NR 546 / NR546 FINAL EXAM GUIDE 2026
: PSYCHOPHARMACOLOGY MASTERY
1. A patient taking Lithium presents with coarse tremors, ataxia, and a serum lithium level of
1.8 mEq/L. Which of the following is the most appropriate next step?
A. Hold the lithium dose and assess for toxicity symptoms
B. Increase fluid intake and maintain current dosage
C. Continue current dose and recheck level in one week
D. Provide a dose of Benztropine to manage the tremors
Answer: A
Conceptual Explanation: Lithium levels between 1.5-2.0 mEq/L indicate mild to moderate
toxicity, characterized by coarse tremors and ataxia. The priority is to hold the medication
and assess the patient.
2. Which dopamine pathway is primarily responsible for the development of extrapyramidal
symptoms (EPS) when D2 receptors are blocked?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
,D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The nigrostriatal pathway controls motor function; blockade of
D2 receptors here results in EPS. The mesolimbic relates to reward, mesocortical to
cognition/negative symptoms, and tuberoinfundibular to prolactin.
3. A client is prescribed Clozapine. Which Absolute Neutrophil Count (ANC) result necessitates
immediate discontinuation and prevents rechallenge?
A. ANC < 1500/mm3
B. ANC < 1000/mm3
C. ANC < 2000/mm3
D. ANC < 500/mm3
Answer: D
Conceptual Explanation: An ANC less than 500/mm3 is considered severe neutropenia,
requiring immediate cessation of Clozapine and usually precludes further use due to the
risk of agranulocytosis.
4. Which of the following antidepressants is considered a multimodal agent, acting as a
serotonin reuptake inhibitor, 5-HT3 antagonist, and 5-HT1A agonist?
A. Escitalopram
B. Vilazodone
, C. Vortioxetine
D. Venlafaxine
Answer: C
Conceptual Explanation: Vortioxetine is a multimodal antidepressant with complex
effects on various serotonin receptors, unlike simple SSRIs or Vilazodone (a SPARI).
5. A patient with ADHD and a history of substance use disorder requires medication. Which
non-stimulant is a selective norepinephrine reuptake inhibitor (NRI)?
A. Guanfacine
B. Clonidine
C. Atomoxetine
D. Lisdexamfetamine
Answer: C
Conceptual Explanation: Atomoxetine is a selective NRI and is non-addictive, making it
suitable for patients with a history of substance abuse.
6. Which enzyme system is inhibited by Fluoxetine and Paroxetine, potentially increasing the
levels of TCAs and certain antipsychotics?
A. CYP1A2
B. CYP2D6
C. CYP3A4
: PSYCHOPHARMACOLOGY MASTERY
1. A patient taking Lithium presents with coarse tremors, ataxia, and a serum lithium level of
1.8 mEq/L. Which of the following is the most appropriate next step?
A. Hold the lithium dose and assess for toxicity symptoms
B. Increase fluid intake and maintain current dosage
C. Continue current dose and recheck level in one week
D. Provide a dose of Benztropine to manage the tremors
Answer: A
Conceptual Explanation: Lithium levels between 1.5-2.0 mEq/L indicate mild to moderate
toxicity, characterized by coarse tremors and ataxia. The priority is to hold the medication
and assess the patient.
2. Which dopamine pathway is primarily responsible for the development of extrapyramidal
symptoms (EPS) when D2 receptors are blocked?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
,D. Tuberoinfundibular pathway
Answer: B
Conceptual Explanation: The nigrostriatal pathway controls motor function; blockade of
D2 receptors here results in EPS. The mesolimbic relates to reward, mesocortical to
cognition/negative symptoms, and tuberoinfundibular to prolactin.
3. A client is prescribed Clozapine. Which Absolute Neutrophil Count (ANC) result necessitates
immediate discontinuation and prevents rechallenge?
A. ANC < 1500/mm3
B. ANC < 1000/mm3
C. ANC < 2000/mm3
D. ANC < 500/mm3
Answer: D
Conceptual Explanation: An ANC less than 500/mm3 is considered severe neutropenia,
requiring immediate cessation of Clozapine and usually precludes further use due to the
risk of agranulocytosis.
4. Which of the following antidepressants is considered a multimodal agent, acting as a
serotonin reuptake inhibitor, 5-HT3 antagonist, and 5-HT1A agonist?
A. Escitalopram
B. Vilazodone
, C. Vortioxetine
D. Venlafaxine
Answer: C
Conceptual Explanation: Vortioxetine is a multimodal antidepressant with complex
effects on various serotonin receptors, unlike simple SSRIs or Vilazodone (a SPARI).
5. A patient with ADHD and a history of substance use disorder requires medication. Which
non-stimulant is a selective norepinephrine reuptake inhibitor (NRI)?
A. Guanfacine
B. Clonidine
C. Atomoxetine
D. Lisdexamfetamine
Answer: C
Conceptual Explanation: Atomoxetine is a selective NRI and is non-addictive, making it
suitable for patients with a history of substance abuse.
6. Which enzyme system is inhibited by Fluoxetine and Paroxetine, potentially increasing the
levels of TCAs and certain antipsychotics?
A. CYP1A2
B. CYP2D6
C. CYP3A4
