CHAMBERLAIN UNIVERSITY – NR 546 ADVANCED
PHARMACOLOGY: PSYCHOPHARMACOLOGY FOR THE
PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER FINAL
EXAM – QUESTIONS AND ANSWERS | 2026/2027 LATEST
UPDATE
Week 5 — Mood Disorders
1. Which neurotransmitter hypothesis has historically been used to explain depressive
symptoms targeted by many antidepressant medications?
A) Reduced monoaminergic neurotransmission
B) Excessive acetylcholine transmission
C) Excessive glutamate blockade
D) Increased GABA transmission
Correct Answer: Reduced monoaminergic neurotransmission
Rationale: The monoamine hypothesis proposes that depression is associated with reduced
or dysregulated signaling involving serotonin, norepinephrine, and dopamine.
Antidepressants influence one or more of these systems, although contemporary models
recognize that depression involves more complex neural circuits and adaptations. The
hypothesis remains clinically useful for understanding antidepressant mechanisms and
therapeutic effects.
2. Before initiating an SSRI in a client with depressive symptoms, which assessment is
particularly important because it can substantially alter treatment planning?
A) Hair color
B) History of manic or hypomanic episodes
C) Dominant hand
D) Visual acuity
Correct Answer: History of manic or hypomanic episodes
Rationale: Screening for past mania or hypomania is essential before prescribing an
antidepressant because unrecognized bipolar disorder may be destabilized by antidepressant
monotherapy. The clinician should assess mood episodes, decreased need for sleep, elevated
or expansive mood, increased goal-directed activity, and impulsivity. This evaluation helps
distinguish unipolar depression from bipolar-spectrum illness.
, 3. Which SSRI is generally considered to have relatively few clinically important CYP450
drug interactions?
A) Fluoxetine
B) Paroxetine
C) Escitalopram
D) Fluvoxamine
Correct Answer: Escitalopram
Rationale: Escitalopram has comparatively limited CYP450 inhibition and is therefore
commonly selected when minimizing metabolic drug interactions is important. Fluoxetine
and paroxetine have more interaction potential, while fluvoxamine strongly affects several
CYP pathways. Interaction burden should still be evaluated against the client’s complete
medication list and medical conditions before prescribing.
4. A client abruptly stops paroxetine after several months of treatment and develops
dizziness, irritability, sensory disturbances, and flu-like symptoms. Which explanation
is most appropriate?
A) Serotonin syndrome
B) Hypertensive crisis
C) Anticholinergic toxicity
D) Antidepressant discontinuation syndrome
Correct Answer: Antidepressant discontinuation syndrome
Rationale: Paroxetine has a relatively short half-life and is particularly associated with
discontinuation symptoms when stopped abruptly. Symptoms may include dizziness,
irritability, anxiety, sensory disturbances, and flu-like complaints. Gradual tapering is
generally preferred when clinically appropriate. Discontinuation syndrome differs from
serotonin syndrome, which results from excessive serotonergic activity.
5. Which antidepressant is particularly useful when depression is accompanied by low
energy and concentration but should generally be avoided in a client with a seizure
disorder?
A) Bupropion
B) Sertraline
C) Escitalopram
D) Mirtazapine
,Correct Answer: Bupropion
Rationale: Bupropion inhibits norepinephrine and dopamine reuptake and can improve
energy, motivation, and alertness. However, it lowers the seizure threshold and is
contraindicated in certain seizure-related conditions and eating disorders. Unlike many
serotonergic antidepressants, bupropion generally has less sexual dysfunction and weight
gain, making its adverse-effect profile useful in selected clients.
6. Which clinical finding most strongly suggests serotonin syndrome in a client taking
multiple serotonergic medications?
A) Mild constipation and dry mouth
B) Bradycardia and hypothermia
C) Hyperreflexia, clonus, agitation, and hyperthermia
D) Isolated weight gain
Correct Answer: Hyperreflexia, clonus, agitation, and hyperthermia
Rationale: Serotonin syndrome results from excessive serotonergic activity and can progress
rapidly. Characteristic findings include agitation, autonomic instability, hyperthermia,
diaphoresis, tremor, hyperreflexia, and clonus. Severe cases may involve seizures or organ
dysfunction. Recognition is critical because treatment requires stopping serotonergic agents
and providing supportive care, with additional therapy for significant toxicity.
7. Which medication may be used as an adjunctive treatment for major depressive
disorder when inadequate response to an antidepressant persists?
A) Lithium
B) Flumazenil
C) Naloxone
D) Disulfiram
Correct Answer: Lithium
Rationale: Lithium can be used as an augmentation strategy in selected patients with
treatment-resistant depression and has additional importance in bipolar disorder. It requires
careful monitoring because its therapeutic range is narrow. Renal function, thyroid function,
hydration, interacting medications, and serum lithium concentrations must be considered to
reduce toxicity risk.
8. A client taking lithium develops vomiting, diarrhea, coarse tremor, confusion, and
marked unsteadiness. What is the priority concern?
A) Mild expected adverse effects
, B) Lithium toxicity
C) SSRI discontinuation
D) Dopamine withdrawal
Correct Answer: Lithium toxicity
Rationale: Gastrointestinal symptoms, coarse tremor, confusion, and neurologic impairment
can indicate lithium toxicity. Lithium is primarily eliminated by the kidneys, so dehydration,
impaired renal function, and interacting medications can increase serum concentrations. The
clinician should promptly assess the lithium level, renal function, hydration status, and
severity of symptoms rather than simply adjusting the dose.
9. Which change is most likely to increase lithium concentrations and toxicity risk?
A) Increased sodium intake
B) Stable hydration
C) Dehydration
D) Increased renal clearance
Correct Answer: Dehydration
Rationale: Lithium and sodium handling by the kidneys are closely related. Dehydration can
reduce renal perfusion and increase lithium reabsorption, raising serum concentrations.
Clients should maintain consistent fluid and sodium intake and seek guidance during
significant vomiting, diarrhea, fever, or other illnesses that may alter hydration and lithium
clearance.
10. Which medication is associated with a potentially serious Stevens-Johnson syndrome
risk requiring slow titration?
A) Lamotrigine
B) Buspirone
C) Methylphenidate
D) Donepezil
Correct Answer: Lamotrigine
Rationale: Lamotrigine is associated with serious cutaneous reactions, including Stevens-
Johnson syndrome and toxic epidermal necrolysis. The risk is reduced by starting at a low
dose and increasing gradually according to recommended schedules. Clients should be
instructed to report new rashes promptly, particularly during the initial weeks or after dose
changes.
PHARMACOLOGY: PSYCHOPHARMACOLOGY FOR THE
PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER FINAL
EXAM – QUESTIONS AND ANSWERS | 2026/2027 LATEST
UPDATE
Week 5 — Mood Disorders
1. Which neurotransmitter hypothesis has historically been used to explain depressive
symptoms targeted by many antidepressant medications?
A) Reduced monoaminergic neurotransmission
B) Excessive acetylcholine transmission
C) Excessive glutamate blockade
D) Increased GABA transmission
Correct Answer: Reduced monoaminergic neurotransmission
Rationale: The monoamine hypothesis proposes that depression is associated with reduced
or dysregulated signaling involving serotonin, norepinephrine, and dopamine.
Antidepressants influence one or more of these systems, although contemporary models
recognize that depression involves more complex neural circuits and adaptations. The
hypothesis remains clinically useful for understanding antidepressant mechanisms and
therapeutic effects.
2. Before initiating an SSRI in a client with depressive symptoms, which assessment is
particularly important because it can substantially alter treatment planning?
A) Hair color
B) History of manic or hypomanic episodes
C) Dominant hand
D) Visual acuity
Correct Answer: History of manic or hypomanic episodes
Rationale: Screening for past mania or hypomania is essential before prescribing an
antidepressant because unrecognized bipolar disorder may be destabilized by antidepressant
monotherapy. The clinician should assess mood episodes, decreased need for sleep, elevated
or expansive mood, increased goal-directed activity, and impulsivity. This evaluation helps
distinguish unipolar depression from bipolar-spectrum illness.
, 3. Which SSRI is generally considered to have relatively few clinically important CYP450
drug interactions?
A) Fluoxetine
B) Paroxetine
C) Escitalopram
D) Fluvoxamine
Correct Answer: Escitalopram
Rationale: Escitalopram has comparatively limited CYP450 inhibition and is therefore
commonly selected when minimizing metabolic drug interactions is important. Fluoxetine
and paroxetine have more interaction potential, while fluvoxamine strongly affects several
CYP pathways. Interaction burden should still be evaluated against the client’s complete
medication list and medical conditions before prescribing.
4. A client abruptly stops paroxetine after several months of treatment and develops
dizziness, irritability, sensory disturbances, and flu-like symptoms. Which explanation
is most appropriate?
A) Serotonin syndrome
B) Hypertensive crisis
C) Anticholinergic toxicity
D) Antidepressant discontinuation syndrome
Correct Answer: Antidepressant discontinuation syndrome
Rationale: Paroxetine has a relatively short half-life and is particularly associated with
discontinuation symptoms when stopped abruptly. Symptoms may include dizziness,
irritability, anxiety, sensory disturbances, and flu-like complaints. Gradual tapering is
generally preferred when clinically appropriate. Discontinuation syndrome differs from
serotonin syndrome, which results from excessive serotonergic activity.
5. Which antidepressant is particularly useful when depression is accompanied by low
energy and concentration but should generally be avoided in a client with a seizure
disorder?
A) Bupropion
B) Sertraline
C) Escitalopram
D) Mirtazapine
,Correct Answer: Bupropion
Rationale: Bupropion inhibits norepinephrine and dopamine reuptake and can improve
energy, motivation, and alertness. However, it lowers the seizure threshold and is
contraindicated in certain seizure-related conditions and eating disorders. Unlike many
serotonergic antidepressants, bupropion generally has less sexual dysfunction and weight
gain, making its adverse-effect profile useful in selected clients.
6. Which clinical finding most strongly suggests serotonin syndrome in a client taking
multiple serotonergic medications?
A) Mild constipation and dry mouth
B) Bradycardia and hypothermia
C) Hyperreflexia, clonus, agitation, and hyperthermia
D) Isolated weight gain
Correct Answer: Hyperreflexia, clonus, agitation, and hyperthermia
Rationale: Serotonin syndrome results from excessive serotonergic activity and can progress
rapidly. Characteristic findings include agitation, autonomic instability, hyperthermia,
diaphoresis, tremor, hyperreflexia, and clonus. Severe cases may involve seizures or organ
dysfunction. Recognition is critical because treatment requires stopping serotonergic agents
and providing supportive care, with additional therapy for significant toxicity.
7. Which medication may be used as an adjunctive treatment for major depressive
disorder when inadequate response to an antidepressant persists?
A) Lithium
B) Flumazenil
C) Naloxone
D) Disulfiram
Correct Answer: Lithium
Rationale: Lithium can be used as an augmentation strategy in selected patients with
treatment-resistant depression and has additional importance in bipolar disorder. It requires
careful monitoring because its therapeutic range is narrow. Renal function, thyroid function,
hydration, interacting medications, and serum lithium concentrations must be considered to
reduce toxicity risk.
8. A client taking lithium develops vomiting, diarrhea, coarse tremor, confusion, and
marked unsteadiness. What is the priority concern?
A) Mild expected adverse effects
, B) Lithium toxicity
C) SSRI discontinuation
D) Dopamine withdrawal
Correct Answer: Lithium toxicity
Rationale: Gastrointestinal symptoms, coarse tremor, confusion, and neurologic impairment
can indicate lithium toxicity. Lithium is primarily eliminated by the kidneys, so dehydration,
impaired renal function, and interacting medications can increase serum concentrations. The
clinician should promptly assess the lithium level, renal function, hydration status, and
severity of symptoms rather than simply adjusting the dose.
9. Which change is most likely to increase lithium concentrations and toxicity risk?
A) Increased sodium intake
B) Stable hydration
C) Dehydration
D) Increased renal clearance
Correct Answer: Dehydration
Rationale: Lithium and sodium handling by the kidneys are closely related. Dehydration can
reduce renal perfusion and increase lithium reabsorption, raising serum concentrations.
Clients should maintain consistent fluid and sodium intake and seek guidance during
significant vomiting, diarrhea, fever, or other illnesses that may alter hydration and lithium
clearance.
10. Which medication is associated with a potentially serious Stevens-Johnson syndrome
risk requiring slow titration?
A) Lamotrigine
B) Buspirone
C) Methylphenidate
D) Donepezil
Correct Answer: Lamotrigine
Rationale: Lamotrigine is associated with serious cutaneous reactions, including Stevens-
Johnson syndrome and toxic epidermal necrolysis. The risk is reduced by starting at a low
dose and increasing gradually according to recommended schedules. Clients should be
instructed to report new rashes promptly, particularly during the initial weeks or after dose
changes.
