NSG 552 ADVANCED
PSYCHOPHARMACOLOGY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient taking Lithium presents with a tremor, ataxia, and confusion. The serum lithium
level is 2.1 mEq/L. Which of the following is the most appropriate next step?
A. Continue the current dose and recheck in 24 hours
B. Increase fluid intake and decrease the dose
C. Hold the lithium and initiate emergency medical evaluation
D. Add a beta-blocker to manage the tremor
Answer: C
Conceptual Explanation: Lithium levels above 1.5 mEq/L are considered toxic. Levels
above 2.0 mEq/L require immediate medical attention as symptoms like ataxia and
confusion indicate severe toxicity.
2. Which dopamine pathway is primarily responsible for the negative symptoms of
schizophrenia when dopamine levels are low?
A. Mesocortical pathway
,B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The mesocortical pathway is associated with cognitive and
negative symptoms of schizophrenia when there is a deficit in dopamine.
3. A 24-year-old female patient started on Valproate (Depakote) should be specifically
monitored for which of the following?
A. Nephrogenic diabetes insipidus
B. Stevens-Johnson Syndrome
C. Agranulocytosis
D. Polycystic Ovary Syndrome (PCOS)
Answer: D
Conceptual Explanation: Valproate is associated with a risk of PCOS in younger women,
along with weight gain and hyperandrogenism.
4. Which antidepressant is most likely to cause a hypertensive crisis if taken with foods
containing high levels of tyramine?
A. Phenelzine
B. Venlafaxine
, C. Sertraline
D. Bupropion
Answer: A
Conceptual Explanation: Phenelzine is an MAOI. Inhibition of MAO-A leads to an
accumulation of tyramine, which can cause massive norepinephrine release and
hypertensive crisis.
5. The mechanism of action for Memantine (Namenda) in the treatment of Alzheimer’s
disease is:
A. Cholinesterase inhibition
B. NMDA receptor antagonism
C. Selective serotonin reuptake inhibition
D. Dopamine agonism
Answer: B
Conceptual Explanation: Memantine works as a low-to-moderate affinity non-competitive
NMDA receptor antagonist to reduce glutamate-mediated excitotoxicity.
6. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 50%
of all psychotropic medications?
A. CYP3A4
B. CYP1A2
PSYCHOPHARMACOLOGY
COMPREHENSIVE EXAM QUESTIONS
AND ANSWERS
1. A patient taking Lithium presents with a tremor, ataxia, and confusion. The serum lithium
level is 2.1 mEq/L. Which of the following is the most appropriate next step?
A. Continue the current dose and recheck in 24 hours
B. Increase fluid intake and decrease the dose
C. Hold the lithium and initiate emergency medical evaluation
D. Add a beta-blocker to manage the tremor
Answer: C
Conceptual Explanation: Lithium levels above 1.5 mEq/L are considered toxic. Levels
above 2.0 mEq/L require immediate medical attention as symptoms like ataxia and
confusion indicate severe toxicity.
2. Which dopamine pathway is primarily responsible for the negative symptoms of
schizophrenia when dopamine levels are low?
A. Mesocortical pathway
,B. Mesolimbic pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The mesocortical pathway is associated with cognitive and
negative symptoms of schizophrenia when there is a deficit in dopamine.
3. A 24-year-old female patient started on Valproate (Depakote) should be specifically
monitored for which of the following?
A. Nephrogenic diabetes insipidus
B. Stevens-Johnson Syndrome
C. Agranulocytosis
D. Polycystic Ovary Syndrome (PCOS)
Answer: D
Conceptual Explanation: Valproate is associated with a risk of PCOS in younger women,
along with weight gain and hyperandrogenism.
4. Which antidepressant is most likely to cause a hypertensive crisis if taken with foods
containing high levels of tyramine?
A. Phenelzine
B. Venlafaxine
, C. Sertraline
D. Bupropion
Answer: A
Conceptual Explanation: Phenelzine is an MAOI. Inhibition of MAO-A leads to an
accumulation of tyramine, which can cause massive norepinephrine release and
hypertensive crisis.
5. The mechanism of action for Memantine (Namenda) in the treatment of Alzheimer’s
disease is:
A. Cholinesterase inhibition
B. NMDA receptor antagonism
C. Selective serotonin reuptake inhibition
D. Dopamine agonism
Answer: B
Conceptual Explanation: Memantine works as a low-to-moderate affinity non-competitive
NMDA receptor antagonist to reduce glutamate-mediated excitotoxicity.
6. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 50%
of all psychotropic medications?
A. CYP3A4
B. CYP1A2
