NR546 PSYCHOPHARMACOLOGY FOR
THE PSYCHIATRIC-MENTAL HEALTH
NURSE PRACTITIONER EXAM
PRACTICE
1. A patient is prescribed Fluoxetine for depression. Which cytochrome P450 enzyme is most
significantly inhibited by this medication, potentially leading to drug-drug interactions?
A. CYP2D6
B. CYP1A2
C. CYP2C9
D. CYP3A4
Answer: A
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which can increase the serum levels of drugs metabolized by this pathway, such as many
TCAs and beta-blockers.
2. Which dopamine pathway is responsible for the development of extrapyramidal symptoms
(EPS) when D2 receptors are blocked by antipsychotic medications?
A. Mesolimbic pathway
,B. Mesocortical pathway
C. Tuberoinfundibular pathway
D. Nigrostriatal pathway
Answer: D
Conceptual Explanation: The nigrostriatal pathway controls motor function; D2
antagonism in this pathway leads to movement disorders like Parkinsonism, dystonia, and
akathisia.
3. A PMHNP is treating a patient with Clozapine. The patient’s Absolute Neutrophil Count
(ANC) is reported as 950/mm³. What is the required immediate action according to REMS
guidelines?
A. Continue current dose and retest in one week
B. Interrupt treatment and monitor ANC daily
C. Increase the dose to stimulate bone marrow production
D. Add Lithium to boost white blood cell count
Answer: B
Conceptual Explanation: An ANC below 1000/mm³ is classified as moderate to severe
neutropenia for most patients, requiring treatment interruption to prevent
agranulocytosis.
, 4. What is the primary mechanism of action of Atomoxetine in the treatment of ADHD?
A. Dopamine reuptake inhibition
B. NMDA receptor antagonism
C. Alpha-2 adrenergic agonist
D. Selective Norepinephrine reuptake inhibition
Answer: D
Conceptual Explanation: Atomoxetine is a non-stimulant that works specifically by
inhibiting the presynaptic norepinephrine transporter (NET).
5. Which medication is considered a first-line treatment for a patient with Bipolar I disorder
experiencing a severe manic episode with psychotic features?
A. Lithium plus an atypical antipsychotic
B. Lamotrigine
C. Sertraline
D. Buspirone
Answer: A
Conceptual Explanation: For severe mania, especially with psychosis, a combination of a
mood stabilizer (Lithium or Valproate) and an atypical antipsychotic is recommended for
faster symptom control.
THE PSYCHIATRIC-MENTAL HEALTH
NURSE PRACTITIONER EXAM
PRACTICE
1. A patient is prescribed Fluoxetine for depression. Which cytochrome P450 enzyme is most
significantly inhibited by this medication, potentially leading to drug-drug interactions?
A. CYP2D6
B. CYP1A2
C. CYP2C9
D. CYP3A4
Answer: A
Conceptual Explanation: Fluoxetine and Paroxetine are potent inhibitors of CYP2D6,
which can increase the serum levels of drugs metabolized by this pathway, such as many
TCAs and beta-blockers.
2. Which dopamine pathway is responsible for the development of extrapyramidal symptoms
(EPS) when D2 receptors are blocked by antipsychotic medications?
A. Mesolimbic pathway
,B. Mesocortical pathway
C. Tuberoinfundibular pathway
D. Nigrostriatal pathway
Answer: D
Conceptual Explanation: The nigrostriatal pathway controls motor function; D2
antagonism in this pathway leads to movement disorders like Parkinsonism, dystonia, and
akathisia.
3. A PMHNP is treating a patient with Clozapine. The patient’s Absolute Neutrophil Count
(ANC) is reported as 950/mm³. What is the required immediate action according to REMS
guidelines?
A. Continue current dose and retest in one week
B. Interrupt treatment and monitor ANC daily
C. Increase the dose to stimulate bone marrow production
D. Add Lithium to boost white blood cell count
Answer: B
Conceptual Explanation: An ANC below 1000/mm³ is classified as moderate to severe
neutropenia for most patients, requiring treatment interruption to prevent
agranulocytosis.
, 4. What is the primary mechanism of action of Atomoxetine in the treatment of ADHD?
A. Dopamine reuptake inhibition
B. NMDA receptor antagonism
C. Alpha-2 adrenergic agonist
D. Selective Norepinephrine reuptake inhibition
Answer: D
Conceptual Explanation: Atomoxetine is a non-stimulant that works specifically by
inhibiting the presynaptic norepinephrine transporter (NET).
5. Which medication is considered a first-line treatment for a patient with Bipolar I disorder
experiencing a severe manic episode with psychotic features?
A. Lithium plus an atypical antipsychotic
B. Lamotrigine
C. Sertraline
D. Buspirone
Answer: A
Conceptual Explanation: For severe mania, especially with psychosis, a combination of a
mood stabilizer (Lithium or Valproate) and an atypical antipsychotic is recommended for
faster symptom control.
