NSG 526 PMHNP ADVANCED
PSYCHOPHARMACOLOGY FINAL
EXAM PREP QUESTIONS WITH
VERIFIED ANSWERS 2026/2027
1. A patient with Treatment-Resistant Schizophrenia is started on Clozapine. Which
laboratory value requires immediate discontinuation of the medication according to the
Clozapine REMS program?
A. Absolute Neutrophil Count (ANC) of 900/mm³
B. Absolute Neutrophil Count (ANC) of 1,200/mm³
C. White Blood Cell (WBC) count of 3,500/mm³
D. Platelet count of 100,000/mm³
Answer: A
Conceptual Explanation: For the general population, Clozapine must be interrupted if the
ANC falls below 1,000/mm³ (Severe Neutropenia). 900/mm³ falls below this critical
threshold.
2. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 25%
of all psychotropic medications, including most SSRIs and TCAs, and is highly prone to genetic
polymorphism?
A. CYP3A4
,B. CYP1A2
C. CYP2C19
D. CYP2D6
Answer: D
Conceptual Explanation: CYP2D6 metabolizes a significant portion of psychotropic drugs.
Genetic variations (poor vs. ultra-rapid metabolizers) significantly impact drug levels and
side effects.
3. A patient taking Phenelzine (an MAOI) presents to the emergency department with a
severe headache, nausea, and a blood pressure of 210/120 mmHg. Which substance most
likely triggered this hypertensive crisis?
A. Tyramine
B. Tryptophan
C. Phenylalanine
D. Glutamate
Answer: A
Conceptual Explanation: Tyramine is a sympathomimetic amine found in aged foods.
When MAO-A is inhibited, tyramine is not broken down, leading to massive norepinephrine
release and hypertensive crisis.
, 4. Blockade of dopamine D2 receptors in which pathway is primarily responsible for the
development of Extrapyramidal Symptoms (EPS)?
A. Nigrostriatal pathway
B. Mesocortical pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The nigrostriatal pathway controls motor function. D2 blockade
here causes movement disorders like parkinsonism, dystonia, and akathisia.
5. A 24-year-old male with Bipolar I Disorder is started on Lithium. He complains of fine hand
tremors. Which of the following is the most appropriate initial management step?
A. Immediately discontinue Lithium
B. Check Lithium serum levels and consider adding Propranolol
C. Switch to Valproic acid
D. Increase Lithium dose to overcome the tremor
Answer: B
Conceptual Explanation: Fine tremors are a common side effect of Lithium. Checking
levels ensures it isn’t toxicity, and beta-blockers like Propranolol are the standard
treatment for Lithium-induced tremors.
PSYCHOPHARMACOLOGY FINAL
EXAM PREP QUESTIONS WITH
VERIFIED ANSWERS 2026/2027
1. A patient with Treatment-Resistant Schizophrenia is started on Clozapine. Which
laboratory value requires immediate discontinuation of the medication according to the
Clozapine REMS program?
A. Absolute Neutrophil Count (ANC) of 900/mm³
B. Absolute Neutrophil Count (ANC) of 1,200/mm³
C. White Blood Cell (WBC) count of 3,500/mm³
D. Platelet count of 100,000/mm³
Answer: A
Conceptual Explanation: For the general population, Clozapine must be interrupted if the
ANC falls below 1,000/mm³ (Severe Neutropenia). 900/mm³ falls below this critical
threshold.
2. Which cytochrome P450 enzyme is responsible for the metabolism of approximately 25%
of all psychotropic medications, including most SSRIs and TCAs, and is highly prone to genetic
polymorphism?
A. CYP3A4
,B. CYP1A2
C. CYP2C19
D. CYP2D6
Answer: D
Conceptual Explanation: CYP2D6 metabolizes a significant portion of psychotropic drugs.
Genetic variations (poor vs. ultra-rapid metabolizers) significantly impact drug levels and
side effects.
3. A patient taking Phenelzine (an MAOI) presents to the emergency department with a
severe headache, nausea, and a blood pressure of 210/120 mmHg. Which substance most
likely triggered this hypertensive crisis?
A. Tyramine
B. Tryptophan
C. Phenylalanine
D. Glutamate
Answer: A
Conceptual Explanation: Tyramine is a sympathomimetic amine found in aged foods.
When MAO-A is inhibited, tyramine is not broken down, leading to massive norepinephrine
release and hypertensive crisis.
, 4. Blockade of dopamine D2 receptors in which pathway is primarily responsible for the
development of Extrapyramidal Symptoms (EPS)?
A. Nigrostriatal pathway
B. Mesocortical pathway
C. Mesolimbic pathway
D. Tuberoinfundibular pathway
Answer: A
Conceptual Explanation: The nigrostriatal pathway controls motor function. D2 blockade
here causes movement disorders like parkinsonism, dystonia, and akathisia.
5. A 24-year-old male with Bipolar I Disorder is started on Lithium. He complains of fine hand
tremors. Which of the following is the most appropriate initial management step?
A. Immediately discontinue Lithium
B. Check Lithium serum levels and consider adding Propranolol
C. Switch to Valproic acid
D. Increase Lithium dose to overcome the tremor
Answer: B
Conceptual Explanation: Fine tremors are a common side effect of Lithium. Checking
levels ensures it isn’t toxicity, and beta-blockers like Propranolol are the standard
treatment for Lithium-induced tremors.
