,NR 546 Advanced Psychopharmacology PMHNP Week 8 | Actual study
Questions and Answers
1. According to Week 8 content for NR 546, which of the following best describes the primary
neuropathology associated with Alzheimer's disease?
A) Excessive dopamine activity in the mesolimbic pathway
B) Amyloid plaques and neurofibrillary tangles
C) Loss of gray matter in the cerebellum
D) Demyelination of white matter tracts
Correct Answer: Amyloid plaques and neurofibrillary tangles
Rationale: The neuropathology of Alzheimer's disease is characterized by the presence of
amyloid plaques (extracellular deposits of beta-amyloid protein) and neurofibrillary tangles
(intracellular aggregates of hyperphosphorylated tau protein) . These are the hallmark features
of the disease and are associated with neuronal damage and death.
2. A PMHNP is evaluating a 62-year-old patient who presents with new-onset anxiety,
irritability, sleep disruption, and mild short-term memory deficits. The patient's family reports
increasing problems with managing finances. Which of the following is the most appropriate
next step?
A) Prescribe an SSRI for anxiety
B) Order a sleep study
C) Conduct a comprehensive health history and rule out other causes of dementia
D) Start donepezil immediately
Correct Answer: Conduct a comprehensive health history and rule out other causes of
dementia
, Rationale: Early signs of Alzheimer's disease can include mood changes, anxiety, irritability,
sleep disruption, and difficulties with managing finances . New-onset mental health symptoms
in a person's late 50s or 60s may be an early stage of AD . A comprehensive health history is key
to gather clues, and it is essential to rule out other potential causes of dementia before making
a diagnosis .
3. A 70-year-old patient with Alzheimer's disease is prescribed donepezil (Aricept). What is the
mechanism of action of this medication?
A) Blocks NMDA receptors to prevent glutamate excitotoxicity
B) Inhibits centrally active acetylcholinesterase
C) Modulates nicotinic acetylcholine receptors
D) Increases dopamine levels in the prefrontal cortex
Correct Answer: Inhibits centrally active acetylcholinesterase
Rationale: Donepezil is a cholinesterase inhibitor (ChEI) that works by inhibiting centrally
active acetylcholinesterase . This action increases the concentration of acetylcholine in the
synaptic cleft, compensating for the decreased acetylcholinergic activity and loss of cholinergic
neurons seen in Alzheimer's disease .
4. A patient with moderate Alzheimer's disease is started on memantine (Namenda). Which of
the following best describes the mechanism of action of this medication?
A) Cholinesterase inhibition
B) NMDA receptor antagonist
C) Dopamine agonist
D) Serotonin reuptake inhibitor
Correct Answer: NMDA receptor antagonist
, Rationale: Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist . It works by
blocking the NMDA receptor to prevent glutamate, an excitatory neurotransmitter, from
binding. This protects neurons from the effects of too much glutamate, which can lead to
excitotoxicity and cell death, without affecting normal neurotransmission .
5. Which of the following is a common side effect of cholinesterase inhibitors (ChEIs) like
donepezil and rivastigmine?
A) Urinary retention
B) Weight gain
C) Nausea and diarrhea
D) Hypertension
Correct Answer: Nausea and diarrhea
Rationale: Gastrointestinal symptoms such as nausea, vomiting, diarrhea, and anorexia are
common side effects of ChEIs . These are related to increased cholinergic activity in the
periphery. Starting at a low dose and titrating slowly can help mitigate these effects.
6. Why should donepezil (Aricept) be tapered rather than stopped abruptly?
A) To prevent a hypertensive crisis
B) To avoid withdrawal effects
C) To prevent seizure activity
D) To avoid serotonin syndrome
Correct Answer: To avoid withdrawal effects
Questions and Answers
1. According to Week 8 content for NR 546, which of the following best describes the primary
neuropathology associated with Alzheimer's disease?
A) Excessive dopamine activity in the mesolimbic pathway
B) Amyloid plaques and neurofibrillary tangles
C) Loss of gray matter in the cerebellum
D) Demyelination of white matter tracts
Correct Answer: Amyloid plaques and neurofibrillary tangles
Rationale: The neuropathology of Alzheimer's disease is characterized by the presence of
amyloid plaques (extracellular deposits of beta-amyloid protein) and neurofibrillary tangles
(intracellular aggregates of hyperphosphorylated tau protein) . These are the hallmark features
of the disease and are associated with neuronal damage and death.
2. A PMHNP is evaluating a 62-year-old patient who presents with new-onset anxiety,
irritability, sleep disruption, and mild short-term memory deficits. The patient's family reports
increasing problems with managing finances. Which of the following is the most appropriate
next step?
A) Prescribe an SSRI for anxiety
B) Order a sleep study
C) Conduct a comprehensive health history and rule out other causes of dementia
D) Start donepezil immediately
Correct Answer: Conduct a comprehensive health history and rule out other causes of
dementia
, Rationale: Early signs of Alzheimer's disease can include mood changes, anxiety, irritability,
sleep disruption, and difficulties with managing finances . New-onset mental health symptoms
in a person's late 50s or 60s may be an early stage of AD . A comprehensive health history is key
to gather clues, and it is essential to rule out other potential causes of dementia before making
a diagnosis .
3. A 70-year-old patient with Alzheimer's disease is prescribed donepezil (Aricept). What is the
mechanism of action of this medication?
A) Blocks NMDA receptors to prevent glutamate excitotoxicity
B) Inhibits centrally active acetylcholinesterase
C) Modulates nicotinic acetylcholine receptors
D) Increases dopamine levels in the prefrontal cortex
Correct Answer: Inhibits centrally active acetylcholinesterase
Rationale: Donepezil is a cholinesterase inhibitor (ChEI) that works by inhibiting centrally
active acetylcholinesterase . This action increases the concentration of acetylcholine in the
synaptic cleft, compensating for the decreased acetylcholinergic activity and loss of cholinergic
neurons seen in Alzheimer's disease .
4. A patient with moderate Alzheimer's disease is started on memantine (Namenda). Which of
the following best describes the mechanism of action of this medication?
A) Cholinesterase inhibition
B) NMDA receptor antagonist
C) Dopamine agonist
D) Serotonin reuptake inhibitor
Correct Answer: NMDA receptor antagonist
, Rationale: Memantine is an N-methyl-D-aspartate (NMDA) receptor antagonist . It works by
blocking the NMDA receptor to prevent glutamate, an excitatory neurotransmitter, from
binding. This protects neurons from the effects of too much glutamate, which can lead to
excitotoxicity and cell death, without affecting normal neurotransmission .
5. Which of the following is a common side effect of cholinesterase inhibitors (ChEIs) like
donepezil and rivastigmine?
A) Urinary retention
B) Weight gain
C) Nausea and diarrhea
D) Hypertension
Correct Answer: Nausea and diarrhea
Rationale: Gastrointestinal symptoms such as nausea, vomiting, diarrhea, and anorexia are
common side effects of ChEIs . These are related to increased cholinergic activity in the
periphery. Starting at a low dose and titrating slowly can help mitigate these effects.
6. Why should donepezil (Aricept) be tapered rather than stopped abruptly?
A) To prevent a hypertensive crisis
B) To avoid withdrawal effects
C) To prevent seizure activity
D) To avoid serotonin syndrome
Correct Answer: To avoid withdrawal effects
