pg. 1
,Exam Coverage Summary
The NR 546 Advanced Psychopharmacology for the PMHNP m examination evaluates comprehensive
understanding of psychotropic medications, neurobiology, and clinical prescribing practices. Key content
areas include: functional neuroanatomy (brain structures, neurotransmitter pathways, receptor locations);
neurotransmitter systems (serotonin, dopamine, norepinephrine, GABA, glutamate, acetylcholine—
synthesis, metabolism, receptor types, clinical relevance); pharmacokinetics (ADME processes, CYP450
enzyme system, half-life, drug-drug interactions, pharmacogenetics); pharmacodynamics (receptor binding,
agonism/antagonism/partial agonism, dose-response relationships, therapeutic index); major psychotropic
drug classes (antidepressants—SSRIs, SNRIs, TCAs, MAOIs, atypicals; antipsychotics—first-generation
and second-generation; mood stabilizers—lithium, valproate, lamotrigine, carbamazepine; anxiolytics and
hypnotics—benzodiazepines, buspirone, Z-drugs; stimulants and non-stimulants for ADHD); clinical
decision-making (evidence-based prescribing, treatment algorithms, medication selection, patient
monitoring, adverse effect management); special populations (pregnancy and lactation, geriatric, pediatric,
hepatic/renal impairment); and key clinical syndromes (serotonin syndrome, neuroleptic malignant
syndrome, antidepressant discontinuation syndrome, lithium toxicity). The examination emphasizes
application of psychopharmacological principles to patient cases, requiring integration of neurobiology,
pharmacology, and clinical judgment.
pg. 2
,NR 546 MIDTERM EXAM MODULE 1
Question 1
A 45-year-old patient with major depressive disorder has been on sertraline 100 mg daily for 8 weeks with minimal
response. The PMHNP decides to augment with a second-generation antipsychotic. Which of the following is the
most evidence-based augmentation strategy for this patient?
A) Add aripiprazole 2-5 mg daily
B) Add quetiapine 300 mg daily
C) Add olanzapine 10 mg daily
D) Add ziprasidone 80 mg daily
Answer: A
Aripiprazole is FDA-approved for adjunctive treatment of major depressive disorder and has strong evidence for
augmentation. Quetiapine also has evidence but at lower doses (50-150 mg) for depression augmentation, not 300
mg. Olanzapine-fluoxetine combination is approved but olanzapine alone is not a first-line augmenting agent.
Question 2
A 28-year-old female with bipolar I disorder is currently experiencing a depressive episode. She has a history of a
mixed episode with rapid cycling. Which mood stabilizer would be most appropriate for this patient?
A) Lithium
B) Lamotrigine
C) Valproate
D) Carbamazepine
Answer: C
pg. 3
, Valproate is effective for acute mania, mixed episodes, and rapid cycling bipolar disorder. Lamotrigine is effective
for bipolar depression but can worsen rapid cycling. Lithium is effective for classic mania but less so for mixed
episodes or rapid cycling.
Question 3
A 62-year-old patient with generalized anxiety disorder is prescribed buspirone. The patient returns after 4 weeks
and reports no improvement. What is the most appropriate next step?
A) Discontinue buspirone and start a benzodiazepine
B) Increase the buspirone dose
C) Continue buspirone and add hydroxyzine
D) Discontinue buspirone and start an SSRI
Answer: B
Buspirone has a slow onset of action (2-4 weeks) and may take up to 6-8 weeks for full effect. Dose optimization is
critical, as many patients are started on subtherapeutic doses. Before switching, ensure the patient has received an
adequate trial at an adequate dose.
Question 4
A patient with schizophrenia has been on haloperidol 15 mg daily for 2 years. He develops involuntary, repetitive
movements of the tongue and lips. Which medication is FDA-approved for treating this condition?
A) Benztropine
B) Propranolol
C) Valbenazine
D) Amantadine
Answer: C
pg. 4
,Exam Coverage Summary
The NR 546 Advanced Psychopharmacology for the PMHNP m examination evaluates comprehensive
understanding of psychotropic medications, neurobiology, and clinical prescribing practices. Key content
areas include: functional neuroanatomy (brain structures, neurotransmitter pathways, receptor locations);
neurotransmitter systems (serotonin, dopamine, norepinephrine, GABA, glutamate, acetylcholine—
synthesis, metabolism, receptor types, clinical relevance); pharmacokinetics (ADME processes, CYP450
enzyme system, half-life, drug-drug interactions, pharmacogenetics); pharmacodynamics (receptor binding,
agonism/antagonism/partial agonism, dose-response relationships, therapeutic index); major psychotropic
drug classes (antidepressants—SSRIs, SNRIs, TCAs, MAOIs, atypicals; antipsychotics—first-generation
and second-generation; mood stabilizers—lithium, valproate, lamotrigine, carbamazepine; anxiolytics and
hypnotics—benzodiazepines, buspirone, Z-drugs; stimulants and non-stimulants for ADHD); clinical
decision-making (evidence-based prescribing, treatment algorithms, medication selection, patient
monitoring, adverse effect management); special populations (pregnancy and lactation, geriatric, pediatric,
hepatic/renal impairment); and key clinical syndromes (serotonin syndrome, neuroleptic malignant
syndrome, antidepressant discontinuation syndrome, lithium toxicity). The examination emphasizes
application of psychopharmacological principles to patient cases, requiring integration of neurobiology,
pharmacology, and clinical judgment.
pg. 2
,NR 546 MIDTERM EXAM MODULE 1
Question 1
A 45-year-old patient with major depressive disorder has been on sertraline 100 mg daily for 8 weeks with minimal
response. The PMHNP decides to augment with a second-generation antipsychotic. Which of the following is the
most evidence-based augmentation strategy for this patient?
A) Add aripiprazole 2-5 mg daily
B) Add quetiapine 300 mg daily
C) Add olanzapine 10 mg daily
D) Add ziprasidone 80 mg daily
Answer: A
Aripiprazole is FDA-approved for adjunctive treatment of major depressive disorder and has strong evidence for
augmentation. Quetiapine also has evidence but at lower doses (50-150 mg) for depression augmentation, not 300
mg. Olanzapine-fluoxetine combination is approved but olanzapine alone is not a first-line augmenting agent.
Question 2
A 28-year-old female with bipolar I disorder is currently experiencing a depressive episode. She has a history of a
mixed episode with rapid cycling. Which mood stabilizer would be most appropriate for this patient?
A) Lithium
B) Lamotrigine
C) Valproate
D) Carbamazepine
Answer: C
pg. 3
, Valproate is effective for acute mania, mixed episodes, and rapid cycling bipolar disorder. Lamotrigine is effective
for bipolar depression but can worsen rapid cycling. Lithium is effective for classic mania but less so for mixed
episodes or rapid cycling.
Question 3
A 62-year-old patient with generalized anxiety disorder is prescribed buspirone. The patient returns after 4 weeks
and reports no improvement. What is the most appropriate next step?
A) Discontinue buspirone and start a benzodiazepine
B) Increase the buspirone dose
C) Continue buspirone and add hydroxyzine
D) Discontinue buspirone and start an SSRI
Answer: B
Buspirone has a slow onset of action (2-4 weeks) and may take up to 6-8 weeks for full effect. Dose optimization is
critical, as many patients are started on subtherapeutic doses. Before switching, ensure the patient has received an
adequate trial at an adequate dose.
Question 4
A patient with schizophrenia has been on haloperidol 15 mg daily for 2 years. He develops involuntary, repetitive
movements of the tongue and lips. Which medication is FDA-approved for treating this condition?
A) Benztropine
B) Propranolol
C) Valbenazine
D) Amantadine
Answer: C
pg. 4
