NR 546 Final Exam: Psychopharmacology
Chamberlain University - 2026 Edition
Question 1
A 45-year-old patient with major depressive disorder has been taking fluoxetine 40 mg daily for 8 weeks
with minimal improvement. The provider decides to switch to duloxetine. What is the MOST appropriate
cross-tapering strategy?
A. Abruptly discontinue fluoxetine and start duloxetine the next day
B. Decrease fluoxetine to 20 mg daily while starting duloxetine 30 mg daily for 1 week, then discontinue
fluoxetine and increase duloxetine to 60 mg daily
C. Maintain fluoxetine at 40 mg daily and add duloxetine 30 mg daily for 2 weeks, then discontinue
fluoxetine
D. Discontinue fluoxetine, wait 2 weeks, then start duloxetine 30 mg daily
ANSWER: B
Rationale: Option B is correct because cross-tapering minimizes withdrawal symptoms and serotonin
syndrome risk. Option A is incorrect due to abrupt discontinuation risks. Option C is incorrect due to
increased serotonin syndrome risk. Option D is incorrect because fluoxetine has a long half-life and 2
weeks may be excessive.
Question 2
Which neurotransmitter system is primarily associated with the therapeutic effects of atypical
antipsychotics in treating negative symptoms of schizophrenia?
A. Dopamine D2 antagonism
B. Serotonin 5-HT2A antagonism
C. Norepinephrine reuptake inhibition
,D. GABA receptor modulation
ANSWER: B
Rationale: Option B is correct because 5-HT2A antagonism reduces negative symptoms. Option A is
incorrect as D2 antagonism primarily addresses positive symptoms. Option C is incorrect as
norepinephrine effects are secondary. Option D is incorrect as GABA modulation is not the primary
mechanism.
Question 3
A patient presents with lithium toxicity. Which of the following findings is MOST characteristic of severe
lithium toxicity (serum level > 2.5 mEq/L)?
A. Fine tremor and polyuria
B. Nausea and diarrhea
C. Seizures and coma
D. Hypothyroidism
ANSWER: C
Rationale: Option C is correct as severe toxicity causes neurological symptoms. Option A is incorrect as
fine tremor occurs at therapeutic levels. Option B is incorrect as GI symptoms occur at mild toxicity.
Option D is incorrect as this is a long-term effect.
Question 4
A patient with bipolar disorder is started on lamotrigine. What is the MOST important teaching point
regarding this medication?
A. Report any rash immediately, even if mild
B. Avoid grapefruit juice consumption
C. Take with food to improve absorption
D. Expect weight gain as a common side effect
,ANSWER: A
Rationale: Option A is correct due to risk of Stevens-Johnson syndrome. Option B is incorrect as
grapefruit interactions are minimal. Option C is incorrect as absorption is not food-dependent. Option D
is incorrect as weight gain is not common.
Question 5
A 30-year-old female with panic disorder has been prescribed clonazepam 0.5 mg BID. What is the
MOST significant risk factor for dependence with long-term use?
A. Short half-life of the medication
B. High potency of the medication
C. Development of tolerance
D. Cost of the medication
ANSWER: C
Rationale: Option C is correct because tolerance leads to dose escalation and dependence. Option A is
incorrect as clonazepam has a long half-life. Option B is incorrect as high potency is not the primary risk
factor. Option D is incorrect as cost does not affect dependence.
Question 6
A patient on phenelzine (MAOI) requires pain management. Which analgesic is CONTRAINDICATED?
A. Acetaminophen
B. Ibuprofen
C. Meperidine
D. Aspirin
ANSWER: C
Rationale: Option C is correct due to risk of serotonin syndrome. Option A is incorrect as acetaminophen
is safe. Option B is incorrect as ibuprofen is safe. Option D is incorrect as aspirin is safe with MAOIs.
, Question 7
A patient with ADHD and comorbid anxiety is being treated with stimulant medication. Which symptom
would MOST warrant discontinuation of the stimulant?
A. Mild appetite suppression
B. Difficulty falling asleep
C. New-onset chest pain
D. Slight increase in heart rate
ANSWER: C
Rationale: Option C is correct due to cardiovascular risk requiring immediate evaluation. Option A is
incorrect as appetite suppression is common but manageable. Option B is incorrect as sleep difficulty
can be managed. Option D is incorrect as slight tachycardia may be expected.
Question 8
A 65-year-old patient with Alzheimer's disease is prescribed donepezil. What is the MOST important
monitoring parameter?
A. Liver function tests
B. Complete blood count
C. Heart rate
D. Serum glucose
ANSWER: C
Rationale: Option C is correct due to risk of bradycardia. Option A is incorrect as liver monitoring is not
primary. Option B is incorrect as CBC is not routinely monitored. Option D is incorrect as glucose is not
affected.
Question 9
A 25-year-old male with schizophrenia is started on clozapine. Which side effect requires the MOST
urgent intervention?
Chamberlain University - 2026 Edition
Question 1
A 45-year-old patient with major depressive disorder has been taking fluoxetine 40 mg daily for 8 weeks
with minimal improvement. The provider decides to switch to duloxetine. What is the MOST appropriate
cross-tapering strategy?
A. Abruptly discontinue fluoxetine and start duloxetine the next day
B. Decrease fluoxetine to 20 mg daily while starting duloxetine 30 mg daily for 1 week, then discontinue
fluoxetine and increase duloxetine to 60 mg daily
C. Maintain fluoxetine at 40 mg daily and add duloxetine 30 mg daily for 2 weeks, then discontinue
fluoxetine
D. Discontinue fluoxetine, wait 2 weeks, then start duloxetine 30 mg daily
ANSWER: B
Rationale: Option B is correct because cross-tapering minimizes withdrawal symptoms and serotonin
syndrome risk. Option A is incorrect due to abrupt discontinuation risks. Option C is incorrect due to
increased serotonin syndrome risk. Option D is incorrect because fluoxetine has a long half-life and 2
weeks may be excessive.
Question 2
Which neurotransmitter system is primarily associated with the therapeutic effects of atypical
antipsychotics in treating negative symptoms of schizophrenia?
A. Dopamine D2 antagonism
B. Serotonin 5-HT2A antagonism
C. Norepinephrine reuptake inhibition
,D. GABA receptor modulation
ANSWER: B
Rationale: Option B is correct because 5-HT2A antagonism reduces negative symptoms. Option A is
incorrect as D2 antagonism primarily addresses positive symptoms. Option C is incorrect as
norepinephrine effects are secondary. Option D is incorrect as GABA modulation is not the primary
mechanism.
Question 3
A patient presents with lithium toxicity. Which of the following findings is MOST characteristic of severe
lithium toxicity (serum level > 2.5 mEq/L)?
A. Fine tremor and polyuria
B. Nausea and diarrhea
C. Seizures and coma
D. Hypothyroidism
ANSWER: C
Rationale: Option C is correct as severe toxicity causes neurological symptoms. Option A is incorrect as
fine tremor occurs at therapeutic levels. Option B is incorrect as GI symptoms occur at mild toxicity.
Option D is incorrect as this is a long-term effect.
Question 4
A patient with bipolar disorder is started on lamotrigine. What is the MOST important teaching point
regarding this medication?
A. Report any rash immediately, even if mild
B. Avoid grapefruit juice consumption
C. Take with food to improve absorption
D. Expect weight gain as a common side effect
,ANSWER: A
Rationale: Option A is correct due to risk of Stevens-Johnson syndrome. Option B is incorrect as
grapefruit interactions are minimal. Option C is incorrect as absorption is not food-dependent. Option D
is incorrect as weight gain is not common.
Question 5
A 30-year-old female with panic disorder has been prescribed clonazepam 0.5 mg BID. What is the
MOST significant risk factor for dependence with long-term use?
A. Short half-life of the medication
B. High potency of the medication
C. Development of tolerance
D. Cost of the medication
ANSWER: C
Rationale: Option C is correct because tolerance leads to dose escalation and dependence. Option A is
incorrect as clonazepam has a long half-life. Option B is incorrect as high potency is not the primary risk
factor. Option D is incorrect as cost does not affect dependence.
Question 6
A patient on phenelzine (MAOI) requires pain management. Which analgesic is CONTRAINDICATED?
A. Acetaminophen
B. Ibuprofen
C. Meperidine
D. Aspirin
ANSWER: C
Rationale: Option C is correct due to risk of serotonin syndrome. Option A is incorrect as acetaminophen
is safe. Option B is incorrect as ibuprofen is safe. Option D is incorrect as aspirin is safe with MAOIs.
, Question 7
A patient with ADHD and comorbid anxiety is being treated with stimulant medication. Which symptom
would MOST warrant discontinuation of the stimulant?
A. Mild appetite suppression
B. Difficulty falling asleep
C. New-onset chest pain
D. Slight increase in heart rate
ANSWER: C
Rationale: Option C is correct due to cardiovascular risk requiring immediate evaluation. Option A is
incorrect as appetite suppression is common but manageable. Option B is incorrect as sleep difficulty
can be managed. Option D is incorrect as slight tachycardia may be expected.
Question 8
A 65-year-old patient with Alzheimer's disease is prescribed donepezil. What is the MOST important
monitoring parameter?
A. Liver function tests
B. Complete blood count
C. Heart rate
D. Serum glucose
ANSWER: C
Rationale: Option C is correct due to risk of bradycardia. Option A is incorrect as liver monitoring is not
primary. Option B is incorrect as CBC is not routinely monitored. Option D is incorrect as glucose is not
affected.
Question 9
A 25-year-old male with schizophrenia is started on clozapine. Which side effect requires the MOST
urgent intervention?
