NR546 ADVANCED PSYCHOPHARMACOLOGY FOR THE PMHNP:
A 200-QUESTION COMPREHENSIVE FINAL EXAM Q-BANK
COVERING NEUROBIOLOGY, ANTIDEPRESSANTS (SSRIS, SNRIS,
TCAS, MAOIS), ANTIPSYCHOTICS (TYPICAL & ATYPICAL), MOOD
STABILIZERS (LITHIUM, ANTICONVULSANTS), ADHD
THERAPIES, SUBSTANCE USE DISORDERS, SLEEP AIDS,
ALZHEIMER'S TREATMENTS, MOVEMENT DISORDERS,
PHARMACOKINETICS (CYP450), DRUG INTERACTIONS, BLACK
BOX WARNINGS, SPECIAL POPULATIONS (PREGNANCY,
GERIATRICS, PEDIATRICS), AND CLINICAL PRESCRIBING
PRINCIPLES WITH DETAILED CLINICAL RATIONALES.
Question 1
A 28-year-old with major depressive disorder (MDD) has been taking
sertraline 50 mg daily for 6 weeks and reports no change in mood.
What is the most appropriate next step?
A) Increase the dose to 100 mg daily.
B) Add trazodone 50 mg at bedtime.
C) Switch to fluoxetine 20 mg daily.
D) Obtain a serum drug level.
Correct answer: A
Rationale: Sertraline's typical therapeutic dose for MDD is 100-200
mg/day. A 6-week trial at a subtherapeutic dose warrants a dose
,increase before considering a switch. Serum drug levels are not
routinely used for SSRIs, and adding trazodone is not first-line for
nonresponse.
Question 2
A 45-year-old patient with chronic insomnia asks for medication.
According to current guidelines, which of the following is the preferred
first-line pharmacological intervention?
A) Zolpidem 10 mg at bedtime.
B) Trazodone 50 mg at bedtime.
C) Diphenhydramine 50 mg at bedtime.
D) Melatonin 5 mg at bedtime.
Correct answer: B
Rationale: Trazodone at low doses (25-100 mg) is commonly used off-
label for sleep maintenance, with low abuse potential and minimal
tolerance. Zolpidem is generally reserved for second-line use due to
risks of dependence and next-day impairment. Antihistamines and
melatonin have weaker evidence.
Question 3
A PMHNP is prescribing a controlled substance for a patient with
anxiety. Under the Ryan Haight Act, what is required before an initial
prescription of a Schedule II medication via telemedicine?
A) A valid DEA registration and an in-person evaluation (with limited
exceptions).
,B) A verbal consent from the patient recorded in the chart.
C) A written prescription mailed to the patient.
D) A concurrent prescription for naloxone.
Correct answer: A
Rationale: The Ryan Haight Online Pharmacy Consumer Protection Act
generally requires an in-person medical evaluation before prescribing
controlled substances via telemedicine, though some exceptions have
temporarily modified this rule.
Question 4
A patient develops fever, muscle rigidity, altered mental status, and
autonomic instability 10 days after starting haloperidol. What is the
most likely diagnosis?
A) Serotonin syndrome.
B) Neuroleptic malignant syndrome (NMS).
C) Acute dystonic reaction.
D) Tardive dyskinesia.
Correct answer: B
Rationale: NMS presents with fever, rigidity, altered mental status, and
autonomic dysfunction, typically occurring within weeks of
antipsychotic initiation. Serotonin syndrome is associated with
serotonergic agents and includes hyperreflexia and clonus.
Question 5
, Which of the following CYP450 enzymes is primarily responsible for the
metabolism of most SSRIs?
A) CYP2D6.
B) CYP3A4.
C) CYP1A2.
D) CYP2C19.
Correct answer: A
Rationale: CYP2D6 is a major pathway for many SSRIs (fluoxetine,
paroxetine, fluvoxamine) and other psychotropics. CYP3A4 metabolizes
some benzodiazepines and antipsychotics; CYP1A2 metabolizes
clozapine; CYP2C19 metabolizes citalopram and escitalopram.
Question 6
A 32-year-old patient with bipolar I disorder and a history of substance
use disorder is prescribed a long-acting injectable antipsychotic. What is
the primary advantage of this formulation?
A) Improved tolerability compared to oral agents.
B) Reduced risk of metabolic side effects.
C) Enhanced adherence and reduced relapse rates.
D) Faster onset of therapeutic action.
Correct answer: C
Rationale: Long-acting injectable antipsychotics are primarily used to
improve adherence, which is a critical issue in bipolar and
schizophrenia, thereby reducing hospitalizations and relapse rates.
A 200-QUESTION COMPREHENSIVE FINAL EXAM Q-BANK
COVERING NEUROBIOLOGY, ANTIDEPRESSANTS (SSRIS, SNRIS,
TCAS, MAOIS), ANTIPSYCHOTICS (TYPICAL & ATYPICAL), MOOD
STABILIZERS (LITHIUM, ANTICONVULSANTS), ADHD
THERAPIES, SUBSTANCE USE DISORDERS, SLEEP AIDS,
ALZHEIMER'S TREATMENTS, MOVEMENT DISORDERS,
PHARMACOKINETICS (CYP450), DRUG INTERACTIONS, BLACK
BOX WARNINGS, SPECIAL POPULATIONS (PREGNANCY,
GERIATRICS, PEDIATRICS), AND CLINICAL PRESCRIBING
PRINCIPLES WITH DETAILED CLINICAL RATIONALES.
Question 1
A 28-year-old with major depressive disorder (MDD) has been taking
sertraline 50 mg daily for 6 weeks and reports no change in mood.
What is the most appropriate next step?
A) Increase the dose to 100 mg daily.
B) Add trazodone 50 mg at bedtime.
C) Switch to fluoxetine 20 mg daily.
D) Obtain a serum drug level.
Correct answer: A
Rationale: Sertraline's typical therapeutic dose for MDD is 100-200
mg/day. A 6-week trial at a subtherapeutic dose warrants a dose
,increase before considering a switch. Serum drug levels are not
routinely used for SSRIs, and adding trazodone is not first-line for
nonresponse.
Question 2
A 45-year-old patient with chronic insomnia asks for medication.
According to current guidelines, which of the following is the preferred
first-line pharmacological intervention?
A) Zolpidem 10 mg at bedtime.
B) Trazodone 50 mg at bedtime.
C) Diphenhydramine 50 mg at bedtime.
D) Melatonin 5 mg at bedtime.
Correct answer: B
Rationale: Trazodone at low doses (25-100 mg) is commonly used off-
label for sleep maintenance, with low abuse potential and minimal
tolerance. Zolpidem is generally reserved for second-line use due to
risks of dependence and next-day impairment. Antihistamines and
melatonin have weaker evidence.
Question 3
A PMHNP is prescribing a controlled substance for a patient with
anxiety. Under the Ryan Haight Act, what is required before an initial
prescription of a Schedule II medication via telemedicine?
A) A valid DEA registration and an in-person evaluation (with limited
exceptions).
,B) A verbal consent from the patient recorded in the chart.
C) A written prescription mailed to the patient.
D) A concurrent prescription for naloxone.
Correct answer: A
Rationale: The Ryan Haight Online Pharmacy Consumer Protection Act
generally requires an in-person medical evaluation before prescribing
controlled substances via telemedicine, though some exceptions have
temporarily modified this rule.
Question 4
A patient develops fever, muscle rigidity, altered mental status, and
autonomic instability 10 days after starting haloperidol. What is the
most likely diagnosis?
A) Serotonin syndrome.
B) Neuroleptic malignant syndrome (NMS).
C) Acute dystonic reaction.
D) Tardive dyskinesia.
Correct answer: B
Rationale: NMS presents with fever, rigidity, altered mental status, and
autonomic dysfunction, typically occurring within weeks of
antipsychotic initiation. Serotonin syndrome is associated with
serotonergic agents and includes hyperreflexia and clonus.
Question 5
, Which of the following CYP450 enzymes is primarily responsible for the
metabolism of most SSRIs?
A) CYP2D6.
B) CYP3A4.
C) CYP1A2.
D) CYP2C19.
Correct answer: A
Rationale: CYP2D6 is a major pathway for many SSRIs (fluoxetine,
paroxetine, fluvoxamine) and other psychotropics. CYP3A4 metabolizes
some benzodiazepines and antipsychotics; CYP1A2 metabolizes
clozapine; CYP2C19 metabolizes citalopram and escitalopram.
Question 6
A 32-year-old patient with bipolar I disorder and a history of substance
use disorder is prescribed a long-acting injectable antipsychotic. What is
the primary advantage of this formulation?
A) Improved tolerability compared to oral agents.
B) Reduced risk of metabolic side effects.
C) Enhanced adherence and reduced relapse rates.
D) Faster onset of therapeutic action.
Correct answer: C
Rationale: Long-acting injectable antipsychotics are primarily used to
improve adherence, which is a critical issue in bipolar and
schizophrenia, thereby reducing hospitalizations and relapse rates.
