NSG 552
EXAM 1
Psychopharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 1 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 552 EXAM 1 - PSYCHOPHARMACOLOGY
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 EXAM PAGES 3 STUDY PAGES FULL PDF LINKED
,Table of Contents
NSG 552 Exam 1...............................................................2
NSG 552 Exam 1 Study Guide ................................. 55
NSG 552 Exam 1
Question 1 (SINGLE BEST ANSWER)
A 24-year-old male with schizophrenia is prescribed haloperidol 10 mg IM for
acute agitation. Which medication should be co-administered to reduce the
risk of severe extrapyramidal symptoms (EPS)?
• A. Propranolol
• B. Benztropine
• C. Amantadine
• D. Clonazepam
Correct Answer: B. Benztropine
Rationale: IM haloperidol should be administered with an anticholinergic agent such
as benztropine or diphenhydramine to reduce the risk of severe EPS, particularly acute
dystonia.
,Question 2 (SINGLE BEST ANSWER)
A patient presents with involuntary movements of the facial muscles, tongue
protrusion, and lip smacking after 5 years of antipsychotic therapy. Which
condition is most likely?
• A. Acute dystonia
• B. Akathisia
• C. Tardive dyskinesia
• D. Neuroleptic malignant syndrome
Correct Answer: C. Tardive dyskinesia
Rationale: Tardive dyskinesia (TD) is characterized by involuntary movements of the
facial muscles, tongue, and limbs. It is a neurotoxic side effect of long-term
antipsychotic use targeting dopamine receptors.
───────────────────────────────────────────────────────
─────────────────────────
Question 3 (SELECT ALL THAT APPLY)
A patient on clozapine presents with fever, sore throat, and malaise. The
PMHNP suspects agranulocytosis. Select all that apply regarding clozapine
monitoring:
• A. Monitor WBC and ANC weekly for the first 6 months
• B. Discontinue clozapine if ANC falls below 1,500/mm³
• C. Agranulocytosis occurs in approximately 1% of patients
• D. Sialorrhea occurs in 30-80% of patients and is managed with glycopyrrolate
• E. Clozapine is first-line for all patients with schizophrenia
Correct Answer: A, B, C, D
Rationale: Clozapine requires WBC/ANC monitoring due to agranulocytosis risk
(1%). It is discontinued if ANC <1,500. Sialorrhea is common (30-80%) and managed
with glycopyrrolate. Clozapine is reserved for treatment-resistant schizophrenia, not
first-line.
,───────────────────────────────────────────────────────
─────────────────────────
Question 4 (SINGLE BEST ANSWER)
A 35-year-old female on risperidone reports galactorrhea and amenorrhea.
Which pathway is primarily responsible for this adverse effect?
• A. Mesolimbic pathway
• B. Mesocortical pathway
• C. Nigrostriatal pathway
• D. Tuberoinfundibular pathway
Correct Answer: D. Tuberoinfundibular pathway
Rationale: D2 blockade in the tuberoinfundibular pathway results in
hyperprolactinemia, causing galactorrhea, amenorrhea, gynecomastia, and decreased
libido. Risperidone is particularly associated with this effect.
───────────────────────────────────────────────────────
─────────────────────────
Question 5 (SINGLE BEST ANSWER)
A patient with bipolar disorder has a lithium level of 2.1 mEq/L. Which clinical
manifestation is most concerning?
• A. Coarse tremor and ataxia
• B. Seizures and coma
• C. Nausea and diarrhea
• D. Polyuria and polydipsia
Correct Answer: B. Seizures and coma
Rationale: Lithium has a narrow therapeutic index (0.6-1.2 mEq/L). Levels >2.0
mEq/L are potentially lethal and manifest with seizures, coma, and death. Early signs
include nausea, vomiting, and coarse tremors.
,───────────────────────────────────────────────────────
─────────────────────────
Question 6 (SELECT ALL THAT APPLY)
A 42-year-old male on haloperidol develops fever (40°C), lead-pipe rigidity,
altered mental status, and diaphoresis. Select all that apply regarding this
emergency:
• A. This is Neuroleptic Malignant Syndrome (NMS)
• B. Immediate discontinuation of the antipsychotic is required
• C. Bromocriptine and dantrolene are treatment options
• D. Mortality rate is approximately 20% if untreated
• E. This condition is more common with atypical antipsychotics
Correct Answer: A, B, C, D
Rationale: NMS (FALTERED) is a life-threatening emergency more common with
FGAs. Management includes discontinuing the offending agent, supportive care, and
medications such as bromocriptine and dantrolene. Mortality is ~20% if untreated.
───────────────────────────────────────────────────────
─────────────────────────
Question 7 (SINGLE BEST ANSWER)
A patient with Parkinson's disease develops psychosis. Which antipsychotic is
FDA-approved for Parkinson's-related psychosis?
• A. Risperidone
• B. Quetiapine
• C. Pimavanserin (Nuplazid)
• D. Olanzapine
Correct Answer: C. Pimavanserin (Nuplazid)
,Rationale: Pharmacokinetics (ADME: absorption, distribution, metabolism, excretion)
describes what the body does to the drug. Pharmacodynamics describes what the drug
does to the body (receptor binding, agonism, antagonism). Half-life is a
pharmacokinetic property.
───────────────────────────────────────────────────────
─────────────────────────
NSG 552 Exam 1 Study Guide
1. Antipsychotics
Psychopharmacology: The use of psychotropic medications in the treatment of psychiatric
disorders.
Pharmacokinetics: What the body does to the drug (absorption, distribution, metabolism,
excretion).
Pharmacodynamics: What drugs do to the body.
,Schizophrenia Symptoms
Positive Symptoms: Hallucinations and delusions
Negative Symptoms: Disturbance of affect, blunting (severe reduction in intensity of affect
expression), flat affect, inappropriate affect (might laugh hysterically while describing
someone's death)
Typical / 1st Generation / Neuroleptics / Conventional
• Introduced in the 1950's
• Block D2 receptors
• Effective for positive symptoms
• Can worsen negative symptoms secondary to ↓ DA in the Mesocortical pathway
• Long-acting forms available (Decanoate)
Atypical / 2nd Generation Antipsychotics
• First line treatment
• Fewer neurological side effects
• Effective for both positive and negative symptoms
• Serotonin-Dopamine antagonist (D2/5HT2A)
• Can cause EPS but at a lower risk
• ↓ incidence of Tardive dyskinesia
• Metabolic side effects: Weight gain, HLD, hyperglycemia, Diabetes, HTN, Cardiac and
respiratory S/E
• Some Antihistaminic, antiadrenergic and antimuscarinic effects
• Elevated Liver function tests (LFTs) - check yearly
• QTC Prolongation
Typical Antipsychotic Side Effects
Blockade of histamine, acetylcholine, alpha 1 and other receptors:
1. High antiadrenergic, anticholinergic and antihistaminic S/E (e.g., sedation, weight gain)
2. Elevated liver enzymes, jaundice
3. Seizures - all antipsychotics lower the seizure threshold
4. Orthostatic hypotension
5. QTC prolongation - obtain baseline EKG
6. Sexual dysfunction
7. Rashes, photosensitivity
8. Elevated liver enzymes, EPS (Akathisia, dystonia, Parkinsonism)
9. Hyperprolactinemia (decreased libido, galactorrhea, gynecomastia, impotence,
amenorrhea)
10. Tardive dyskinesia
11. Neuroleptic Malignant Syndrome (FALTERED)
, 2. Extrapyramidal Symptoms (EPS)
Acute Dystonia
• Sudden onset
• Fixed/Sustained painful contraction of the neck muscles (torticollis), tongue, eyes
(oculogyric crisis)
• Can be life threatening if it affects airway
• Onset: hours to days
Oculogyric crisis: Fixation of the eyeballs in an upward position
Treatment: Cogentin, Artane, Benadryl, Benzos (Ativan). Lower dose if possible.
Akathisia
• Internal and external restlessness
• Subjective anxiety, restlessness, inability to remain still
• Constant need to pace or walk
• Onset: days to months
Treatment: Drug of choice = Beta blocker (Propranolol), Benzos (Klonopin, Ativan). Lower
dose if possible.
Pseudo-Parkinsonism
• Bradykinesia (shuffled gait), masklike face, cogwheel rigidity, pill-rolling tremor
• Onset: days to months
Treatment: Cogentin, Artane, Benadryl, Symmetrel (Amantadine). Lower dose if possible.
Tardive Dyskinesia (TD)
Definition: Involuntary movements of the facial muscles, tongue, and limbs; a possible
neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine
receptors.
Risk Factors: Older age, women, patients with affective disorders, patients with substance
abuse hx; FGA, duration of treatment, higher dose, African American
Management: Dose reduction; D/C med; switch to an atypical antipsychotic; Clonazepam,
Amantadine, Tetrabenazine.
FDA Approved Treatments (2017): Valbenazine (Ingrezza); Deutetrabenazine (Austedo).
Consider switching to Clozaril (Lowest risk of TD).
Patient Education: TD symptoms may initially worsen transiently as medication dosages
are lowered. Affects about 20-30% of patients on antipsychotics for months or years. Up to
50% of cases will remit (without further antipsychotic use). Mostly irreversible.
EXAM 1
Psychopharmacology
Actual Questions with Verified Answers
Wilkes University
Pass the Exam with Confidence
What You Will Get:
➢100 Exam Questions w/ Answers
➢Expert Rationales included.
➢Exam 1 Comprehensive Study Guide
, Preview Pages Below
Get the Complete PDF After Purchase
NSG 552 EXAM 1 - PSYCHOPHARMACOLOGY
If you require further clarification
or in need of any study resources,
feel free to Message me.
3 EXAM PAGES 3 STUDY PAGES FULL PDF LINKED
,Table of Contents
NSG 552 Exam 1...............................................................2
NSG 552 Exam 1 Study Guide ................................. 55
NSG 552 Exam 1
Question 1 (SINGLE BEST ANSWER)
A 24-year-old male with schizophrenia is prescribed haloperidol 10 mg IM for
acute agitation. Which medication should be co-administered to reduce the
risk of severe extrapyramidal symptoms (EPS)?
• A. Propranolol
• B. Benztropine
• C. Amantadine
• D. Clonazepam
Correct Answer: B. Benztropine
Rationale: IM haloperidol should be administered with an anticholinergic agent such
as benztropine or diphenhydramine to reduce the risk of severe EPS, particularly acute
dystonia.
,Question 2 (SINGLE BEST ANSWER)
A patient presents with involuntary movements of the facial muscles, tongue
protrusion, and lip smacking after 5 years of antipsychotic therapy. Which
condition is most likely?
• A. Acute dystonia
• B. Akathisia
• C. Tardive dyskinesia
• D. Neuroleptic malignant syndrome
Correct Answer: C. Tardive dyskinesia
Rationale: Tardive dyskinesia (TD) is characterized by involuntary movements of the
facial muscles, tongue, and limbs. It is a neurotoxic side effect of long-term
antipsychotic use targeting dopamine receptors.
───────────────────────────────────────────────────────
─────────────────────────
Question 3 (SELECT ALL THAT APPLY)
A patient on clozapine presents with fever, sore throat, and malaise. The
PMHNP suspects agranulocytosis. Select all that apply regarding clozapine
monitoring:
• A. Monitor WBC and ANC weekly for the first 6 months
• B. Discontinue clozapine if ANC falls below 1,500/mm³
• C. Agranulocytosis occurs in approximately 1% of patients
• D. Sialorrhea occurs in 30-80% of patients and is managed with glycopyrrolate
• E. Clozapine is first-line for all patients with schizophrenia
Correct Answer: A, B, C, D
Rationale: Clozapine requires WBC/ANC monitoring due to agranulocytosis risk
(1%). It is discontinued if ANC <1,500. Sialorrhea is common (30-80%) and managed
with glycopyrrolate. Clozapine is reserved for treatment-resistant schizophrenia, not
first-line.
,───────────────────────────────────────────────────────
─────────────────────────
Question 4 (SINGLE BEST ANSWER)
A 35-year-old female on risperidone reports galactorrhea and amenorrhea.
Which pathway is primarily responsible for this adverse effect?
• A. Mesolimbic pathway
• B. Mesocortical pathway
• C. Nigrostriatal pathway
• D. Tuberoinfundibular pathway
Correct Answer: D. Tuberoinfundibular pathway
Rationale: D2 blockade in the tuberoinfundibular pathway results in
hyperprolactinemia, causing galactorrhea, amenorrhea, gynecomastia, and decreased
libido. Risperidone is particularly associated with this effect.
───────────────────────────────────────────────────────
─────────────────────────
Question 5 (SINGLE BEST ANSWER)
A patient with bipolar disorder has a lithium level of 2.1 mEq/L. Which clinical
manifestation is most concerning?
• A. Coarse tremor and ataxia
• B. Seizures and coma
• C. Nausea and diarrhea
• D. Polyuria and polydipsia
Correct Answer: B. Seizures and coma
Rationale: Lithium has a narrow therapeutic index (0.6-1.2 mEq/L). Levels >2.0
mEq/L are potentially lethal and manifest with seizures, coma, and death. Early signs
include nausea, vomiting, and coarse tremors.
,───────────────────────────────────────────────────────
─────────────────────────
Question 6 (SELECT ALL THAT APPLY)
A 42-year-old male on haloperidol develops fever (40°C), lead-pipe rigidity,
altered mental status, and diaphoresis. Select all that apply regarding this
emergency:
• A. This is Neuroleptic Malignant Syndrome (NMS)
• B. Immediate discontinuation of the antipsychotic is required
• C. Bromocriptine and dantrolene are treatment options
• D. Mortality rate is approximately 20% if untreated
• E. This condition is more common with atypical antipsychotics
Correct Answer: A, B, C, D
Rationale: NMS (FALTERED) is a life-threatening emergency more common with
FGAs. Management includes discontinuing the offending agent, supportive care, and
medications such as bromocriptine and dantrolene. Mortality is ~20% if untreated.
───────────────────────────────────────────────────────
─────────────────────────
Question 7 (SINGLE BEST ANSWER)
A patient with Parkinson's disease develops psychosis. Which antipsychotic is
FDA-approved for Parkinson's-related psychosis?
• A. Risperidone
• B. Quetiapine
• C. Pimavanserin (Nuplazid)
• D. Olanzapine
Correct Answer: C. Pimavanserin (Nuplazid)
,Rationale: Pharmacokinetics (ADME: absorption, distribution, metabolism, excretion)
describes what the body does to the drug. Pharmacodynamics describes what the drug
does to the body (receptor binding, agonism, antagonism). Half-life is a
pharmacokinetic property.
───────────────────────────────────────────────────────
─────────────────────────
NSG 552 Exam 1 Study Guide
1. Antipsychotics
Psychopharmacology: The use of psychotropic medications in the treatment of psychiatric
disorders.
Pharmacokinetics: What the body does to the drug (absorption, distribution, metabolism,
excretion).
Pharmacodynamics: What drugs do to the body.
,Schizophrenia Symptoms
Positive Symptoms: Hallucinations and delusions
Negative Symptoms: Disturbance of affect, blunting (severe reduction in intensity of affect
expression), flat affect, inappropriate affect (might laugh hysterically while describing
someone's death)
Typical / 1st Generation / Neuroleptics / Conventional
• Introduced in the 1950's
• Block D2 receptors
• Effective for positive symptoms
• Can worsen negative symptoms secondary to ↓ DA in the Mesocortical pathway
• Long-acting forms available (Decanoate)
Atypical / 2nd Generation Antipsychotics
• First line treatment
• Fewer neurological side effects
• Effective for both positive and negative symptoms
• Serotonin-Dopamine antagonist (D2/5HT2A)
• Can cause EPS but at a lower risk
• ↓ incidence of Tardive dyskinesia
• Metabolic side effects: Weight gain, HLD, hyperglycemia, Diabetes, HTN, Cardiac and
respiratory S/E
• Some Antihistaminic, antiadrenergic and antimuscarinic effects
• Elevated Liver function tests (LFTs) - check yearly
• QTC Prolongation
Typical Antipsychotic Side Effects
Blockade of histamine, acetylcholine, alpha 1 and other receptors:
1. High antiadrenergic, anticholinergic and antihistaminic S/E (e.g., sedation, weight gain)
2. Elevated liver enzymes, jaundice
3. Seizures - all antipsychotics lower the seizure threshold
4. Orthostatic hypotension
5. QTC prolongation - obtain baseline EKG
6. Sexual dysfunction
7. Rashes, photosensitivity
8. Elevated liver enzymes, EPS (Akathisia, dystonia, Parkinsonism)
9. Hyperprolactinemia (decreased libido, galactorrhea, gynecomastia, impotence,
amenorrhea)
10. Tardive dyskinesia
11. Neuroleptic Malignant Syndrome (FALTERED)
, 2. Extrapyramidal Symptoms (EPS)
Acute Dystonia
• Sudden onset
• Fixed/Sustained painful contraction of the neck muscles (torticollis), tongue, eyes
(oculogyric crisis)
• Can be life threatening if it affects airway
• Onset: hours to days
Oculogyric crisis: Fixation of the eyeballs in an upward position
Treatment: Cogentin, Artane, Benadryl, Benzos (Ativan). Lower dose if possible.
Akathisia
• Internal and external restlessness
• Subjective anxiety, restlessness, inability to remain still
• Constant need to pace or walk
• Onset: days to months
Treatment: Drug of choice = Beta blocker (Propranolol), Benzos (Klonopin, Ativan). Lower
dose if possible.
Pseudo-Parkinsonism
• Bradykinesia (shuffled gait), masklike face, cogwheel rigidity, pill-rolling tremor
• Onset: days to months
Treatment: Cogentin, Artane, Benadryl, Symmetrel (Amantadine). Lower dose if possible.
Tardive Dyskinesia (TD)
Definition: Involuntary movements of the facial muscles, tongue, and limbs; a possible
neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine
receptors.
Risk Factors: Older age, women, patients with affective disorders, patients with substance
abuse hx; FGA, duration of treatment, higher dose, African American
Management: Dose reduction; D/C med; switch to an atypical antipsychotic; Clonazepam,
Amantadine, Tetrabenazine.
FDA Approved Treatments (2017): Valbenazine (Ingrezza); Deutetrabenazine (Austedo).
Consider switching to Clozaril (Lowest risk of TD).
Patient Education: TD symptoms may initially worsen transiently as medication dosages
are lowered. Affects about 20-30% of patients on antipsychotics for months or years. Up to
50% of cases will remit (without further antipsychotic use). Mostly irreversible.
