NR546 PSYCHOPHARMACOLOGY FOR
THE PMHNP EXAM QUESTIONS AND
ANSWERS
1. Which neurotransmitter is primarily implicated in the reward system and the
pathophysiology of addiction?
A. Serotonin
B. GABA
C. Dopamine
D. Acetylcholine
Answer: C
Conceptual Explanation: Dopamine, particularly in the mesolimbic pathway, is the
primary neurotransmitter involved in the brain’s reward system and the development of
substance use disorders.
2. Which antidepressant is most likely to cause dose-dependent hypertension?
A. Venlafaxine
B. Sertraline
,C. Fluoxetine
D. Mirtazapine
Answer: A
Conceptual Explanation: Venlafaxine, an SNRI, can cause increased blood pressure due to
its norepinephrine reuptake inhibition, especially at higher doses (typically above 150mg).
3. A patient taking Clozapine presents with an Absolute Neutrophil Count (ANC) of 900/mm³.
What is the appropriate clinical action?
A. Interrupt treatment and consult hematology
B. Increase the dose to compensate for metabolism
C. Continue current dose and monitor weekly
D. Switch to Risperidone immediately without titration
Answer: A
Conceptual Explanation: According to the Clozapine REMS program, an ANC below
1000/mm³ (Severe Neutropenia) requires treatment interruption and daily monitoring
until the ANC recovers.
4. What is the primary mechanism of action of Second-Generation Antipsychotics (SGAs) that
distinguishes them from First-Generation Antipsychotics (FGAs)?
A. Pure D2 receptor antagonism
B. Selective Serotonin Reuptake Inhibition
, C. GABA-A receptor modulation
D. D2 receptor antagonism and 5HT2A receptor antagonism
Answer: D
Conceptual Explanation: SGAs are characterized by their dual action of blocking both
Dopamine D2 receptors and Serotonin 5HT2A receptors, which generally leads to lower
risk of EPS compared to FGAs.
5. Which mood stabilizer is associated with a risk of Stevens-Johnson Syndrome, particularly
in patients of Asian descent with the HLA-B*1502 allele?
A. Lithium
B. Valproic Acid
C. Carbamazepine
D. Gabapentin
Answer: C
Conceptual Explanation: Carbamazepine has a black box warning regarding serious
dermatologic reactions; the HLA-B*1502 allele significantly increases this risk.
6. When switching a patient from a Monoamine Oxidase Inhibitor (MAOI) to an SSRI, how
long is the recommended washout period?
A. 24 hours
B. 5 days
THE PMHNP EXAM QUESTIONS AND
ANSWERS
1. Which neurotransmitter is primarily implicated in the reward system and the
pathophysiology of addiction?
A. Serotonin
B. GABA
C. Dopamine
D. Acetylcholine
Answer: C
Conceptual Explanation: Dopamine, particularly in the mesolimbic pathway, is the
primary neurotransmitter involved in the brain’s reward system and the development of
substance use disorders.
2. Which antidepressant is most likely to cause dose-dependent hypertension?
A. Venlafaxine
B. Sertraline
,C. Fluoxetine
D. Mirtazapine
Answer: A
Conceptual Explanation: Venlafaxine, an SNRI, can cause increased blood pressure due to
its norepinephrine reuptake inhibition, especially at higher doses (typically above 150mg).
3. A patient taking Clozapine presents with an Absolute Neutrophil Count (ANC) of 900/mm³.
What is the appropriate clinical action?
A. Interrupt treatment and consult hematology
B. Increase the dose to compensate for metabolism
C. Continue current dose and monitor weekly
D. Switch to Risperidone immediately without titration
Answer: A
Conceptual Explanation: According to the Clozapine REMS program, an ANC below
1000/mm³ (Severe Neutropenia) requires treatment interruption and daily monitoring
until the ANC recovers.
4. What is the primary mechanism of action of Second-Generation Antipsychotics (SGAs) that
distinguishes them from First-Generation Antipsychotics (FGAs)?
A. Pure D2 receptor antagonism
B. Selective Serotonin Reuptake Inhibition
, C. GABA-A receptor modulation
D. D2 receptor antagonism and 5HT2A receptor antagonism
Answer: D
Conceptual Explanation: SGAs are characterized by their dual action of blocking both
Dopamine D2 receptors and Serotonin 5HT2A receptors, which generally leads to lower
risk of EPS compared to FGAs.
5. Which mood stabilizer is associated with a risk of Stevens-Johnson Syndrome, particularly
in patients of Asian descent with the HLA-B*1502 allele?
A. Lithium
B. Valproic Acid
C. Carbamazepine
D. Gabapentin
Answer: C
Conceptual Explanation: Carbamazepine has a black box warning regarding serious
dermatologic reactions; the HLA-B*1502 allele significantly increases this risk.
6. When switching a patient from a Monoamine Oxidase Inhibitor (MAOI) to an SSRI, how
long is the recommended washout period?
A. 24 hours
B. 5 days
