NR 546 PSYCHOPHARMACOLOGY
ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A 28-year-old patient diagnosed with schizophrenia has failed two trials of antipsychotics
and is now starting Clozapine. Which laboratory parameter must be monitored strictly
according to the REMS program?
A. Liver function tests (LFTs)
B. Thyroid Stimulating Hormone (TSH)
C. Serum Creatinine
D. Absolute Neutrophil Count (ANC)
Answer: D
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis,
necessitating the monitoring of the Absolute Neutrophil Count (ANC) to prevent life-
threatening infections.
,2. Which dopaminergic pathway is primarily associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
B. Mesolimbic pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: B
Conceptual Explanation: Hyperactivity of dopamine in the mesolimbic pathway is
theorized to mediate the positive symptoms of psychosis.
3. A patient taking Phenelzine (an MAOI) presents to the emergency department with a
severe headache, palpitations, and a blood pressure of 210/120 mmHg. Which dietary
interaction likely occurred?
A. High-glucose intake
B. High-tyramine food consumption
C. Excessive vitamin K intake
D. Gluten-containing grains
Answer: B
Conceptual Explanation: MAOIs inhibit the breakdown of tyramine; elevated tyramine
levels cause the release of excessive norepinephrine, leading to a hypertensive crisis.
, 4. Lithium toxicity can be exacerbated by which of the following medication classes?
A. Beta-blockers
B. NSAIDs
C. Proton pump inhibitors
D. Antihistamines
Answer: B
Conceptual Explanation: NSAIDs (except aspirin and sulindac) reduce renal blood flow
and lithium excretion, increasing the risk of lithium toxicity.
5. The ‘Black Box Warning’ for all SSRIs and other antidepressants in children, adolescents,
and young adults refers to an increased risk of:
A. Serotonin Syndrome
B. Suicidal ideation and behavior
C. Metabolic Syndrome
D. Prolonged QT interval
Answer: B
Conceptual Explanation: The FDA mandates a black box warning for antidepressants
regarding the increased risk of suicidal thinking and behavior in individuals under age 24.
ADVANCED PRACTICE EXAM
QUESTIONS AND ANSWERS
1. A 28-year-old patient diagnosed with schizophrenia has failed two trials of antipsychotics
and is now starting Clozapine. Which laboratory parameter must be monitored strictly
according to the REMS program?
A. Liver function tests (LFTs)
B. Thyroid Stimulating Hormone (TSH)
C. Serum Creatinine
D. Absolute Neutrophil Count (ANC)
Answer: D
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis,
necessitating the monitoring of the Absolute Neutrophil Count (ANC) to prevent life-
threatening infections.
,2. Which dopaminergic pathway is primarily associated with the positive symptoms of
schizophrenia, such as hallucinations and delusions?
A. Nigrostriatal pathway
B. Mesolimbic pathway
C. Tuberoinfundibular pathway
D. Mesocortical pathway
Answer: B
Conceptual Explanation: Hyperactivity of dopamine in the mesolimbic pathway is
theorized to mediate the positive symptoms of psychosis.
3. A patient taking Phenelzine (an MAOI) presents to the emergency department with a
severe headache, palpitations, and a blood pressure of 210/120 mmHg. Which dietary
interaction likely occurred?
A. High-glucose intake
B. High-tyramine food consumption
C. Excessive vitamin K intake
D. Gluten-containing grains
Answer: B
Conceptual Explanation: MAOIs inhibit the breakdown of tyramine; elevated tyramine
levels cause the release of excessive norepinephrine, leading to a hypertensive crisis.
, 4. Lithium toxicity can be exacerbated by which of the following medication classes?
A. Beta-blockers
B. NSAIDs
C. Proton pump inhibitors
D. Antihistamines
Answer: B
Conceptual Explanation: NSAIDs (except aspirin and sulindac) reduce renal blood flow
and lithium excretion, increasing the risk of lithium toxicity.
5. The ‘Black Box Warning’ for all SSRIs and other antidepressants in children, adolescents,
and young adults refers to an increased risk of:
A. Serotonin Syndrome
B. Suicidal ideation and behavior
C. Metabolic Syndrome
D. Prolonged QT interval
Answer: B
Conceptual Explanation: The FDA mandates a black box warning for antidepressants
regarding the increased risk of suicidal thinking and behavior in individuals under age 24.
