NR546 PSYCHOPHARMACOLOGY FOR
PMHNP COMPREHENSIVE FINAL
QUESTIONS AND ANSWERS
1. A patient on Clozapine (Clozaril) presents with a fever, sore throat, and lethargy. Which of
the following laboratory values is the priority concern for the PMHNP?
A. Total white blood cell count of 4,000/mm³
B. Serum glucose of 140 mg/dL
C. Potassium level of 3.6 mEq/L
D. Absolute Neutrophil Count (ANC) of 900/mm³
Answer: D
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis. An
ANC below 1,000/mm³ requires immediate discontinuation and monitoring per REMS
protocols to prevent life-threatening infection.
2. Which antidepressant is most likely to cause a hypertensive crisis if the patient consumes
foods high in tyramine?
A. Tranylcypromine (Parnate)
,B. Duloxetine (Cymbalta)
C. Sertraline (Zoloft)
D. Bupropion (Wellbutrin)
Answer: A
Conceptual Explanation: Tranylcypromine is a Monoamine Oxidase Inhibitor (MAOI).
MAOIs inhibit the breakdown of tyramine; excess tyramine can cause a massive release of
norepinephrine, leading to a hypertensive crisis.
3. A 24-year-old female patient with bipolar disorder wishes to start a family. Which mood
stabilizer should be avoided due to the highest risk of neural tube defects?
A. Lithium
B. Quetiapine (Seroquel)
C. Lamotrigine (Lamictal)
D. Valproate (Depakote)
Answer: D
Conceptual Explanation: Valproate is highly teratogenic, associated with a 1-5% risk of
neural tube defects (e.g., spina bifida). Lithium carries a risk for Ebstein’s anomaly, but
Valproate’s risks are often considered more severe in early pregnancy.
, 4. What is the primary mechanism of action for second-generation antipsychotics (SGAs) that
reduces the risk of extrapyramidal symptoms (EPS) compared to first-generation
antipsychotics?
A. Selective D2 receptor antagonism
B. 5-HT2A receptor antagonism coupled with D2 antagonism
C. Alpha-1 adrenergic blockade
D. GABA-A receptor modulation
Answer: B
Conceptual Explanation: SGAs block 5-HT2A receptors, which promotes dopamine
release in the nigrostriatal pathway, thereby offsetting the D2 blockade and reducing the
incidence of EPS.
5. A patient with ADHD and a history of substance use disorder requires treatment. Which
medication is the most appropriate non-stimulant choice?
A. Lisdexamfetamine (Vyvanse)
B. Methylphenidate (Ritalin)
C. Atomoxetine (Strattera)
D. Modafinil (Provigil)
Answer: C
PMHNP COMPREHENSIVE FINAL
QUESTIONS AND ANSWERS
1. A patient on Clozapine (Clozaril) presents with a fever, sore throat, and lethargy. Which of
the following laboratory values is the priority concern for the PMHNP?
A. Total white blood cell count of 4,000/mm³
B. Serum glucose of 140 mg/dL
C. Potassium level of 3.6 mEq/L
D. Absolute Neutrophil Count (ANC) of 900/mm³
Answer: D
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis. An
ANC below 1,000/mm³ requires immediate discontinuation and monitoring per REMS
protocols to prevent life-threatening infection.
2. Which antidepressant is most likely to cause a hypertensive crisis if the patient consumes
foods high in tyramine?
A. Tranylcypromine (Parnate)
,B. Duloxetine (Cymbalta)
C. Sertraline (Zoloft)
D. Bupropion (Wellbutrin)
Answer: A
Conceptual Explanation: Tranylcypromine is a Monoamine Oxidase Inhibitor (MAOI).
MAOIs inhibit the breakdown of tyramine; excess tyramine can cause a massive release of
norepinephrine, leading to a hypertensive crisis.
3. A 24-year-old female patient with bipolar disorder wishes to start a family. Which mood
stabilizer should be avoided due to the highest risk of neural tube defects?
A. Lithium
B. Quetiapine (Seroquel)
C. Lamotrigine (Lamictal)
D. Valproate (Depakote)
Answer: D
Conceptual Explanation: Valproate is highly teratogenic, associated with a 1-5% risk of
neural tube defects (e.g., spina bifida). Lithium carries a risk for Ebstein’s anomaly, but
Valproate’s risks are often considered more severe in early pregnancy.
, 4. What is the primary mechanism of action for second-generation antipsychotics (SGAs) that
reduces the risk of extrapyramidal symptoms (EPS) compared to first-generation
antipsychotics?
A. Selective D2 receptor antagonism
B. 5-HT2A receptor antagonism coupled with D2 antagonism
C. Alpha-1 adrenergic blockade
D. GABA-A receptor modulation
Answer: B
Conceptual Explanation: SGAs block 5-HT2A receptors, which promotes dopamine
release in the nigrostriatal pathway, thereby offsetting the D2 blockade and reducing the
incidence of EPS.
5. A patient with ADHD and a history of substance use disorder requires treatment. Which
medication is the most appropriate non-stimulant choice?
A. Lisdexamfetamine (Vyvanse)
B. Methylphenidate (Ritalin)
C. Atomoxetine (Strattera)
D. Modafinil (Provigil)
Answer: C
