NR546 PSYCHOPHARMACOLOGY FOR
THE PSYCHIATRIC-MENTAL HEALTH
NURSE PRACTITIONER EXAM PREP
1. Which neurotransmitter is primarily implicated in the ‘reward’ pathway and is targeted by
both stimulants and most substances of abuse?
A. Dopamine
B. Serotonin
C. GABA
D. Norepinephrine
Answer: A
Conceptual Explanation: Dopamine, particularly in the mesolimbic pathway (nucleus
accumbens), is the primary neurotransmitter involved in reward, motivation, and the
reinforcing effects of drugs.
2. A patient is prescribed Clozapine. Which laboratory value must be monitored weekly for
the first six months to assess for life-threatening agranulocytosis?
A. Serum Glucose
,B. Liver Function Tests (LFTs)
C. Absolute Neutrophil Count (ANC)
D. Platelet Count
Answer: C
Conceptual Explanation: Clozapine carries a Black Box Warning for agranulocytosis; the
Absolute Neutrophil Count (ANC) must be monitored regularly via the REMS program.
3. What is the primary mechanism of action of Selective Serotonin Reuptake Inhibitors
(SSRIs)?
A. Antagonism of 5HT2A receptors
B. Increasing production of tryptophan hydroxylase
C. Inhibition of the Serotonin Transporter (SERT)
D. Direct stimulation of postsynaptic 5HT1A receptors
Answer: C
Conceptual Explanation: SSRIs work by blocking the Serotonin Transporter (SERT),
which prevents the reuptake of serotonin into the presynaptic neuron, thereby increasing
its availability in the synaptic cleft.
4. A patient smoking one pack of cigarettes per day is started on Olanzapine. How does
cigarette smoke affect the metabolism of this medication?
A. It inhibits CYP2D6, increasing olanzapine levels.
, B. It inhibits CYP3A4, leading to toxicity.
C. It induces CYP1A2, decreasing olanzapine levels.
D. It has no effect on antipsychotic metabolism.
Answer: C
Conceptual Explanation: Polycyclic aromatic hydrocarbons in cigarette smoke induce the
CYP1A2 enzyme. Because Olanzapine is a substrate of 1A2, smoking results in lower serum
levels of the drug.
5. Which of the following describes the mechanism of action of Buspirone?
A. GABA-A Receptor Positive Allosteric Modulator
B. 5HT1A Partial Agonist
C. Norepinephrine Reuptake Inhibitor
D. Alpha-2 Adrenergic Antagonist
Answer: B
Conceptual Explanation: Buspirone is a 5HT1A partial agonist used primarily for
Generalized Anxiety Disorder. It does not have the immediate sedative or addictive
properties of benzodiazepines.
6. Lithium is known to have a narrow therapeutic index. What is the generally accepted
therapeutic range for steady-state serum levels?
A. 0.6 - 1.2 mEq/L
THE PSYCHIATRIC-MENTAL HEALTH
NURSE PRACTITIONER EXAM PREP
1. Which neurotransmitter is primarily implicated in the ‘reward’ pathway and is targeted by
both stimulants and most substances of abuse?
A. Dopamine
B. Serotonin
C. GABA
D. Norepinephrine
Answer: A
Conceptual Explanation: Dopamine, particularly in the mesolimbic pathway (nucleus
accumbens), is the primary neurotransmitter involved in reward, motivation, and the
reinforcing effects of drugs.
2. A patient is prescribed Clozapine. Which laboratory value must be monitored weekly for
the first six months to assess for life-threatening agranulocytosis?
A. Serum Glucose
,B. Liver Function Tests (LFTs)
C. Absolute Neutrophil Count (ANC)
D. Platelet Count
Answer: C
Conceptual Explanation: Clozapine carries a Black Box Warning for agranulocytosis; the
Absolute Neutrophil Count (ANC) must be monitored regularly via the REMS program.
3. What is the primary mechanism of action of Selective Serotonin Reuptake Inhibitors
(SSRIs)?
A. Antagonism of 5HT2A receptors
B. Increasing production of tryptophan hydroxylase
C. Inhibition of the Serotonin Transporter (SERT)
D. Direct stimulation of postsynaptic 5HT1A receptors
Answer: C
Conceptual Explanation: SSRIs work by blocking the Serotonin Transporter (SERT),
which prevents the reuptake of serotonin into the presynaptic neuron, thereby increasing
its availability in the synaptic cleft.
4. A patient smoking one pack of cigarettes per day is started on Olanzapine. How does
cigarette smoke affect the metabolism of this medication?
A. It inhibits CYP2D6, increasing olanzapine levels.
, B. It inhibits CYP3A4, leading to toxicity.
C. It induces CYP1A2, decreasing olanzapine levels.
D. It has no effect on antipsychotic metabolism.
Answer: C
Conceptual Explanation: Polycyclic aromatic hydrocarbons in cigarette smoke induce the
CYP1A2 enzyme. Because Olanzapine is a substrate of 1A2, smoking results in lower serum
levels of the drug.
5. Which of the following describes the mechanism of action of Buspirone?
A. GABA-A Receptor Positive Allosteric Modulator
B. 5HT1A Partial Agonist
C. Norepinephrine Reuptake Inhibitor
D. Alpha-2 Adrenergic Antagonist
Answer: B
Conceptual Explanation: Buspirone is a 5HT1A partial agonist used primarily for
Generalized Anxiety Disorder. It does not have the immediate sedative or addictive
properties of benzodiazepines.
6. Lithium is known to have a narrow therapeutic index. What is the generally accepted
therapeutic range for steady-state serum levels?
A. 0.6 - 1.2 mEq/L
