NR546 /NR 546: Midterm Exam
-Psychopharmacology for the Psychiatric-Mental
Health Nurse Practitioner |
-Advanced Psychopharmacology
2026| 2027| 2028 Testing Cycle | Complete Guide
75 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Chamberlain
Q1: A 28-year-old research participant is given a compound that increases inositol trisphosphate
(IP3) and diacylglycerol (DAG) in neuronal membranes. Which G-protein subtype mediates this
second messenger cascade?
A. Gs
B. Gi
C. Gq
D. Go
Correct Answer: C
Rationale: Correct because Gq proteins activate phospholipase C, which hydrolyzes
phosphatidylinositol 4,5-bisphosphate into IP3 and DAG, leading to intracellular calcium release
and protein kinase C activation. This second messenger cascade is characteristic of metabotropic
receptors such as 5-HT2A and alpha-1 adrenergic receptors. Gs stimulates adenylyl cyclase to
increase cAMP, while Gi inhibits this enzyme.
,Q2: A 45-year-old patient on clozapine for treatment-resistant schizophrenia decides to quit
smoking. The nurse practitioner reduces the clozapine dose. Which metabolic explanation
supports this clinical decision?
A. Smoking induces CYP1A2, and cessation decreases metabolism, increasing clozapine levels
B. Smoking inhibits CYP3A4, increasing clozapine metabolism
C. Nicotine induces CYP2D6, decreasing clozapine levels
D. Smoking inhibits CYP1A2, decreasing clozapine levels
Correct Answer: A
Rationale: Correct because cigarette smoke contains polycyclic aromatic hydrocarbons that
induce CYP1A2, the primary enzyme metabolizing clozapine; smoking cessation removes this
induction, causing clozapine plasma concentrations to rise by up to 50%. Failure to reduce the
dose places the patient at risk for seizures, sedation, and orthostatic hypotension from clozapine
toxicity. CYP3A4 and CYP2D6 are not the primary pathways for clozapine metabolism.
Q3: A 79-year-old patient with insomnia is prescribed a benzodiazepine. The nurse recognizes
that which agent is potentially inappropriate per the Beers Criteria due to accumulation and fall
risk?
A. Lorazepam
B. Oxazepam
C. Temazepam
D. Chlordiazepoxide
Correct Answer: D
Rationale: Correct because chlordiazepoxide is a long-acting benzodiazepine with active
metabolites that accumulate in elderly patients due to reduced hepatic oxidation, causing
prolonged sedation, cognitive impairment, and increased fall and fracture risk. The Beers Criteria
explicitly recommend avoiding long-acting benzodiazepines in older adults, preferring short-
acting agents such as lorazepam, oxazepam, or temazepam. All benzodiazepines require caution,
but long-acting agents pose the greatest risk in geriatric populations.
,Q4: A 52-year-old patient on phenelzine for atypical depression attends a dinner party and
consumes aged salami, aged cheddar, and red wine. Within 30 minutes, she develops a severe
throbbing headache, neck stiffness, and blood pressure of 200/110. What is the priority nursing
action?
A. Administer sumatriptan for migraine relief
B. Start an SSRI immediately to offset the hypertensive effect
C. Give haloperidol for acute agitation
D. Administer IV phentolamine or nitroprusside and monitor closely
Correct Answer: D
Rationale: Correct because the patient has developed a tyramine-induced hypertensive crisis
requiring immediate blood pressure reduction with IV phentolamine or nitroprusside to prevent
intracranial hemorrhage and acute heart failure. Aged cheeses, cured meats, and red wine contain
high tyramine levels that bypass degraded MAO-A in the gut and liver, triggering massive
norepinephrine release. Sumatriptan is contraindicated in MAOI users, SSRIs would precipitate
serotonin syndrome, and haloperidol does not address the hypertensive emergency.
Q5: A patient with schizophrenia has prominent negative symptoms including flat affect,
avolition, and social withdrawal. According to the dopamine hypothesis, which pathway is most
likely underactive?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Correct Answer: B
Rationale: Correct because the mesocortical pathway projects dopamine from the ventral
tegmental area to the prefrontal cortex, and hypofunction in this circuit is implicated in negative
symptoms such as flat affect, alogia, and avolition. First-generation antipsychotics may worsen
negative symptoms by further blocking D2 receptors in this already underactive pathway. The
mesolimbic pathway is hyperactive in positive symptoms, the nigrostriatal pathway mediates
motor control, and the tuberoinfundibular pathway regulates prolactin secretion.
, Q6: A 58-year-old patient on chronic antipsychotic therapy has an AIMS examination. The
provider notes mild tongue movements. What is the recommended frequency of AIMS
monitoring for this patient?
A. Every 3 months
B. Every 6 to 12 months
C. Only at baseline
D. Only when symptoms become severe
Correct Answer: B
Rationale: Correct because patients on long-term antipsychotics require AIMS assessment every
6 to 12 months to detect early signs of tardive dyskinesia and facilitate timely intervention before
movements become irreversible. Baseline assessment is mandatory before starting
antipsychotics, but ongoing surveillance is essential throughout treatment. Monitoring only at
baseline or solely when symptoms are obvious misses the window for early dose reduction or
switching to lower-risk agents.
Q7: A patient on clozapine has an absolute neutrophil count of 1800. What is the appropriate
clinical action?
A. Continue clozapine and maintain regular monitoring
B. Stop clozapine immediately
C. Reduce the dose by 50%
D. Switch to olanzapine immediately
Correct Answer: A
Rationale: Correct because an ANC above 1500 is within the normal range and permits
continued clozapine therapy with standard REMS monitoring frequencies, which include weekly
testing for the first six months. Dose reduction or discontinuation is unnecessary at this
neutrophil count, as the threshold for intervention is ANC below 1000 for discontinuation or
1000 to 1500 for intensified monitoring. Switching to olanzapine would disrupt therapeutic
stability without hematologic indication.
-Psychopharmacology for the Psychiatric-Mental
Health Nurse Practitioner |
-Advanced Psychopharmacology
2026| 2027| 2028 Testing Cycle | Complete Guide
75 Questions With Answers & Expert Rationales
Guaranteed Pass | Graded A+ | Chamberlain
Q1: A 28-year-old research participant is given a compound that increases inositol trisphosphate
(IP3) and diacylglycerol (DAG) in neuronal membranes. Which G-protein subtype mediates this
second messenger cascade?
A. Gs
B. Gi
C. Gq
D. Go
Correct Answer: C
Rationale: Correct because Gq proteins activate phospholipase C, which hydrolyzes
phosphatidylinositol 4,5-bisphosphate into IP3 and DAG, leading to intracellular calcium release
and protein kinase C activation. This second messenger cascade is characteristic of metabotropic
receptors such as 5-HT2A and alpha-1 adrenergic receptors. Gs stimulates adenylyl cyclase to
increase cAMP, while Gi inhibits this enzyme.
,Q2: A 45-year-old patient on clozapine for treatment-resistant schizophrenia decides to quit
smoking. The nurse practitioner reduces the clozapine dose. Which metabolic explanation
supports this clinical decision?
A. Smoking induces CYP1A2, and cessation decreases metabolism, increasing clozapine levels
B. Smoking inhibits CYP3A4, increasing clozapine metabolism
C. Nicotine induces CYP2D6, decreasing clozapine levels
D. Smoking inhibits CYP1A2, decreasing clozapine levels
Correct Answer: A
Rationale: Correct because cigarette smoke contains polycyclic aromatic hydrocarbons that
induce CYP1A2, the primary enzyme metabolizing clozapine; smoking cessation removes this
induction, causing clozapine plasma concentrations to rise by up to 50%. Failure to reduce the
dose places the patient at risk for seizures, sedation, and orthostatic hypotension from clozapine
toxicity. CYP3A4 and CYP2D6 are not the primary pathways for clozapine metabolism.
Q3: A 79-year-old patient with insomnia is prescribed a benzodiazepine. The nurse recognizes
that which agent is potentially inappropriate per the Beers Criteria due to accumulation and fall
risk?
A. Lorazepam
B. Oxazepam
C. Temazepam
D. Chlordiazepoxide
Correct Answer: D
Rationale: Correct because chlordiazepoxide is a long-acting benzodiazepine with active
metabolites that accumulate in elderly patients due to reduced hepatic oxidation, causing
prolonged sedation, cognitive impairment, and increased fall and fracture risk. The Beers Criteria
explicitly recommend avoiding long-acting benzodiazepines in older adults, preferring short-
acting agents such as lorazepam, oxazepam, or temazepam. All benzodiazepines require caution,
but long-acting agents pose the greatest risk in geriatric populations.
,Q4: A 52-year-old patient on phenelzine for atypical depression attends a dinner party and
consumes aged salami, aged cheddar, and red wine. Within 30 minutes, she develops a severe
throbbing headache, neck stiffness, and blood pressure of 200/110. What is the priority nursing
action?
A. Administer sumatriptan for migraine relief
B. Start an SSRI immediately to offset the hypertensive effect
C. Give haloperidol for acute agitation
D. Administer IV phentolamine or nitroprusside and monitor closely
Correct Answer: D
Rationale: Correct because the patient has developed a tyramine-induced hypertensive crisis
requiring immediate blood pressure reduction with IV phentolamine or nitroprusside to prevent
intracranial hemorrhage and acute heart failure. Aged cheeses, cured meats, and red wine contain
high tyramine levels that bypass degraded MAO-A in the gut and liver, triggering massive
norepinephrine release. Sumatriptan is contraindicated in MAOI users, SSRIs would precipitate
serotonin syndrome, and haloperidol does not address the hypertensive emergency.
Q5: A patient with schizophrenia has prominent negative symptoms including flat affect,
avolition, and social withdrawal. According to the dopamine hypothesis, which pathway is most
likely underactive?
A. Mesolimbic pathway
B. Mesocortical pathway
C. Nigrostriatal pathway
D. Tuberoinfundibular pathway
Correct Answer: B
Rationale: Correct because the mesocortical pathway projects dopamine from the ventral
tegmental area to the prefrontal cortex, and hypofunction in this circuit is implicated in negative
symptoms such as flat affect, alogia, and avolition. First-generation antipsychotics may worsen
negative symptoms by further blocking D2 receptors in this already underactive pathway. The
mesolimbic pathway is hyperactive in positive symptoms, the nigrostriatal pathway mediates
motor control, and the tuberoinfundibular pathway regulates prolactin secretion.
, Q6: A 58-year-old patient on chronic antipsychotic therapy has an AIMS examination. The
provider notes mild tongue movements. What is the recommended frequency of AIMS
monitoring for this patient?
A. Every 3 months
B. Every 6 to 12 months
C. Only at baseline
D. Only when symptoms become severe
Correct Answer: B
Rationale: Correct because patients on long-term antipsychotics require AIMS assessment every
6 to 12 months to detect early signs of tardive dyskinesia and facilitate timely intervention before
movements become irreversible. Baseline assessment is mandatory before starting
antipsychotics, but ongoing surveillance is essential throughout treatment. Monitoring only at
baseline or solely when symptoms are obvious misses the window for early dose reduction or
switching to lower-risk agents.
Q7: A patient on clozapine has an absolute neutrophil count of 1800. What is the appropriate
clinical action?
A. Continue clozapine and maintain regular monitoring
B. Stop clozapine immediately
C. Reduce the dose by 50%
D. Switch to olanzapine immediately
Correct Answer: A
Rationale: Correct because an ANC above 1500 is within the normal range and permits
continued clozapine therapy with standard REMS monitoring frequencies, which include weekly
testing for the first six months. Dose reduction or discontinuation is unnecessary at this
neutrophil count, as the threshold for intervention is ANC below 1000 for discontinuation or
1000 to 1500 for intensified monitoring. Switching to olanzapine would disrupt therapeutic
stability without hematologic indication.
