NR 546 FINAL EXAM – ADVANCED
PSYCHOPHARMACOLOGY 100
COMPREHENSIVE QUESTIONS & ANSWERS
STUDY GUIDE (2026) CHAMBERLAIN
1. Which dopaminergic pathway is primarily implicated in the
positive symptoms of schizophrenia?
A) Mesolimbic pathway
B) Mesocortical pathway
C) Nigrostriatal pathway
D) Tuberoinfundibular pathway
Correct Answer: A) Mesolimbic pathway
Rationale: The mesolimbic pathway projects from the ventral tegmental
area to the nucleus acumens and is associated with reward, motivation,
and addiction. Overactivity of dopamine in this pathway contributes to
hallucinations and delusions. Antipsychotics block D2 receptors here to
reduce positive symptoms.
2. Which antipsychotic requires absolute neutrophil count monitoring
through a REMS program?
A) Quetiapine
B) Clozapine
C) Risperidone
D) Olanzapine
Correct Answer: B) Clozapine
,Rationale: Clozapine carries a black box warning for agranulocytosis, a
potentially fatal reduction in neutrophils. The REMS program mandates
regular absolute neutrophil count monitoring. If the count falls below a
threshold, clozapine must be stopped immediately to prevent life-
threatening infection.
3. A client taking lithium has a serum level of 1.8 mEq/L with confusion
and coarse tremor. How should this be interpreted?
A) The level is subtherapeutic
B) The level is within normal range
C) The level is toxic and requires immediate intervention
D) The level is expected in acute mania
Correct Answer: C) The level is toxic and requires immediate intervention
Rationale: Lithium therapeutic range is generally 0.6 to 1.2 mEq/L. Levels
above
1.5 mEq/L are toxic and can cause severe neurologic and renal
complications. Confusion, coarse tremor, and ataxia indicate toxicity. The
dose should be reduced or held immediately.
4. Which antidepressant is contraindicated in clients with seizure
disorders or eating disorders?
A) Sertraline
B) Escitalopram
C) Fluoxetine
D) Bupropion
Correct Answer: D) Bupropion
,Rationale: Bupropion lowers the seizure threshold and is
contraindicated in seizure disorders. It is also contraindicated in
anorexia and bulimia because electrolyte imbalances increase seizure
risk. Providers must screen for these conditions before prescribing
bupropion.
5. A client starting lamotrigine should receive what most critical education?
A) Risk of significant weight gain
B) Need for weekly blood draws
C) Possibility of developing a life-threatening rash
D) High risk of developing diabetes
Correct Answer: C) Possibility of developing a life-threatening rash
Rationale: Lamotrigine is associated with Stevens-Johnson syndrome, a
rare but potentially fatal skin reaction. Patients must stop the medication
and seek emergency care at the first sign of rash or mucosal lesions. Slow
titration reduces this risk.
6. Monoamine oxidase inhibitors affect which neurotransmitter group?
A) Serotonin, GABA, glutamate
B) Serotonin, dopamine, norepinephrine
C) Dopamine, GABA, acetylcholine
D) Acetylcholine, norepinephrine, glutamate
Correct Answer: B) Serotonin, dopamine, norepinephrine
, Rationale: Monoamine oxidase inhibitors block the enzyme that breaks
down monoamines. This increases serotonin, dopamine, and
norepinephrine levels. These neurotransmitters are involved in mood
regulation. Dietary and drug interactions are significant with MAOIs.
7. A 35-year-old smoker craves cigarettes about every 2 hours. What
causes this craving and withdrawal?
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 desensitizes nicotinic acetylcholine
receptors. Upon cessation, these receptors resensitize and become
responsive again. This resensitization contributes to withdrawal symptoms
and intense craving. Nicotine replacement can reduce symptoms.
8. Which brain region is considered the primary pleasure and reward center?
A) Nigrostriatal pathway
B) Mesolimbic dopamine pathway
C) Mesocortical pathway
D) Tuberoinfundibular pathway
PSYCHOPHARMACOLOGY 100
COMPREHENSIVE QUESTIONS & ANSWERS
STUDY GUIDE (2026) CHAMBERLAIN
1. Which dopaminergic pathway is primarily implicated in the
positive symptoms of schizophrenia?
A) Mesolimbic pathway
B) Mesocortical pathway
C) Nigrostriatal pathway
D) Tuberoinfundibular pathway
Correct Answer: A) Mesolimbic pathway
Rationale: The mesolimbic pathway projects from the ventral tegmental
area to the nucleus acumens and is associated with reward, motivation,
and addiction. Overactivity of dopamine in this pathway contributes to
hallucinations and delusions. Antipsychotics block D2 receptors here to
reduce positive symptoms.
2. Which antipsychotic requires absolute neutrophil count monitoring
through a REMS program?
A) Quetiapine
B) Clozapine
C) Risperidone
D) Olanzapine
Correct Answer: B) Clozapine
,Rationale: Clozapine carries a black box warning for agranulocytosis, a
potentially fatal reduction in neutrophils. The REMS program mandates
regular absolute neutrophil count monitoring. If the count falls below a
threshold, clozapine must be stopped immediately to prevent life-
threatening infection.
3. A client taking lithium has a serum level of 1.8 mEq/L with confusion
and coarse tremor. How should this be interpreted?
A) The level is subtherapeutic
B) The level is within normal range
C) The level is toxic and requires immediate intervention
D) The level is expected in acute mania
Correct Answer: C) The level is toxic and requires immediate intervention
Rationale: Lithium therapeutic range is generally 0.6 to 1.2 mEq/L. Levels
above
1.5 mEq/L are toxic and can cause severe neurologic and renal
complications. Confusion, coarse tremor, and ataxia indicate toxicity. The
dose should be reduced or held immediately.
4. Which antidepressant is contraindicated in clients with seizure
disorders or eating disorders?
A) Sertraline
B) Escitalopram
C) Fluoxetine
D) Bupropion
Correct Answer: D) Bupropion
,Rationale: Bupropion lowers the seizure threshold and is
contraindicated in seizure disorders. It is also contraindicated in
anorexia and bulimia because electrolyte imbalances increase seizure
risk. Providers must screen for these conditions before prescribing
bupropion.
5. A client starting lamotrigine should receive what most critical education?
A) Risk of significant weight gain
B) Need for weekly blood draws
C) Possibility of developing a life-threatening rash
D) High risk of developing diabetes
Correct Answer: C) Possibility of developing a life-threatening rash
Rationale: Lamotrigine is associated with Stevens-Johnson syndrome, a
rare but potentially fatal skin reaction. Patients must stop the medication
and seek emergency care at the first sign of rash or mucosal lesions. Slow
titration reduces this risk.
6. Monoamine oxidase inhibitors affect which neurotransmitter group?
A) Serotonin, GABA, glutamate
B) Serotonin, dopamine, norepinephrine
C) Dopamine, GABA, acetylcholine
D) Acetylcholine, norepinephrine, glutamate
Correct Answer: B) Serotonin, dopamine, norepinephrine
, Rationale: Monoamine oxidase inhibitors block the enzyme that breaks
down monoamines. This increases serotonin, dopamine, and
norepinephrine levels. These neurotransmitters are involved in mood
regulation. Dietary and drug interactions are significant with MAOIs.
7. A 35-year-old smoker craves cigarettes about every 2 hours. What
causes this craving and withdrawal?
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 desensitizes nicotinic acetylcholine
receptors. Upon cessation, these receptors resensitize and become
responsive again. This resensitization contributes to withdrawal symptoms
and intense craving. Nicotine replacement can reduce symptoms.
8. Which brain region is considered the primary pleasure and reward center?
A) Nigrostriatal pathway
B) Mesolimbic dopamine pathway
C) Mesocortical pathway
D) Tuberoinfundibular pathway
