAOIs prevent
degradation. The combination produces excessive serotonergic activity. A
minimum 5-week washout from fluoxetine is required before starting an MAOI.
Fluoxetine-lithium, citalopram-valproic acid, and citalopram-aripiprazole are
commonly used combinations without this life-threatening interaction.
