NSG552 Exam 1 | Psychopharmacology | Wilkes University Passan School of Nursing | 2026-2027
NSG552 / NSG 552 Exam 1 (Latest ): Psychopharmacology
Grade A Questions and Verified Answers | 100% Correct - Wilkes University Passan School of Nursing
Section 1: Neurobiology and Neurotransmission
Q1: A psychiatric nurse practitioner is explaining synaptic transmission to a nursing student. Which sequence
correctly describes the process of synaptic neurotransmission?
A. Neurotransmitter release -> receptor binding -> reuptake -> action potential
B. Action potential -> neurotransmitter release -> receptor binding -> postsynaptic response -> reuptake or
enzymatic degradation [CORRECT]
C. Receptor binding -> action potential -> neurotransmitter release -> enzymatic degradation
D. Postsynaptic response -> neurotransmitter release -> action potential -> reuptake
Correct Answer: B
Rationale: Synaptic transmission begins with an action potential traveling down the axon, which triggers calcium influx and
vesicular release of neurotransmitter into the synaptic cleft. The neurotransmitter then binds to postsynaptic receptors,
generating a postsynaptic response (excitatory or inhibitory), and is ultimately removed from the cleft via reuptake transporters
(e.g., SERT, DAT, NET) or enzymatic degradation (e.g., MAO, COMT). Option A reverses the first two steps, and options C
and D place receptor binding or postsynaptic response before neurotransmitter release, which is physiologically incorrect.
Q2: A patient with major depressive disorder is prescribed an SSRI. The nurse practitioner understands that
SSRIs exert their therapeutic effect primarily by targeting which neuronal structure?
A. The axon hillock, where action potentials are generated
B. SERT, the serotonin transporter protein on presynaptic neurons that removes serotonin from the
synaptic cleft [CORRECT]
C. The myelin sheath, which increases conduction velocity of serotonergic neurons
D. The dendritic spines, where serotonin is synthesized and stored
Correct Answer: B
Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) block the serotonin transporter (SERT), a presynaptic reuptake
protein located on serotonergic axon terminals. By inhibiting SERT, SSRIs increase the concentration of serotonin in the
synaptic cleft, enhancing serotonergic neurotransmission. The axon hillock generates action potentials but is not a drug target
for SSRIs. The myelin sheath is unrelated to neurotransmitter reuptake. Serotonin is synthesized in the cell body (soma) from
tryptophan, not in dendritic spines.
Q3: Which dopamine pathway is primarily associated with the positive symptoms of schizophrenia, such as
hallucinations and delusions, when overactive?
A. The nigrostriatal pathway
B. The mesolimbic pathway [CORRECT]
C. The mesocortical pathway
D. The tuberoinfundibular pathway
Correct Answer: B
Page 1
,Rationale: The mesolimbic dopamine pathway projects from the ventral tegmental area (VTA) to the nucleus accumbens and
limbic structures, and is the primary pathway implicated in the positive symptoms of schizophrenia (hallucinations, delusions,
thought disorganization) when dopamine activity is excessive. The nigrostriatal pathway regulates motor function (dysfunction
leads to Parkinsonism and extrapyramidal symptoms). The mesocortical pathway modulates cognition and executive function
(hypofrontality leads to negative symptoms). The tuberoinfundibular pathway inhibits prolactin release from the anterior
pituitary.
Q4: A nursing student asks about the difference between ionotropic and metabotropic receptors. Which
response by the nurse practitioner is most accurate?
A. Ionotropic receptors are G-protein coupled and produce slow, long-lasting effects, while metabotropic
receptors are ligand-gated ion channels producing rapid, brief responses
B. Ionotropic receptors are ligand-gated ion channels that produce rapid, brief responses, while
metabotropic receptors are G-protein coupled receptors that produce slower, prolonged signaling cascades
[CORRECT]
C. Both receptor types use G-proteins, but ionotropic receptors open sodium channels while metabotropic
receptors open potassium channels
D. There is no clinically significant difference between the two receptor types in psychopharmacology
Correct Answer: B
Rationale: Ionotropic receptors (e.g., GABA-A, NMDA, AMPA, nicotinic acetylcholine) are ligand-gated ion channels that
open immediately upon neurotransmitter binding, allowing ions to flow through and producing rapid, millisecond-scale
responses. Metabotropic receptors (e.g., 5-HT1A, 5-HT2A, D2, muscarinic ACh, GABA-B) are G-protein coupled receptors
(GPCRs) that activate second messenger systems (cAMP, IP3/DAG), producing slower but more sustained effects. Option A
reverses the definitions. Options C and D contain inaccuracies about their mechanisms and clinical relevance.
Q5: A patient taking a medication that blocks 5-HT2A receptors would most likely experience which
therapeutic or adverse effect?
A. Increased anxiety and insomnia due to reduced serotonin activity
B. Improved mood with reduced hallucinations, as 5-HT2A antagonism is associated with antidepressant
and antipsychotic effects [CORRECT]
C. Enhanced appetite and weight loss due to increased serotonergic signaling
D. Seizures due to excessive glutamate release in the cortex
Correct Answer: B
Rationale: 5-HT2A receptor antagonism is a key mechanism of several atypical antipsychotics (e.g., clozapine, olanzapine)
and some antidepressants (e.g., mirtazapine, trazodone). Blocking 5-HT2A receptors reduces cortical dopamine release
modulation and is associated with improvement in both psychotic symptoms and mood. 5-HT2A antagonism also promotes
sleep and increases appetite (not weight loss). Option A describes effects more consistent with 5-HT2A agonism. Option D is not
a recognized effect of 5-HT2A receptor blockade.
Q6: GABA is the primary inhibitory neurotransmitter in the central nervous system. A nurse practitioner is
reviewing medications that enhance GABA activity. Which of the following correctly pairs a GABA receptor
subtype with its classification?
A. GABA-A receptors are metabotropic and slow-acting; GABA-B receptors are ionotropic and fast-acting
B. GABA-A receptors are ionotropic ligand-gated chloride channels; GABA-B receptors are metabotropic
G-protein coupled receptors [CORRECT]
, C. Both GABA-A and GABA-B receptors are ionotropic channels that allow chloride influx
D. GABA-A receptors are G-protein coupled; GABA-B receptors are ligand-gated ion channels
Correct Answer: B
Rationale: GABA-A receptors are ionotropic ligand-gated chloride channels; when GABA binds, the channel opens and
chloride ions flow into the neuron, hyperpolarizing it and reducing neuronal excitability. Benzodiazepines and barbiturates act
as positive allosteric modulators at GABA-A receptors. GABA-B receptors are metabotropic G-protein coupled receptors linked
to potassium channels and calcium channel inhibition, producing slower, more prolonged inhibitory effects. Options A and D
reverse the classifications. Option C incorrectly states both are ionotropic.
Q7: A patient with schizophrenia begins treatment with a dopamine D2 receptor antagonist. The nurse
practitioner should monitor for which adverse effect related to the nigrostriatal dopamine pathway?
A. Hyperprolactinemia and galactorrhea
B. Extrapyramidal symptoms (EPS), including parkinsonism, dystonia, akathisia, and tardive dyskinesia
[CORRECT]
C. Serotonin syndrome with hyperthermia and autonomic instability
D. Weight gain and metabolic syndrome
Correct Answer: B
Rationale: The nigrostriatal dopamine pathway projects from the substantia nigra to the caudate and putamen (striatum) and
regulates motor function. D2 receptor antagonism in this pathway depletes dopamine activity, producing extrapyramidal
symptoms (EPS) such as parkinsonism (tremor, rigidity, bradykinesia), acute dystonia, akathisia (subjective restlessness), and
tardive dyskinesia (involuntary choreoathetoid movements). Hyperprolactinemia results from D2 blockade in the
tuberoinfundibular pathway. Weight gain and metabolic syndrome are related to 5-HT2C and histamine H1 receptor
antagonism. Serotonin syndrome is unrelated to D2 blockade.
Q8: Norepinephrine is synthesized from dopamine through the action of which enzyme?
A. Tryptophan hydroxylase
B. DOPA decarboxylase
C. Dopamine beta-hydroxylase (DBH) [CORRECT]
D. Monoamine oxidase (MAO)
Correct Answer: C
Rationale: The norepinephrine synthesis pathway begins with the amino acid tyrosine, which is converted by tyrosine
hydroxylase to L-DOPA, then by DOPA decarboxylase to dopamine. Dopamine is then converted to norepinephrine by the
enzyme dopamine beta-hydroxylase (DBH), which adds a hydroxyl group to the beta carbon of dopamine. Tryptophan
hydroxylase is the rate-limiting enzyme in serotonin synthesis (converting tryptophan to 5-HTP). MAO is a degradative enzyme
that breaks down monoamine neurotransmitters rather than synthesizing them.
Q9: Which second messenger system is activated when a Gq-protein coupled receptor (such as 5-HT2A or
muscarinic M1) is stimulated?
A. Adenylyl cyclase -> increased cAMP production
B. Inhibition of adenylyl cyclase -> decreased cAMP production
C. Phospholipase C -> IP3 (calcium release) and DAG (protein kinase C activation) [CORRECT]
D. Direct opening of chloride channels without second messenger involvement
Correct Answer: C
NSG552 / NSG 552 Exam 1 (Latest ): Psychopharmacology
Grade A Questions and Verified Answers | 100% Correct - Wilkes University Passan School of Nursing
Section 1: Neurobiology and Neurotransmission
Q1: A psychiatric nurse practitioner is explaining synaptic transmission to a nursing student. Which sequence
correctly describes the process of synaptic neurotransmission?
A. Neurotransmitter release -> receptor binding -> reuptake -> action potential
B. Action potential -> neurotransmitter release -> receptor binding -> postsynaptic response -> reuptake or
enzymatic degradation [CORRECT]
C. Receptor binding -> action potential -> neurotransmitter release -> enzymatic degradation
D. Postsynaptic response -> neurotransmitter release -> action potential -> reuptake
Correct Answer: B
Rationale: Synaptic transmission begins with an action potential traveling down the axon, which triggers calcium influx and
vesicular release of neurotransmitter into the synaptic cleft. The neurotransmitter then binds to postsynaptic receptors,
generating a postsynaptic response (excitatory or inhibitory), and is ultimately removed from the cleft via reuptake transporters
(e.g., SERT, DAT, NET) or enzymatic degradation (e.g., MAO, COMT). Option A reverses the first two steps, and options C
and D place receptor binding or postsynaptic response before neurotransmitter release, which is physiologically incorrect.
Q2: A patient with major depressive disorder is prescribed an SSRI. The nurse practitioner understands that
SSRIs exert their therapeutic effect primarily by targeting which neuronal structure?
A. The axon hillock, where action potentials are generated
B. SERT, the serotonin transporter protein on presynaptic neurons that removes serotonin from the
synaptic cleft [CORRECT]
C. The myelin sheath, which increases conduction velocity of serotonergic neurons
D. The dendritic spines, where serotonin is synthesized and stored
Correct Answer: B
Rationale: Selective Serotonin Reuptake Inhibitors (SSRIs) block the serotonin transporter (SERT), a presynaptic reuptake
protein located on serotonergic axon terminals. By inhibiting SERT, SSRIs increase the concentration of serotonin in the
synaptic cleft, enhancing serotonergic neurotransmission. The axon hillock generates action potentials but is not a drug target
for SSRIs. The myelin sheath is unrelated to neurotransmitter reuptake. Serotonin is synthesized in the cell body (soma) from
tryptophan, not in dendritic spines.
Q3: Which dopamine pathway is primarily associated with the positive symptoms of schizophrenia, such as
hallucinations and delusions, when overactive?
A. The nigrostriatal pathway
B. The mesolimbic pathway [CORRECT]
C. The mesocortical pathway
D. The tuberoinfundibular pathway
Correct Answer: B
Page 1
,Rationale: The mesolimbic dopamine pathway projects from the ventral tegmental area (VTA) to the nucleus accumbens and
limbic structures, and is the primary pathway implicated in the positive symptoms of schizophrenia (hallucinations, delusions,
thought disorganization) when dopamine activity is excessive. The nigrostriatal pathway regulates motor function (dysfunction
leads to Parkinsonism and extrapyramidal symptoms). The mesocortical pathway modulates cognition and executive function
(hypofrontality leads to negative symptoms). The tuberoinfundibular pathway inhibits prolactin release from the anterior
pituitary.
Q4: A nursing student asks about the difference between ionotropic and metabotropic receptors. Which
response by the nurse practitioner is most accurate?
A. Ionotropic receptors are G-protein coupled and produce slow, long-lasting effects, while metabotropic
receptors are ligand-gated ion channels producing rapid, brief responses
B. Ionotropic receptors are ligand-gated ion channels that produce rapid, brief responses, while
metabotropic receptors are G-protein coupled receptors that produce slower, prolonged signaling cascades
[CORRECT]
C. Both receptor types use G-proteins, but ionotropic receptors open sodium channels while metabotropic
receptors open potassium channels
D. There is no clinically significant difference between the two receptor types in psychopharmacology
Correct Answer: B
Rationale: Ionotropic receptors (e.g., GABA-A, NMDA, AMPA, nicotinic acetylcholine) are ligand-gated ion channels that
open immediately upon neurotransmitter binding, allowing ions to flow through and producing rapid, millisecond-scale
responses. Metabotropic receptors (e.g., 5-HT1A, 5-HT2A, D2, muscarinic ACh, GABA-B) are G-protein coupled receptors
(GPCRs) that activate second messenger systems (cAMP, IP3/DAG), producing slower but more sustained effects. Option A
reverses the definitions. Options C and D contain inaccuracies about their mechanisms and clinical relevance.
Q5: A patient taking a medication that blocks 5-HT2A receptors would most likely experience which
therapeutic or adverse effect?
A. Increased anxiety and insomnia due to reduced serotonin activity
B. Improved mood with reduced hallucinations, as 5-HT2A antagonism is associated with antidepressant
and antipsychotic effects [CORRECT]
C. Enhanced appetite and weight loss due to increased serotonergic signaling
D. Seizures due to excessive glutamate release in the cortex
Correct Answer: B
Rationale: 5-HT2A receptor antagonism is a key mechanism of several atypical antipsychotics (e.g., clozapine, olanzapine)
and some antidepressants (e.g., mirtazapine, trazodone). Blocking 5-HT2A receptors reduces cortical dopamine release
modulation and is associated with improvement in both psychotic symptoms and mood. 5-HT2A antagonism also promotes
sleep and increases appetite (not weight loss). Option A describes effects more consistent with 5-HT2A agonism. Option D is not
a recognized effect of 5-HT2A receptor blockade.
Q6: GABA is the primary inhibitory neurotransmitter in the central nervous system. A nurse practitioner is
reviewing medications that enhance GABA activity. Which of the following correctly pairs a GABA receptor
subtype with its classification?
A. GABA-A receptors are metabotropic and slow-acting; GABA-B receptors are ionotropic and fast-acting
B. GABA-A receptors are ionotropic ligand-gated chloride channels; GABA-B receptors are metabotropic
G-protein coupled receptors [CORRECT]
, C. Both GABA-A and GABA-B receptors are ionotropic channels that allow chloride influx
D. GABA-A receptors are G-protein coupled; GABA-B receptors are ligand-gated ion channels
Correct Answer: B
Rationale: GABA-A receptors are ionotropic ligand-gated chloride channels; when GABA binds, the channel opens and
chloride ions flow into the neuron, hyperpolarizing it and reducing neuronal excitability. Benzodiazepines and barbiturates act
as positive allosteric modulators at GABA-A receptors. GABA-B receptors are metabotropic G-protein coupled receptors linked
to potassium channels and calcium channel inhibition, producing slower, more prolonged inhibitory effects. Options A and D
reverse the classifications. Option C incorrectly states both are ionotropic.
Q7: A patient with schizophrenia begins treatment with a dopamine D2 receptor antagonist. The nurse
practitioner should monitor for which adverse effect related to the nigrostriatal dopamine pathway?
A. Hyperprolactinemia and galactorrhea
B. Extrapyramidal symptoms (EPS), including parkinsonism, dystonia, akathisia, and tardive dyskinesia
[CORRECT]
C. Serotonin syndrome with hyperthermia and autonomic instability
D. Weight gain and metabolic syndrome
Correct Answer: B
Rationale: The nigrostriatal dopamine pathway projects from the substantia nigra to the caudate and putamen (striatum) and
regulates motor function. D2 receptor antagonism in this pathway depletes dopamine activity, producing extrapyramidal
symptoms (EPS) such as parkinsonism (tremor, rigidity, bradykinesia), acute dystonia, akathisia (subjective restlessness), and
tardive dyskinesia (involuntary choreoathetoid movements). Hyperprolactinemia results from D2 blockade in the
tuberoinfundibular pathway. Weight gain and metabolic syndrome are related to 5-HT2C and histamine H1 receptor
antagonism. Serotonin syndrome is unrelated to D2 blockade.
Q8: Norepinephrine is synthesized from dopamine through the action of which enzyme?
A. Tryptophan hydroxylase
B. DOPA decarboxylase
C. Dopamine beta-hydroxylase (DBH) [CORRECT]
D. Monoamine oxidase (MAO)
Correct Answer: C
Rationale: The norepinephrine synthesis pathway begins with the amino acid tyrosine, which is converted by tyrosine
hydroxylase to L-DOPA, then by DOPA decarboxylase to dopamine. Dopamine is then converted to norepinephrine by the
enzyme dopamine beta-hydroxylase (DBH), which adds a hydroxyl group to the beta carbon of dopamine. Tryptophan
hydroxylase is the rate-limiting enzyme in serotonin synthesis (converting tryptophan to 5-HTP). MAO is a degradative enzyme
that breaks down monoamine neurotransmitters rather than synthesizing them.
Q9: Which second messenger system is activated when a Gq-protein coupled receptor (such as 5-HT2A or
muscarinic M1) is stimulated?
A. Adenylyl cyclase -> increased cAMP production
B. Inhibition of adenylyl cyclase -> decreased cAMP production
C. Phospholipase C -> IP3 (calcium release) and DAG (protein kinase C activation) [CORRECT]
D. Direct opening of chloride channels without second messenger involvement
Correct Answer: C
