NR546 PSYCHOPHARMACOLOGY
PMHNP EXAM PREP 2026/2027
QUESTIONS AND ANSWERS
1. A patient with schizophrenia exhibits severe apathy, social withdrawal, and lack of
motivation. Which dopamine pathway is primarily associated with these negative symptoms?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The mesocortical pathway, particularly the projection to the
prefrontal cortex, is associated with negative symptoms and cognitive impairment when
dopamine activity is deficient.
2. Which antipsychotic is most associated with a high risk of agranulocytosis, requiring
regular Absolute Neutrophil Count (ANC) monitoring?
A. Clozapine
,B. Risperidone
C. Olanzapine
D. Quetiapine
Answer: A
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis, a
potentially life-threatening drop in white blood cell counts, necessitating strict REMS
monitoring of the ANC.
3. The ‘cheese effect’ refers to a hypertensive crisis caused by the interaction of Tyramine and
which class of medications?
A. SSRIs
B. SNRIs
C. MAOIs
D. TCAs
Answer: C
Conceptual Explanation: Monoamine Oxidase Inhibitors (MAOIs) prevent the breakdown
of tyramine; high levels of tyramine can cause a massive release of norepinephrine, leading
to a hypertensive crisis.
, 4. A patient taking Lithium for Bipolar Disorder presents with coarse tremors, ataxia, and
confusion. What is the likely serum lithium level range indicating this toxicity?
A. > 1.5 mEq/L
B. 1.2 - 1.5 mEq/L
C. 0.6 - 1.2 mEq/L
D. < 0.5 mEq/L
Answer: A
Conceptual Explanation: While therapeutic levels are generally 0.6-1.2 mEq/L, levels
above 1.5 mEq/L are typically associated with moderate to severe toxicity symptoms like
ataxia and coarse tremors.
5. Which antidepressant is contraindicated in patients with a history of seizures or eating
disorders due to a lowered seizure threshold?
A. Bupropion
B. Sertraline
C. Fluoxetine
D. Mirtazapine
Answer: A
Conceptual Explanation: Bupropion is known to lower the seizure threshold, particularly
in patients with electrolyte imbalances associated with bulimia or anorexia nervosa.
PMHNP EXAM PREP 2026/2027
QUESTIONS AND ANSWERS
1. A patient with schizophrenia exhibits severe apathy, social withdrawal, and lack of
motivation. Which dopamine pathway is primarily associated with these negative symptoms?
A. Mesolimbic pathway
B. Nigrostriatal pathway
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Answer: C
Conceptual Explanation: The mesocortical pathway, particularly the projection to the
prefrontal cortex, is associated with negative symptoms and cognitive impairment when
dopamine activity is deficient.
2. Which antipsychotic is most associated with a high risk of agranulocytosis, requiring
regular Absolute Neutrophil Count (ANC) monitoring?
A. Clozapine
,B. Risperidone
C. Olanzapine
D. Quetiapine
Answer: A
Conceptual Explanation: Clozapine carries a black box warning for agranulocytosis, a
potentially life-threatening drop in white blood cell counts, necessitating strict REMS
monitoring of the ANC.
3. The ‘cheese effect’ refers to a hypertensive crisis caused by the interaction of Tyramine and
which class of medications?
A. SSRIs
B. SNRIs
C. MAOIs
D. TCAs
Answer: C
Conceptual Explanation: Monoamine Oxidase Inhibitors (MAOIs) prevent the breakdown
of tyramine; high levels of tyramine can cause a massive release of norepinephrine, leading
to a hypertensive crisis.
, 4. A patient taking Lithium for Bipolar Disorder presents with coarse tremors, ataxia, and
confusion. What is the likely serum lithium level range indicating this toxicity?
A. > 1.5 mEq/L
B. 1.2 - 1.5 mEq/L
C. 0.6 - 1.2 mEq/L
D. < 0.5 mEq/L
Answer: A
Conceptual Explanation: While therapeutic levels are generally 0.6-1.2 mEq/L, levels
above 1.5 mEq/L are typically associated with moderate to severe toxicity symptoms like
ataxia and coarse tremors.
5. Which antidepressant is contraindicated in patients with a history of seizures or eating
disorders due to a lowered seizure threshold?
A. Bupropion
B. Sertraline
C. Fluoxetine
D. Mirtazapine
Answer: A
Conceptual Explanation: Bupropion is known to lower the seizure threshold, particularly
in patients with electrolyte imbalances associated with bulimia or anorexia nervosa.
