E X A M I N AT I O N P R E P A R AT I O N | 2 0 2 0 2 7 E D I T I O N
NSG 552
Psychopharmacology
Exam 1, 2 & 3
225 actual-style questions with verified correct answers and
detailed advanced-practice rationales, aligned with the Wilkes
University NSG 552 psychopharmacology curriculum and
2026/2027 course standards for Advanced Practice Psychiatric
Nursing.
■ Exam 1: Foundations of Psychopharmacology (Q1–75)
■ Exam 2: Major Psychiatric Disorder Pharmacology (Q76–150)
■ Exam 3: Complex Psychopharmacology & Special Populations (Q151–225)
Wilkes University · Advanced Practice Psychiatric Nursing
Actual Questions and Verified Correct Answers · PMHNP Prescribing Practice
NSG 552 PSYCHOPHARMACOLOGY 2026/2027
,NSG 552 Psychopharmacology | Exam 1, 2 & 3 | Wilkes University | 2026/2027
EXAM 1: FOUNDATIONS OF PSYCHOPHARMACOLOGY
75 Questions | Sections 1-5 | Q1-Q75 | Wilkes University NSG 552 | 2026/2027 Edition
Section 1: Neuroanatomy and Neurotransmission
Brain Structures, Neurons, Synapses, and Neurotransmitters | Questions 1-15
Q1: A 32-year-old combat veteran with posttraumatic stress disorder reports intrusive memories, nightmares,
and exaggerated startle to loud noises. Neuroimaging studies in PTSD consistently show reduced volume and
impaired function of the hippocampus. Which of the following best explains how hippocampal dysfunction
contributes to this presentation?
A. Excess dopamine release in the nucleus accumbens whenever trauma reminders occur
B. Loss of serotonergic tone from the raphe nuclei producing irritability and anger
C. Weakened contextual encoding of safe settings, so fear generalizes to nonthreatening cues
[CORRECT]
D. Dopamine depletion in the nigrostriatal pathway producing motor slowing and rigidity
Correct Answer: C
Rationale: The amygdala attaches emotional salience during fear conditioning while the hippocampus
encodes contextual memory; hippocampal volume loss in PTSD impairs discrimination of safe contexts from
trauma cues, so fear responses generalize. Dopamine release in the nucleus accumbens mediates reward, not
contextual fear discrimination. Raphe serotonergic loss is not the primary neuroimaging finding in PTSD, and
nigrostriatal changes produce motor symptoms rather than intrusions.
Q2: A 26-year-old man with schizophrenia is adherent to risperidone 4 mg daily, and his hallucinations and
delusions have resolved. He continues to perform poorly on tests of working memory and cannot organize
multi-step tasks at his part-time job. These persistent cognitive deficits are most closely associated with
dysfunction in which brain region?
A. Dorsolateral prefrontal cortex [CORRECT]
B. Nucleus accumbens
C. Locus coeruleus
D. Cerebellar vermis
Correct Answer: A
Rationale: The dorsolateral prefrontal cortex subserves executive function and working memory, and
hypofrontality in schizophrenia helps explain cognitive and negative symptoms that respond poorly to D2
blockade. The nucleus accumbens mediates reward and reinforcement. The locus coeruleus supplies
norepinephrine for arousal and vigilance, and the cerebellum coordinates motor execution rather than
executive cognition.
1
,NSG 552 Psychopharmacology | Exam 1, 2 & 3 | Wilkes University | 2026/2027
Q3: Following a traumatic brain injury involving the orbitofrontal cortex, a 45-year-old woman becomes
socially inappropriate, impulsive, and emotionally labile even though her memory, language, and motor
examinations are intact. Which prefrontal function was most likely disrupted?
A. Executive planning and working memory
B. Impulse control and emotional regulation [CORRECT]
C. Fear conditioning and startle modulation
D. Voluntary coordination of gait and balance
Correct Answer: B
Rationale: The ventromedial and orbitofrontal prefrontal cortex regulates mood, emotional responses, and
inhibitory control; injury there produces disinhibition, affective lability, and poor social judgment with
otherwise intact cognition. Dorsolateral damage impairs working memory and planning, fear conditioning is
amygdala-mediated, and gait coordination is cerebellar rather than prefrontal.
Q4: A 58-year-old man with schizophrenia treated with haloperidol 10 mg daily develops cogwheel rigidity,
bradykinesia, and a resting tremor over 3 weeks. Dopamine blockade in which pathway best explains these
findings?
A. Mesolimbic pathway
B. Nigrostriatal pathway [CORRECT]
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Correct Answer: B
Rationale: The nigrostriatal pathway projects from the substantia nigra to the dorsal striatum within basal
ganglia motor circuits; D2 blockade there produces parkinsonism, dystonia, and akathisia. Mesolimbic
blockade is therapeutic for positive symptoms, mesocortical blockade relates to negative and cognitive
symptoms, and tuberoinfundibular blockade raises prolactin.
Q5: A 34-year-old woman with alcohol use disorder tells the PMHNP that drinking produces pleasure she
cannot obtain from ordinary activities, and she continues drinking despite repeated consequences. Which
structure, serving as the terminal field of the mesolimbic dopamine pathway, is the principal mediator of
reward and reinforcement in addiction?
A. Raphe nuclei
B. Locus coeruleus
C. Nucleus basalis of Meynert
D. Nucleus accumbens [CORRECT]
Correct Answer: D
Rationale: Dopamine neurons of the ventral tegmental area project to the nucleus accumbens, where
transmitter release reinforces drug and alcohol seeking and mediates euphoric reward. The raphe nuclei
supply serotonin, the locus coeruleus supplies norepinephrine for arousal, and the nucleus basalis is a
cholinergic nucleus involved in attention and memory.
2
, NSG 552 Psychopharmacology | Exam 1, 2 & 3 | Wilkes University | 2026/2027
Q6: A 29-year-old woman with panic disorder describes episodes of sudden tachycardia, diaphoresis,
trembling, and intense hypervigilance. Activity in the principal noradrenergic nucleus of the brainstem,
which fires in response to perceived threat, is thought to drive this state of heightened arousal. Which nucleus
is involved?
A. Locus coeruleus [CORRECT]
B. Raphe nuclei
C. Ventral tegmental area
D. Nucleus accumbens
Correct Answer: A
Rationale: The locus coeruleus is the main source of central norepinephrine; threat-related firing produces
sympathetic arousal, vigilance, and anxiety symptoms, and it is implicated in panic disorder and PTSD. The
raphe nuclei are serotonergic, the ventral tegmental area is dopaminergic, and the nucleus accumbens is a
reward target rather than a noradrenergic nucleus.
Q7: The cell bodies of essentially all serotonin neurons in the brain are located in which of the following
structures?
A. Ventral tegmental area
B. Locus coeruleus
C. Raphe nuclei [CORRECT]
D. Substantia nigra
Correct Answer: C
Rationale: The raphe nuclei, a midline chain of nuclei in the brainstem, contain nearly all central serotonin
cell bodies and project diffusely to forebrain structures targeted by SSRIs. The ventral tegmental area and
substantia nigra house dopamine neurons, and the locus coeruleus houses norepinephrine neurons.
Q8: A 24-year-old man presenting with a first episode of psychosis is described as having dysregulated
dopamine activity in mesolimbic and mesocortical circuits. The cell bodies for these dopaminergic
projections are located in which region?
A. Substantia nigra pars compacta
B. Ventral tegmental area [CORRECT]
C. Raphe nuclei
D. Hippocampus
Correct Answer: B
Rationale: Ventral tegmental area cell bodies give rise to the mesolimbic pathway to the nucleus accumbens
and the mesocortical pathway to the prefrontal cortex, circuits implicated in the positive and cognitive
symptoms of psychosis. The substantia nigra gives rise to the nigrostriatal motor pathway, and the raphe
nuclei are serotonergic.
3
NSG 552
Psychopharmacology
Exam 1, 2 & 3
225 actual-style questions with verified correct answers and
detailed advanced-practice rationales, aligned with the Wilkes
University NSG 552 psychopharmacology curriculum and
2026/2027 course standards for Advanced Practice Psychiatric
Nursing.
■ Exam 1: Foundations of Psychopharmacology (Q1–75)
■ Exam 2: Major Psychiatric Disorder Pharmacology (Q76–150)
■ Exam 3: Complex Psychopharmacology & Special Populations (Q151–225)
Wilkes University · Advanced Practice Psychiatric Nursing
Actual Questions and Verified Correct Answers · PMHNP Prescribing Practice
NSG 552 PSYCHOPHARMACOLOGY 2026/2027
,NSG 552 Psychopharmacology | Exam 1, 2 & 3 | Wilkes University | 2026/2027
EXAM 1: FOUNDATIONS OF PSYCHOPHARMACOLOGY
75 Questions | Sections 1-5 | Q1-Q75 | Wilkes University NSG 552 | 2026/2027 Edition
Section 1: Neuroanatomy and Neurotransmission
Brain Structures, Neurons, Synapses, and Neurotransmitters | Questions 1-15
Q1: A 32-year-old combat veteran with posttraumatic stress disorder reports intrusive memories, nightmares,
and exaggerated startle to loud noises. Neuroimaging studies in PTSD consistently show reduced volume and
impaired function of the hippocampus. Which of the following best explains how hippocampal dysfunction
contributes to this presentation?
A. Excess dopamine release in the nucleus accumbens whenever trauma reminders occur
B. Loss of serotonergic tone from the raphe nuclei producing irritability and anger
C. Weakened contextual encoding of safe settings, so fear generalizes to nonthreatening cues
[CORRECT]
D. Dopamine depletion in the nigrostriatal pathway producing motor slowing and rigidity
Correct Answer: C
Rationale: The amygdala attaches emotional salience during fear conditioning while the hippocampus
encodes contextual memory; hippocampal volume loss in PTSD impairs discrimination of safe contexts from
trauma cues, so fear responses generalize. Dopamine release in the nucleus accumbens mediates reward, not
contextual fear discrimination. Raphe serotonergic loss is not the primary neuroimaging finding in PTSD, and
nigrostriatal changes produce motor symptoms rather than intrusions.
Q2: A 26-year-old man with schizophrenia is adherent to risperidone 4 mg daily, and his hallucinations and
delusions have resolved. He continues to perform poorly on tests of working memory and cannot organize
multi-step tasks at his part-time job. These persistent cognitive deficits are most closely associated with
dysfunction in which brain region?
A. Dorsolateral prefrontal cortex [CORRECT]
B. Nucleus accumbens
C. Locus coeruleus
D. Cerebellar vermis
Correct Answer: A
Rationale: The dorsolateral prefrontal cortex subserves executive function and working memory, and
hypofrontality in schizophrenia helps explain cognitive and negative symptoms that respond poorly to D2
blockade. The nucleus accumbens mediates reward and reinforcement. The locus coeruleus supplies
norepinephrine for arousal and vigilance, and the cerebellum coordinates motor execution rather than
executive cognition.
1
,NSG 552 Psychopharmacology | Exam 1, 2 & 3 | Wilkes University | 2026/2027
Q3: Following a traumatic brain injury involving the orbitofrontal cortex, a 45-year-old woman becomes
socially inappropriate, impulsive, and emotionally labile even though her memory, language, and motor
examinations are intact. Which prefrontal function was most likely disrupted?
A. Executive planning and working memory
B. Impulse control and emotional regulation [CORRECT]
C. Fear conditioning and startle modulation
D. Voluntary coordination of gait and balance
Correct Answer: B
Rationale: The ventromedial and orbitofrontal prefrontal cortex regulates mood, emotional responses, and
inhibitory control; injury there produces disinhibition, affective lability, and poor social judgment with
otherwise intact cognition. Dorsolateral damage impairs working memory and planning, fear conditioning is
amygdala-mediated, and gait coordination is cerebellar rather than prefrontal.
Q4: A 58-year-old man with schizophrenia treated with haloperidol 10 mg daily develops cogwheel rigidity,
bradykinesia, and a resting tremor over 3 weeks. Dopamine blockade in which pathway best explains these
findings?
A. Mesolimbic pathway
B. Nigrostriatal pathway [CORRECT]
C. Mesocortical pathway
D. Tuberoinfundibular pathway
Correct Answer: B
Rationale: The nigrostriatal pathway projects from the substantia nigra to the dorsal striatum within basal
ganglia motor circuits; D2 blockade there produces parkinsonism, dystonia, and akathisia. Mesolimbic
blockade is therapeutic for positive symptoms, mesocortical blockade relates to negative and cognitive
symptoms, and tuberoinfundibular blockade raises prolactin.
Q5: A 34-year-old woman with alcohol use disorder tells the PMHNP that drinking produces pleasure she
cannot obtain from ordinary activities, and she continues drinking despite repeated consequences. Which
structure, serving as the terminal field of the mesolimbic dopamine pathway, is the principal mediator of
reward and reinforcement in addiction?
A. Raphe nuclei
B. Locus coeruleus
C. Nucleus basalis of Meynert
D. Nucleus accumbens [CORRECT]
Correct Answer: D
Rationale: Dopamine neurons of the ventral tegmental area project to the nucleus accumbens, where
transmitter release reinforces drug and alcohol seeking and mediates euphoric reward. The raphe nuclei
supply serotonin, the locus coeruleus supplies norepinephrine for arousal, and the nucleus basalis is a
cholinergic nucleus involved in attention and memory.
2
, NSG 552 Psychopharmacology | Exam 1, 2 & 3 | Wilkes University | 2026/2027
Q6: A 29-year-old woman with panic disorder describes episodes of sudden tachycardia, diaphoresis,
trembling, and intense hypervigilance. Activity in the principal noradrenergic nucleus of the brainstem,
which fires in response to perceived threat, is thought to drive this state of heightened arousal. Which nucleus
is involved?
A. Locus coeruleus [CORRECT]
B. Raphe nuclei
C. Ventral tegmental area
D. Nucleus accumbens
Correct Answer: A
Rationale: The locus coeruleus is the main source of central norepinephrine; threat-related firing produces
sympathetic arousal, vigilance, and anxiety symptoms, and it is implicated in panic disorder and PTSD. The
raphe nuclei are serotonergic, the ventral tegmental area is dopaminergic, and the nucleus accumbens is a
reward target rather than a noradrenergic nucleus.
Q7: The cell bodies of essentially all serotonin neurons in the brain are located in which of the following
structures?
A. Ventral tegmental area
B. Locus coeruleus
C. Raphe nuclei [CORRECT]
D. Substantia nigra
Correct Answer: C
Rationale: The raphe nuclei, a midline chain of nuclei in the brainstem, contain nearly all central serotonin
cell bodies and project diffusely to forebrain structures targeted by SSRIs. The ventral tegmental area and
substantia nigra house dopamine neurons, and the locus coeruleus houses norepinephrine neurons.
Q8: A 24-year-old man presenting with a first episode of psychosis is described as having dysregulated
dopamine activity in mesolimbic and mesocortical circuits. The cell bodies for these dopaminergic
projections are located in which region?
A. Substantia nigra pars compacta
B. Ventral tegmental area [CORRECT]
C. Raphe nuclei
D. Hippocampus
Correct Answer: B
Rationale: Ventral tegmental area cell bodies give rise to the mesolimbic pathway to the nucleus accumbens
and the mesocortical pathway to the prefrontal cortex, circuits implicated in the positive and cognitive
symptoms of psychosis. The substantia nigra gives rise to the nigrostriatal motor pathway, and the raphe
nuclei are serotonergic.
3
