NURS 752 Advanced Psychopharmacology 1-4 &
Final Exam – 150 Practice Questions with
Verified Answers & Rationales
CORE DOMAINS
Neurobiology and Receptor Pharmacology
Antidepressants and Mood Stabilizers
Antipsychotics and Schizophrenia Treatment
Anxiety, PTSD, and OCD Pharmacotherapy
Bipolar Disorder and Treatment-Resistant Depression
Pharmacokinetics, Drug Interactions, and Special Populations
Adverse Effects and Risk Management
ADHD and Substance Use Disorders
Geriatric and Perinatal Psychopharmacology
INTRODUCTION
This comprehensive examination is designed to assess the advanced knowledge and clinical
judgment required for the NURS 752 Advanced Psychopharmacology course at Liberty
University. The exam covers essential content across all four modules and the final cumulative
exam, including receptor pharmacology, antidepressants, antipsychotics, mood stabilizers,
anxiolytics, and medications for PTSD, OCD, and ADHD. Questions are based on evidence-
based prescribing guidelines, FDA indications, and clinical best practices for Psychiatric-
Mental Health Nurse Practitioners (PMHNPs). This assessment prepares graduate nursing
students for success in advanced psychopharmacology and clinical practice.
SECTION ONE: NEUROBIOLOGY AND RECEPTOR PHARMACOLOGY (Questions
1-25)
QUESTION 1
A 28-year-old male with a new diagnosis of schizophrenia presents with auditory hallucinations,
delusions, and disorganized speech. Which receptor affinity profile would be most therapeutic
for his positive symptoms while minimizing extrapyramidal symptoms (EPS)?
A) High D2 affinity with low 5-HT2A affinity
B) High D2 affinity with high 5-HT2A affinity
,C) Low D2 affinity with low 5-HT2A affinity
D) Low D2 affinity with high 5-HT2A affinity
Correct answer: B
RATIONALE: Second-generation antipsychotics with high D2 and high 5-HT2A receptor
affinity provide effective positive symptom control through D2 blockade while the 5-HT2A
antagonism modulates dopamine release in the nigrostriatal pathway, reducing EPS risk. This
receptor profile distinguishes atypical from typical antipsychotics.
QUESTION 2
A 22-year-old patient with schizoaffective disorder is started on risperidone. Four days later, she
develops severe muscle rigidity, fever (103°F), autonomic instability, and elevated creatine
kinase (CK) to 5,000 U/L. Which condition is most likely and what is the appropriate treatment?
A) Serotonin syndrome; administer cyproheptadine
B) Neuroleptic malignant syndrome (NMS); discontinue risperidone and supportively manage
C) Extrapyramidal symptoms; administer benztropine
D) Tardive dyskinesia; administer tetrabenazine
Correct answer: B
RATIONALE: Neuroleptic malignant syndrome (NMS) is characterized by muscle rigidity,
hyperthermia, autonomic instability, and elevated CK. It is a life-threatening emergency
requiring immediate discontinuation of the antipsychotic and supportive care.
QUESTION 3
D2 receptor antagonism in which brain pathway is primarily responsible for the therapeutic
effects of antipsychotics on positive symptoms?
A) Mesocortical pathway
B) Mesolimbic pathway
C) Nigrostriatal pathway
D) Tuberoinfundibular pathway
Correct answer: B
RATIONALE: D2 receptor antagonism in the mesolimbic pathway is the primary
mechanism by which antipsychotics reduce positive symptoms such as hallucinations and
delusions. Blockade of D2 receptors in this pathway decreases the excessive dopaminergic
transmission thought to underlie psychosis.
,QUESTION 4
A 65-year-old female with bipolar disorder and renal impairment is being initiated on lithium.
What monitoring parameter is most critical before starting therapy and throughout treatment?
A) Serum lithium level only
B) Renal function, thyroid function, and serum lithium level
C) Complete blood count and liver function tests
D) Electrocardiogram and cardiac monitoring
Correct answer: B
RATIONALE: Lithium requires monitoring of renal function (BUN/creatinine), thyroid
function (TSH), and serum lithium levels before and during treatment. Renal impairment
increases the risk of lithium toxicity, making baseline and ongoing renal assessment critical.
QUESTION 5
Which neurotransmitter system is most directly implicated in the pathophysiology of
schizophrenia?
A) Serotonin
B) Dopamine
C) Norepinephrine
D) GABA
Correct answer: B
RATIONALE: The dopamine hypothesis of schizophrenia suggests that hyperactivity in the
mesolimbic dopamine pathway contributes to positive symptoms. This is supported by the fact
that all effective antipsychotics block D2 dopamine receptors.
QUESTION 6
A patient is started on a medication that acts as a partial agonist at D2 receptors. Which
medication has this mechanism?
A) Haloperidol
B) Aripiprazole
C) Risperidone
D) Clozapine
Correct answer: B
, RATIONALE: Aripiprazole is a partial agonist at D2 receptors, which contributes to its
lower risk of extrapyramidal symptoms. It stabilizes dopamine activity rather than simply
blocking it.
QUESTION 7
Which receptor is primarily responsible for the therapeutic effect of benzodiazepines?
A) Dopamine D2
B) GABA-A
C) Serotonin 5-HT1A
D) Norepinephrine alpha-2
Correct answer: B
RATIONALE: Benzodiazepines bind to the benzodiazepine site on the GABA-A receptor,
enhancing the inhibitory effects of GABA and producing anxiolytic, sedative, and muscle
relaxant effects.
QUESTION 8
The therapeutic action of SSRIs is primarily due to:
A) Blocking dopamine reuptake
B) Blocking serotonin reuptake
C) Blocking norepinephrine reuptake
D) Blocking GABA reuptake
Correct answer: B
RATIONALE: SSRIs selectively block the reuptake of serotonin at the presynaptic terminal,
increasing the availability of serotonin in the synaptic cleft. This enhances serotonergic
neurotransmission and is the primary mechanism for their antidepressant and anxiolytic effects.
QUESTION 9
A patient is prescribed a medication that has both serotonin and norepinephrine reuptake
inhibition. Which medication fits this description?
A) Fluoxetine
B) Duloxetine
C) Bupropion
D) Sertraline
Final Exam – 150 Practice Questions with
Verified Answers & Rationales
CORE DOMAINS
Neurobiology and Receptor Pharmacology
Antidepressants and Mood Stabilizers
Antipsychotics and Schizophrenia Treatment
Anxiety, PTSD, and OCD Pharmacotherapy
Bipolar Disorder and Treatment-Resistant Depression
Pharmacokinetics, Drug Interactions, and Special Populations
Adverse Effects and Risk Management
ADHD and Substance Use Disorders
Geriatric and Perinatal Psychopharmacology
INTRODUCTION
This comprehensive examination is designed to assess the advanced knowledge and clinical
judgment required for the NURS 752 Advanced Psychopharmacology course at Liberty
University. The exam covers essential content across all four modules and the final cumulative
exam, including receptor pharmacology, antidepressants, antipsychotics, mood stabilizers,
anxiolytics, and medications for PTSD, OCD, and ADHD. Questions are based on evidence-
based prescribing guidelines, FDA indications, and clinical best practices for Psychiatric-
Mental Health Nurse Practitioners (PMHNPs). This assessment prepares graduate nursing
students for success in advanced psychopharmacology and clinical practice.
SECTION ONE: NEUROBIOLOGY AND RECEPTOR PHARMACOLOGY (Questions
1-25)
QUESTION 1
A 28-year-old male with a new diagnosis of schizophrenia presents with auditory hallucinations,
delusions, and disorganized speech. Which receptor affinity profile would be most therapeutic
for his positive symptoms while minimizing extrapyramidal symptoms (EPS)?
A) High D2 affinity with low 5-HT2A affinity
B) High D2 affinity with high 5-HT2A affinity
,C) Low D2 affinity with low 5-HT2A affinity
D) Low D2 affinity with high 5-HT2A affinity
Correct answer: B
RATIONALE: Second-generation antipsychotics with high D2 and high 5-HT2A receptor
affinity provide effective positive symptom control through D2 blockade while the 5-HT2A
antagonism modulates dopamine release in the nigrostriatal pathway, reducing EPS risk. This
receptor profile distinguishes atypical from typical antipsychotics.
QUESTION 2
A 22-year-old patient with schizoaffective disorder is started on risperidone. Four days later, she
develops severe muscle rigidity, fever (103°F), autonomic instability, and elevated creatine
kinase (CK) to 5,000 U/L. Which condition is most likely and what is the appropriate treatment?
A) Serotonin syndrome; administer cyproheptadine
B) Neuroleptic malignant syndrome (NMS); discontinue risperidone and supportively manage
C) Extrapyramidal symptoms; administer benztropine
D) Tardive dyskinesia; administer tetrabenazine
Correct answer: B
RATIONALE: Neuroleptic malignant syndrome (NMS) is characterized by muscle rigidity,
hyperthermia, autonomic instability, and elevated CK. It is a life-threatening emergency
requiring immediate discontinuation of the antipsychotic and supportive care.
QUESTION 3
D2 receptor antagonism in which brain pathway is primarily responsible for the therapeutic
effects of antipsychotics on positive symptoms?
A) Mesocortical pathway
B) Mesolimbic pathway
C) Nigrostriatal pathway
D) Tuberoinfundibular pathway
Correct answer: B
RATIONALE: D2 receptor antagonism in the mesolimbic pathway is the primary
mechanism by which antipsychotics reduce positive symptoms such as hallucinations and
delusions. Blockade of D2 receptors in this pathway decreases the excessive dopaminergic
transmission thought to underlie psychosis.
,QUESTION 4
A 65-year-old female with bipolar disorder and renal impairment is being initiated on lithium.
What monitoring parameter is most critical before starting therapy and throughout treatment?
A) Serum lithium level only
B) Renal function, thyroid function, and serum lithium level
C) Complete blood count and liver function tests
D) Electrocardiogram and cardiac monitoring
Correct answer: B
RATIONALE: Lithium requires monitoring of renal function (BUN/creatinine), thyroid
function (TSH), and serum lithium levels before and during treatment. Renal impairment
increases the risk of lithium toxicity, making baseline and ongoing renal assessment critical.
QUESTION 5
Which neurotransmitter system is most directly implicated in the pathophysiology of
schizophrenia?
A) Serotonin
B) Dopamine
C) Norepinephrine
D) GABA
Correct answer: B
RATIONALE: The dopamine hypothesis of schizophrenia suggests that hyperactivity in the
mesolimbic dopamine pathway contributes to positive symptoms. This is supported by the fact
that all effective antipsychotics block D2 dopamine receptors.
QUESTION 6
A patient is started on a medication that acts as a partial agonist at D2 receptors. Which
medication has this mechanism?
A) Haloperidol
B) Aripiprazole
C) Risperidone
D) Clozapine
Correct answer: B
, RATIONALE: Aripiprazole is a partial agonist at D2 receptors, which contributes to its
lower risk of extrapyramidal symptoms. It stabilizes dopamine activity rather than simply
blocking it.
QUESTION 7
Which receptor is primarily responsible for the therapeutic effect of benzodiazepines?
A) Dopamine D2
B) GABA-A
C) Serotonin 5-HT1A
D) Norepinephrine alpha-2
Correct answer: B
RATIONALE: Benzodiazepines bind to the benzodiazepine site on the GABA-A receptor,
enhancing the inhibitory effects of GABA and producing anxiolytic, sedative, and muscle
relaxant effects.
QUESTION 8
The therapeutic action of SSRIs is primarily due to:
A) Blocking dopamine reuptake
B) Blocking serotonin reuptake
C) Blocking norepinephrine reuptake
D) Blocking GABA reuptake
Correct answer: B
RATIONALE: SSRIs selectively block the reuptake of serotonin at the presynaptic terminal,
increasing the availability of serotonin in the synaptic cleft. This enhances serotonergic
neurotransmission and is the primary mechanism for their antidepressant and anxiolytic effects.
QUESTION 9
A patient is prescribed a medication that has both serotonin and norepinephrine reuptake
inhibition. Which medication fits this description?
A) Fluoxetine
B) Duloxetine
C) Bupropion
D) Sertraline
