NSG552 / NSG 552 Exam 2 (Latest 2026/2027)
OBJECTIVE ASSESSMENT - EXAM
NSG552 / NSG 552 Exam 2
(Latest 2026/2027):
Psychopharmacology
Grade A Questions and Verified Answers
100% Correct - Wilkes 2026/2027
A+ Verified
Edition: 2026/2027 | Passing Score: 80%
Graduate-Level Psychopharmacology
COVER PAGE - 1
,SECTIONS COVERED
Section 1: Antidepressants: Mechanisms, Selection, and Management
Section 2: Antipsychotics: Typical, Atypical, and Monitoring
Section 3: Mood Stabilizers and Bipolar Disorder Pharmacotherapy
Section 4: Anxiolytics, Hypnotics, and ADHD Pharmacotherapy
Section 5: Adverse Effects, Special Populations, and Clinical Decision-Making
NSG552 / NSG 552 Exam 2 (Latest 2026/2027): Psychopharmacology | Grade A Questions and Verified Answers | 100%
Correct - Wilkes 2026/2027
This examination assesses graduate-level competence in psychopharmacology, including mechanisms of action, clinical selection of
psychiatric medications, recognition and management of adverse effects, and evidence-based decision-making across diverse patient
populations. Each question is worth 1 mark. A score of 80% or higher is required to pass.
SECTION 1: Antidepressants: Mechanisms, Selection, and Management
Question 1
A 34-year-old woman with major depressive disorder has failed two adequate trials of SSRIs and reports persistent anhedonia, fatigue,
and low motivation. She has no history of mania or seizures. The psychiatric nurse practitioner decides to switch to an agent with a
distinct mechanism. Which medication is most appropriate to target these residual symptoms while minimizing sexual side effects?
A. Venlafaxine extended-release 75 mg daily
B. Bupropion XL 150 mg daily
C. Mirtazapine 15 mg at bedtime
D. Paroxetine 20 mg daily
Correct Answer: B
Rationale:
Bupropion is a norepinephrine-dopamine reuptake inhibitor that is particularly effective for residual anhedonia, fatigue, and low motivation, and it
has a low incidence of sexual side effects. Venlafaxine is an SNRI that may worsen sexual dysfunction; mirtazapine can cause sedation and weight
gain; paroxetine is another SSRI with high sexual side-effect burden.
Question 2
A 28-year-old patient starts sertraline 50 mg daily for generalized anxiety and depression. After 10 days he reports intense
restlessness, inability to sit still, and feeling 'wired.' He denies suicidal ideation. Vital signs are normal. Which adverse effect is most
likely responsible, and what is the preferred initial management?
A. Serotonin syndrome; discontinue immediately and give cyproheptadine
B. Akathisia; reduce dose or switch agent and consider a short course of a benzodiazepine or beta-blocker
C. Activation syndrome; increase the dose to overcome initial side effects
D. Neuroleptic malignant syndrome; hospitalize and start dantrolene
Correct Answer: B
Rationale:
Early restlessness and inability to sit still after starting an SSRI are classic for akathisia or activation. Management includes dose reduction,
switching agents, or short-term symptomatic treatment with a benzodiazepine or beta-blocker. Serotonin syndrome typically includes autonomic
instability, hyperreflexia, and clonus; NMS is associated with antipsychotics.
, Question 3
A 52-year-old man with recurrent major depression has been stable on fluoxetine 40 mg daily for three years. He now requires
tamoxifen for estrogen-receptor-positive breast cancer. Which action best addresses the clinically significant drug interaction?
A. Continue fluoxetine; the interaction is theoretically minor
B. Switch to an antidepressant with minimal CYP2D6 inhibition such as venlafaxine or mirtazapine
C. Increase fluoxetine to 60 mg to overcome competitive inhibition
D. Add a CYP2D6 inducer to accelerate tamoxifen activation
Correct Answer: B
Rationale:
Fluoxetine is a strong CYP2D6 inhibitor and can reduce conversion of tamoxifen to its active metabolite endoxifen, potentially compromising
breast-cancer outcomes. Switching to an agent with little or no CYP2D6 inhibition (e.g., venlafaxine, mirtazapine, or desvenlafaxine) is the
evidence-based recommendation.
Question 4
A 41-year-old woman with treatment-resistant depression is being considered for augmentation after partial response to an SNRI. She
has a history of mild metabolic syndrome. Which augmentation strategy has the strongest evidence for efficacy while carrying a lower
risk of metabolic worsening compared with atypical antipsychotics?
A. Aripiprazole 5 mg daily
B. Lithium carbonate 300 mg twice daily with level monitoring
C. Olanzapine 5 mg at bedtime
D. Quetiapine XR 150 mg at bedtime
Correct Answer: B
Rationale:
Lithium remains one of the best-evidenced augmentation agents for treatment-resistant depression and does not carry the metabolic liability of
atypical antipsychotics. Aripiprazole, olanzapine, and quetiapine all increase risk of weight gain and metabolic dysregulation to varying degrees.
Question 5
A 67-year-old patient with late-life depression is started on an SSRI. Two weeks later he develops hyponatremia (Na 128 mEq/L),
confusion, and mild gait unsteadiness. Which SSRI is most strongly associated with this adverse effect in older adults, and what is the
priority action?
A. Escitalopram; continue current dose and recheck sodium in one week
B. Paroxetine; discontinue the SSRI and correct sodium carefully
C. Sertraline; add salt tablets and continue the antidepressant
D. Fluoxetine; switch to a TCA immediately
Correct Answer: B
Rationale:
SSRIs, particularly paroxetine and fluoxetine, are associated with SIADH and hyponatremia in older adults. Symptomatic hyponatremia requires
discontinuation of the offending agent and careful sodium correction. Continuing the SSRI or switching to a TCA without addressing the electrolyte
imbalance is inappropriate.
OBJECTIVE ASSESSMENT - EXAM
NSG552 / NSG 552 Exam 2
(Latest 2026/2027):
Psychopharmacology
Grade A Questions and Verified Answers
100% Correct - Wilkes 2026/2027
A+ Verified
Edition: 2026/2027 | Passing Score: 80%
Graduate-Level Psychopharmacology
COVER PAGE - 1
,SECTIONS COVERED
Section 1: Antidepressants: Mechanisms, Selection, and Management
Section 2: Antipsychotics: Typical, Atypical, and Monitoring
Section 3: Mood Stabilizers and Bipolar Disorder Pharmacotherapy
Section 4: Anxiolytics, Hypnotics, and ADHD Pharmacotherapy
Section 5: Adverse Effects, Special Populations, and Clinical Decision-Making
NSG552 / NSG 552 Exam 2 (Latest 2026/2027): Psychopharmacology | Grade A Questions and Verified Answers | 100%
Correct - Wilkes 2026/2027
This examination assesses graduate-level competence in psychopharmacology, including mechanisms of action, clinical selection of
psychiatric medications, recognition and management of adverse effects, and evidence-based decision-making across diverse patient
populations. Each question is worth 1 mark. A score of 80% or higher is required to pass.
SECTION 1: Antidepressants: Mechanisms, Selection, and Management
Question 1
A 34-year-old woman with major depressive disorder has failed two adequate trials of SSRIs and reports persistent anhedonia, fatigue,
and low motivation. She has no history of mania or seizures. The psychiatric nurse practitioner decides to switch to an agent with a
distinct mechanism. Which medication is most appropriate to target these residual symptoms while minimizing sexual side effects?
A. Venlafaxine extended-release 75 mg daily
B. Bupropion XL 150 mg daily
C. Mirtazapine 15 mg at bedtime
D. Paroxetine 20 mg daily
Correct Answer: B
Rationale:
Bupropion is a norepinephrine-dopamine reuptake inhibitor that is particularly effective for residual anhedonia, fatigue, and low motivation, and it
has a low incidence of sexual side effects. Venlafaxine is an SNRI that may worsen sexual dysfunction; mirtazapine can cause sedation and weight
gain; paroxetine is another SSRI with high sexual side-effect burden.
Question 2
A 28-year-old patient starts sertraline 50 mg daily for generalized anxiety and depression. After 10 days he reports intense
restlessness, inability to sit still, and feeling 'wired.' He denies suicidal ideation. Vital signs are normal. Which adverse effect is most
likely responsible, and what is the preferred initial management?
A. Serotonin syndrome; discontinue immediately and give cyproheptadine
B. Akathisia; reduce dose or switch agent and consider a short course of a benzodiazepine or beta-blocker
C. Activation syndrome; increase the dose to overcome initial side effects
D. Neuroleptic malignant syndrome; hospitalize and start dantrolene
Correct Answer: B
Rationale:
Early restlessness and inability to sit still after starting an SSRI are classic for akathisia or activation. Management includes dose reduction,
switching agents, or short-term symptomatic treatment with a benzodiazepine or beta-blocker. Serotonin syndrome typically includes autonomic
instability, hyperreflexia, and clonus; NMS is associated with antipsychotics.
, Question 3
A 52-year-old man with recurrent major depression has been stable on fluoxetine 40 mg daily for three years. He now requires
tamoxifen for estrogen-receptor-positive breast cancer. Which action best addresses the clinically significant drug interaction?
A. Continue fluoxetine; the interaction is theoretically minor
B. Switch to an antidepressant with minimal CYP2D6 inhibition such as venlafaxine or mirtazapine
C. Increase fluoxetine to 60 mg to overcome competitive inhibition
D. Add a CYP2D6 inducer to accelerate tamoxifen activation
Correct Answer: B
Rationale:
Fluoxetine is a strong CYP2D6 inhibitor and can reduce conversion of tamoxifen to its active metabolite endoxifen, potentially compromising
breast-cancer outcomes. Switching to an agent with little or no CYP2D6 inhibition (e.g., venlafaxine, mirtazapine, or desvenlafaxine) is the
evidence-based recommendation.
Question 4
A 41-year-old woman with treatment-resistant depression is being considered for augmentation after partial response to an SNRI. She
has a history of mild metabolic syndrome. Which augmentation strategy has the strongest evidence for efficacy while carrying a lower
risk of metabolic worsening compared with atypical antipsychotics?
A. Aripiprazole 5 mg daily
B. Lithium carbonate 300 mg twice daily with level monitoring
C. Olanzapine 5 mg at bedtime
D. Quetiapine XR 150 mg at bedtime
Correct Answer: B
Rationale:
Lithium remains one of the best-evidenced augmentation agents for treatment-resistant depression and does not carry the metabolic liability of
atypical antipsychotics. Aripiprazole, olanzapine, and quetiapine all increase risk of weight gain and metabolic dysregulation to varying degrees.
Question 5
A 67-year-old patient with late-life depression is started on an SSRI. Two weeks later he develops hyponatremia (Na 128 mEq/L),
confusion, and mild gait unsteadiness. Which SSRI is most strongly associated with this adverse effect in older adults, and what is the
priority action?
A. Escitalopram; continue current dose and recheck sodium in one week
B. Paroxetine; discontinue the SSRI and correct sodium carefully
C. Sertraline; add salt tablets and continue the antidepressant
D. Fluoxetine; switch to a TCA immediately
Correct Answer: B
Rationale:
SSRIs, particularly paroxetine and fluoxetine, are associated with SIADH and hyponatremia in older adults. Symptomatic hyponatremia requires
discontinuation of the offending agent and careful sodium correction. Continuing the SSRI or switching to a TCA without addressing the electrolyte
imbalance is inappropriate.
