NURS 6630 – Psychopharmacology 2026/2027 Midterm
Practice Exam with correct answers and rationales
1. A 28-year-old patient with major depressive disorder is prescribed fluoxetine. Which
mechanism best explains the therapeutic effect of this medication?
A. Blocks dopamine receptors in the mesolimbic pathway
B. Inhibits the reuptake of serotonin at the presynaptic neuron
C. Increases the release of gamma-aminobutyric acid (GABA)
D. Blocks norepinephrine receptors
Correct Answer: B
Rationale: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). It increases serotonin
levels within the synaptic cleft by inhibiting its reuptake into the presynaptic neuron, improving
symptoms of depression and anxiety.
2. A patient taking sertraline asks when to expect improvement in depressive symptoms.
What is the best response?
A. Within 24 hours
B. Within 2 to 6 weeks
C. After the first dose
D. Only after six months
Correct Answer: B
Rationale: SSRIs typically require 2 to 6 weeks before significant clinical improvement occurs,
although some patients may notice improvements in sleep or appetite earlier.
3. A patient with bipolar disorder reports nausea, coarse tremors, muscle weakness, and
confusion while taking lithium. What is the priority nursing action?
,A. Administer the next scheduled dose
B. Encourage increased fluid intake only
C. Obtain a serum lithium level immediately
D. Reassure the patient that these are expected side effects
Correct Answer: C
Rationale: Coarse tremors, confusion, muscle weakness, and gastrointestinal symptoms are
classic signs of lithium toxicity. Immediate assessment of the serum lithium concentration is
required to prevent severe complications.
4. Which laboratory value requires ongoing monitoring during lithium therapy?
A. Serum calcium
B. Absolute neutrophil count (ANC)
C. Serum lithium concentration
D. Platelet count
Correct Answer: C
Rationale: Lithium has a narrow therapeutic index. Regular monitoring of serum lithium levels
is essential to maintain therapeutic concentrations and prevent toxicity.
5. A patient prescribed phenelzine receives dietary education. Which food should the patient
avoid?
A. Fresh oranges
B. Aged cheddar cheese
C. Baked potatoes
D. Boiled eggs
Correct Answer: B
, Rationale: Tyramine-rich foods such as aged cheeses may precipitate a hypertensive crisis when
consumed with monoamine oxidase inhibitors (MAOIs).
6. A patient taking phenelzine develops a severe headache, diaphoresis, and blood pressure
of 220/118 mmHg after eating cured meat. Which complication is most likely?
A. Serotonin syndrome
B. Hypertensive crisis
C. Neuroleptic malignant syndrome
D. Acute dystonia
Correct Answer: B
Rationale: MAOIs combined with tyramine-containing foods can cause excessive
catecholamine release, resulting in a hypertensive crisis that requires immediate medical
treatment.
7. Before initiating clozapine therapy, which laboratory test is mandatory?
A. Troponin level
B. Serum sodium
C. Absolute neutrophil count (ANC)
D. Blood glucose level
Correct Answer: C
Rationale: Clozapine can cause severe neutropenia (agranulocytosis). A baseline ANC and
routine monitoring are required throughout treatment.
8. Which adverse effect is most commonly associated with second-generation
antipsychotics?
A. Ototoxicity
Practice Exam with correct answers and rationales
1. A 28-year-old patient with major depressive disorder is prescribed fluoxetine. Which
mechanism best explains the therapeutic effect of this medication?
A. Blocks dopamine receptors in the mesolimbic pathway
B. Inhibits the reuptake of serotonin at the presynaptic neuron
C. Increases the release of gamma-aminobutyric acid (GABA)
D. Blocks norepinephrine receptors
Correct Answer: B
Rationale: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). It increases serotonin
levels within the synaptic cleft by inhibiting its reuptake into the presynaptic neuron, improving
symptoms of depression and anxiety.
2. A patient taking sertraline asks when to expect improvement in depressive symptoms.
What is the best response?
A. Within 24 hours
B. Within 2 to 6 weeks
C. After the first dose
D. Only after six months
Correct Answer: B
Rationale: SSRIs typically require 2 to 6 weeks before significant clinical improvement occurs,
although some patients may notice improvements in sleep or appetite earlier.
3. A patient with bipolar disorder reports nausea, coarse tremors, muscle weakness, and
confusion while taking lithium. What is the priority nursing action?
,A. Administer the next scheduled dose
B. Encourage increased fluid intake only
C. Obtain a serum lithium level immediately
D. Reassure the patient that these are expected side effects
Correct Answer: C
Rationale: Coarse tremors, confusion, muscle weakness, and gastrointestinal symptoms are
classic signs of lithium toxicity. Immediate assessment of the serum lithium concentration is
required to prevent severe complications.
4. Which laboratory value requires ongoing monitoring during lithium therapy?
A. Serum calcium
B. Absolute neutrophil count (ANC)
C. Serum lithium concentration
D. Platelet count
Correct Answer: C
Rationale: Lithium has a narrow therapeutic index. Regular monitoring of serum lithium levels
is essential to maintain therapeutic concentrations and prevent toxicity.
5. A patient prescribed phenelzine receives dietary education. Which food should the patient
avoid?
A. Fresh oranges
B. Aged cheddar cheese
C. Baked potatoes
D. Boiled eggs
Correct Answer: B
, Rationale: Tyramine-rich foods such as aged cheeses may precipitate a hypertensive crisis when
consumed with monoamine oxidase inhibitors (MAOIs).
6. A patient taking phenelzine develops a severe headache, diaphoresis, and blood pressure
of 220/118 mmHg after eating cured meat. Which complication is most likely?
A. Serotonin syndrome
B. Hypertensive crisis
C. Neuroleptic malignant syndrome
D. Acute dystonia
Correct Answer: B
Rationale: MAOIs combined with tyramine-containing foods can cause excessive
catecholamine release, resulting in a hypertensive crisis that requires immediate medical
treatment.
7. Before initiating clozapine therapy, which laboratory test is mandatory?
A. Troponin level
B. Serum sodium
C. Absolute neutrophil count (ANC)
D. Blood glucose level
Correct Answer: C
Rationale: Clozapine can cause severe neutropenia (agranulocytosis). A baseline ANC and
routine monitoring are required throughout treatment.
8. Which adverse effect is most commonly associated with second-generation
antipsychotics?
A. Ototoxicity
