CHAMBERLAIN UNIVERSITY NR 546
FINAL EXAM – QUESTIONS AND WELL-
ELABORATED ANSWERS
Psychopharmacology for the Psychiatric-Mental
Health Nurse Practitioner
Latest Update: 2026/2027
, 1. A patient with schizophrenia has been on haloperidol for 6 months and now
presents with involuntary, repetitive movements of the tongue and lips. Which of the
following is the most appropriate next step?
A) Increase the dose of haloperidol
B) Switch to clozapine
C) Add benztropine
D) Continue current therapy and monitor
Rationale: The patient is displaying signs of Tardive Dyskinesia (TD), a late-onset
movement disorder caused by long-term use of typical antipsychotics (haloperidol). The first-line
management for TD is to discontinue the offending typical antipsychotic and switch to an
atypical antipsychotic with a lower risk of EPS/TD, such as clozapine. Benztropine is used for
acute dystonia, not TD.
2. What is the mechanism of action of buspirone?
A) GABA-A receptor positive modulation
B) Dopamine D2 receptor antagonism
C) Partial 5-HT1A receptor agonism
D) Serotonin and norepinephrine reuptake inhibition
, Rationale: Buspirone is a non-benzodiazepine anxiolytic that works as a partial agonist
at serotonin 5-HT1A receptors. It does not affect GABA receptors (like benzodiazepines) and
does not have significant dopamine or SNRI activity. Its delayed onset of action (1-2 weeks)
makes it unique.
3. Which medication is most appropriate for a patient experiencing a manic episode
associated with Bipolar I Disorder?
A) Sertraline
B) Bupropion
C) Lithium
D) Lamotrigine
Rationale: Lithium is a first-line mood stabilizer for the acute treatment of mania.
Sertraline and Bupropion are antidepressants that can precipitate mania in bipolar patients.
Lamotrigine is effective for bipolar depression maintenance but is not effective for acute mania.
4. Which of the following is a black box warning for all antidepressants in pediatric
and young adult populations?
A) Hyponatremia
B) Suicidal ideation
C) Weight gain
, D) Hepatotoxicity
Rationale: The FDA mandates a black box warning for all antidepressants regarding
an increased risk of suicidal thinking and behavior in children, adolescents, and young adults
(ages 18-24) during initial treatment.
5. A patient is prescribed phenelzine (MAOI). Which dietary restriction is most
critical for the PMHNP to emphasize?
A) Grapefruit juice
B) Caffeine
C) Tyramine-rich foods (aged cheese, cured meats)
D) High-sodium foods
Rationale: Phenelzine irreversibly inhibits MAO-A and MAO-B, preventing the
breakdown of tyramine. Dietary tyramine can cause a hypertensive crisis if consumed in large
amounts. Patients must avoid aged cheeses, cured/smoked meats, and fermented products.
6. What is the primary metabolite monitored for toxicity in patients taking lithium?
A) Lithium serum trough level
B) BUN and Creatinine
C) Serum sodium level
FINAL EXAM – QUESTIONS AND WELL-
ELABORATED ANSWERS
Psychopharmacology for the Psychiatric-Mental
Health Nurse Practitioner
Latest Update: 2026/2027
, 1. A patient with schizophrenia has been on haloperidol for 6 months and now
presents with involuntary, repetitive movements of the tongue and lips. Which of the
following is the most appropriate next step?
A) Increase the dose of haloperidol
B) Switch to clozapine
C) Add benztropine
D) Continue current therapy and monitor
Rationale: The patient is displaying signs of Tardive Dyskinesia (TD), a late-onset
movement disorder caused by long-term use of typical antipsychotics (haloperidol). The first-line
management for TD is to discontinue the offending typical antipsychotic and switch to an
atypical antipsychotic with a lower risk of EPS/TD, such as clozapine. Benztropine is used for
acute dystonia, not TD.
2. What is the mechanism of action of buspirone?
A) GABA-A receptor positive modulation
B) Dopamine D2 receptor antagonism
C) Partial 5-HT1A receptor agonism
D) Serotonin and norepinephrine reuptake inhibition
, Rationale: Buspirone is a non-benzodiazepine anxiolytic that works as a partial agonist
at serotonin 5-HT1A receptors. It does not affect GABA receptors (like benzodiazepines) and
does not have significant dopamine or SNRI activity. Its delayed onset of action (1-2 weeks)
makes it unique.
3. Which medication is most appropriate for a patient experiencing a manic episode
associated with Bipolar I Disorder?
A) Sertraline
B) Bupropion
C) Lithium
D) Lamotrigine
Rationale: Lithium is a first-line mood stabilizer for the acute treatment of mania.
Sertraline and Bupropion are antidepressants that can precipitate mania in bipolar patients.
Lamotrigine is effective for bipolar depression maintenance but is not effective for acute mania.
4. Which of the following is a black box warning for all antidepressants in pediatric
and young adult populations?
A) Hyponatremia
B) Suicidal ideation
C) Weight gain
, D) Hepatotoxicity
Rationale: The FDA mandates a black box warning for all antidepressants regarding
an increased risk of suicidal thinking and behavior in children, adolescents, and young adults
(ages 18-24) during initial treatment.
5. A patient is prescribed phenelzine (MAOI). Which dietary restriction is most
critical for the PMHNP to emphasize?
A) Grapefruit juice
B) Caffeine
C) Tyramine-rich foods (aged cheese, cured meats)
D) High-sodium foods
Rationale: Phenelzine irreversibly inhibits MAO-A and MAO-B, preventing the
breakdown of tyramine. Dietary tyramine can cause a hypertensive crisis if consumed in large
amounts. Patients must avoid aged cheeses, cured/smoked meats, and fermented products.
6. What is the primary metabolite monitored for toxicity in patients taking lithium?
A) Lithium serum trough level
B) BUN and Creatinine
C) Serum sodium level
