NR 546
FINAL EXAMS
(2 FULL SET EXAMS)
Actual Questions & Answers with Rationales
WEEKS 5 – 8 COVERED
(Advanced Psychopharmacology for the PMHNP)
Chamberlain
What You Will Get:
➢200+ Questions with correct answers.
➢Detailed rationales included.
➢Final exam review questions.
➢Study points for quick revision.
, PREVIEW
P
Preview Pages Below
Get the Complete PDF After
Purchase
If you require further clarification or in need of any study
resources, feel free to Message me.
PREVIEW QUESTIONS FOLLOW
,Table of Contents
NR 546 FINAL EXAM SET 1 ................................................................ 2
NR 546 FINAL EXAM SET 2 .............................................................. 43
NR 546 FINAL EXAM REVIEW QS .................................................... 85
NR 546 FINAL EXAM STUDY POINTS ............................................... 95
NR 546 FINAL EXAM SET 1
1. When treating a patient for major depression disorder which medication would the PMHNP
consider first?
A. Depakote
B. Selegiline
C. Escitalopram
D. Isocarboxazid
Correct Answer: C. Escitalopram
Rationale: Escitalopram is a selective serotonin reuptake inhibitor (SSRI), which is considered
first-line pharmacotherapy for major depressive disorder (MDD) due to its favorable efficacy and
safety profile. Depakote is a mood stabilizer used primarily for bipolar disorder and seizure
disorders. Selegiline and isocarboxazid are monoamine oxidase inhibitors (MAOIs), which are
reserved for treatment-resistant depression due to dietary restrictions and side effect profiles.
2. Which of the following medication should be considered for a patient diagnosed with major
depressive disorder who reports "always forgetting to take my pills"?
A. Mirtazapine
B. Fluvoxamine
C. Fluoxetine
D. Carbamazepine
,Correct Answer: C. Fluoxetine
Rationale: Fluoxetine has a long half-life (24–72 hours) and an active metabolite (norfluoxetine)
with a half-life of 4–16 days, making it more forgiving if doses are missed occasionally. This
pharmacokinetic profile is advantageous for patients with adherence challenges. Mirtazapine
and fluvoxamine have shorter half-lives, and carbamazepine is not indicated for depression.
3. Which of the following medication has a black box warning of a life-threatening skin rash?
A. Lithium
B. Lamotrigine
C. Lurasidone
D. Lorazepam
Correct Answer: B. Lamotrigine
Rationale: Lamotrigine carries an FDA black box warning for serious rash, including Stevens-
Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which can be life-threatening. The
risk is highest during the initial titration period. Slow dose titration significantly reduces this risk.
4. Which medication is considered the best tolerated SSRI?
A. Venlafaxine
B. Bupropion
C. Sertraline
D. Escitalopram
Correct Answer: D. Escitalopram
Rationale: Escitalopram is often cited as the best-tolerated SSRI due to its high selectivity for
the serotonin transporter (SERT) with minimal effects on other receptors (e.g., muscarinic,
histaminic, or adrenergic). This selectivity results in fewer anticholinergic, sedating, and
cardiovascular side effects compared to other antidepressants.
5. During a 4-week follow up appointment, Rashida, who is prescribed Sertraline 25 mg qAM
reports slight improvement in depression symptoms and tolerating medication well. Which of
the following should the PMHNP do?
,A. Increase Sertraline dose
B. Switch to an SNRI
C. Switch to a different SSRI
D. Add Trazodone qHS for sleep
Correct Answer: A. Increase Sertraline dose
Rationale: Sertraline 25 mg is a subtherapeutic starting dose for most adults with MDD. The
usual therapeutic range is 50–200 mg daily. Since Rashida is tolerating the medication well with
slight improvement, the appropriate next step is to titrate upward to a therapeutic dose rather
than switching agents or adding adjunctive medications prematurely.
6. Which medication should be avoided for the 66-year patient diagnosed with major
depressive disorder and anxiety with a reported fall 3 months ago?
A. Citalopram
B. Sertraline
C. Paroxetine
D. Aripiprazole
Correct Answer: C. Paroxetine
Rationale: Paroxetine has significant anticholinergic properties compared to other SSRIs,
contributing to sedation, orthostatic hypotension, and cognitive impairment, which increase fall
risk in elderly patients. The Beers Criteria recommends avoiding highly anticholinergic
medications in older adults. Sertraline and citalopram are preferred in this population.
7. A patient reports upset stomach and diarrhea 3 days after taking new prescription of
sertraline. Which of the following is the most appropriate response from the PMHNP?
A. "Start doubling the dose of sertraline and your symptoms will begin to ease up"
B. "Most side effects subside after 4–5 days. Your body is getting adjusted to the increased
serotonin levels"
C. "Stop taking it immediately and go to the local emergency"
D. "You must take Sertraline with food, otherwise you will continue to experience GI distress"
Correct Answer: B. "Most side effects subside after 4–5 days. Your body is getting adjusted to
the increased serotonin levels"
, NR 546 FINAL EXAM SET 2
1. Which of the following is considered the pleasure center of the brain?
A. Cortico-striatal-thalamic-cortical loop
B. Mesolimbic dopamine pathway
C. Mesocortical dopamine pathway
D. None of the above
Correct Answer: B. Mesolimbic dopamine pathway
,Rationale: The mesolimbic dopamine pathway, projecting from the ventral tegmental area
(VTA) to the nucleus accumbens, is the brain’s primary reward and pleasure circuit. It is critically
involved in reinforcement, motivation, and addiction.
2. A 35-year-old cigarette smoker would like to quit but is nervous because she typically
craves a cigarette approximately every 2 hours. The craving and withdrawal are due to:
A. Desensitization of nicotinic receptors
B. Resensitization of nicotinic receptors
C. Desensitization of muscarinic receptors
D. Resensitization of muscarinic receptors
Correct Answer: B. Resensitization of nicotinic receptors
Rationale: Chronic nicotine exposure causes desensitization of nicotinic acetylcholine receptors
(nAChRs). Upon cessation, these receptors resensitize and upregulate, leading to withdrawal
symptoms and intense craving.
3. The reactive reward system signals the immediate prospect of pleasure or pain and triggers
drug-seeking behavior.
A. True
B. False
Correct Answer: A. True
Rationale: The reactive reward system (mesolimbic pathway) responds to immediate cues
predicting reward or punishment, driving motivated behaviors including drug-seeking.
4. What role does the amygdala play in substance abuse?
A. Releases phasic bursts of dopamine to the nucleus accumbens when drugs of abuse are
present
B. Communicates to the ventral tegmental area when cues related to drugs of abuse are present
C. Site of binding for most drugs of abuse
D. A and B
E. A, B, and C
, NR 546
FINAL EXAMS
(2 FULL SET EXAMS)
Actual Questions & Answers with Rationales
WEEKS 5 – 8 COVERED
(Advanced Psychopharmacology for the PMHNP)
Chamberlain
What You Will Get:
➢200+ Questions with correct answers.
➢Detailed rationales included.
➢Final exam review questions.
➢Study points for quick revision.
,Table of Contents
NR 546 FINAL EXAM SET 1 ................................................................ 2
NR 546 FINAL EXAM SET 2 .............................................................. 43
NR 546 FINAL EXAM REVIEW QS .................................................... 85
NR 546 FINAL EXAM STUDY POINTS ............................................... 95
NR 546 FINAL EXAM SET 1
1. When treating a patient for major depression disorder which medication would the PMHNP
consider first?
A. Depakote
B. Selegiline
C. Escitalopram
D. Isocarboxazid
Correct Answer: C. Escitalopram
Rationale: Escitalopram is a selective serotonin reuptake inhibitor (SSRI), which is considered
first-line pharmacotherapy for major depressive disorder (MDD) due to its favorable efficacy and
safety profile. Depakote is a mood stabilizer used primarily for bipolar disorder and seizure
disorders. Selegiline and isocarboxazid are monoamine oxidase inhibitors (MAOIs), which are
reserved for treatment-resistant depression due to dietary restrictions and side effect profiles.
2. Which of the following medication should be considered for a patient diagnosed with major
depressive disorder who reports "always forgetting to take my pills"?
A. Mirtazapine
B. Fluvoxamine
C. Fluoxetine
D. Carbamazepine
, Correct Answer: C. Fluoxetine
Rationale: Fluoxetine has a long half-life (24–72 hours) and an active metabolite (norfluoxetine)
with a half-life of 4–16 days, making it more forgiving if doses are missed occasionally. This
pharmacokinetic profile is advantageous for patients with adherence challenges. Mirtazapine
and fluvoxamine have shorter half-lives, and carbamazepine is not indicated for depression.
3. Which of the following medication has a black box warning of a life-threatening skin rash?
A. Lithium
B. Lamotrigine
C. Lurasidone
D. Lorazepam
Correct Answer: B. Lamotrigine
Rationale: Lamotrigine carries an FDA black box warning for serious rash, including Stevens-
Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which can be life-threatening. The
risk is highest during the initial titration period. Slow dose titration significantly reduces this risk.
4. Which medication is considered the best tolerated SSRI?
A. Venlafaxine
B. Bupropion
C. Sertraline
D. Escitalopram
Correct Answer: D. Escitalopram
Rationale: Escitalopram is often cited as the best-tolerated SSRI due to its high selectivity for
the serotonin transporter (SERT) with minimal effects on other receptors (e.g., muscarinic,
histaminic, or adrenergic). This selectivity results in fewer anticholinergic, sedating, and
cardiovascular side effects compared to other antidepressants.
5. During a 4-week follow up appointment, Rashida, who is prescribed Sertraline 25 mg qAM
reports slight improvement in depression symptoms and tolerating medication well. Which of
the following should the PMHNP do?
FINAL EXAMS
(2 FULL SET EXAMS)
Actual Questions & Answers with Rationales
WEEKS 5 – 8 COVERED
(Advanced Psychopharmacology for the PMHNP)
Chamberlain
What You Will Get:
➢200+ Questions with correct answers.
➢Detailed rationales included.
➢Final exam review questions.
➢Study points for quick revision.
, PREVIEW
P
Preview Pages Below
Get the Complete PDF After
Purchase
If you require further clarification or in need of any study
resources, feel free to Message me.
PREVIEW QUESTIONS FOLLOW
,Table of Contents
NR 546 FINAL EXAM SET 1 ................................................................ 2
NR 546 FINAL EXAM SET 2 .............................................................. 43
NR 546 FINAL EXAM REVIEW QS .................................................... 85
NR 546 FINAL EXAM STUDY POINTS ............................................... 95
NR 546 FINAL EXAM SET 1
1. When treating a patient for major depression disorder which medication would the PMHNP
consider first?
A. Depakote
B. Selegiline
C. Escitalopram
D. Isocarboxazid
Correct Answer: C. Escitalopram
Rationale: Escitalopram is a selective serotonin reuptake inhibitor (SSRI), which is considered
first-line pharmacotherapy for major depressive disorder (MDD) due to its favorable efficacy and
safety profile. Depakote is a mood stabilizer used primarily for bipolar disorder and seizure
disorders. Selegiline and isocarboxazid are monoamine oxidase inhibitors (MAOIs), which are
reserved for treatment-resistant depression due to dietary restrictions and side effect profiles.
2. Which of the following medication should be considered for a patient diagnosed with major
depressive disorder who reports "always forgetting to take my pills"?
A. Mirtazapine
B. Fluvoxamine
C. Fluoxetine
D. Carbamazepine
,Correct Answer: C. Fluoxetine
Rationale: Fluoxetine has a long half-life (24–72 hours) and an active metabolite (norfluoxetine)
with a half-life of 4–16 days, making it more forgiving if doses are missed occasionally. This
pharmacokinetic profile is advantageous for patients with adherence challenges. Mirtazapine
and fluvoxamine have shorter half-lives, and carbamazepine is not indicated for depression.
3. Which of the following medication has a black box warning of a life-threatening skin rash?
A. Lithium
B. Lamotrigine
C. Lurasidone
D. Lorazepam
Correct Answer: B. Lamotrigine
Rationale: Lamotrigine carries an FDA black box warning for serious rash, including Stevens-
Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which can be life-threatening. The
risk is highest during the initial titration period. Slow dose titration significantly reduces this risk.
4. Which medication is considered the best tolerated SSRI?
A. Venlafaxine
B. Bupropion
C. Sertraline
D. Escitalopram
Correct Answer: D. Escitalopram
Rationale: Escitalopram is often cited as the best-tolerated SSRI due to its high selectivity for
the serotonin transporter (SERT) with minimal effects on other receptors (e.g., muscarinic,
histaminic, or adrenergic). This selectivity results in fewer anticholinergic, sedating, and
cardiovascular side effects compared to other antidepressants.
5. During a 4-week follow up appointment, Rashida, who is prescribed Sertraline 25 mg qAM
reports slight improvement in depression symptoms and tolerating medication well. Which of
the following should the PMHNP do?
,A. Increase Sertraline dose
B. Switch to an SNRI
C. Switch to a different SSRI
D. Add Trazodone qHS for sleep
Correct Answer: A. Increase Sertraline dose
Rationale: Sertraline 25 mg is a subtherapeutic starting dose for most adults with MDD. The
usual therapeutic range is 50–200 mg daily. Since Rashida is tolerating the medication well with
slight improvement, the appropriate next step is to titrate upward to a therapeutic dose rather
than switching agents or adding adjunctive medications prematurely.
6. Which medication should be avoided for the 66-year patient diagnosed with major
depressive disorder and anxiety with a reported fall 3 months ago?
A. Citalopram
B. Sertraline
C. Paroxetine
D. Aripiprazole
Correct Answer: C. Paroxetine
Rationale: Paroxetine has significant anticholinergic properties compared to other SSRIs,
contributing to sedation, orthostatic hypotension, and cognitive impairment, which increase fall
risk in elderly patients. The Beers Criteria recommends avoiding highly anticholinergic
medications in older adults. Sertraline and citalopram are preferred in this population.
7. A patient reports upset stomach and diarrhea 3 days after taking new prescription of
sertraline. Which of the following is the most appropriate response from the PMHNP?
A. "Start doubling the dose of sertraline and your symptoms will begin to ease up"
B. "Most side effects subside after 4–5 days. Your body is getting adjusted to the increased
serotonin levels"
C. "Stop taking it immediately and go to the local emergency"
D. "You must take Sertraline with food, otherwise you will continue to experience GI distress"
Correct Answer: B. "Most side effects subside after 4–5 days. Your body is getting adjusted to
the increased serotonin levels"
, NR 546 FINAL EXAM SET 2
1. Which of the following is considered the pleasure center of the brain?
A. Cortico-striatal-thalamic-cortical loop
B. Mesolimbic dopamine pathway
C. Mesocortical dopamine pathway
D. None of the above
Correct Answer: B. Mesolimbic dopamine pathway
,Rationale: The mesolimbic dopamine pathway, projecting from the ventral tegmental area
(VTA) to the nucleus accumbens, is the brain’s primary reward and pleasure circuit. It is critically
involved in reinforcement, motivation, and addiction.
2. A 35-year-old cigarette smoker would like to quit but is nervous because she typically
craves a cigarette approximately every 2 hours. The craving and withdrawal are due to:
A. Desensitization of nicotinic receptors
B. Resensitization of nicotinic receptors
C. Desensitization of muscarinic receptors
D. Resensitization of muscarinic receptors
Correct Answer: B. Resensitization of nicotinic receptors
Rationale: Chronic nicotine exposure causes desensitization of nicotinic acetylcholine receptors
(nAChRs). Upon cessation, these receptors resensitize and upregulate, leading to withdrawal
symptoms and intense craving.
3. The reactive reward system signals the immediate prospect of pleasure or pain and triggers
drug-seeking behavior.
A. True
B. False
Correct Answer: A. True
Rationale: The reactive reward system (mesolimbic pathway) responds to immediate cues
predicting reward or punishment, driving motivated behaviors including drug-seeking.
4. What role does the amygdala play in substance abuse?
A. Releases phasic bursts of dopamine to the nucleus accumbens when drugs of abuse are
present
B. Communicates to the ventral tegmental area when cues related to drugs of abuse are present
C. Site of binding for most drugs of abuse
D. A and B
E. A, B, and C
, NR 546
FINAL EXAMS
(2 FULL SET EXAMS)
Actual Questions & Answers with Rationales
WEEKS 5 – 8 COVERED
(Advanced Psychopharmacology for the PMHNP)
Chamberlain
What You Will Get:
➢200+ Questions with correct answers.
➢Detailed rationales included.
➢Final exam review questions.
➢Study points for quick revision.
,Table of Contents
NR 546 FINAL EXAM SET 1 ................................................................ 2
NR 546 FINAL EXAM SET 2 .............................................................. 43
NR 546 FINAL EXAM REVIEW QS .................................................... 85
NR 546 FINAL EXAM STUDY POINTS ............................................... 95
NR 546 FINAL EXAM SET 1
1. When treating a patient for major depression disorder which medication would the PMHNP
consider first?
A. Depakote
B. Selegiline
C. Escitalopram
D. Isocarboxazid
Correct Answer: C. Escitalopram
Rationale: Escitalopram is a selective serotonin reuptake inhibitor (SSRI), which is considered
first-line pharmacotherapy for major depressive disorder (MDD) due to its favorable efficacy and
safety profile. Depakote is a mood stabilizer used primarily for bipolar disorder and seizure
disorders. Selegiline and isocarboxazid are monoamine oxidase inhibitors (MAOIs), which are
reserved for treatment-resistant depression due to dietary restrictions and side effect profiles.
2. Which of the following medication should be considered for a patient diagnosed with major
depressive disorder who reports "always forgetting to take my pills"?
A. Mirtazapine
B. Fluvoxamine
C. Fluoxetine
D. Carbamazepine
, Correct Answer: C. Fluoxetine
Rationale: Fluoxetine has a long half-life (24–72 hours) and an active metabolite (norfluoxetine)
with a half-life of 4–16 days, making it more forgiving if doses are missed occasionally. This
pharmacokinetic profile is advantageous for patients with adherence challenges. Mirtazapine
and fluvoxamine have shorter half-lives, and carbamazepine is not indicated for depression.
3. Which of the following medication has a black box warning of a life-threatening skin rash?
A. Lithium
B. Lamotrigine
C. Lurasidone
D. Lorazepam
Correct Answer: B. Lamotrigine
Rationale: Lamotrigine carries an FDA black box warning for serious rash, including Stevens-
Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which can be life-threatening. The
risk is highest during the initial titration period. Slow dose titration significantly reduces this risk.
4. Which medication is considered the best tolerated SSRI?
A. Venlafaxine
B. Bupropion
C. Sertraline
D. Escitalopram
Correct Answer: D. Escitalopram
Rationale: Escitalopram is often cited as the best-tolerated SSRI due to its high selectivity for
the serotonin transporter (SERT) with minimal effects on other receptors (e.g., muscarinic,
histaminic, or adrenergic). This selectivity results in fewer anticholinergic, sedating, and
cardiovascular side effects compared to other antidepressants.
5. During a 4-week follow up appointment, Rashida, who is prescribed Sertraline 25 mg qAM
reports slight improvement in depression symptoms and tolerating medication well. Which of
the following should the PMHNP do?
